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."
Among the organizational changes was creation of a Center for Neuroscience and Behavioral Medicine under one roof, in essence, to coordinate aspects of care, Packer says, referring to his neuroscience specialty. In the process, various executive duties were changed and clinical programs underwent reorganization. Meanwhile, the number of board-certified or eligible child neurologists for the program tripled to more than 30 over a decade.
"A stated premise of this new administrative structure involved breaking down artificial divisional barriers to allow the development of multidisciplinary, patient-centered programs, so as to overcome 'turf' issues and [a] 'silo mentality," Packer and his colleagues wrote. "For the Neuroscience and Behavioral Medicine Center, all programs that dealt primarily with conditions of the central and peripheral nervous system would operate under the purview of the center, without constraints of determining if these were 'owned" by neurology, neurosurgery, psychiatry, psychology, genetics, child development or physical therapy."
Within the divisions under the center "we made it clear to the division chiefs at least 50% of the goals had to be common goals, they have had to be shared goals," he tells me. "We use the multiple goals of the division chiefs to make sure we are working together. We don't let turf stand in the way." In that way, "multidisciplinary programs" were carried out, Packer says.
As programs grew, "turf issues were minimized by promoting the approach that all disorders primarily centered on nervous system function were the primary responsibility of the center and not of individual subspecialties or divisions, and the center would set priorities and determine the optimal program structure," according to Packer's report.
Besides issues involving care, "a unique component of the center's structure" involves its administrative and financial responsibility. Since 2001, the center has met its financial targets, and patient revenues for the center have increased from $50 million to more than $77 million anticipated in 2010, according to Packer.
The center's work does not remain static and is continually refined. With the growth of neurogenetic programs, for instance, a division of genetics was transferred to the center.
"In terms of patient care, this is value added," he says, referring to the work of the center and the constant review of its multidisciplinary work. And there's a lesson for others who seek to revamp their structures: "without commitment," he says, "it can unravel quickly."
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Joe Cantlupe is a senior editor with HealthLeaders Media Online.
