The 2012 IOM Report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, addresses the need to broaden the definition of communities.  “The typical definition of a community is a group located in a particular geographic area.  However, communities that promote continuous learning and improvement in healthcare go beyond geographic boundaries to include groups linked through culture, occupation, conditions based on a common workplace, prognosis, stage in the care process, intensity of care needed and more.”  (7-14).

The most unique healthcare community I have ever been engaged with is the CPM International Consortium.  More than 25 years ago, the CPM Resource Center recognized that uniting like-minded organizations to make the healthcare transformation journey together was not only a smart solution, but also a less risky one. We recognized that one healthcare organization cannot change the world, but together we could collectively learn and impact the creation of an integrated health care system and the health of a global community.  That’s why the CPM International Consortium was created; a voluntary community made up of hundreds of our client hospitals, health systems, and educational institutions.

The CPM International Consortium Model gathers a group of organizations that unite around a common vision for sustainable healthcare transformation through the use of a common culture and professional practice framework.  The CPM Consortium community has the opportunity to participate in collective thought leadership, implementation science and clinical scholarship.

An example of this is a recent study published that was conducted to better understand the relationship between self-efficacy and EBP Implementation in clinical environments that have undergone efforts to increase EBP utilization. In the study, Does self-efficacy influence the application of evidence-based practice: A survey and structural equation model , the researchers’ analyzed data by a 2011 survey of clinicians working within a national sample of hospitals that are actively participating in the CPM Consortium to guide the implementation of EBP into the work worlds of clinicians. (2013, Abrahamson, K., Arling, A., & Gillette, J.)

Another example of tapping lessons from this unique learning community that has implemented a common framework with replicable interventions and sustainable outcomes is described in Lessons from the Field: The Essential Elements of Point-of-Care Transformation. (2011, Wesorick & Doebbeling) Medical Care 49 (12), S49-S58. 

Community sharing can decrease “re-inventing the wheel” and move us much faster to sustainable improved health of a broad community.

Recommendation 5:  Community Links

Promote community-clinical partnerships and services aimed at managing and improving health at the community level.  Care delivery and community-based organizations and agencies should partner with each other to develop cooperative strategies for the design, implementation, and accountability of services aimed at improving individual and population health.

Strategies for progress toward this goal:

• Health care delivery organizations and clinicians should partner with community-based organizations and public health agencies to leverage and coordinate prevention, health promotion, and community-based interventions to improve health outcomes, including strategies related to the assessment and use of web-based tools.
• Public and private payers should incorporate population health improvement into their health care payment and contracting policies and accountability measures.
• Health economists, health service researchers, professional specialty societies, and measure development organizations should continue to improve measures that can readily be applied to assess performance on both individual and population health

What does community mean to you?

What are ways your organization is constantly improving transformation strategies, tools and resources?

Cheers,

I love the beginning of a new year!

I especially love it since I abandoned “New Year Resolutions” and started “New Year 101 Wishes.”  The idea came to me from a dear wise friend, Merry Brown.  Merry is an amazing artist and donated some art for the 2001 CPM International Consortium Conference’s silent auction which resulted in a wonderful dialogue at her kitchen table on 9/11/01.  Yes, we all remember where we were on Sept. 11, 2001.  After watching the horrifying events on TV, I drove to Merry’s home where we had a deep conversation about life and what matters most, and she shared with me the power of asking for what you want.

Two weeks later a book arrived called The Aladdin Factor, with this written on the inside:

Michelle,

This is a dangerous book.  Everything I’ve asked for – I’ve received, so be careful what you ask for – but ask!  God bless you, precious friend.  Merry

The authors identify in the first chapter The 5 BARRIERS TO ASKING: The Main Reasons We Don’t Ask for What We Want

1. IGNORANCE:  We don’t know what to ask for. 
2. LIMITING AND INACCURATE BELIEFS:  Which have been programmed into our subconscious and which silently control all of our actions.
3. FEAR:  The main overriding fear that stops us from asking for what we want is the fear of rejection.
4. LOW SELF ESTEEM:  We end up sacrificing our own fulfillment on the altar of taking care of others.
5. PRIDE:  We become too arrogant to admit we need anyone or anything.

The part of the book that intrigued me the most was on pages 64-67.  The First Task: Make a List of 101 Wishes. 

