Hardwiring Cultural Change Through Nurse-Physician Committees
When neuro-intensivist Kiwon Lee, M.D., FACP, FAHA, FCCM, accepted the position of director of neurocritical care at the Memorial Hermann Mischer Neuroscience Institute at the Texas Medical Center in 2012, he came with a plan – to build strong collegial relationships between physicians and nurses, particularly in the Neuroscience Intensive Care Unit.
“When I started here, doctors were rounding on patients and writing orders for nurses to carry out later. We consider that outdated medicine,” says Dr. Lee, an associate professor in the department of Neurology and the Vivian L. Smith Department of Neurosurgery at UTHealth Medical School. “We want to be proactive in providing care rather than reactive, and quick administration of critical medical treatment can occur only when communication is seamless. Nurses have to be part of the discussion, which is why they round with us. When they give their input and make decisions with us, there’s no lag between the decision-making process and the execution.”
Dr. Lee is also a strong proponent of education. “When nurses and doctors are on the same page, communication is efficient,” he says. “We consider nurses our partners and want them to be as knowledgeable as we are about the patient. This is the only way to provide excellent critical care service and produce better outcomes.”
Cultural change at the Mischer Neuroscience Institute has been formalized through eight committees, each co-chaired by a nurse and a doctor. Tiffany Chang, M.D., co-chairs the Clinical Practice Committee with Colleen
Zuckero, RN, B.S.N., CNRN, clinical education specialist and manager of the Neuroscience ICU.
“Collaboration is critical to the care of neuroscience patients. It’s no longer a culture of doctors giving orders and nurses following them,” says Dr. Chang, an assistant professor in the Vivian L. Smith Department of Neurosurgery at UTHealth Medical School. “The nurse is an active member of the treatment team, rounding with us in the morning and advocating for the needs of patients. They know the patient best because they’re at the bedside 24/7. We respect their input as an important member of the team.”
The new committee structure plays a vital role in continuous quality improvement. “For example, data collected by the Quality and Safety Committee provides information that aids the Clinical Practice Committee with process improvement initiatives,” says Nicole Harrison, RN, B.S.N., M.B.A., administrative director of the Institute. “If we discover a need to reeducate nurses based on the data, the Staff/Nursing Education Committee puts together a plan and disseminates the information. The new structure ensures that nurses and doctors alike are aware of everything that goes on in the Neuroscience ICU. It also positions us as equal partners on the patient care team. Nurses can agree or disagree. It’s complete equality.”
H. Alex Choi, M.D., chairs the Critical Care Research and Evidence-based Practice Committee with Christina Luther, RN, and the Cerebrovascular Committee with Christine Glendening, RN. “The challenges nurses face are different than the challenges doctors face,” says Dr. Choi, an assistant professor in the department of Neurology and the Vivian L. Smith Department of Neurosurgery at UTHealth Medical School. “Nurses are on the frontlines around the clock. When we work together cohesively and creatively, our patients benefit. We understand that it’s the nurses who take care of patients. If physicians and nurses are not on the same page and moving in the same direction, treatment becomes fragmented. Families don’t understand what’s happening to their loved one and our patients suffer. With good communication and teamwork, everyone excels in patient care and academic development.”