Physician Nursing Dyad Supercharges Inpatient Care
November 2, 2023 - by John Knox
A program that doubles double down on the combined strengths of physician and nursing leadership at the unit level is paying rich rewards for hospital patients at Stanford.
“At its core, the Unit Based Medical Director and Patient Care Manager (UBMD-PCM) program ensures that the physician and nurse leaders on the inpatient units are working together to make sure our patients get the best care possible,” says Lisa Shieh, MD, PhD, clinical professor of hospital medicine. Shieh and Karen Hirsch, MD, associate professor of neurology, are co-medical directors of the UBMD-PCM program.
It was Joe Hopkins, MD, now Stanford Hospital associate chief medical officer and senior medical director for quality, who conceived and implemented the program as a dyadic relationship between a physician lead and a nurse lead to improve quality care on each of the hospital’s inpatient units.
“The program that Joe created was phenomenal,” says Shieh, who had been a unit based medical director for 15 years and was one of the first UBMDs on the medicine unit. “It gave us physicians the ability to work with our counterparts in nursing on improvement and patient care on the unit, as well as working with other UBMDs on other units as well to share best practices so we can all learn from each other.”
When Hopkins announced he was stepping down from leading the program, Shieh and Hirsch were selected to serve as the physician leads along with two nursing leads: Barbara Mayer, PhD, RN, executive director of professional practice and clinical improvement for Stanford Medicine; and Dennis Manzanades, MSN, MBA, RN, director of clinical services for Stanford Health Care. They are now supported by the UBMD-PCM Program Office, led by Renee Box, director of strategic initiatives in the Office of the Chief Medical Officer at Stanford Health Care, and Jessica DeNurra, project program coordinator.
More than just maintaining the program that Hopkins developed, the new leadership team sought to broaden the multi-disciplinary perspective, starting with an increased role for nursing. In addition, the program size nearly doubled – from 18 to 33 inpatient units – with the opening of the new Stanford Hospital in 2019.
“Having both the physician and nurse perspective is really key. It wasn’t until I joined this program and worked closely with nursing leadership that I realized how important it is to work together and how much value there is in partnering with them,” says Shieh, who is also medical director of quality for the Department of Medicine.
“It’s been said that leadership occurs on the system level, but I think this program is a great example of frontline leadership. We have great executives in senior positions in the organization, but these are leaders who are actually involved in frontline work,” she adds.
Cooperation between nursing and medicine has solved numerous problems on the inpatient units.
“Reducing hospital-associated infections, or HAIs, has been a very big push from the UBMD perspective. Not only is that because it goes across multiple patient populations and most of the units, but it’s also a high priority for the organization,” Mayer says. Two recent successes in that area are reductions in central line infections and catheter-associated urinary tract infections.
The UBMD-PCM program has also been focusing on improving communication between the nursing staff and the medical staff.
“We recognized the need for better understanding of the information that needs to be exchanged and how to exchange that information using the technology that we have. We’ve seen improvement on several units with more concise communication that leads to getting things done more quickly for the patient with less calling back and forth,” Mayer notes.
Overall safety has been a third focus for the dyadic partnership. General safety rounding as a team, rather than individual safety rounding, has led to improvement in that area.
Mayer applauds how Shieh and Hirsch have been able to broaden the general understanding of roles throughout the organization.
“They have applied the dyads to our management guidance teams and the Stanford Health Care operating plan, for example. They’ve really aligned the dyad work that's going on at the unit level with the rest of the organization. One of the best examples is the work that's been going on with the HAIs, which was completely in alignment with one of the organization’s top priorities,” Mayer says.
Neera Ahuja, MD, division chief of hospital medicine, says that Shieh and Hirsch “completely revamped and improved a long-standing program that oversees quality improvement across all of the inpatient units in the hospital.”
To recognize the entire community involved in that quality improvement effort, the UBMD-PCM program held a celebration event last August tied to announcement of Stanford Health Care operational goals.
“In addition to showing appreciation to the leadership of the units, we are really intentional to align the work our units do with the hospital operational plan,” Shieh explains. The accompanying chart illustrates how the UBMD-PCM program aligns with Stanford Health Care goals [click the graphic to download the PDF]. The collective efforts have focused on reducing falls and other hospital-associated conditions as well as reducing length of stay, improving patient flow, provider wellness, and bed capacity.
“There are different domains like quality, engagement, financial and wellness, and patient experience, so it was important to have leaders from each of those areas at our celebration event.
“Our community on improvement is more than just the unit based medical directors and the patient care managers. We also collaborate with the infection prevention team and certain leaders like Chief Nursing Officer Dale Beatty, DNP, RN; Chief Quality Officer Paul Maggio, MD; CEO of Wellness Tait Shanafelt, MD; and of course Neera as chief of the division of hospital medicine. These are some of the many collaborators in our community,” Shieh says.
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