Portal de Periódicos da CAPES

Culture, practice, science and leadership: Natural partners

2016; Elsevier BV; Volume: 64; Issue: 5 Linguagem: Inglês

10.1016/j.outlook.2016.07.012

1528-3968

Bobbie Berkowitz,

Organizational Strategy and Culture

The Academy is committed to the critical role that social determinants of health play in creating healthier people and healthier communities. We positioned the social determinants of health as one of three strategic goals in our 2014 to 2017 strategic plan. The Academy Board is currently engaged in refreshing our strategic plan for 2017 to 2020. A commitment to the health of populations and to health equity is threaded throughout our focus on policy, practice, and leadership and it is evident in the Academy's signature initiatives, policy briefs, position statements, and engagement with partners. As we join with partners such as the Robert Wood Johnson Foundation and their action framework around building a “Culture of Health” (http://www.cultureofhealth.org/), the American Nurses Association's launch of “Healthy Nurse, Healthy Nation: Grand Challenge” (http://www.nursingworld.org/), and the Macy Foundation's commitment to the role of registered nurses in transforming primary care (http://macyfoundation.org/), I am reminded why this work to strengthen the basic building blocks of society, culture, and health is such an important goal for the Academy. We have a remarkable culture of our own; one that is committed to nursing knowledge, science, organizational excellence, and leadership that advances health policy in support of a healthier global community. We have many examples of how we have been successful in executing on that commitment. I would like to invite you to explore a few powerful exemplars of our commitment to creating a culture of health through partnerships, practice excellence, science, and leadership. The Robert Wood Johnson Foundation's commitment to creating a culture of health highlights how focusing on a population's social determinants of health and empowering individuals to lead healthier lives can bring about profound change in health and health equity. The idea that health systems have a role in improving the total health of populations is gaining traction from many sectors that pay for, measure, and provide health care. For example, The Centers for Medicare and Medicaid Services, 2016The Centers for Medicare and Medicaid ServicesCMS quality strategy.2016https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/qualityinitiativesgeninfo/downloads/cms-quality-strategy.pdfGoogle Scholar contains a specific goal that addresses the social determinants of health defined as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life” (CMS Quality Strategy, pg. 26). The National Quality Forum has convened several workgroups to develop a national priority on population health including an action guide (National Quality Forum, 2014National Quality ForumMulti-stakeholder input on a national priority: improving population health by working with communities – action guide 1.0.2014file:///C:/Users/bb2509/Downloads/pop-health_action-guide-1_08012014%20(1).pdfGoogle Scholar and National Quality Forum, 2015National Quality ForumMulti-stakeholder input on a national priority: Improving population health by working with communities – action guide 2.0.2015file:///C:/Users/bb2509/Downloads/action_guide_final_report%20(2).pdfGoogle Scholar) that stressed the need for a multisector approach to improving the health of all populations and a focus on social determinants of health. While population health has long been a role for public health, the expectation that all health care organizations bear some responsibility for assuring that the social determinants are integrated as a part of the individual's set of risk or protective factors is relatively new. The Robert Wood Johnson Foundation recognized that in order to achieve a population perspective within all health sectors, guidance was needed for the health professions and health systems. Although nursing has been a critical force in examining social determinants as a factor in population health, particularly in public health, there has not been a systematic evaluation of how nurses contribute to building a culture of health. The Academy has become an important partner in identifying nurse-led models with a strong evidence base, cost-effective strategies, and measures of positive health outcomes. These models are the heart of the Academy's Edge Runner program. Here are two examples of nurse-led, evidence-based models that are driving the transformation of health care. Marilyn Rantz, PhD, RN, FAAN, leads the Aging in Place Project: Assuring Quality At-Home Services for Seniors. Within the University of Missouri–Columbia School of Nursing, a licensed home care agency, Sinclair Home Care, provides community-based care to residents of the “TigerPlace” nursing home. This program supports the aging in place model that maximizes the mental, physical, and psychosocial strengths of elders within a full service apartment complex that combines housing and health care focused on promoting the integration of mind and body. They have been able to reduce hospitalizations, sustained outcomes of maintaining mobility and independence, early illness recognition, involvement in life and community activities, and successful hospice care for those at end of life. The costs of the program have never exceeded the costs of nursing home care (American Academy of Nursing, 2012American Academy of Nursing. (2012). The aging in place project. Retrieved from http://www.aannet.org/edge-runners--aging-in-place-projectGoogle Scholar). Diane Spatz, PhD, RN-BC, FAAN, is the innovator behind the “10 Steps to Promote and Protect Human Milk and Breastfeeding in Vulnerable Infants” program (American Academy of Nursing, 2015American Academy of Nursing. (2015). 10 steps to promote and protect human milk and breastfeeding in vulnerable infants. Retrieved from http://www.aannet.org/edge-runners--10-steps-to-promote-and-protect-human-milkGoogle Scholar). Dr Spatz implemented this program within the Children's Hospital of Philadelphia (CHOP) to increase the percent of infants discharged from the Newborn Intensive Care Unit receiving human milk from 30% to over 86%. The program also extended the time that mothers provided human milk to their infants after discharge and launched a training program for staff nurses to provide evidence-based lactation support and care for mothers and infants. Over 600 staff nurses with CHOP are now available to deliver this intervention. These examples along with the many other extraordinary stories of our Edge Runners demonstrate the profound impact that nurses can have on transforming health systems and ultimately led to the Academy's interest in understanding more about how nurse models also contribute to a culture of health. The Robert Wood Johnson Foundation provided a grant to the Academy and its subcontractor Rand to study the extent to which the Academy Edge Runners have addressed the Robert Wood Johnson Foundation's Culture of Health action areas: shared value, cross-sector collaboration, healthier communities, and integrated systems. The Academy believes that the results of this study will provide insight into the contribution of nurse-led models of care that are building a culture of health within communities and stimulating action from all health sectors, educators, researchers, and policy leaders. Author Description Bobbie Berkowitz is the President of the American Academy of Nursing.