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A Neurologist's Guide to Hospital Reorganization

Joe Cantlupe, for HealthLeaders Media, February 24, 2011

You don't need to be a neurologist to figure out the intricacies of developing the best patient care for a hospital. Well, maybe it helps.

Roger J. Packer, MD, head of the division of child neurology at Children's National Medical Center in Washington, DC, was thinking about multidisciplinary approaches long before they became the focus of many hospital strategies.

The neurosciences team at Children's National Medical Center is one of the largest in the country, having more than 85 pediatric specialists, and dozens of programs focusing on patient care from epilepsy to general neurology. For years, the service line was disorganized. "There was a void until we hit the right structure," Packer, senior vice president of the Center for Neuroscience and Behavioral Medicine at the Children's National Medical Center, tells me.

A decade ago, Packer and his team began a reorganization process that "fostered development of numerous multidisciplinary programs and is fiscally sustainable," Packer and his colleagues write in the recent issue of Pediatric Neurology in a piece entitled, "Center for Neuroscience and Behavioral Medicine: An Innovative Administrative Structure and Possible Paradigm for the Future." That process of change and reorganization, when necessary, continues today, he says.

When the Children's National Medical Center opened in 1970, it soon faced challenges involving its economic stability. At that time, the structure included a department of neurology, with some specialties reporting to it within separate divisions. Other aspects of care that now would be blended within the neurology function reported to a department of pediatrics.

"With a silo mentality, there were individual divisions, and (people) not communicating or being responsible for one another," Packer recalls. That structure, it was decided, "wasn't going to take us where we wanted to be," he adds. "We didn't have the depth of resources to allow people not to communicate or not work toward the common goal."

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