UT MD Anderson and Cooper University Health Care unite
The University of Texas MD Anderson Cancer Center and Cooper University Health Care have signed a partnership agreement to create a joint, comprehensive cancer center and co-branded satellites in New Jersey.
MD Anderson Cancer Center at Cooper recently opened on the Cooper Health Sciences Campus in Camden. The stateof- the-art, freestanding facility will provide all outpatient cancer care services with MD Anderson’s signature multidisciplinary approach to oncology care. Services will include medical, radiation and surgical oncology, as well as pathology, laboratory, diagnostic imaging and other supportive clinical services.
“We’re proud to unite with Cooper University Health Care to offer the highest quality cancer care in the region,” said Ronald DePinho, M.D., MD Anderson president. “Our mission, simply, is to end cancer. This partnership is an extraordinary opportunity for us to advance that mission by extending our compassionate and effective clinical care and, in turn, positively impacting the lives of many.”
The new center will be a full clinical extension of MD Anderson and will feature the same research-driven, patient-centered care provided at the main campus in Houston. The partnership will also offer patients across the East Coast access to MD Anderson’s world-renowned treatment protocols, extensive clinical trials and cutting edge translational research.
“Our partnership is a beacon of hope for cancer patients in New Jersey, Pennsylvania, Delaware and beyond,” said George E. Norcross, III, Chairman of the Board at Cooper. “MD Anderson Cancer Center at Cooper will take cancer care in our region to a new level by bringing the best proven methods of cancer treatment and an increased access to MD Anderson clinical trials right here in New Jersey.”
Cooper University Health Care includes the 600-licensed bed Cooper University Hospital in Camden and more than 100 outpatient offices throughout southern New Jersey and into Pennsylvania. ▼
Obesity is costly in more ways than one
Many of us recognize that obesity is a big problem. In fact, it is of such concern that one of the national health objectives for 2010 is to reduce the prevalence of obesity among adults
BY Victor S. Sierpina, MD, ABFM, ABIHM Director, Medical Student Education Program, WD
Laura Nell Nicholson Family Professor of Integrative
Medicine, Professor, Family Medicine University of Texas Distinguished Teaching Professor
In the emerging healthcare scenario, the health coach is becoming an increasingly significant player.
Health coaching can be defined as helping patients gain the knowledge, skills, tools and confidence to become active participants in
their care so that they can reach their selfidentified health goals.
The fact of the matter is that behavioral and lifestyle change is hard for our patients. If a patient has asthma, diabetes, obesity,
or other chronic condition or is just having problems setting or achieving wel lnessoriented goals, a health coach may be appropriate.
If, for example, an audit of your medical records determines you are below an expected national benchmark for HbgA1C for a certain percentage of your diabetic patients, a health coach may be the way to help to more effectively manage those patients who are significantly above target. Regular lifestyle tips, closer glucose monitoring, feedback, patient education, nutritional advice and so on between quarterly office visits can help move the
needle on diabetic control. Rather than feeling frustrated with such patients, or even worse, blaming them for non-compliance, providing a practical intervention such as coaching can make a big difference in their lives and disease management skills. Health coaches can help identify goals,
create and achieve small steps toward goals, improve self-management, and help sustain motivation.
The average brief physician office visit cannot possibly effectively address all important health issues. Such visits include updating current vaccines, addressing new and chronic complaints, ordering and reviewing tests, refilling medications, generating referrals, and managing paperwork associated with multiple health issues. Thus the important time and effort required for effective health care counseling and motivation are often squeezed into just a few moments at the end of the visit. What happens between office visits is what truly matters in helping patients make significant and enduring changes to their health-related behavior such as activity, nutrition, stress management, and more. Health coaches can be nurses, social workers,
medical assistants (MAs), community health workers such as promotores, other health educators, or even other patients in group visits or peer-peer interactions if they are given appropriate training and support. A health coach is not just a personal trainer or fitness instructor, though these people
can play an important role in helping in supporting optimization of health. Medical Assistants (MA’s) are often a good choice for filling the role of a coach in the primary care office. While their scope of practice prevents them from making medical assessments, MAs are ideally suited to provide between office visit coaching. Working closely with clinicians or RNs, they can address medication adherence and lifestyle changes and alert other team members when an assessment or visit may be needed. This use of MA’s and other team members as health coaches is a foundational
strategy in the Patient Centered Medical Home. MA’s can support patients working on smoking cessation and other tough to change habits that benefit from regular contact, tips, and encouragement. Motivational interviewing skills are key to effective behavioral change and coaches from any background must be skilled in this communication approach.
