Last week, MASS wrapped up the first phase of our work with the Cerebral Palsy team at Cincinnati Children’s Hospital (CCHMC-CP). Our presentation to the board was well received and the next several weeks look to be busy as we prepare a proposal for integrating the various programs that play a part in diagnosing and treating cerebral palsy in kids from Ohio, western Appalachia and beyond.
Through a chance meeting between Michael and John B. and his innovation team from CCHMC at a conference last fall, an idea germinated for MASS to bring their approach to bear on a first-world hospital problem. John was inspired by our commitment to building better healthcare facilities and the unique strategies we utilized in doing so. He also had a particular program (CP) that was tapped for special focus and on the lookout for innovative solutions. A partnership was formed and plans were laid. The project finally launched in May with an initial ethnography and needfinding visit where a team from MASS spent three weeks immersed with the CP clinicians and patients in Cincinnati. Cerebral Palsy covers an extraordinary breadth of conditions and symptoms, with no two patients alike. CP occurs in about 2 of every 1000 births, or about 10,000 infants per year. Major difficulties include motor, sensory and cognitive impairments, thus requiring a complicated and comprehensive treatment plan to ensure the highest level of functioning and autonomy.
We were energized by some of the challenges we saw and the potential for the MASS approach to take CCHMC-CP from being a very good program to a truly excellent program. As an example of one of the problems we are tackling, consider the twice-weekly CP clinic: Patients come in for a 2-3 hour session and during this time see a veritable army of physicians including a pediatric rehab resident, nutritionist, physical therapist, occupational therapist, social worker, and various nurses in addition to the pediatrician. Depending on the patient, they might then see a gastroenterologist or orthopedic surgeon for further diagnosis and treatment. The question of how to coordinate the flow of these specialists during the clinic, prioritizing efficiency while ensuring adequate time for all to collaborate on a treatment plan and share information is huge. Currently, 4-5 patients are seen in a 4-hour clinic session. However, they hope to grow from 250 patients to 2000 patients over the next few years. How do we create a ten-fold increase in capacity while at the same time improving the quality of care? How can we facilitate the transformation of the formerly independent CP cowboys into a perfectly integrated CP pit crew (as Atul Gawande of the New Yorker described physician teams in his address to this year’s graduating class at the Harvard Medical School)? The solutions have spatial implications as well as logistical and organizational aspects and MASS are confident we can find an innovative way to meet these two difficult criteria.
CCHMC is one of the very best children’s hospitals in the world, reaching the top 3 of the U.S. rankings in various disciplines every single year. That MASS was asked to collaborate on taking their CP program to the next level is a validation of what we have believed since day one: that architecture is about so much more than the building. It also confirms another radical notion of MASS’s: that our work changing health outcomes with a well-built environment in Rwanda is just as relevant and valid in the developed world. Healthcare facilities in the U.S. could benefit from many of the lessons learned and interventions employed in designing and building the Butaro Hospital. With their buy-in and support, the CP and DSIOP teams with whom we are working in Cincinnati have been amazing partners in this groundbreaking adventure.
Atul Gawande
US News Hospital Rankings
