Nada Ghandour
Administrative Fellow
Corporate Learning
Gundersen Lutheran
“I thought I could help people, and I could help patients, by helping redesign on the business side of it because I understand the clinical side.” (1:18)
My name is Nada Ghandour, and I work now in quality improvement in Gundersen Lutheran, La Crosse, Wisconsin. It’s an integrated health care delivery system. It’s physician-run. We have like 400 clinicians, 6,000 employees, and a 300-bed hospital. It covers southwestern Wisconsin, northeastern Iowa, and southeastern Minnesota. We have many regional clinics and one main center. My background is as a physician. I’ve always thought I would be in clinical practice, but we came to this country from Lebanon — I say “we,” my husband and I — and we planned to train and he would get boards, and I will do fellowship and go back to Lebanon and practice there. And when the time came to go back, no job opportunities were opening up, and the situation was not very stable so we thought we’ll wait a couple more years. But then I had children and I wanted to raise them myself, so I left my clinical practice and did a Masters in Business — I thought I could help people then, and I could help patients, by helping redesign on the business side of it because I understand the clinical side.
“We used the Model for Improvement, which was my first experience with it, and it’s a really fascinating way to actually implement change and make it stick.” (1:38)
I was asked to work on improving hypertension control in the organization. We’re part of Wisconsin Collaborative for Healthcare Quality, and this a public measure we report and our rate could use improvement, and that became my major work since last winter. I researched the literature and, instead of just tackling it from a superficial point of view, I approached my executive sponsors and said, “I want to implement the Chronic Care Model and that way we could really provide the care those patients would need.” And then, researching more, I encountered this collaborative on IHI, the New Health Partnerships. Well, looking at it, “Oh, my God, that’s what we need to do this work because we don’t know what is self-management support.” It’s a nice way to say it, but how to do it, and they offered us to work on it. So I convinced my executive sponsors. They were afraid it’s going to be too much work, but I was like, “No, no. That’s the way to go,” and they agreed, and I applied and we were accepted as a team to be part of this collaborative.
We used the Model for Improvement, which was my first experience with it, and it’s a really fascinating way to actually implement change and make it stick. I learned a lot about that and how to do proper reporting and the proper way to collect measures. And the PDSAs and New Health Partnerships really helped ground us in this work.
“We have actually a couple of patient advisors on our team, and… we’ve never done that before… and it really was eye-opening.” (1:29)
From the clinical perspective, the patient population that went with this planned care model of delivery — we have implemented self-management support. We work with the patient on building relationships, exploring their beliefs, we share their information in a very good way, and then we collaboratively set goals and do an action plan for lifestyle modification that they choose so that it becomes their own goal. We try to solve problems and then [offer] close follow-up, and we have noticed that those 35 patients that went through this model, their blood pressure control improved markedly. We have actually a couple of patient advisors on our team, and that is the fun part of it because we’ve never done that before. It was really eye-opening, hearing their perspective and what’s important for them, and how they would suggest improvement.
I believe the clinicians loved it. When we started, it wasn’t clear to them what we were planning to do. But as the work kept going, you can see the nurses are fascinated by the work and they’re talking to their colleagues, same thing for the physicians. And that has been really a nice surprise because it was an unknown, and we were speculating how people on the team would react and that outcome was very good.
“The vision would be that all patients with chronic diseases ultimately will have self-management support in one way or another.” (1:07)
We’re hoping to spread within the organization because we have a large primary care practice. The hope would be that all patients with chronic diseases ultimately will have self-management support in one way or another. We have care coordinators that would take the really extremely needy patients and sick patients in the out-care setting, but the patients that are just hypertensive, where would they get that self-management support? And that would be my goal to get that integrated in the primary care setting.
The good thing is that we have a disease management program, and it’s for diabetes and congestive heart failure and chronic kidney disease, and now hypertension is part of it. So that we have this IT baseline. So when I presented my work to this group, they thought it’s something to adopt for all chronic diseases, which gave me validation with the other providers. We’re now dealing with the practicality of things to spread.
02/04/2008