This year marks a Decade of 101 Wishes for me.  Every January since 2004 I sit down and write my list of 101 Wishes.  I can tell you that 1010 Wishes later it is amazing how many have come true.  I have shared this experience with family, friends, colleagues and graduating classes of new healthcare professionals.

As healthcare undergoes major shifts, are we asking the right questions?  Do we know what to ask for?  Are we just silent observers convinced in our subconscious minds that it doesn’t matter what we (I) think?  Is fear of rejection overcoming our need to speak up and be innovative?  Are we worried more about others than of ourselves and being “just a ___________ (fill in the blank)?”  Are we ready to partner and collaborate to co-create a new ways of experiencing healthcare education and practice?

The only way to discover the limits of the possible is to go beyond them into the impossible.  ~Arthur C. Clarke

What seems impossible today that is most needed in healthcare?

What are your personal wishes to live a life well-lived and being part of a Meaningful Transformation?

Cheers,

In just a few seconds it was over. The dirt and debris still hung in the air as the Tahoe had finished rolling, end over end, into a tree. The man who had uttered those few short words had been ejected and was laying twenty feet away, motionless. His body had been broken and punctured so badly that it was almost beyond any possible repair. His wife was paralyzed and trapped between seats as her two young children looked on, dazed and still strapped in their seat belts.

Everything had changed.

In those few seconds, in that flash of time, an entire family had been transported from a world of freedom, comfort and normalcy to one of incredible struggle, pain and dependence.  The world they would now be thrust into was owned by healthcare providers, from the emergency responders, ER physicians, surgeons and nurses, to the respiratory therapists, physical therapists and imaging technicians, as well as so many others.  How they would emerge from this new world would rest squarely on the shoulders of those who cared for them…practitioners and people…just like us.

The prognosis for the man was grim.  He had been ejected from the vehicle and was so badly injured he was given an incredibly small chance of survival.  And, if he were to survive, there was little hope that he would have much function, either physically or mentally.  The woman, a mother of an eight-year-old boy and a four-year-old girl, had fractured her back and neck, and she was now paralyzed from the chest down.  In this moment they would start an unbelievably painful journey and a separation from their children that would last for months on end.

The couple, Terry and Vicky, are just two of the faces that make this goal of “patient-centered care” so vitally important. Concerned that the people taking care of her didn’t know the relationship that she had with Terry and how incredibly strong he was, she became desperate to get a message to those caring for her husband.  ”I kept asking about Terry.  I kept thinking people were lying to me, and that he really was dead and they weren’t telling me.”  Because she had fractured her cheekbone and nose, it was difficult to speak, so Vicky wrote what she needed them to know.  ”The first night there I wrote a letter to Terry’s doctors to let them know who he was.  I wanted them to know that he was a man of amazing strength, and not to give up on him, not to underestimate him.”  When she and Terry were finally reunited, from that day on, his condition began to improve.  There is such power in knowing who your patients really are and it is the beginning step of the IOM’s fourth recommendation to improve care.

Recommendation 4: Patient-Centered Care

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

Involve patients and families in decisions regarding health and healthcare, tailored to fit their preferences. Patients and families should be given the opportunity to be fully engaged participants at all levels, including individual care decisions, health system learning and improvement activities, and community-based interventions to promote health.

Strategies for progress toward this goal:

• Patients and families should expect to be offered full participation in their own care and health and encouraged to partner, according to their preference, with clinicians in fulfilling those expectations.
• Clinicians should employ high quality, reliable tools and skills for informed shared decision making with patients and families, tailored to clinical needs, patient goals, social circumstances, and the degree of control patients prefer.

Often, as healthcare professionals, we have no idea what outcomes lie ahead for the people we care for or just how valuable some of the decisions we make in the care process are to the end result. In Terry and Vicky’s case, her not knowing the truth of his condition was more detrimental to her healing than it was good, and when they were finally were reunited, Terry’s condition improved steadily.

These are the kinds of examples that make the mission at Elsevier CPM to “co-create best places to give and receive care” so important.  The partnership that bedside practitioners have with patients and the use of the best tools, the latest evidence, and the best care practices possible, are absolutely essential in giving our patients the best chance to fully heal.

By the way, I celebrated New Year’s Eve 2012 with the couple involved in this horrendous accident. Since 2009, they been graciously telling their story and teaching the members of the CPM consortium about what is truly important, what we do well, and what we must learn to do so much better.

