IN BRIEF

Designing a Center for Collaborative Care

June 30, 2015
Written by

Effective pediatric care for complicated conditions such as colorectal abnormalities requires a unique infrastructure and an innovative approach to care.

Part of the challenge of designing a truly effective approach to complicated care is that it often requires an entirely new way of doing things. Pediatric health problems that demand the expertise of multiple specialties don’t come with a guidebook for building a treatment program, but collaborative centers are what our patients deserve. If they were easy to organize, everyone would do it.

“Center of care” programs don’t respect the traditional line-ups of medical expertise. They require taking people who don’t normally work together and finding a way for them to collaborate both professionally and administratively. It’s a foreign infrastructure for most hospitals to work with and it necessitates an open-minded, forward-thinking institution to support such endeavors both in word and in deed.

For example, a leading cardiologist may have the blessing from his hospital to start a program designed to integrate care by involving physicians from a wide number of specialties, including neonatology, genetics and surgery. But if the hospital doesn’t then help supply and inform administrative assistants, nurses and scheduling staff who understand and can help facilitate this collaboration among specialties, the center has little chance of success.

In my own experience at Nationwide Children’s Hospital with the new Center for Colorectal and Pelvic Reconstruction, it was no simple task to communicate the center’s needs in terms of infrastructure and support. It required explaining — as many times as necessary to as many people as necessary — the importance of heavily involving experts who I, as a general pediatric surgeon, would only very rarely collaborate with in the whole of my career: gynecologists, urologists, gastroenterologists, neurosurgeons, orthopedists, adolescent medicine specialists, behavioral health experts, geneticists, researchers, tissue engineering scientists and more.

Coordinating scheduling, communication, weekly meetings and truly seamless care with people whose work may seem, to some, tangentially related (at best) to the mission of excellent colorectal care was as much of a hurdle for people central to the program’s mission as it was for people who were still struggling to understand how the program needed to function. Involving pathologists, for instance, though not an obvious need for organizing a colorectal program, is essential for effective surgical management of Hirschsprung disease, just as including orthopedic experts is critical for assessing patients’ spinal involvement in certain abnormalities.

Missing any one of the specialties we chose to involve would mean missing out on a key aspect of care for some of our patients and would significantly limit our ability to effectively tackle the most challenging cases. Many of our patients require upfront coordination of multiple specialties as well as multiple surgeons in the operating room. And what an amazing service it would be to have a child with a complex condition see all appropriate specialists in a single two- or three-day visit. Without the determination and commitment of the hospital to fund and implement structural, hierarchy and scheduling changes as well as flexibility and fluidity in operations and follow-up plan organization, the idea of a center of care involving specialists from such a wide range of fields would have fallen flat.

A final challenge to creating a center of care for complicated colorectal cases revolves around the concept of life-cycle care. When you position your center as the best resource for all aspects of care for certain conditions, you need to be able to answer their questions and treat them appropriately for all of their related needs. In our center, we may diagnose a patient in utero, conduct their newborn surgical repairs, assist with potty training, help the patient prepare for menstruation or other pubertal changes, discuss intercourse with them as young adults and eventually even help them prepare for starting families of their own. Because we have the resources — professionally, fiscally, organizationally and otherwise — we are able to offer them comprehensive approaches to managing long-term care of their conditions. It’s a 25-year commitment to our patients, which is quite a feat and hard to deliver.

In short, to build a center of care that truly enables collaboration for a specific condition, the following conditions are necessary:

  • Adequate and consistent communication of the program’s goals and needs regarding the degree of involvement and variety of specialists needed for effective collaborative care
  • An institution committed to enabling the infrastructure in terms of personnel, scheduling and treating patients
  • The ability to address long-term or life-cycle health needs of patients related to the center’s conditions of focus
  • Devotion to the role of nursing in the long-term care of patients
  • Team dynamics that embrace the structured and repeat collaboration necessary for providing the best care

In my opinion, our centralized method for discussing and treating patients results in tremendous professional growth and a substantial improvement in the experience and outcomes for our patients. I now know things about gastrointestinal motility and urological care that I otherwise would never have learned, but that have improved my ability to understand the health concerns and long-term care needs of my patients, and I trust that my gastroenterology and urology colleagues could say the same about their knowledge of my colorectal surgery work.

Collaborative centers of care in which the expertise and communication do exist at a level sufficient for providing complex care for specific conditions require extreme commitment both from the people and the institutions involved. But they’re worth the effort — they provide patients with the care that they need in the most convenient, professional and comprehensive way possible.

 

Join the conversation. How do you define collaborative care? What challenges has your organization faced in facilitating collaborative care from an infrastructure or administrative angle?

 

Marc A. Levitt, MD, is an internationally renowned colorectal surgeon and serves as the surgical director for the Center for Colorectal and Pelvic Reconstruction at Nationwide Children’s Hospital.  He has directed numerous colorectal training courses attended by established surgeons and surgical trainees from all over the world. Dr. Levitt dedicates much of his free time to educational trips around the world to train surgeons in his complex surgical techniques. He has published more than 120 manuscripts and 60 book chapters and has delivered more than 300 national/international and 100 local/regional presentations of his work.