PEM advises 'focus daily on greatest impact'

Never enough hours in day to accomplish all tasks

Annette Mercurio, MPH, CHES, manager of patient, family, and community education at City of Hope National Medical Center in Duarte, CA, has been in her position for 13 years. However, her job duties have changed quite a bit since she started.

"When I first started, it was primarily a community focus and now it is primarily a patient education focus," says Mercurio.

Currently, her job description is to plan, develop, direct, and evaluate patient and community education programs. She also is responsible for managing the institution's community benefit programs. California requires nonprofit, private hospitals to report the benefits they provide to their community and conduct needs assessments.

City of Hope is one of 40 comprehensive cancer centers in the United States designated by the National Cancer Institute. It has 160 inpatient beds and more than 100,000 outpatient visits a year.

To meet the educational needs of this number of patients, Mercurio is assisted by a staff of five people. She supervises the patient and family education coordinator, coordinator of the patient and family learning center, coordinator of the patient and family resource desk, oncology resource nurse for the telephone information service, and senior secretary. In addition to staff members, Mercurio often oversees interns from either undergraduate or graduate programs in health sciences. She reports to the vice president for patient care services and chief nurse executive.

Mercurio has a master's of public health and has been in hospital-based health education for about 24 years. Before her move to Southern California, she directed patient and community education at the University of Virginia Health Sciences Center in Charlottesville.

In a recent interview, Mercurio, who also sits on the editorial board of Patient Education Management, discussed her job, her philosophy on patient education, the challenges she has met, and the skills she has developed that help her do her job well.

Q: What is your best success story?

A: "When we had to bounce back from downsizing and a lot of community functions were trimmed. I think the greatest part of that success was finding really outstanding people to help develop services we deliver to patients and families directly such as the patient and family resource desk and learning center.

"Initially, when I came here we had a stronger community focus. We had a mobile screening program with a nurse, nurse educator, nurse practitioner, and clinic assistant that traveled to underserved communities, and that program was cut. Also, we had a telephone information service with three nurses and that program was cut except for one nurse. The institution felt we needed to focus more internally, and it has made for stronger patient and family education services."

Q: What is your area of strength?

A: "To collaborate across disciplines and departments and with other organizations in the community to stretch resources. For example, the education department works with the social work, clinical nutrition services, and other departments to offer the 'I Can Cope' workshop to patients and families. Either social work or education takes the lead in organizing the sessions depending on which department has an intern.

"I am working on a performance improvement team right now called Patient and Family Partnership and Safety. We have representatives from many disciplines working on that team. So much of coordinating patient and family education across the institution is about being able to build and facilitate interdisciplinary teams."

Day-by-day accomplishments

Q: What lesson did you learn the hard way?

A: "Each day you must focus on achieving the greatest impact you can. Certainly we all experience change. We might lose funding or staffing, but knowing you have personal integrity and that you worked your hardest to make a difference endures no matter. It's important to look at what you have accomplished and what you can impact."

Q: What is your weakest link or greatest challenge?

A: "Balancing work and personal time. I definitely blur the boundaries by staying late and taking work home with me. It is really a challenge to make sure I am creating some space for other needs in my life, too, such as exercise. I wouldn't have been in this field for as many years as I have if I wasn't passionate about it, wanting to do better and better. You can't accomplish everything you want to in a 24-hour day so it is hard to stop finally and say 'I need to have a little time for me' so that is what I work on."

Q: What is your vision for patient education for the future?

A: "When I first started in patient and family education, there was a lot of defining the learning needs of individual patients and the educational needs of groups of patients from the standpoint of health care professionals. I think we have gotten more and more to the point where we really do want to have patient and families involved in shaping the programs.

"The Patient and Family Partnership and Safety team has patients helping us look at what we can do across our patient populations to involve patients and families more in advancing safety. That is just one example. In the future we are going to see more and more of the partnerships between hospitals, patients and families, and health care providers in shaping services."

Q: What have you done differently since your last JCAHO visit?

A: "Our last Joint Commission survey was in September 2005. The greatest difference has been to involve the frontline staff in looking at the whole auditing process of medical records within patient care services. We are really trying to do more to involve frontline staff in those reviews and implement more of a peer review process, instead of a department outside the immediate area being the one to audit the records and give feedback. In this way, the bedside nurses have more of a chance to see what the strengths and deficits might be in patient and family education documentation."

Q: When trying to create and implement a new form, patient education materials, or program where do you go to get information and ideas from which to work?

A: "If it is a form I tend to go to frontline staff within City of Hope or other colleagues outside the system depending on the subject matter. For example, if I felt the patient education documentation form was not working, I might go to a listserv I belong to or informally talk with some of the nursing staff and other professionals.

"For programs and materials usually we have patients and families working with us. Also we go to staff meetings to identify nurses that will work with us in developing a program. The experts are the frontline care providers and patients and families."

Sources

For more information about patient education management at City of Hope National Medical Center, contact:

  • Annette Mercurio, MPH, CHES, manager, patient, family and community education, City of Hope National Medical Center, 1500 East Duarte Rd, Duarte, CA 91010-0269. Phone: (626) 301-8926. E-mail: amercurio@coh.org.