Terry can hold his own in any conversation. He works in his woodshop each day, and he is loved by a great many people.  Vicky is an awesome mother and grandmother and plays wheelchair tennis all over the country.  She is also downright beautiful, both inside and out.  These are two of the strongest people that I know and they are a testament to the human spirit, both in their desire to heal, as well as in their love for each other.

How do you engage patients and families so their goals and priorities are identified within the plan of care?

In what ways do you inquire and capture what is most important to know about the patient in daily care and in the electronic health record?

Cheers,

That was the surprise response from a nurse at the TIGER (Technology Informatics Guiding Education Reform) Summit in 2006 after seeing how the CPM interdisciplinary evidence-based clinical practice guidelines were integrated into the clinical workflow of an EHR vendor system. 

“I applaud you for embedding evidence-based practice into the clinician’s workflow.”

This is the comment that I received, just last week, from a physician & chief quality officer looking for a feasible way to sustain and optimize the health information technology system that they had spent so much time and resources in building. Regrettably, these two statements occurred 6 years apart and, the idea that embedding evidence-based practice inside an EHR is still a novelty should make us all sit down and really think. The fact that he, like many other leaders in his position, is trying to find a way to sustain the kinds of “unique” EHR systems that are common in our large hospital systems today is an indictment of our collective efforts to build a healthcare system that is sustainable and scalable. The fact is, the effort to support systems like these is extremely challenging, especially absent another huge commitment of funds and intellectual energy.

In order to achieve a transparent, seamless, and knowledgeable health care system, that is exponentially expandable, we must learn to think in a different way.

I celebrate the progress that has been made toward this goal over the years but remain frustrated at how long it is taking to adopt and enhance evidence-based and meaningful clinical decision support to the point of care.  The 2012 IOM Report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, addresses how much of a challenge it is, in the face of our current technological progress, for clinical research and clinical decision support to keep pace with the introduction of these new procedures, treatments, and care delivery models. Add to that the further challenge of getting the information into the hands of the clinicians where it can be used starts to glimpse of the size of the challenge. Put simply, building health information systems without an integrated clinical infrastructure is akin to putting bicycle tires on a race car.

In light of this, let’s take a look at the next recommendation from the IOM.

Recommendation 3:  Clinical Decision Support

Accelerate integration of the best clinical knowledge into care decisions.  Decision support tools and knowledge management systems should be routine features of health care delivery to ensure that decisions made by clinicians and patients are informed by current best evidence.

Strategies for progress toward this goal:

• Clinicians and healthcare organizations should adopt tools that deliver reliable, current clinical knowledge to the point of care, and organizations should facilitate the development, accessibility, and use of evidence-based and harmonized clinical practice guidelines
• Health professional education programs should teach new methods for accessing, managing, and applying evidence; engaging in lifelong learning; understanding human behavior and social science; and delivering safe care in an interdisciplinary environment

The IOM’s emphasis on “accelerated integration” must not be overlooked! Without this element being central to the plan, we will surely fail in our efforts. This need for a simple framework was foreseen by my colleague and mentor Bonnie Wesorick over thirty years ago. Ever since then, it has been my personal mission and the shared mission of Elsevier CPM Resource Center to make this a reality. For any of us interested in realizing the dream of a having a truly integrated, sustainable, and scalable healthcare system, we would be wise to avail ourselves of this visionary leader.  Just as the IOM Report calls for “accelerated integration” of clinical knowledge, Wesorick has called for “exponential growth” of a practice platform as recently addressed in this national webcast.

Additionally, our “new ways of thinking” must also extend to the interdisciplinary team charged with the care of our patients and we must start at the beginning of the education process. This allows all of our care providers to learn to work on the same platform of care, have a clear understanding of the scope of each other’s practice, and to develop and use shared knowledge to improve outcomes, identify and refine new processes that work, and to develop efficiencies that allow our systems not only to survive, but to thrive. One first step in this direction has been the establishment of the Bonnie Wesorick Center for Healthcare Transformation at Grand Valley State University’s Kirkhof School of Nursing in Grand Rapids, Michigan.  By affiliation with Grand Valley State University, the Elsevier Resource Center will be engaged as an innovative incubator in the new HRSA Grant for a National Coordinating Center for Interprofessional Education and Collaborative Practice granted to University of Minnesota.