Registered nurses (RNs) are well trained to impart skills, build confidence and provide tools for patients, particularly for patients discharged from the hospital or with multiple chronic conditions. They are not usually a part of the team in most physicians’ offices however.
A new book, Nursing Coaching: Integrative Approaches for Health and Wellbeing by Barbara Dossey, Susan Luck, and Bonney Schaub, (Miami: International Coach Association, 2015) is an in depth guide to how nurses can be our best allies in the coaching realm. It is a must read for nursing
educators who wish to keep abreast of this dimension of nursing scope of practice and is a how-to, evidence-based guide on how to implement such training. It includes background, theories, actionable objectivesand communication skills, practical case studies, self-development tools, research
and leadership guidelines, and many patient assessment instruments all related to making nurses skilled coaches. This textbook is also a beautifully synchronous thematically with the principles of nursing laid down well over a century ago by Florence Nightingale. Because of their advanced training and clinical expertise, nurse coaches are uniquely positioned to coach and engage individuals, families, and communities in the process of meaningful and healthpromoting strategies for behavioral change.
Nurses are well respected and trusted by both the public and physicians. As longterm partners with physicians, nurse coaches are a natural choice for leadership in health coaching. Even physicians not particularly familiar with the health coaching field can feel confident in well-trained nurse coaches
as interprofessional partners.
An Integrative Nurse Coach Certificate Program is recommended and appropriate for all registered nurses in any health sector. It is an excellent pathway for nurses seeking new professional challenges and work opportunities. It is offered through the International Nurse Coach Association at
www.inursecoach.com/programs/. Other health care team members can develop the skills it takes to become an effective health coach as well. There are a number of certification programs leading to the skills to become a health coach, for example, the National Society of Health Coaches at http://www.nshcoa.com/ certification.
As we are increasingly held to metrics for improved control of chronic diseases in accountable care organizations (ACO’s), reimbursement is being tied to achieving these goals. In this setting the nurse coach or other team member who provides health coaching will increasingly become a cost-effective, core component of the interprofessional healthcare team.
Book Review: In Awe of Being Human—A Doctor’s Stories from the Edge of Life and Death by Betsy MacGregor, MD
BY VICTOR S. SIERPINA, MD, ABFP, ABIHM, Distinguished Teaching Professor, Family and Integrative Medicine, UTMB Health
When my friend and editor of Explore, Ben Kligler asked me to review this book, I could never have guessed what a joy it would be to do so. Dr. Betsy MacGregor, the author, is a gifted writer with an penchant for bringing real life stories to vivid clarity with meaning and vital lessons. The heart and soul of this book are compact yet detailed, poignant and powerful narratives from her practice. They span her career as a pediatrician, adolescent medicine specialist, and palliative care doctor from medical school, residency, and professional practice and keep the reader turning pages expectedly as the tales unfold. Usually only a few pages each, the experiences she shares are tragic, thought-provoking, tear-evoking. At the same time they give the reader a deep appreciation and awe for the resilience, courage, compassion, and sacredness of life in patients, their families, and the doctors and other health professionals who care for them.
To show you how impressed I was by this incredible work, after just reading the first couple of chapters, I asked Betsy to send us a couple of cases to distribute to our medical students at the University of Texas Medical Branch just starting a new 4-year track entitled the Physician Healer. This track is an educational foray into improving mindfulness, self-awareness, empathy, compassion, communication skills, and enhancing professional identity in a dedicated cohort of students. It explores issues Dr. MacGregor describes in her book by talking about the stress of practice and medical education, the struggles we face with unanswerable questions, preventing burnout, and how we try to cope with untold suffering. In Awe of Being Human will make a perfect companion to our students as they begin their medical journeys and Betsy generously contributed the books at the author’s rate, meaning she didn’t make a dime of royalties.
Somehow, that gesture did not surprise me. Throughout the book she struck me as a deeply committed, loving, compassionate human being, dedicated to healing, alleviating pain and suffering, and honestly wrestling with life’s great enigmas as spotlighted in the practice of medicine.
To give you some flavor of the broad range of dynamic tensions she addresses in this masterful work, I will list the thoughtful and creative chapter titles. It will be up to you to imagine how she might have developed those chapters, until you read them yourselves, as you must.
