Category Archives: Voices from the Field
Michael Hochman, MD, MPH, is medical director for innovation at AltaMed Health Services, the largest independent federally qualified health center in the United States. AltaMed has enrolled more than 30,000 Southern Californians in Medi-Cal and Covered California, the state health care exchange. Hochman is an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program at the University of California, Los Angeles, and the U.S. Department of Veterans Affairs. Martin Serota, MD, is AltaMed’s chief medical officer.
Although the dust is still settling, most indicators suggest that the first wave of national health care reform was a success, particularly in California. More than 8 million Americans enrolled in commercial health plans under the Affordable Care Act, surpassing targets set by the Obama administration. Many more will qualify for plans under Medicaid expansion. As leaders at a community health center that serves a large population of low-income patients—many of whom currently lack coverage—we could not be happier about the new opportunities for our patients.
But we also know that the work is far from complete. Health care reform will only be a success if coverage expansion results in improvements in quality and efficiency, and better health for the population. As we know from the Massachusetts experience, it took time and a lot of effort for these benefits to ensue. Only now, several years after health care reform began in Massachusetts, are residents of the state starting to reap the benefits.
Timothy Landers, PhD, CNP, and Jason Farley, PhD, MPH, CRNP, are Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars. In his work, Landers focuses on the epidemiology and prevention of antibiotic-resistant infections, including the use of hand hygiene as a means of prevention. Farley evaluates treatment outcomes in multi-drug resistant infections including tuberculosis (TB) and Methicillin-Resistant Staphylococcus aureus (MRSA) in patients with HIV, with a focus on sub-Saharan Africa.
The recent outbreak of Ebola virus in West Africa is a stark reminder that we live in a globally connected world and that outbreaks can occur without warning. As infection prevention specialists, we are acutely aware of the risks health care workers face in caring for the public, both now and in times of relatively less chaos.
The good news is that despite media reports, nurses, physicians, infection prevention specialists and other health care workers are in an ideal position to lead the global response to this disease.
Our experience with measures to address hospital-acquired infections—isolation precautions, hand hygiene, contact tracing and public health measures—are also the same methods necessary to contain the spread of Ebola.
Building on experience addressing these infections, along with recognition of the differences in Ebola virus transmission, the Centers for Disease Control & Prevention (CDC) regularly updates the guidelines and is currently recommending enhanced versions of isolation precautions, including enhanced standard precautions, contact precautions, and droplet precautions.
Swet Patel is a sophomore at the College of New Jersey, majoring in psychology. He is a graduate of Project L/EARN, a 10-week summer internship that provides training, experience and mentoring to undergraduate college students from socioeconomic, ethnic and cultural groups that traditionally have been underrepresented in graduate education. Project L/EARN is a project of the Robert Wood Johnson Foundation (RWJF), the Institute for Health, Health Care Policy and Aging Research, and Rutgers University.
On May 27, 2014, I finally ended my teens and entered my 20s. But I will forever remember this date as more than just my birthday. This was the first day of Project L/EARN.
Like my peers entering the program, I expected to gain research exposure that would be a great résumé booster. Little did I know I would gain so much more than just research experience. Although the 10-week program was intensive, and at some points it made me question why I was doing it, I never imagined I would be able to achieve so much in such a short period of time. I realized after seeing the fruits of my labor—the poster, the oral presentation, and the paper—that this program was beyond worth it.
Project L/EARN boosted my confidence. I actually feel like a researcher. And it was truly remarkable that I was able to meet such diverse individuals from a wide range of fields during the guest lecture series. I learned a great deal from these esteemed professionals regarding the different aspects of health care. The networking the program provided gave me lifelong relationships that I will forever cherish.
Patricia Drehobl, MPH, RN, is associate director for program development at the Centers for Disease Control & Prevention (CDC). She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2007-2010).
Human Capital Blog: CDC is engaging in new partnerships with the American Association of Colleges of Nursing (AACN) to promote public health nursing. How did the new collaboration come about?