At the end of the day, we must realize that the designs of the past will simply not serve the needs of the future of healthcare. To continue to pursue them will ultimately lead to our failure in our reach for a truly sustainable healthcare system.

So, no matter whether you are a clinician, healthcare vendor, politician, or patient, we all have a stake in or own health where the future brings us. Each of us also has a voice. I for one will be continuing to boldly raise mine. I hope that you will join me!

What do you think is needed to “accelerate integration” of best clinical knowledge into care decisions?

What is your vision for interprofessional health education?

Cheers,

As I held the special, white “graduation” certificate in my hand, signed by every one of my skilled group of healthcare professionals, I knew that my course of radiation treatment was now complete and I no longer had to return. I felt blessed for the experience. I felt grateful for my level of care and for the friendships that I now had with the people who helped me walk this path of treatment and become a “survivor”.

What surprised me, though, and what I hadn’t expected to feel at the beginning of this journey, was the tinge of sadness and loss that came with my leaving. Without even realizing it, over my weeks of treatment and at the same time every morning, my husband and I had accidentally been introduced into a very special, very unique club, one that we would forever be a part of in our hearts.

Every morning at 8:40, the dance would begin. We would get our coffee, say hello to the people who were on their way out, and settle in to the small circle of couches to wait our turn. Over those weeks, we met a young man with brain cancer, whose father would drive him every day. We had wonderful muffins, baked by the daughter of a patient and shared with an absolutely beautiful spirit who is engaged in her third battle with breast cancer. Then, there was the woman with the double mastectomy who simply couldn’t do another round of chemo, but, she could bake peanut butter cookies with her grandchildren, and she could still laugh without reservation. There was the very proper, older, Asian couple that couldn’t resist being pulled in. And, we will never forget the always optimistic, ever pleasant, constantly smiling woman who had only learned of her brain tumor three months before.

On one special morning, we learned that her cancer was incurable.

In those weeks, my husband and I became part of “The Breakfast Club” as we had come to affectionately call it, our own special group of fellow travelers on a healing journey and a small slice of the humanity that we, as healthcare providers, have pledged to serve with our very hearts. Now, we would be leaving to make room for the next members who would take our place.
On my signed “Graduation from Radiation Therapy” Certificate was the following poem that also hangs on a plaque in the club:

What Cancer Cannot Do
Cancer is so limited……
It cannot cripple love.
It cannot shatter hope.
It cannot corrode faith.
It cannot eat away peace.
It cannot destroy confidence.
It cannot kill friendship.
It cannot silence courage.
It cannot reduce eternal life.
It cannot quench the Spirit.
- Author Unkown

Although what this poem says covers every base, the place where we realized the sheer depth, the amazing impact of these words, was in the lives of our fellow “Breakfast Club” members every morning at 8:40. To them we say “thank you so much fellow club members”. You will be forever in our hearts and prayers…

How have patients and families touched your lives?

What life lessons have you learned in surprising ways?

Cheers,

Now there’s a call to take “access to clinical data” and “clinical research data” a step further, pushing pretty much every stakeholder to think about and then take action on new strategies to turn readily available clinical data into valuable information to improve patient care. This recommendation calls for polarity thinking – “and & both” thinking: accessing published research to support evidence-based care and accessing real time clinical data that can inform care.

For many years, I cared for critically ill patients and clinical questions always came up as the team and I strived to deliver “best care.”  Thinking back on the time when everything was paper, it certainly makes me appreciate the significance of electronic health records and the growing digital infrastructure today.

In 1986, I began working at a CPM Consortium hospital and many of my clinical questions were answered by evidence-based guidelines that we used, and then documented to, at the point of care.  That was so wonderful – evidence kept me focused on the most important clinical data and helped me assess, monitor, detect and prevent potential problems the patient was at risk for, due to their diagnosis.

Today, with the benefit of technology, these same guidelines bring the information to clinicians even faster because it is embedded in the computerized clinical workflow.  And, it continues to get better and better.

But as technology and the digital infrastructure grow, there is still a need to gain real time clinical insights from the clinical data that is being recorded, documented and stored.  Hence, the second recommendation from the 2012 IOM Report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America, deals with data utility.

Recommendation 2:  The Data Utility

Streamline and revise research regulation to improve care, promote the capture of clinical data, and generate knowledge.  Regulatory agencies should clarify and improve regulations governing the collection and use of clinical data to ensure patient privacy but also the seamless use of clinical data for better care coordination and management, improved care, and knowledge enhancement.

