Lisa Graham, MSN, RN-BC, director of the Patient Care Resource Management (PCRM) and Social Work department at the James Cancer Hospital and Solove Research Institute, is always on the lookout for what's next.
What's next could be the implementation of a new program, conducting research on effective case management techniques, helping her staff continue their education, or any number of measures that make patient care at The James run more smoothly. Lisa is constantly looking at current trends in health care to find out what works well and how it can be implemented at Ohio State.
"Lisa works with all staff and organizational leaders to identify where change is needed, create a vision for that change and execute the change in tandem with committed members of the group," says Nurse Manager Kerri Walker.
It's this innovation that makes Lisa such an effective leader and a valuable resource to everyone at The James. We asked Lisa about herself, her work and how others can look for areas of innovation in their own lives.
Tell us a little bit about you.
I have a bachelor's degree in nursing and initially became an RN. I worked in critical care areas for a while and then decided after 3 or 4 years that I wanted to do something different. I got into case management with my first job in a managed care company. I worked for a couple different companies after that, but there was always this conflict surrounding how to advocate for the patients. It was sometimes difficult to advocate for patients when there were business restrictions that were inherent in my role. I left the managed care environment because of that conflict and the lack of real-time patient interaction at the point-of-care. I came to The James for that patient contact and to be unrestricted in the ability to fully advocate for my patients.
What does your job entail?
I direct the programs for three groups: patient care resource managers (PCRMs), social workers and clinical documentation improvement specialists (CDIs).
The PCRMs have inpatient and outpatient roles. The role on the inpatient side is trifold: doing care coordination for patients using the nursing case management process, establishing and implementing a plan of care for discharge and managing length of stay/appropriate resource utilization.
The outpatient PCRM is similar as far as implementation of a plan of care but they're really case managing the high-risk, complex patients. They manage these patients in the same way: they set goals and a plan of care with their patients and use the case management process to carry it out.
The social workers provide psychosocial care and linkage with community resources for our patients. They do a lot of crisis intervention, mental health counselling and resource referral.
The CDIs are here to help the providers improve the clinical documentation in the medical record so that our records are complete, accurate and reflect the complexity of our patients.
What are some of the initiatives you have worked to implement?
One initiative is the establishment of the outpatient PCRM role. When you look at the literature and where health care is heading, oncology care is moving to a focus on value-based care initiatives and improving care management for these patients. When a patient comes here for oncology treatment, we really become their primary provider during their cancer journey. We created the outpatient PCRM role over three years ago to respond to this changing health care environment. Currently, we have 35 outpatient PCRMs covering our high-risk, complex patients. We are excited about the good results we've seen from the implementation of this program: we've been able to show that implementations of this role in the oncology setting can decrease readmissions in our cancer population as well as decrease our surgical length of stay and our Emergency Department utilization. It has also increased patient adherence to treatments and utilization of palliative care.
Another is The James cancer readmission risk model. We really wanted to find a way to identify which of our patients was most at risk to be readmitted to the hospital so we could intervene early and prevent another hospital admission. This model was nonexistent in the oncology world. Working with a great team of other leaders at The James, we developed and tested this model and it is now being implemented in a couple of pilot service lines at The James to identify at-risk patients and provide early interventions to improve outcomes.
What is the benefit of looking ahead and making changes?
I'm constantly looking for areas of improvement. I'm constantly in the literature, constantly asking the questions, "How can we do this better?" and, "How can we be more efficient?" It always comes down to being curious, asking questions and looking at what's happening locally and nationally in the field. That then informs how we make decisions and helps improve the care and services we provide to our patients.
What piece of advice have you found most helpful in your work?
One of my mentors in my managed care experience advised me that relationships determine results. The nature of your relationships will determine what your results will be. I've always found that to be extremely valuable and absolutely true.
The medical center's values are inclusiveness, determination, empathy, sincerity, ownership and innovation. Does one of these values ring true to you or your department? If so, which one and how is it demonstrated?
I'd say innovation. Our job is like solving a puzzle every day and our staff are so creative in the solutions they utilize to help our patients and families be successful in their care. From a leadership perspective, our leadership team is always looking for new and better ways to improve patient care and to make our area a workplace of choice.
How can others strive for improvement and find areas for change in their own work?
Always be curious. Never stop asking what can be better. We are constantly asking those questions and looking for the answers.
Anything else you'd like to share about your job, coworkers or working at Ohio State?
I have the best department in the health system and at Ohio State. I couldn't ask for better staff or better managers, and that really makes a difference. My leadership at The James is also extremely supportive and forward-thinking. I think my position here at The James is the best position I've ever had because I get to do everything that I love, and it's great to see the difference we make in our patients' lives.
Thank you, Lisa, for Improving People's Lives!