Let’s Stay Together

Why our co-located C.S. Mott Children’s and Von Voigtlander Women’s hospitals are a model for optimal collaboration and patient and family-centered  care 

After being raised in a home that doubled as a children’s daycare center, ballet dancer Danielle Haviland was excited to have a baby of her own. And when Danielle’s husband, Ben, a specialist in the United States Army, learned that he would not have to serve a second tour in Afghanistan and was eligible for honorable discharge, the couple was excited to relocate from Nashville, Tennessee, where they were stationed, to Fenton, Michigan, which is home to Danielle’s mother and other relatives.

However, 20 weeks into the pregnancy and two months before they were scheduled to move, Danielle and Ben learned that their baby had a benign lung malformation called a Congenital Pulmonary Airway Malformation, or CPAM. A CPAM is a lung mass that requires frequent monitoring because of its potential to grow quickly and lead to heart failure. Two weeks before the Havilands’ move to Michigan, Danielle’s Vanderbilt University Medical Center team contacted the University of Michigan Fetal Diagnosis and Treatment Center (FDTC) to transfer her care. In December 2012, Danielle became a U-M patient.

Of the 4,200 deliveries we perform annually at UMHS, 30 percent are classified as high risk. UMHS is a referral destination for many high risk Obstetrics/Gynecology (OB/GYN) patients because we have leading specialists in some of the most complex OB/GYN and pediatric conditions and because we are one of a handful of health systems in the nation to co-locate our children’s and women’s hospitals.

Co-location of C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital means that mother and baby are not separated – they stay together – and that other family members don’t have to navigate multiple buildings to see them. It means that the patient is seen in one location by everyone that provides care to her and her baby, which is a fundamental element of patient and family-centered care. And it sets the stage for optimal collaboration and communication between providers, which minimizes errors and improves patient satisfaction. The positive impact on patient satisfaction is evident in “overall rating of care” data for Mott, which rose from 89.7 in 2010 to 90.2 in 2012 and is currently at 94.0, and Von Voigtlander, which rose from 87.6 in 2010 to 89.3 in 2012 and is currently at 91.0.

Of course, all that Danielle and Ben Haviland wanted to know is that she and their baby would be in capable, caring hands.

Almost weekly, Danielle saw Dr. Marcie Treadwell, director of the U-M Fetal Diagnostic Center, for ultrasound evaluations. At just over 31 weeks gestation, Danielle underwent a fetal MRI to better evaluate the mass and assess the size of the unaffected lung. A team of maternal and pediatric physicians reviewed the imaging and determined that the CPAM was so large that the baby’s chances for survival at birth were low even with conventional treatment such as a breathing tube and mechanical ventilation. Thus, the team decided that the best course of action was to perform fetal surgery to remove the CPAM in utero and then deliver the baby.  This type of open fetal surgery at the end of pregnancy is called an ex utero intrapartum treatment (EXIT) procedure. During the EXIT procedure, the baby doesn’t have to breathe on its own since he/she remains attached to the umbilical cord and receives oxygen from the placenta.  The ability to operate on babies before birth allows for a smooth transition to life outside the womb.  Notably, our Fetal Diagnosis and Treatment Center is the only comprehensive fetal therapy center in Michigan and one of only a handful in the country.

So, on the morning of March 5, at 39 weeks, Danielle was admitted for the EXIT procedure.

“When I was going in to have my baby I was really scared and I started to cry,” Danielle remembers. “But, I felt they would do what was best for my baby and for me.  They made me feel so good and safe and like they were going to take care of us.”

The “they” Danielle refers to is the nearly 30 people who were ready to take care of the two patients – a team led by pediatric/fetal surgeon and FDTC Director Dr. George Mychaliska and Maternal-Fetal Medicine’s Dr. Clark Nugent, and organized by FDTC Nurse Coordinator Jeannie Kreutzman. The team included specialists from maternal and pediatric anesthesia, pediatric cardiology for continuous monitoring of the baby’s heart, ECMO in case the lungs could not be aerated well after the mass removal and the NICU for transition care and transport.

