By Marissa Lee
As the Neonatal Intensive Care Unit (NICU) Discharge Coordinator at Loma Linda University Health’s (LLUH) Medical Center, Jeannette Loriezo, RN, plays an important role in making sure parents are fully equipped to take their babies home after a sometimes extensive stay in the hospital. Many of these children have special needs and require expert care. For some parents, they may need to make 14 calls to schedule follow up appointments with specialists and obtain complicated equipment in order to ensure their baby is cared for at home. However, Loriezo explains, “In my role … I can give them a list of the things they have to do, but the follow through is something I have to either trust or pray that will happen.” Lack of follow through can cause further preventable harm to the baby, increased medical costs, and unnecessary grief and pain for the family.
But recently, a new addition to the medical team in the NICU has been transforming the discharge process. During the summer of 2017, the Promotores Academy, a program from LLUH Institute for Community Partnerships, launched its first pilot clinic-based Community Health Workers (CHWs) Program. Trained in medical terminology, cultural competency, disease prevention, and individual and community empowerment, these new clinical CHWs culminated their summer training with a three-month clinical practicum. In the fall of 2017, two clinical CHWs were placed on the NICU discharge team.
In the NICU, clinical CHWs were trained community members who served as a bridge between the patient and the healthcare team – as the advocate for the patient and the ambassador for the medical team. Among many roles, NICU clinical CHWs were peer counselors – providing emotional support when parents received a difficult diagnosis about their child and were faced with hard decisions; as health educators and translators – reinforcing information from the medical team in the language and terminology the family could understand; and as empowering agents – coaching a family through an insurance phone call, and sometimes assisting them in pestering insurance companies to get them coverage.
Stacey Belliard, a Doctor of Physical Therapy in the NICU who also served as an instructor for the clinic-based CHW program, noted that the medical staff could not connect with the parents in the same way as clinical CHWs. “They are not mini versions of any of us in the health care team. They are a completely different creature … In healthcare, we don’t need more experts, we don’t need more knowledge, we don’t need more technology… the community health workers bring something totally new… They can access those patients in ways we can’t.”
Dressed in plain clothes, these clinical CHWs were found in patient waiting rooms, sitting down with family members in a comfortable setting, and building relationships. Other CHWs were assigned by Loriezo to specific families who needed translation or who had requested someone to talk to further after the doctor had shared difficult news. Loriezo shared many stories of patients who came back into the office months after being discharged to follow up on appointments because of their relationship with their CHW. She said, “I felt more comfortable with several of our complicated discharges knowing that our community Health workers had been working with these parents.”
But the CHWs are not just transforming the patient experience, they are transforming the health care system itself. In response to increasing costs and patient dissatisfaction, the Institute for Healthcare Improvement created the Triple Aim for America’s healthcare system: improving patient experience, improving population health, and reducing the cost of healthcare. This triple aim has been used to guide national health care policy including the recent Affordable Care Act under the Obama Administration. Lily Lee, the director of the Promotores Academy, believes these Clinical CHWs have the promise to transform the broken healthcare system. “Where we have stepped in, as Loma Linda, is to bridge the gap in the workforce need – given the different health care crisis that we are facing. It goes back to the whole triple aim to improve patient experience and population health. That’s where community health workers come in to facilitate the national aims and the national standards.” She adds, “we are all learning their potentials and still learning.”
It all starts with bringing compassion and respect back to America’s health care system. What sets a CHW apart is their shared experience with the patient. They are members of the community who have a passion to serve, a heart of compassion, and a willingness to be completely available to meet the patient’s emotional and mental needs first. Belliard summarized it when she said, “[CHWs] changed the heart of other people. I saw, especially in the NICU, a change in our practice based on how they were treating patients … [CHWs] are like little mirrors and they are reflecting to us who we should be according to our values … without preaching a sermon or criticizing … just by modeling it.”