Pat Drehobl: CDC has funded some national academic associations for many years, including the Association of Schools of Public Health, the Association of Prevention Teaching and Research, and the Association of American Medical Colleges. We recognized the need to include nursing representation because nursing is the largest discipline in the public health workforce. We added AACN as a partner in 2012 when we developed our funding opportunity announcement to work with academic partners.
HCB: Why did CDC decide to reach out to the nursing community in 2012?
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Tune in to the sixth episode of RWJF’s Pioneering Ideas podcast to hear from RWJF Investigator Award in Health Policy Research recipient, premier medical historian and Princeton educator Keith Wailoo, PhD. RWJF’s Steve Downs, SM, joins Keith to discuss how deeply held cultural narratives influence our perceptions of health, and how today’s wild ideas are often tomorrow’s cutting edge innovations.
Visit iTunes to download this episode and subscribe to future episodes.
In this episode, we also look at innovations that ask, “What if?” and explore simple shifts in perspective:
- OpenNotes’ Tom Delbanco and Jan Walker talk to RWJF’s Emmy Ganos about why they decided getting health care providers to share their notes with patients was an essential innovation—and where their work is headed next.
- Founder and CEO of LIFT Kirsten Lodal talks to RWJF’s Susan Mende and shares some simple ideas with the potential to revolutionize our approach to helping people achieve economic stability and well being.
For 23 years, Project L/EARN has created stronger candidates for admission to graduate programs. The intensive, 10-week summer internship provides training, experience, and mentoring to undergraduate college students from socioeconomic, ethnic, and cultural groups that traditionally have been underrepresented in graduate education. Project L/EARN is a project of the Robert Wood Johnson Foundation (RWJF), the Institute for Health, Health Care Policy and Aging Research, and Rutgers University. In this post, interns and mentors share their insights on the value of mentoring in general, and on Project L/EARN in particular. For more, check out an accompanying Infographic: Project L/EARN: Milestones.
“Project L/EARN mentoring has been incredibly instrumental in my career path and has contributed greatly to my professional success. The program was my first major introduction to research, and helped me to apply and reinforce research methods and statistical analysis skills throughout my undergraduate and graduate years.” — Anuli Uzoaru Njoku, 1999 Intern
“Mentoring means allowing me to experience how someone else sees me—someone who believes in me and sees my potential, someone who can set my sights higher and in the right direction.” — Tamarie Macon, 2006 Intern
“Project L/EARN mentoring, then and now, has been the difference between the summer program being a one-time experience, and the beginning of an educational and professional career that will undoubtedly contribute to the story of my life. The mentoring was the avenue by which my truest potential, of which I had no real awareness, was discovered and cultivated. That cultivation has resulted, and is still resulting, in opportunities and accomplishments that are beyond my imagination.” — David Fakunle, 2008 Intern
Let’s Have a Conversation about Food that Goes Beyond Restriction and Restraint—and Resonates with Real People
Sonya Grier, PhD, MBA, is an associate professor of marketing at the Kogod School of Business at American University in Washington, D.C., and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2003-2005).
Human Capital Blog: Congratulations on receiving the Thomas C. Kinnear award for your 2011 article in the Journal of Public Policy & Marketing on food well-being! Please tell us about the award.
Sonya Grier: The award honors articles published in the Journal of Public Policy & Marketing (JPP&M) that have made a significant contribution to the understanding of marketing and public policy issues. This year, eligible articles needed to have been published between 2010 and 2012. The marketing community was called upon to nominate articles for the award. JPP&M editorial review board members and associate editors then voted among the nominees.
Generously funded by Thomas C. Kinnear, his colleagues, friends and former students, and administered through the American Marketing Association Foundation, the award’s purpose is to recognize authors who have produced particularly high-quality and impactful research in marketing and public policy.
HCB: How did your article do that?