Chapter headings in order are: Beauty & Brutality, Mystery & Miracles, Tenderness & Technology, Contradictions & Incongruity, Loving & Being Loved, Caring & Connection, Suffering & Compassion, Giving & Receiving, Turning Wounds into Wisdom.
Each chapter is a series of stories from her practice illustrating beautifully and magnificently the juxtaposition of these characteristics of life, of patients, of doctors, and of the experience of being human. The heartfelt and enthusiastic endorsements are from an array of incredible healers such as Rachel Remen, Larry Dossey, James Gordon, Andrew Weil, Roshi Joan Halifax, Michael Lerner, and more.
I can think of no better advice to offer anyone in the healing arts than to read this treasure chest of a book. It will refresh your practice and view of humankind. It will validate and bring to light experiences and emotions perhaps long ignored, unanswered, or suppressed. It will bring you back to a place of awe and a new respect for what we do as healers and the incredible wonderfulness of those we care for.
As Lao Tsu once said, “Without a sense of awe, life is without meaning.” This book is a path back to rediscover awe, wisdom, and the affirmation of life within yourself and others. Read it. ▼
Texas Hospitals leading the way in quality and patient safety
Special to Medical Journal – Houston By Dan Stult z, M.D., FACP, FACHE, President/ CEO, Texas Hospital Association
Hospitals exist to promote health and healing. Even one patient harmed by one mistake is one too many. They are missionbound to be invested in patient safety and quality improvement, and striving to deliver the highest-quality care is a daily responsibility.
Quality improvement is not new for hospitals, but what is new is the level of interest from government, payors and consumers in measuring and evaluating hospitals’ performance on quality and patient safety. For example, as of October 2011, hospitals are required to report information on infections acquired during a hospital admission to the Texas Department of State Health Services. Shining the public spotlight on these data reveals that Texas hospitals have outperformed hospitals nationally in reducing surgical site infections and central line-associated bloodstream infections, two of the most costly and deadly of health care-acquired infections. This accomplishment translates to complications avoided and lives saved. This type of success is achieved because of Texas hospitals’ commitment to quality and patient safety and because of their willingness to work together on initiatives that will improve care for all patients. The Texas Center for Quality & Patient Safety, a member of the Texas Hospital Association’s family of companies, is working with Texas hospitals throughout the state on a number of collaborative initiatives to improve care.
These initiatives aim to:
• Eliminate preventable errors and reduce adverse events;
• Improve teamwork and communication; and
• Engage patients and families.
Through Partnership for Patients, a national initiative of the Center for Medicare & Medicaid Innovation, nearly 200 Texas hospitals are working together to reduce 10 of the most common health care-associated infections and readmissions, including adverse drug events, pressure ulcers, and catheter-associated urinary tract infections. The goal is to reduce hospital-acquired conditions by 40 percent and preventable readmissions by 20 percent by December 2013. TCQPS is working with more than 70 of these hospitals to achieve this goal. As of September, 72 percent of participating hospitals have reduced 60 percent of all applicable conditions by at least 30 percent or had no conditions or readmissions for 12 months or longer. The reductions have been most dramatic for ventilator-associated pneumonia and central line-associated bloodstream infections.
Two of the most common and fatal of health care-acquired infections are the target of the TCQPS HAI Prevention Collaborative. As part of this collaborative, 17 Texas hospitals are working towards reducing certain surgical site infections and central line-associated bloodstream infections by 20 percent by the end of this year. Among this initiative’s many accomplishments is the achievement of 100 percent of participating hospitals maintaining a zero rate of infection for patients following surgery involving a coronary artery bypass graft with a chest incision.
Preventing medical errors and improving patient safety by improving communication among providers and building teamwork skills are the goals of the TeamSTEPPS Initiative. More than 400 hospital staff at 33 hospitals have undergone extensive training in leadership, situation monitoring, mutual support and communication to create an environment that promotes patient safety and putting the patient first.
The other critical piece for improving patient outcomes is patient and family engagement. In partnership with the Institute for Patient and Family Centered Care, TCQPS works with 65 hospitals to provide specific, actionable steps that providers and administrators at multiple levels can take to engage patients and families in their care to help reduce preventable infections and readmissions after hospital discharge.
These are just a few of the quality and patient safety investments that Texas hospitals are making with leadership and guidance from the Texas Hospital Association to improve care and reduce preventable errors and infections. From data-driven projects to reduce hospital-acquired conditions to education and training focused on hospital culture, Texas hospitals are continually working to maximize patient outcomes and provide the right care at the right time in the right place. ▼