A strategy for progress toward this goal is:

• Patient and consumer groups, clinicians, professional specialties, health care delivery organizations, voluntary organizations, researchers, and grant-makers should develop strategies and outreach to improve understanding of the benefits and importance of accelerating the use of clinical data to improve care and health outcomes.

One of my favorite stories in the IOM Report is in Box 4-2 Gleaning Real-Time Insights from Clinical Data, based on the work of Frankovich, Longhurst & Sutherland (2011).  It is a case study about a 13-year-old girl with systemic lupus erythematosus (SLE) and, due to lack of peer-review literature or expert opinion for her clinical situation, the team turned to EHR recorded data in their organization and made a clinical decision with a positive outcome.  It illustrates the power of pattern recognition over multiple data points…in this case, clinical data points.

Because clinical data is now so much more accessible, we need to find a way to free it, tap it, and improve patient care while protecting the individual privacy of each patient.  Surely we can figure this out!

Frankovich, J., Longhurst, C.A., & Suttherlund, S.M. (2011). Evidence-based medicine in the EMR era.  New England Journal of Medicine.  365 (19): 1758-1759.

What clinical questions would you ask if you could tap real-time clinical data from your electronic health record?

What strategies can you think of to improve understanding of the benefits of accelerating the use of clinical data to improve care and health outcomes?

Cheers,

Is there any question of the need for the Digital Infrastructure to achieve a learning healthcare system?  Absolutely not.

The reality is that the goals of the Digital Infrastructure also require attention to the Practice Infrastructure and culture, as you dig deeper into this foundational element of the 2012 IOM Report Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.

My professional experience of having been in literally thousands of healthcare facilities over the past two decades is that while digitalization is imperative, it is not the sole answer.  This was really brought to light when a physician stood up at a recent healthcare conference and said, “We are named one of the “Most Wired” healthcare organizations year after year, but the truth is we are a fragmented system that does not achieve the promise and hope of technology because something is missing.”

My personal experience is like most of yours.  The system I go to for my healthcare has been heavily investing in health information technology (HIT), however as I navigate within the system – and even to other healthcare providers in my community – there is no connecting of the dots, despite the automation.  One of the best examples of this is are the paper forms I receive by mail at my house, from surgeon, oncologist, radiation oncologist, etc., as I am referred to another physician’s care, despite the fact that each of the practices had invested significantly in health information technology.  Even having one’s own digital personal health record (PHR) that is able to be un-tethered from the healthcare organization’s disparate systems does not help to connect the dots.  Although PHRs are full of such potential, at present many only really end up saving patient/family time with having your health history and story documented.

Recommendation 1:  The Digital Infrastructure

Improve the capacity to capture clinical, care delivery process, and financial data for better care, system improvement, and the generation of new knowledge.  Data generated in the course of care delivery should be digitally collected, compiled, and protected as a reliable and accessible resource for care management, process improvement, public health, and the generation of new knowledge.

A strategy for progress toward this goal is:

• Health care delivery organizations and clinicians should fully and effectively employ digital systems that capture patient care experiences reliability and consistently, and implement standards and practices that advance the interoperability of data systems. (IOM 2012)

Although a digital infrastructure is essential to improving care, information technologies alone cannot provide coordinated patient care that is focused on quality and safety. True care coordination (aka, “connecting the dots”) depends on a solid framework-driven practice infrastructure that is intentionally designed to meet the needs of interdisciplinary providers, patients and families.  If we continue to “reinvent the wheel” when it comes to establishing a framework for clinical practice to “improve the capacity to capture clinical, care delivery process and financial data,” we will miss the opportunity to exponentially grow the digital infrastructure in a way that achieves best care at lower cost.

The power of organizational change from a practice framework [infrastructure] embedded in digital technology [infrastructure] is evident in replicable interventions and sustainable outcomes as described in Lessons from the Field: The Essential Elements of Point-of-Care Transformation. (2011, Wesorick & Doebbeling) Medical Care 49 (12), S49-S58.  I sincerely hope every reader of this blog takes the time to read this very important Emerging Perspectives article that was published in Medical Care and captures how the Clinical Practice Model (CPM) addresses many of the foundational elements recently outlined by the Institute of Medicine (IOM).  It shows the promise of a learning health care system well.

