How do you get board members, journalists and policymakers to understand physician woes? Put them in scrubs

At Mission Health in Asheville, N.C., the old adage "walk a mile in someone else's shoes" has a very literal meaning. Except in this case, the health system's board members walk the hospital corridors dressed in scrubs.

The U.S. healthcare system is riddled with complex, often controversial issues, such as incomplete and unequal access to care, fragmented care delivery, perverse financial incentives and more. These issues are top of mind for board members, who are largely responsible mapping out a healthcare organization's direction for the future. However, a significant disconnect between hospital boards and the real life happenings within the hospital poses a key barrier to effective governance and policymaking, according to Richard Bock, MD, a vascular surgeon at Mission Health, and Ronald Paulus, MD, the health system's president and CEO.

In a recent article published in The New England Journal of Medicine, Drs. Bock and Paulus describe how, as part of an effort to bridge the divide between hospital workers and board members, Mission Health created an immersion program.

In 2013, the health system created "Immersion Day," when board members — dressed in scrubs — spent nine to 12 hours immersed in the nuances of care delivery. Participants of the program arrive at the hospital at 7:30 a.m., undergo orientation and finalize confidentiality agreements. Then they receive an education like never before.

The board members visit preoperative care, listen to patient stories, watch a surgery performed and talk with anesthesiologists, nurses and surgeons. They see the "surgical supply cost" come alive. Then the participants join multidisciplinary rounds in the intensive care units, observing critically ill patients and talking to nurses and case managers about their challenges and fears.

They make rounds with nephrologists, pulmonologists, trauma surgeons, and hospitalists. They witness first hand clinicians' struggles with EHRs, vividly illustrating the link between the data entry process and revenue that is often a topic of conversation in the board room. When they walk through the overcrowded emergency department at the end of the day, the scrubs-clad board members see patients on stretchers in hallways and observe the controlled chaos.

Drs. Bock and Paulus said board members have called their experiences during Immersion Day "eye-opening and endlessly fascinating," "unforgettable and humbling" and even "the best spent day of my life." One member told them, "I learned more about hospitals and healthcare form my 10 immersion hours than six years sitting on our board." The staff benefits from Immersion Day too; the encounters build mutual trust and admiration, and clinicians are grateful that board members are taking the time to learn about what they do.

Since the creation of Immersion Day for Mission Health board members, the health system has created other immersion programs. One was a multiweek immersion program for a local journalist, and another is geared toward state and federal policymakers.

"Deep immersion in the work of our health system has strengthened governance and engendered trust in our community, staff, and physicians, while elucidating healthcare for policymakers," Drs. Bock and Paulus wrote. "After three years of Immersion Days, we cannot imagine being governed by a board that hasn’t seen so intimately how a health system works."

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