Just 2.5 hours after Danielle entered the operating room, Noah Haviland was born via successful EXIT procedure. He transitioned well with only ventilator support and spent just 20 days recovering in the NICU. His incision has healed well and his lung capacity is expected to be normal.

havilands_h

The Haviland Family

To orchestrate and perform complex procedures like the one that brought Noah safely into the world with the ability to develop healthy lungs exemplifies what is truly exceptional about having co-located children’s and women’s hospitals: any specialist can be on the scene during the surgery or within minutes; mother and baby are safe with access to any care they need; we are providing effective and collaborative team care; and families stay together.In the next several years, we aim to ensure our ability to handle more cases, expand our fetal therapy program and make outcomes data available online to improve transparency and accessibility with the public and researchers.

I am extremely proud of our Mott and Von Voigtlander faculty and staff, and their continued dedication to excellence and patient and family-centered care. This is The Michigan Difference. This is what it means to be Victors Valiant.

In Celebration of Nurses

“You must never so much think as whether you like it or not, whether it is bearable or not; you must never think of anything except the need, and how to meet it.”  ― Clara Barton, Nurse & Founder of the American Red Cross

Each year for a week, in honor of Florence Nightingale’s birthday on May 12, we celebrate those individuals who have dedicated their lives to a profession that is among the most noble, demanding and rewarding: Nursing.

Nurses are important ambassadors of the patient and family experience because they are on the frontlines delivering care and comfort 24 hours a day, seven days a week, 365 days a year.  They are in classrooms, labs and clinics training future generations of nursing professionals and discovering ways to improve care and care delivery. They are in the community working and volunteering at shelters and in schools.  And, across the country, nursing professionals are strong voices for innovation and change when it comes to shaping health care policy and influencing health care reform.

Under the steadfast leadership of Kate Potempa, Dean of the U-M School of Nursing, and Margaret Calarco, Chief Nurse at UMHHC, nursing at Michigan is thriving and our institution continues to be regarded as one of the country’s best academic nursing centers.  The School’s Master’s Program is the sixth best in the nation, according to U.S. News & World Report, its research-focused Ph.D. programs rank in the National Research Council’s top 5 percent and it ranks sixth in NIH research funding. Additionally, it is a hub of groundbreaking innovation, as demonstrated by being the first U.S. nursing school to partner with the Peace Corps’ Masters International Program, achievement of a 5-year grant to fund the prestigious Hillman Scholars Program in Nursing Innovation, and, in partnership with the UMHS nursing community, establishing the Clinical Initiative for Excellence in Education, Practice and Scholarship to improve the quality and safety of nursing care practice and delivery. UMHS nurses have influenced the profession by publishing more than 50 manuscripts and book chapters this past year alone and presenting more than 70 paper and poster presentations to national and international audiences. Additionally, the Health System’s new Nursing governance model is enabling deeper partnerships with patients and families and establishing new models of nursing care.  As clinical mentors to the hundreds of nursing students we serve, our nurses join with nursing students and faculty to educate our next generation of nurses and create the future of health care delivery.

From care at the bedside to outpatient appointments to nursing education and research to professional and peer support and mentorship, there is no more committed community of nurses than the 4,000 plus nursing professionals at Michigan.

While it shouldn’t take a national event to remind us to thank the incredible nursing professionals who enable excellence across our Health System and University, there certainly is no better time for all of us to offer gratitude to the nursing heroes, teachers, mentors and leaders in our community. Thank you for all that you do!!

VIDEOS: Demonstrating our Values; Achieving our Goals

STRATEGIC GOALS IN ACTION: PROMOTING DIVERSITY, CULTURAL COMPETENCY AND SATISFACTION & IPCE
Jane Miller conveys the importance of Interpreter Services in helping people get the right care, in the right way:

PATIENT- & FAMILY-CENTERED CARE
Laura Hurst, mother of twins Alex and Levi, shares how one thoughtful second made a world of difference. Hear her story:


Art & Medicine

Employee Art Exhibition

This year, I was honored to participate in Gifts of Art’s 25th Anniversary Employee Art Exhibition in two meaningful ways. First, I was delighted to co-host the Sept. 11 awards presentation and second, since I am not an artist myself, I submitted one of my late husband’s photographs to the show. To see such exceptional creative work by UMHS faculty and staff was truly inspiring. If you have an opportunity to view this exhibit, which is on display in South Taubman Lobby, Floor 1, through October 8, I encourage you to do so.