What is the commitment in your organization – to automate or transform?

Cheers,

We were just leaving a restaurant when out of the corner of my eye I saw the big headlines in USA Today – “U.S. Health System Broken” – in the newsstand box.  As we drove away I read aloud the story about the now infamous 2001 Institute of Medicine (IOM) Report “Crossing the Quality Chasm.”  Ironically I was in-between jobs, and I had taken the week off between leaving my role as a CPM Coordinator at large health system in Western Michigan and joining the CPM Resource Center as VP of Point-of-Care Automation.  As I finished the article, I turned to my husband.  “This is all about the work the CPM Resource Center has been doing for the past 18 years!  This will be what my work will be focused on going forward!”

I was so excited about the timing of the IOM report and how it was calling out what was needed.  I was even more excited about how I was living some of the things that were already being done, and how my new role would further satisfy my deep need to make far more meaningful contributions to the goal of mending a broken health care system.

When I joined CPM Resource Center in 2001, the company’s mission was “Co-Creating Best Places to Give and Receive Care.”  Fast forward nearly 12 years later, and the mission is still the same.  However, since finding our new home with Elsevier in 2008, our potential impact has become worldwide.  As the Elsevier CPM Resource Center, and in my role as EVP and Chief Professional Practice Officer, I more passionate than ever about what has been done and what still needs to be done.  And we still have lots of work to do!

For nearly 30 years and with an active international consortium, the CPM Framework and Models have been a demonstration of how a learning healthcare community has committed to sustainable healthcare transformation.  Yet, the exponential growth of these concepts is still escaping the collective consciousness of healthcare in America.

And then comes along my new favorite IOM report – “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America” – examines some basic facts about the nation’s healthcare system and makes recommendations for improvement.  It points out that although healthcare has made many strides in “knowledge, innovation, and capacity to manage previously fatal conditions, paradoxically, it falls short on such fundamentals as quality, outcomes, cost, and equity.”  This IOM report, which was unveiled in September 2012, was the result of a committee the IOM convened.  The goal was “to explore health care challenges and to recommend ways to create a continuously learning health care system.” The healthcare system wasted $750 Billion in 2009 – diverting resources from productive use was a key finding in the report.

Over the next few weeks I will examine the IOM’s recommendations and bring some of my experience to bear on them.  Given my current daily involvement as a patient in our healthcare system, and my professional ones as a leader engaged with culture and practice transformation at the point of care, I hope to use my unique circumstances to both, pass along what I am learning as a patient and, stimulate meaningful discussion among us, as professionals and leaders in this system that we are so dedicated to getting “right”. We also will explore each of the 10 areas the IOM made specific recommendations listed below:

1. Digital Infrastructure
2. Data Utility
3. Clinical Decision Support
4. Patient-Centered Care
5. Community Links
6. Care Continuity
7. Optimized Operations
8. Financial Incentives
9. Performance Transparency
10. Broad Leadership

I would also like to hear from YOU and your perspectives.  We invite you to a Meaningful Transformation Blog Dialogue.

What is your take on this latest IOM Report?

Cheers,

For me, my two worlds came together in a hotel room far from home when I got “the call.”

As a stared down at my physician’s number on my mobile phone, my mind quickly flashed back to my husband dropping me off at the airport two days earlier, with us both knowing that we would find out the biopsy results when I was in a another state, 2,000 miles away. I quickly picked up the phone, and my doctor began sharing the path report, somewhat slowly and begrudgingly, as he knew my husband was not with me. “I wish I had better news, Michelle, but I don’t. It’s cancer.”

My reply was, “You’re kidding me!” Like my physician would call me to kid about such things!

Needless to say, in that moment, my sense of urgency in improving the quality of the healthcare we provide, while finding the efficiencies we need to make it sustainable, became very personal and very real.

So here is the good news – early stage breast cancer caught on a routine mammogram that I happened to schedule on my birthday because I was in town. Happy Birthday to Me. ☺

However, I am most grateful for “the best birthday present I have ever received,” not only for the early detection and good prognosis, but also for the many “gifts” that have come with the experience of becoming both the server and the served in a blink of an eye.

