Keys to Building a Successful Interdisciplinary Program

I think this is important because many of the questions that have come through throughout the session were about engagement. Can I have the mouse? Great, thank you, um, were about engagement and getting a program moving in your institution and so the first is about engagement and you saw this slide earlier, but it requires all of us working together to be able to have a successful program. And one of the things that we thought brought us further more quickly was really engaging the primary team or the oncology team. That's why I was kind of giving a little nod here and a little elbow to my oncology colleague next to me. It was very important for us to build street credibility with them that we are not going to delay treatment, and we had developed a street record of not delaying treatment and thus build confidence. We began by being visible and uh Olivia talked about attending team meetings. Going anywhere, doing anything, being on social media, doing a blog, doing a global cast, doing anything to show us within the institution or outside the institution and what we're doing and how important it really is, but really being timely with not only our communication with the primary team, getting the consultation done in a, uh, a timely way. And then following up and closing the loop with patients and families you'll see on the subsequent slide it's a minority of patients and families who choose to intervene, but we believe in our program it is important for every patient and family to have the opportunity to understand what are their risks and what are their options. We began towards working towards fertility consultation becoming expected and not an option. And so when you look down on the slide you don't see that we changed our approach from going to the physician providers to focusing on the care managers who are the nurses and nurse practitioners who manage the care for the patients, making things like standardized epic orders, making it an opt out instead of an opt in on the order set so that everyone gets a fertility consult order. So now actually within our program having started 8 years ago. We find that here we are with like if we miss a consult or someone doesn't put an order the oncology team is like oh my gosh someone didn't order the someone didn't order the fertility consult. I'm so sorry we were supposed to order that we we know we're supposed to so it's actually come full circle for us in our program but these are steps that help us to get there. Using the culture that's already here to work for us, we had talked about attending those meetings, but if I were to say one thing that has made this program move forward in the most significant way is having a stable, consistent fertility navigator that the oncology team knows who it is, how to get to that person and knows that that person will follow up with them in a timely way. As much as some of our um administrators in our hospital want to to not understand that sometimes it's about a person and about an FTE or supporting an individual, it is the critical part of this program and its success, and you will see when I show you our run charts about our success, you can tell when our fertility navigator has maternity leave or is out for a certain amount of time that piece is so critical and that's where I think there are so many questions about funding, etc. Engaging your institution is important. We have used our institutional intranet as much as possible to highlight everything that our team does, right? Um, any program achievements, any developments in the field, we mentioned about those reported pregnancies in patients who had had ovarian tissue cryopreservation. Guess what? We went to our marketing folks, we put that up on our hospital Internet. We had a local story in the news here that was actually broadcast nationally as well. And we have used every opportunity that presents itself. You see that beautiful picture of our team that's our, uh, 2017 faculty clinical team award that our team was recognized and we took our entire team out to celebrate that recognition, which is important to understand our leadership in our institution have recognized that there is a return on the mission and it is not a return on the investment in this particular program. You can see what some of those initial barriers are that I think you all have been texting us and communicating with us throughout the session today that these are your similar barriers that you have experienced and I thought ways that we overcome some of those barriers, uh, developing a sound business plan where we could find ways to leverage resources, um, i.e. initially we leveraged our own gynecology divisional resources to fund our fertility navigator. And then in my sessions with our financial leadership I demonstrated the growth within our division and our inability to leverage nursing support in the clinics for that growth in our GYN program, but yet I could then take those funds to support her and get additional nursing support. We then found the patient satisfaction and improvement in care. I'm not sure that many of you know that on the new US News and World Report that I think came out yesterday with rankings. That at several areas in those assessments there are questions about your fertility preservation services provided in your facility. What do you offer? What percent of patients are receiving it? And we all know that all of our institutions are very, very tied to what their ranking is. So there are ways to leverage institutional support for these kinds of endeavors. We have also partnered with our patients and family support groups, which is critical to satisfying what are important needs for patients and families. And then additionally garnishing philanthropic funds to support those patient care costs. I know that there are some questions that have been sent to us about these things aren't always covered by insurance and yes we have leveraged a discounted bundled research cost for these investigational procedures TTC and OTC so we can say to the family this will be the exact cost. It will be and it is discounted on a research basis. In addition, we have philanthropic funds to support those families so it's not a choice about do I wanna preserve fertility for my child or do I wanna pay the rent this month. So these are things that we can leverage those uh institutionally philanthropically, and then those patient and family support groups also have some resources for families. So we established this sound business plan and that was what moved us forward in many ways. I wanted to show, uh, just a couple slides before we leave because there were questions about some of our criteria. We are in this institution are very married to assessing the quality of the work we do, so quality improvement science is integrated throughout all that we do. And this will tell you how we assess eligibility. You can find it in the breach slide set on engagement, resources and quality improvement, and at the bottom of the slide you will see what we consider in our institution to be eligibility criteria for a fertility consultation. So for example, in April of 2017 we had 46 patients that were seen in the institution. Of them you can see that 25 were ineligible and 21 were eligible, so we run somewhere around 50 to 60% of patients would be eligible by our definition. We keep track of it, so one of the things that will show when you look at the slides is that you will be able to see when our FN, our fertility navigator, increased her time. You can see that our performance wasn't as good. She began attending the weekly meetings. She delivered an email education about having an email now. Then we began getting a list from the BMT team so you can see all of our interventions. 4 patients missed during the fertility navigator transition. So this might be data that you can even use in your institution to justify the support of a fertility navigator helping to improve the effectiveness of consultation. Now you can see that when we fall off we wanna understand why we have a proton therapy um opportunity in our institution that is a newer innovation and a new opportunity and that has a new process that we have to identify how our fertility team is gonna work within that new process. So always using each miss as an opportunity to improve the care for patients. Last slide before we close is I think that we don't expect that every patient and family are going to choose to proceed with an option. So this is showing you that our median is about 15%, I mean 16.9% for the percent of eligible patients who elect to proceed with some sort of option. So you can see that the majority of patients are satisfied hearing about it and making a decision. I'm not ready to move ahead with that right now, but I'm satisfied that I was aware of the options and we made a decision at that point. So we hope that this session today has helped your team be prepared to provide those consultations for patients and families and to think about how you might set up your program at home, knowing the evidence that's available currently and what options you have. We as a team want to very much thank the Global cast team for helping to support us today to have a session that is a dream for us to share what we do and to hope to support all of you in developing your programs as well. I wanted to thank the members of our team for giving up their afternoon today to share this information. And hope that we can continue our conversation electronically either through the global cast support or even through I think I sent out on the question sheet the fertility consult at CCHMC.org is a way that you could continue the conversation with our team.