- change ups
Michelle Troseth is on a medical mission
She finally settled on “Chief Professional Practice Officer” to capture her work with the CPM Resource Center, based in Grand Rapids and now part of science and health information giant Elsevier, which is headquartered in The Netherlands.
“I really found myself on the road more, talking to health care executives about why this is so important,” Troseth said.
“I was traveling one night and I was like, what really is my role? I knew I wasn’t really a chief nursing officer because I deal with all the disciplines. I just came up with the name chief professional practice officer and it’s just stuck.”
CPM stands for clinical practice model. Founded in the 1980s by Grand Rapids nurse Bonnie Wesorick, CPM was an early proponent of delivering evidence-based patient care information at the bedside. The company’s content and clinical documentation system are embedded in hospital technology systems.
But CPM’s more dramatic efforts go beyond bits and bytes to human beings. At nearly 300 hospitals in the U.S. and Canada, CPM has introduced a clinical practice management plan that is meant to transform hospital cultures around interprofessional teamwork, quality and patient safety.
Many people didn’t understand the approach of Wesorick when she founded CPM, Troseth said. Wesorick is now chairman emeritus and still works on projects that she enjoys.
“Can you imagine in the beginning, when we would go to talk to chief information officers at hospitals and say, ‘We’d like to implement councils throughout your hospital.’ They’d go, ‘What? What the heck are you talking about? We’re not going do that.’”
The councils are one technique that CPM uses to bring together the myriad of health professions — including physicians — to enhance both patient care and the working environment.
The transformation process begins with a half-day overview meeting, Troseth said.
“It’s a very interactive four-hour session. We literally invite clinicians, executives, physicians. We do multiple rounds of them. And we take them through a process of really having them do an assessment: Are these things alive in your organization?
“What we’ve learned is, if these fundamental elements are not present, then you’re not going to have the best place to give and receive care.”
The CPM framework and its six clinical practice models are based on those elements, she said.
Among the questions that are asked: Is the shared purpose clear to everyone? At what level are communication and dialogue skills, particularly between disciplines? What is the scope of practice for each health profession? Are evidence-based tools currently incorporated into patient care?
“We take them through this exercise, and it’s very, very powerful,” Troseth said.
Interdisciplinary approaches are now being incorporated in education, she added.
Wesorick established the Center for Health Care Transformation at Grand Valley State University’s Kirkof School of Nursing. The university has established interprofessional education as its educational philosophy, with core competencies in patient-centered care, evidence-based practice, quality improvement, informatics and interdisciplinary teams.
Troseth said she feels that CPM is finally getting some understanding. She has advocated at the federal level for CPM’s principles and for incorporating evidence-based patient care information into electronic health records that are being paid for by increased Medicare payments under the American Recovery and Reinvestment Act of 2009.
The CPM Resource Center received the 2010 Interdisciplinary Group Award from the Maryland-based National Academies of Practice.
“We’re starting to get noticed: What we’re doing is very unique and we are not doing it at one hospital; we’re doing it around the nation and Canada,” Troseth said.
Troseth moved with her family to Grand Rapids from North Dakota when she was in grade school. The eldest of five children of Tom Troseth, a salesman for McGraw Hill, and his wife, Vi, a manager at the former Rogers Department Store, she graduated from Wyoming Park High School.
“I really had no intention about being a nurse, but my high school counselor pulled me out of class one day and said we’re starting a co-op nurse’s aide program at Grand Rapids Osteopathic Hospital, back then. You’re one of three high school students that have high grades in science and math, and blah, blah, blah.
“I looked right at him and said, ‘I don’t want to be a nurse.’”
After consulting with her parents, Troseth agreed to check out the hospital program.
“I was amazed at what nurses do — seriously,” she said. “That whole year I was just like, wow, they are where the care and the action happens. I had incredible experiences. I decided quite quickly I am absolutely going to go into nursing.”
She graduated from Grand Valley State University in 1983, and developed an interest in interprofessional collaboration after an experience at her first job, working nights in the critical care unit at Grand Rapids Osteopathic Hospital, now Metro Health.
“There was a physician who was an internal medicine resident. He was really smart and I had a lot of respect for him. I used to pick his brain all the time about stuff, about different cases, and we had a fairly good relationship,” she recalled.
At the end of one shift, a long-term pulmonary disease patient was being prepped for surgery when Troseth noticed a change in the patient’s heart rate. She asked the doctor about the significance of it, only to be greeted with a snapping response.
“He looked at me and said, ‘I am not here to spoon feed the nurses; go look it up yourself.’ That’s when I knew I wanted to study the nurse/physician relationships. It just flipped something inside of me.
“There is a lot of importance in collaboration, but the relationships between nurses and physicians are critical. I went back to school and got my master’s and studied nurse physician/ relationships.”
Excited about Wesorick’s use of CPM at Butterworth Hospital, she took a job there. Wesorick started a pilot program with 12 hospitals to test her theories before leaving to found the company.
“I first met Bonnie when I was a senior nursing student. She was an amazing instructor. She really changed my whole vision of what nursing could be. And that year that I graduated, she left to start what is now CPM — Clinical Practice Model.
“I loved using the tools as a staff nurse,” Troseth said. “I was a part of a team that went with her to interview health care IT companies, and they really didn’t know what we were talking about with needing clinical information at the bedside. So it’s always been kind of an idea ahead of its time. But we finally, after years, found one vendor that understood.”
The system was used for at time at Butterworth, but disappeared with its merger with Blodgett Hospital to become Spectrum Health, Troseth said. Today, CPM can be found at Holland Hospital and at Northern Michigan Regional Hospital, she said.
Troseth’s busy travel schedule is supported by her husband, Kevin Moore, a real estate developer, a stepson and two teenage sons, as well as her parents. Introduced by Troseth’s sister, the couple eloped after four months and has been married for nearly 19 years. They are in the process of writing a relationships manual that was prompted by — of all things — cow turds.
“We’re writing a book together on marriage,” she said. “We have a really great marriage. Our book is about a concept that we put into place from the very beginning. We call it foundation management.”
Moore grew up in Arizona near a cattle operation, where workers often chipped cow manure, baked in the hot sun, off a cement foundation.
“We kind of adopted that,” Troseth said. “We really believe that if you keep your foundation clean every day — even for the small stuff —you always have that metaphor in your mind. It has really made a difference. Just this last year, we decided to finally write the book.”
“In the beginning when I started traveling, I was a little bit nervous because the boys were young then,” she said. “But there’s always been a sense that this is really important work; this isn’t just like going to a job and coming home. We’re trying to change something really big.”
The whole family loves to golf and travel, and Troseth and her husband are wine aficionados.
“I do a lot of international travel as a result of my work. Some of it is work related, much of it is because I speak — I’m a speaker, as well.
“I have taken (Kevin) with me to Ireland, to Singapore, we just came back from Capetown, South Africa. We’ve been to Vienna; we’ve been to Germany.”
Troseth and Elsevier are planning an international strategy for CPM, which is likely to take Troseth out of the country more often.
“As we have shown with our success in Canada, it doesn’t matter if you’re a social government-support-funded health care system or private. This really is about a process that needs to change for the betterment of the quality of care for patients,” she said.
“There is some real opportunity here.”