• “Welcome to the Club” – those were words from a physician colleague who specializes in breast cancer and has had breast cancer herself. I was not aware that about 1 in 8 U.S. women, just under 12 percent, will develop breast cancer (www.breastcancer.org). Wow!
• “You are not alone” – the human compassion that emerges is humbling and amazing. Family, friends, co-workers and professional colleagues have made sure to reach out and let me know that I am in their prayers and thoughts and will do whatever to help me and my family through this time. The tree image with the pink ribbons represents to me all the women “in the club” as well as the Elsevier Tree with Latin term “Non Solus” – meaning “not alone”. My Elsevier Family has made me feel the Non Solus tradition. Of course I must call out Delta Airlines because flying during the month of October shortly after my diagnosis was certainly a warm and grateful “not alone” experience as well. The Breast Cancer Research Foundation has partnered with Delta Airlines since 2005, and throughout this October as I flew several Delta flights they certainly made me feel like I was not alone – thank-you, Delta!
• “Don’t Miss the Gifts” – more words of wisdom shared with me from many who have had cancer or other diseases. Everything from the day-to-day insights, to more time with loved ones, to time for pause and reflection, to recognizing that naps are gifts, to not wasting cancer by not recognizing the role of God and Faith on my journey. Of course, there are the other “gifts” – like a pink Pandora Breast Cancer bracelet filled with charms from awesome friends that want to remind me they are with me and that someday I will tell “my story” as I travel the world (Hint – great gift!)
• “Make it Meaningful” – these are my words to myself. As someone whose daily focus it is to transform the quality of care delivered, what am I to learn and make meaningful from all of this? For starters, it is being hyper-vigilant about how far science has grown but also about the reality that we are still in a broken healthcare system. I am now experiencing the reality of multiple physician and hospital visits where my personal health story and health record is not shared. After filling out my fourth patient history, I stopped. “This is in your electronic health record and I am not filling it out.” The truth is that I have seen the advancements but, more glaringly, I’ve seen how much we have to learn and how far we have to go.

For the rest of 2012, I will be sharing highlights and considerations from the recently published Institute of Medicine Report, Best Care at Lower Costs: The Path to Continuously Learning in Health Care in America. We all have to make every diagnosis and every patient experience a step towards Meaningful Transformation.

Let me leave you with a few questions:

Have you ever had an impactful experience of being both the server and the served?

What “gifts” have you or someone close to you experienced to help inform Meaningful Transformation?

Cheers,

The workshop was co-sponsored by the Gordon & Betty Moore Foundation, University of Minnesota, University of Maryland, and the American Colleges of Nursing.  It was 3 days of bold conversations – to learn, challenge, and co-create the next strategies for the future of informatics and practice.

The workshop engaged nationally recognized informatics and policy leaders poised to engage regional leaders into their curriculums and educational programs.  I had the privilege of teaching one of seven modules on “Roles, Competencies, Skills, Organizations and Legislatives Aspects”:

Objectives

1. Describe the history of nursing informatics as an emerging field in the nursing profession
2. Discuss evolving roles, competencies and skills impacting nursing informatics practice
3. Identify key nursing informatics organizations shaping nursing informatics impact in healthcare
4. Identify key nursing reports,  journals and books shaping nursing informatics impact in healthcare
5. Describe key legislative aspects impacting nursing informatics

Introduction

This module provides an overview of the historical development of nursing informatics as well as critical factors shaping the profession (roles, competencies and skills) and landmark legislative acts providing future direction on the significance of nursing informatics.  Each objective will be met by providing information and resources for nursing faculty and educators to incorporate into their respective school and health system curriculums.  This is an exciting time as healthcare becomes “digitalized” and our healthcare system becomes a “learning healthcare system”, therefore, the roles, competencies and skills that nursing brings to integrate informatics into education and practice has never been more important.  A key takeaway of this module is not only how to provide methods for integrating knowledge, skills and actions (KSAs) necessary for training nursing informatics competencies but how faculty, educators, students and practicing nurses can engage in the shaping of the future of nursing informatics as well as healthcare education and practice transformation.

I am pleased to tell you all how well received my module and others were embraced.  It was also great to introduce and discuss the importance of interprofessional competencies as they relate to informatics competencies.

All presentations and curricular materials for each presenter will be available for download from the AACN.QSEN Deep Dive Workshop website.  To access, go to www.aacn.nche.edu/qsen-informatics/2012-workshop

We are all called to shape the future!  My closing reflections are that it will take many individuals and many organizations to step-up and step-together to shape our future.                                                                                                                                                          

Cheers,

Michelle