Personal Experience Ignites a Passion for Improving Care
Thomas F. Boat,MD, has been director of the Cincinnati Children's Research Foundation for the past 11 years. He's seen gradual improvements to the health care system since first arriving at Cincinnati Children's. But it took a personal experience for him to realize that these improvements need to happen much more quickly than has been the case.
Upon accepting the Joseph W. St. Geme, Jr., Leadership Award last year, Dr. Boat spoke about improving health outcomes for children. Rather than focusing on data and statistics, he instead told the story of how his family lost his granddaughter Katie to neuroblastoma when she was just 4 years old.
Throughout two years of treatments for Katie's cancer, Dr. Boat and his family saw firsthand many shortcomings in the health care system. He used this example to emphasize that leaders in pediatrics need to concentrate on improving both what is done for children, as well as how it is done. "At a cerebral level, I recognized that there were a lot of disconnects in the system," he says."But until you experience it personally, it's easy to be in denial and not pay attention to the problems." Dr. Boat now more readily recognizes the need for change throughout the pediatric health care system.
His family became regular visitors to Cincinnati Children's throughout Katie's medical care.They experienced many facets of the health care system – both good and bad – as Katie went through everything from chemotherapy, bone marrow transplant and radiation, to surgery and experimental immunotherapy.
To cite just one example, Dr. Boat described the process for Katie's chemotherapy. Her clinic appointment time was 9 am. Numerous steps had to be taken before Katie could finally start her chemotherapy as an inpatient more than 12 hours later, close to midnight.At this point, staffing numbers were low and a nurse new to Katie's care had just come on shift. Katie and her parents were then awake most of the night and exhausted by morning. Dr. Boat saw vast room for improvement.
Making Advances
Fortunately, progress has been made. Since he first spoke about this more than a year ago, Dr. Boat has seen improvements in the system."I think we've been able to deal with a lot of issues," he says.The Division of Hematology/Oncology has worked with the lab to improve how quickly lab results are returned.They also have made staffing changes, have improved their admitting procedures, and are working on medicine ordering and dispensing.The current expectation is that no chemotherapy starts after 7 pm.
Dr. Boat is encouraged by these changes. But he stresses that more needs to be done."People notice all the time that things need to be fixed," he says."But one person can't make the change alone."With that in mind, improvement teams have been created at Cincinnati Children's.
Most recently, Cincinnati Children's received a grant from the Robert Wood Johnson Foundation allowing resources to be put toward raising the standard for health care performance. Teams throughout the medical center are working on initiatives such as improving the discharge planning process to allow families to go home sooner after the child reaches discharge criteria; reducing wait times; and working with families to customize treatments to best meet the family's and patient's needs.
Ultimately, Dr. Boat recognizes that no matter how good Katie's care, her battle needed to be won with a cure. With this in mind, Dr. Boat maintains that research advances resulting in new and better therapies must develop at a similar pace to care delivery improvements. Putting resources toward translational research and taking medicine "from the bench to the bedside" is a top priority of his.
Involving Community Physicians
Dr. Boat feels it is equally important for community pediatricians to look at their own practices for opportunities to improve.To be successful, he recommends (1) making a commitment to an improvement agenda, and (2) identifying a person or persons in each practice who are dedicated to setting the agenda and seeing it through.
At Cincinnati Children's, community physicians have already played a big role in transforming the health care system. In a joint effort with Cincinnati Children's staff, community physicians have worked to create close to 30 evidence-based best practice guidelines that are now in use at the medical center and across the Cincinnati area.
In the end, the research conducted and the care given need to work hand in hand to make the health care system function to its maximum potential. It is this thought that keeps Dr. Boat's passion for improvements at the forefront of his mind.
"We are well ahead of many places in the country in terms of improving pediatric care. For me that's exciting, and this is a place doing the right things with its improvement agenda," Dr. Boat says."I feel very good about working at a medical center that's made a commitment to be a leader in figuring out how we can most assuredly and rapidly institute improvements in care."
Dr. Boat is physician-in-chief at Cincinnati Children's, director of the Cincinnati Children's Research Foundation and chair of the Department of Pediatrics at the University of Cincinnati College of Medicine. His talk was published in Journal of Pediatrics, (143[5]:559-563, 2003 November).
