It is hard to believe but I have been at MD Anderson Cancer Center as the Director of Rehabilitation Services for two and one-half years. When I interviewed for the position I had to give a presentation to the staff about my vision for the future and when I did I made several promises.

  1. Review the Department Mission Statement (Check! Done!)
  2. Assess the culture and work on fostering a culture to support a positive work place (Check! Ongoing!)
  3. Develop the Department’s first vision statement. (Check! Done!).
  4. Focus on best practice and foster a culture of clinical reasoning and open sharing and ongoing communication about how to improve our daily practice (Ch….., ooops! Oh Yeah!).

I have become increasingly frustrated about the fact that while the amazing staff in my department already do work of VERY high quality, the leadership (myself and my leadership team) have not been doing much to foster attention on clinical reasoning and “best practice.” We are already a pretty top notch place, but if as leaders we are not talking about practice on a consistent basis, we have to expect inconsistent results. We have been so focused on logistics and building and adding staffing and policies and procedures and operations………and made great headway but still………

A few weeks ago we started talking about doing something different and we quickly decided the best way forward was to just jump in the deep end. On Monday we announced at our “All Staff Meeting” that fiscal year 2014 was going to be (the first, but not the last) YEAR OF PRACTICE!

We started by doing 2 assessments.

We asked staff about their perception of the quality of support our department provided to foster best practice in oncology rehabilitation. The result was a 3rd rated it as good or very good, a 3rd rated it as average and (yikes!) a 3rd rated it as poor or very poor! We also had staff do a self-assessment on the extent to which they perceived themselves as reflective practitioners. We placed these self-assessments in sealed envelopes as a “time capsule” and next August we will conduct both assessments again. Jumping in the deep end means you sink or swim!

Our first step is an all staff inservice on clinical reasoning at our monthly performance improvement meeting. We also have identified a list of strategies to jump start our focus on practice. These include:

  • Scorecard Metrics with real quality and practice foci
  • Small group case-based discussions scheduled routinely and on an “as needed” basis
  • Department sponsored CE paid for by the Department on site
  • Standard of care development/evaluation
  • EBP resource organization
  • Changing our approach to inservice education and student presentations

This is not going to be easy and it is not going to be quick, but our vision is to be the globally recognized leader in oncology rehabilitation and if conversation and debate about daily practice is not front and center we will sink….so time to get swimming.

This is not going to be easy, but it is going to be a lot of fun!