Perspectives on the Acute Care Continuum

The Acute Care Continuum is the integration of urgent, emergent, inpatient and post-discharge care of patients with acute medical conditions.

Nurturing the Nurturers: How CEP Provides Opportunities for Early Leadership

3/1/2017 11:33:03 AM | 1 comments

I may be just a few years out of residency, but the experiences I have had and the opportunities I have been granted since graduating have been far greater than I could have ever imagined.
 
I'm an ED Medical Director at French Hospital Medical Center and have held clinical leadership positions at three other hospitals. I also serve as CEP America's Director of Palliative Care.
 
Combine that with taking care of my two kids, who are 19 months and four-months-old, respectively.
 
I make a lot of lists. Without them, I’d easily forget things.
 
Making lists was just one of the great habits I developed as an Administrative Fellow at CEP.
 
Back in medical school, I didn’t give leadership much thought. But then I became a chief resident, which gave me a taste of having my own vision for change and bringing it to life.
 
However, it was CEP’s one-year Administrative Fellowship that taught me — in a very hands-on way — what it really takes to lead.
 
More importantly, it provided me with all the resources I needed to succeed as a leader, from shoring up my presentation skills to giving me a seat at the table at committee meetings. It was the perfect environment to network, find mentors, and in the process, find my niche.
 

The Fellowship Project

 
I had already been considering CEP when I heard about the Administrative Fellowship. I called seeking more information, and the recruiter connected me with then-CMO Prentice Tom, MD, who's been a dedicated mentor to many fellows. He convinced me that the fellowship was what I wanted and that CEP was where I wanted to be.
 
The program is designed to give new attending physicians a thorough understanding of the Partnership. The ability to attend various governance and management meetings, for example, allowed me to understand firsthand its inner workings. And it enabled me to meet all kinds of different people along the way.
 
But for me, the heart of the program was a project that we were tasked with designing and implementing. Through that project, I learned how to navigate the Partnership’s committees and layers of administration in order to bring to fruition something I was deeply passionate about. It also connected me with other physicians who were equally passionate and could provide guidance and expertise.
 
I chose to focus on palliative care. During my residency, one of my attendings had been very involved in that discipline. She told me that the ED is one of the most appropriate environments to have a conversation about palliative care with patients. However, few ED physicians are given the tools they need to do so. It seemed like a great place to make an impact.
 
So with the help of various palliative care experts at CEP like Sabiha Pasha, MD, and Jeff Frank, MD, we created what has since become a practice-wide palliative care program. It’s an integrated framework that can be used in various departments, as it encompasses emergency and hospitalist care and can easily extend to the ICU as well.
 
It has an educational component, which consists of a workshop that goes over key phrases and scripting and offers some tools to help ED physicians and hospitalists have effective goals-of-care conversations — including ways to identify the right patients with whom to have them.
 
The workshop includes an interactive role-playing session, where we bring in actors to play the roles of patients and family members. It makes for some pretty dramatic conversations, which is a powerful way for physicians to practice what they’ve just learned in theory.
 
We've also mapped out a palliative care clinical pathway that hospitals can use to steer the patient across the care continuum, from the ED to inpatient admission and discharge. For example, it specifies order sets and documentation checklists for admitting providers. It also spells out things to think about when it comes to preparing the patient for discharge. For the clinician at the bedside, it suggests what sorts of patients would benefit from palliative care and offers some key phrases to use in a subsequent discussion.
 
The work undertaken in the fellowship program is more than just a training exercise. CEP takes it very seriously. Indeed, toward the end of my fellowship year, it was decided that the program would be implemented at hospitals across the practice, a decision that thrilled me to no end.
 
It’s been really exciting to find this community of physicians and providers who are interested in palliative care and who want to better their own practice and improve on their existing skills. Moreover, we have data showing that the pathway has been instrumental in increasing the amount of palliative care referrals at some of our sites.
 
In fact, it’s been so successful that CEP is now looking to build on it. At one site we’re working with business development to create a pro forma staffing model for a palliative care department run by a palliative care fellowship-trained and boarded CEP hospitalist. At another site, we’re creating a model that integrates an advanced provider along with a palliative care physician who can supervise via telemedicine.
 

Out of the Fellowship and Into the Fire

 
After the fellowship, I stepped into an Assistant Medical Director role at my current site, French Hospital. Initially, I became involved in various committees, such as those dedicated to critical care, credentialing, and hospital throughput. Through this work, I was able to establish relationships with administration and medical staff across the hospital.
 
A few years later, the opportunity arose at my site to become the Medical Director. I gladly stepped into it, and it has been an incredible opportunity. I have been thankful to have great mentors at my site like Dan Culhane, MD, and Juan Reynoso, MD, both of whom have leadership roles within the partnership and who have provided me with invaluable guidance.
 
My formal leadership training didn’t end with the Administrative Fellowship. As part of my Medical Director training, I attended various leadership academy sessions and was trained in LEAN and Six Sigma principles. CEP understands that its physicians need robust continuing education in order to really take on these roles. Its willingness to provide such training is very unique to our partnership.
 

Work-Life Balance? Yes, We Can!

 
CEP also understands the importance of wellness and balance, in particular that our family lives are a key part of who we are. And so hand-in-hand with leadership training, it also provides education on resilience. And it offers numerous opportunities for balance, such as sabbaticals and parental leave.
 
Taking on a leadership role isn't easy. You have to be very mindful to carve out personal time for yourself. But in addition to giving me the chance to work on a project that has fundamentally changed the way we care for patients, CEP’s Administrative Fellowship taught me to be more efficient with all of my time, because I know now how truly valuable it is. Besides, I can always make another list!
 
Interested in learning more about palliative care? CEP America's Palliative Care Team will be presenting a poster at the Coalition for Compassionate Care of California Annual Summit, which takes place March 13–14 in Sacramento. If you're attending, we'd love to meet you, so stop by and say hello!

Topics: Careers

Comments
David Birdsall
Great article Shauna. Thanks for your comments and your leadership
3/2/2017 10:02:36 AM