Linda H. Aiken, PhD, RN, FAAN, is the Claire Fagin Professor of Nursing, professor of sociology, director of the Center for Health Outcomes and Policy Research, and senior fellow of the Leonard Davis Institute for Health Economics at the University of Pennsylvania. Olga Yakusheva, PhD, is an associate professor at the University of Michigan School of Nursing.
Four years ago the Institute of Medicine’s (IOM) landmark report on the future of nursing was released. The study was remarkable in multiple respects including the interdisciplinary perspectives of national experts comprising the study committee, the breadth and scope of the study, its actionable recommendations, and the commitment of the Robert Wood Johnson Foundation (RWJF) to provide philanthropic funds to help implement the study’s recommendations—a rarity. One net result of the IOM Report, as viewed on the 4th anniversary of its release, is its notable impact on the commitment of stakeholders to finally make the transition of the nation’s nurse workforce to BSN qualifications, after many decades of limited progress.
Changing trends in nurse employment and education: The IOM recommended that 80 percent of nurses in the United States hold at least a baccalaureate in nursing (BSN) by the year 2020. The recommendation was quite bold considering that two-thirds of new nurses still graduated with less than a BSN, despite numerous previous reports and commissions over decades recommending the BSN as the entry qualification for professional nurses.
While the percentage of nurses with bachelor’s and graduate education had been slowly increasing over time, when the IOM report was issued only about 49 percent of nurses held a BSN. However, the IOM’s recommendation, based upon a growing research base documenting that patient outcomes were better in settings that employed more BSN-qualified nurses, acted as a tipping point to mobilize responses from many stakeholders that together are impacting changes in nurses’ qualifications.
Nurses truly run the front lines of hospitals. Their leadership oversees every hospital quality initiative essential to improving care—from reducing hospital-acquired infections, to cutting unnecessary readmissions, to preventing patient falls.
Poor scores in these quality measures now result in government penalties that can hit hospitals hard.
And as health care evolves and hospitals stretch beyond their own walls, nurses are leading the programs that bring health care into communities. They are critical to the success of health reform as more Americans obtain health insurance and seek primary care.
So tell me something? Why is the highest level of hospital leadership in our nation nearly devoid of nurses?
Surveys find the number of nurses with voting positions on hospital boards is about 4 to 6 percent — an unfathomable statistic for anyone who understands, even a little, how hospitals work.
We need the leadership of nurses on every hospital board.
This week marks the 4th anniversary of the Institute of Medicine’s future of nursing report. Fran Roberts, PhD, RN, FAAN, is owner and executive leader of the Fran Roberts Group, a consulting and contracting practice providing expertise on health care leadership, higher education, governance, regulation and patient safety. The Kate Aurelius Visiting Professor for the University of Arizona College of Medicine–Phoenix, Roberts serves on the boards of directors of several health care organizations, including the Presbyterian Central New Mexico Health System. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive News Fellows program.
“Leadership from nurses is needed at every level and across all settings.” That’s what the Institute of Medicine’s (IOM) Future of Nursing panel wrote in its 2011 report—a message I’ve taken to heart. Here’s why the IOM was exactly right.
I’ve served (and still serve) on several health-related boards, in most cases as the only nurse in a group dominated by physicians, local business leaders, and administrators. My experience on the Presbyterian Central New Mexico Healthcare Services board, which I now chair, is both representative and instructive. I joined the board about eight years ago, recruited by one of my colleagues in the RWJF Executive Nurse Fellows program, Kathy Davis, RN, the senior vice president and chief nursing officer at Presbyterian.
It was an honor to be asked, doubly so because I live and work out of state. But Presbyterian had concluded that it needed a nurse with executive experience on its board, so I got the call.
I started my first term on the board determined not to pigeon-hole myself as “the nurse on the board.” I didn’t want my fellow board members to think I had tunnel vision, unable to see beyond the need to advocate for nurses. That’s not to say I didn’t intend to advocate for nurses when that was called for, but I didn’t want to be limited to that, either in my colleagues’ estimation or in reality.