With a clinical and business imperative to start with, North Shore-LIJ began to design a template for a women's health center of excellence, for which Mieres was appointed director. The strategic plan was built around four areas of focus:
A vice president was appointed to each of the four areas of focus, with Stacey Rosen, MD, a practicing cardiologist, appointed VP of clinical services for the Katz Institute. A clinical services steering committee was formed with representatives from the major clinical areas of women's health, including the traditional practices dedicated strictly to women such as OB-GYN and gynecological and breast cancer, Mieres says, but also cardiology, neurology, endocrinology, radiology, urology, and rheumatology. Rosen began the integration process by going department by department to break down barriers—some structural and some cultural—that had kept women's health services from acting as a single unit and guiding patients to where they need to be.
"If you meet with the chairs of obstetrics and gynecology, they are going to be hard-pressed to deny that I am better at managing cardiac and hypertension and diabetes than they are," Rosen says. "And I don't deliver babies. So wouldn't it be great if every time their patient had an OB-GYN visit they were reminded about other nongynecologic opportunities for wellness?"
The bridge was different with each department, Rosen says. So for the GYN oncologists, the cardiologists could offer to preop screen their patients and follow them after their hysterectomies. Or for the psychiatrists, it might be adding a postpartum depression flyer in the materials given to mothers after delivery.