Women’s centers target a market, meet a need

Can improve emotional well-being and cure rates

Anyone who knows someone who has developed breast cancer knows how important it is to the mental well-being of the patient to get a diagnosis and start treatment quickly. But for many women in that dire situation, there is a delay of weeks or even months between the first inkling of a problem and any subsequent surgery. At the Milford-Whitinsville Regional Hospital Women’s Pavilion in Milford, MA, that’s no longer the case.

By creating a women’s center that puts oncology, radiology, and reconstructive surgery under one room, the hospital has been able to cut the time between a positive mammogram and a biopsy to as little as one day. This not only improves the emotional well being of patients, but may also improve cure rates, says medical director Barbara Ciak, MD.

"There may not be a huge clinical difference in most cases. We don’t know the cell doubling rate in all cases. But we do know that premenopausal women have more aggressive cancers; we can see people waiting months between biopsy and surgery, which can have an adverse effect on outcomes," she says.

As an added bonus, patient satisfaction increases. In a recent state study of patient satisfaction, the Women’s Pavilion ranked third of all Massachusetts hospitals. Ciak has played steward to a program that promotes cooperation between specialists who, in the past, have not worked well together.

Ciak says she believes the success of the Pavilion stems from people "buying into doing things faster. Doctors realize they will stay popular and busy if they cater to patient demands. This is a demand of these particular patients."

The Women’s Pavilion is a multimillion-dollar project that Ciak shepherded from inception to its current form. It started with a committee of oncologists, radiologists, and surgeons — groups that she has seen work poorly together in the past.

"I tried this before, and radiology and surgeons’ meetings became turf battles. But this time, we set clear boundaries from the start. If they don’t want to play, they don’t have to stay."

Patient satisfaction exit interviews help ensure that the Pavilion — which offers breast care, as well as obstetrical, gynecological, fertility, and headache care — continues to offer what patients want. What those interviews have found is that patients have more interest in getting a call from physicians when lab reports are back than in a pleasant ambiance. Quick lab results and on-time physicians are more important than having fax machines and modem hookups in the waiting room.

But Ciak admits that letting patients call all the shots can be costly and unproductive.

"Women’s centers can have things included that aren’t medically necessary, but attract patients. It’s up to physicians to help cut to the chase on what is state-of-the art and necessary."

For example, she says, there is a lot of new machinery available that can offer more than one technique. "We may choose one over the other, but if a patient says they want something because a friend had it, we have to put a stop to it. Don’t do ultrasounds if they aren’t necessary. Stick to the standard of care."

The center has four surgeons, two medical oncologists, two radiation therapists, perinatology, plastic surgery, and two neurologists for the headache clinics. All the choices of what to offer — and that will continue to change over time — come from meetings between the initial committee members, says Ciak, as well as from looking at other women’s centers.

The Faulkner Breast Center in Boston was one model Ciak used.

"They had a lot of plastics and other services in one place so that patients didn’t have to run from one place to another," she explains. "They also wanted to include gynecological subspecialties, so I latched onto that. You have to sit back and look at what women deal with and what disorders are frequent in perimenopausal and menopausal women."

One new addition is a clinician in teen female medicine with a specialty in eating disorders. "We have players picked out, but getting money is slower than I had hoped," she notes.

Women’s centers vary greatly from place to place, says Ciak. Northside Hospital in Atlanta is building a 150,000-square-foot center that will feature everything from breast care to fertility assistance. There will be special care nurseries, a shop for women’s health care products, health education facilities, and places for support group meetings.

At Natividad Medical Center in Salinas, CA, the emphasis is on providing high-tech maternity and gynecological care.

The hospital has an exclusive agreement with the purveyor of a minimally invasive system for treating abnormal uterine bleeding. This allows for faster recovery and helps some patients avoid hysterectomies. In addition, Natividad’s center offers many social services to its patient population — largely Hispanic, often poor. Along with educational facilities, there is access to social services programs such as WIC and drop-in child care for patients. The hospital even offers an English as a Second Language class in its family center.

This is a trend that will continue, says Ciak.

"Women in the family generate most medical decisions," she says. "Every facility should look at its demographics and see if it is tapping the right percentage of OB/GYN care. If you aren’t, think of doing something like this. You don’t have to hire new people or spend millions of dollars on a new women’s center. Just get the physicians you have to buy into it. Get people to agree to work together and think of the patient first."

Sources

Cherie Stock, director of marketing and public relations, Shirley Algire, RN, assistant director of nursing, and Virginia Matthews, RN, MBA, assistant hospital administrator, nursing services, Natividad Medical Center, Salinas, CA. Telephone: (831) 755-4189.

Eileen Hayes, CHE, director of planning, Northside Hospital, Atlanta. Telephone: (404) 851-8086.

Barbara Ciak, MD, medical director, Milford-Whitinsville Regional Hospital Women’s Pavilion, Milford, MA. Telephone: (508) 473-1190.