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Outside-the-box thinking yields creative solutions
Manager shares insights on working in education
As the manager of the Center for Education and Development at University of Missouri Health Care in Columbia, Ceresa Ward, MS, RN, oversees the operational, financial, and personnel activities at the center, which has 20 employees. She is responsible for strategic planning, staff development, and patient and family education as well as leadership, service quality, and compliance training.
She took this position in March 2001 when the medical center underwent a redesign due to financial difficulties. At that time patient education, community education, and staff development merged into one department.
"It has been an effective model, and we work well as a team but it was difficult merging departments at first," says Ward, who previously was the coordinator of patient and community education and manager of health improvement services. She has worked in some form of patient and staff education since March of 1986. In her current position, she reports to the chief human resources officer.
Ward has a background in nursing and worked as a supervisor in the general medicine/cardiac area for five years and as an advanced practice nurse in cardiothoracic surgery and in thoracic intensive care. She received a bachelor of science in nursing in 1981 from Truman State University in Kirksville, MO, and a master of science degree in nursing education and clinical specialty in 1986 from the University of Missouri.
University of Missouri Health Care has more than 4,000 employees and 319 attending physicians. It is comprised of many entities, including University Hospital, Children’s Hospital, Ellis Fischel Cancer Center, Mount Vernon Rehabilitation Center, Columbia Regional Hospital, and associated clinics. University Hospital is the only Level I trauma center and helicopter service in central Missouri.
"We are also affiliated with other hospitals, rural clinics, and providers through mid-Missouri," says Ward.
Sharing lessons learned
In a recent interview with Patient Education Management, Ward provided information about the lessons she has learned working in the field of patient education. Following is the information that she shared:
Question: What is your best success story?
Answer: "It’s hard to pinpoint one area for success. To make improvements along the way that impact patient care, the community or the training that staff receive are always rewarding," says Ward. Most recently she facilitated the integration of all patient and staff education into one department during redesign, but there are many other successes.
She helped to open a very successful community resource center at a local mall that operated for 13 years until the hospital began experiencing severe financial difficulties.
Ward helped immunize about 10,000 people annually with flu shots. Flu immunization sites were implemented around the community to reach a large segment of the population. Sites included the health information center at the mall, businesses, and community access points such as grocery stores.
Staff would set up a drive-through site in the stadium parking lot on the college campus where people could be screened and immunized without ever having to leave their car. About 2,500 people would be immunized in one morning.
The flu immunization program began as a free service to the community but eventually was altered so that only the elderly and high-risk population received free shots. Others paid a minimal fee.
In addition, she worked with an advance practice nurse to establish the Day of Surgery Admission Center several years ago when such establishments were rare. Part of its purpose was to provide better pre-op education.
The development of the preprinted interdisciplinary patient teaching records was another success for Ward. It is unique in that the generic form, that outlines basic education needs such as the assessment of barriers to learning, is paired with diagnosis specific teaching records.
For example, if a patient had open-heart surgery, the form would be used to document education. It lists specific teaching materials as well as expected outcomes. The nurse would still assess the patients learning needs to provide individualized education but overall the form helps to provide better instruction and consistency, says Ward.
Currently all 22 patient teaching records are being put on the electronic medical record. "It is a lot of work, but I think it will make documentation more effective and more accessible," says Ward.
Ward also spearheaded the creation of an on-line centralized inventory of patient education materials that can be ordered on-line and delivered within 24-48 hours.
Question: What is your area of strength?
Answer: The fact that Ward is detail-oriented yet creative is perhaps her greatest strength, she says. "I have always been organized and detail-oriented, but sometimes that can leave you a little flat. You work too much within the rules and don’t see the bigger picture. I have learned to think outside the box and be creative," she explains.
A good example is the material development process. Rather than sending drafts back and forth and having them sit on people’s desk a new group development process has been initiated. The experts come to the table with the writer to produce the product. "The product is produced a lot faster with the content experts there to give feedback," says Ward.
Question: What lesson did you learn the hard way?
Answer: Ward has learned that that it can be difficult to make major organizational changes in a nonrevenue-generating department. For example, she feels that patient care would improve if an on-demand closed-circuit television system were installed at the hospital. A number of times she has submitted proposals, but funding has not yet been allocated.
Also, she has learned that while the education department can supply the best education tools unless there is administrative support for the documentation of patient education, it isn’t a priority with staff. "We can get staff input on the tool development and they can be 100% behind it, but if their administrators don’t make it an expectation except when it is being audited, it tends to drop," says Ward.
Accessing physicians for training is a major challenge as well. Because Ward does not oversee their training, it is difficult to get the message to them when there is a new standard or a patient concern. "There is not a good communication link," she says.
Question: What is your weakest link?
Answer: The lack of financial resources and thus the inability to replace key positions needed to make leadership training possible is the weakest link, she says. Although the institution is set to launch a big leadership initiative and the plan is in place, there needs to be a part-time person dedicated to putting the program together and there is no money to hire that person. "Without the personnel with the expertise and time to concentrate on that, it is very hard to get those kinds of programs developed and initiated," says Ward.
Question: What is your vision for patient education for the future?
Answer: University of Missouri Health Care is implementing an electronic medical record; therefore, on-line versions of the patient teaching records are being created, and a lot of in-house-developed materials will be available on the Internet, she explains.
"My dream for patient education would be that all resources for patient teaching are readily available and follow a consistent standard for all staff to access. I would like to see interdisciplinary planning occur as well as interdisciplinary delivery and documentation," says Ward.
Patients and families need to be active participants in their education and have their needs and fears addressed, says Ward. There also needs to be resources readily available either through outpatient or community access for ongoing follow up of diagnosed conditions as well as wellness and prevention activities.
"I guess this is more a dream than a realistic vision," says Ward.
Question: What have you done differently since your last JCAHO visit?
Answer: There have been new patient safety standards and the Health Insurance Portability and Accountability Act requirements have been implemented concerning patient confidentiality. Therefore, there has been staff and patient training on these two topics, says Ward.
The education department also is much more cognizant of cultural and limited-English proficiency issues. It is becoming more and more common even in rural Missouri to find people of different cultures, says Ward. Therefore, the health care system has acquired a telephone language service and is trying to improve on-site interpreter services. Many of the patient education materials have been translated into Spanish.
Question: When trying to create and implement a new form, patient education materials, or program, where do you go to get information/ideas from which to work?
Answer: Ward works with a patient education committee and nursing patient education unit-based representatives as well as content experts such as physicians, advanced practice nurses, and other clinical experts such as dietitians, respiratory therapists, nurses, and pharmacists. Also, she subscribes to the PatEdNet listserv to get information and looks to pre-developed sources for materials such as commercial vendors and professional organizations. Staff at University of Missouri Health Care uses Micromedex CareNotes as a primary resource for patient drug information and as a supplemental resource for patient education materials.
"I don’t like to reinvent the wheel unless our need is incredibly specific to our organization," says Ward.
To obtain additional information about programs or concepts mentioned in this profile on Ceresa Ward, MS, RN, Manager, Center for Education & Development, University of Missouri Health Care, contact her at: One Hospital Drive, DC030.00, Columbia, MO 65212. Telephone: (573) 882-7126. E-mail: firstname.lastname@example.org.