I’ve always believed that art and medicine are interconnected, and that the practice of art and the practice of medicine are strikingly similar. Both start with the act of observation – reflecting on an existing idea, theory or problem – and then finding a way to express that existing notion in a novel way and with new vision. In art and in medicine, the process that takes you from what is to what can be is cerebral, creative and full of limitless possibilities. And this is one of the many reasons that a career in medicine and health care is one of the most rewarding, because there is no limit to what can be achieved or to the impact you can have on others. In the words of the early-twentieth century physician Dr. William Osler: The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.”

I was reminded of this quote recently when I read the August issue of the journal Academic Medicine. The issue features a perspective piece titled “Acts of Interpretation: A Philosophical Approach to Using Creative Arts in Medical Education” written by our very own Dr. Arno Kumagai, clinical professor of Internal Medicine and Medical Education. In the article, Dr. Kumagai shares insights from his experience as director of the UMMS Family Centered Experience (FCE) program, a required course that uses creative arts to teach first and second-year medical students. Of particular note, it is unique among medical schools to require a course that uses creative arts as part of its curriculum.

Two Worlds Apart
Artists: Sara Neill and Alex Donaghy, UMMS Class of 2014

As part of the FCE program, students spend time with patients who volunteer to share their experiences with the students to help them better understand that the person in the exam room is much more than his or her disease. Midway through the first year, the students work together in small teams to create a work of art – be it a poem, song, painting, dance, multimedia presentation or something else. The work of art must tell the story of the patient experience based on what the students learned from the patient-volunteers.

This concept of storytelling is a cornerstone of the FCE program. In the article, Dr. Kumagai explains how storytelling can enhance empathy, complement traditional learning strategies, deepen self-awareness and expression in students, and, ultimately, make better doctors who appreciate and understand the importance of patient-centered, relationship-based medical care.

The FCE program is a wonderful example of just how powerful the combination of art and medicine can be for learners, for patients and for the future of health care.  You can view some FCE interpretive projects here.

From paintings that adorn our walls to music that fills our patient rooms to sculptures that decorate our grounds to curricula that inspire our learners, the University of Michigan Health System is demonstrating the art of practicing medicine equally with our heads and with our hearts.

New Translational Oncology Program Represents the U-M Health System’s Tradition of Visionary Cancer Research and Patient Care

Diane Simeone, M.D.

Today, we announced creation of a new UMHS Translational Oncology program to be housed at the North Campus Research Complex and led by Diane Simeone, M.D. This program will strengthen the bridge between our tremendous strength in basic science and our excellent clinical care.

I first heard the impressive vision for a UMHS Translational Oncology program from Cancer Center director Max Wicha within my first few months at Michigan. Since then, he, Diane and others in the Health System have worked diligently to bring this idea to fruition.

The new program will bring together scientists from diverse areas, as well as industry partners, thus promoting multidisciplinary collaboration and innovation. The program fulfills the mission and vision of the NCRC, which are to expand the University’s capabilities as one of the nation’s top translational research institutions and create a world of fast-paced scientific discovery that ignites improvements to humanity’s health and well-being.

At the same time, it is one of many efforts that will ‘move the needle’ on our cancer-related strategic goals and, thus, move us closer to achieving our institutional vision of creating the future of health care through discovery and establishing UMHS as a national leader in health care and biomedical innovation.

As Diane says, the new Translational Oncology program will provide an opportunity to “really make a difference in patients’ lives – which is the real reason we are all here.”

I can think of no one more suited to direct this new program and ensure its success than Diane. She has served as the director of the Gastrointestinal Oncology Program at the Cancer Center since 2005 and is a world-renowned leader in pancreatic cancer surgery. Her lab was the first to identify cancer stem cells in pancreatic tumors, and has translated this finding into clinical trials testing new treatments aimed at the cancer stem cells. Additionally, she is co-PI on the GI SPORE (Specialized Program in Research Excellence) grant and was part of the team responsible for the original work defining the genes important in pancreatic cancer development and progression. Nationally, she has served as president of the American Pancreatic Association.

This is an exciting initiative for our Health System and one that holds tremendous promise in the fight against cancer. Please join me in congratulating Diane and taking great pride in the exemplary science taking place in our Health System.

More about the new Translational Oncology program