Dr. Timothy Sielaff: Coordinated Care At the Bedside

timothy-sielaffIn the world of healthcare, the Twin Cities of Minneapolis-St. Paul area is a fantastic place to be. The state has been always on the cutting edge of healthcare reform. Allina Health in Minneapolis has been among the leaders in remaking healthcare in the state; creating a unique coordinated care approach across the spectrum of oncology care.

“We’re always trying to advance things on behalf of the communities we serve,” says Dr. Timothy Sielaff, Chief Medical Officer and Senior Vice President of Allina Health’s Specialty Care and Research, and the Eugene W. and Elizabeth B. Leonard Trusts Chair in Oncology and President of the Virginia Piper Cancer Institute at Abbott Northwestern Hospital in Minneapolis.. “That’s really a crucial ethic about the State of Minnesota. We are really very mission-driven and dedicated to improve the health of populations.”

Surgery: A Small Slice of a Patient’s Life

Dr. Sielaff is a practicing liver and pancreas surgeon concentrating on minimally invasive surgery, clinical trials, and multidisciplinary cancer care models. While at the University of Minnesota, he became cognizant, thanks to Marie, an expert registered nurse coordinator, of the need to coordinate care and treat the entire patient, not just the illness.

“The folks that I deal with have pancreatic cancer and liver cancer. They have really complicated problems. The operations that we do to treat the cancers are potentially quite morbid and have consequences that are physiological, social, functional, and nutritional,” he said. “It’s beyond what we might imagine even under the very best of circumstances.

“I learned very early-on from Marie that we always need to be thinking about the whole person,” Dr. Sielaff said. When I first started working with Marie I thought surgery was the center of the universe in a pancreatic cancer patients’ life. I very quickly learned that’s just absolutely wrong. Everything that happens before and everything that happens after is almost certainly more important.”

Thanks to Marie and his patients, Dr. Sielaff was able was able to apply a coordinated care approach across the spectrum of oncology care at Abbott Northwestern Hospital, the Virginia Piper Cancer Institute.

A Nurse Care Coordinator: Communicator, Trouble-Shooter, and Patient Advocate

The team soon saw the benefits this coordinated care approach brought to patients and their families. The results were so remarkable, the organization committed that every new cancer patient will have access to a nurse care coordinator.

“And that’s a huge commitment, that’s a huge financial commitment to the organization,” Dr. Sielaff said. “But it’s also a signal we’re sending that how we deliver care at the bedside is of the primary importance.”

Not every patient is as complex as a pancreatic cancer patient or has as many nutritional, psychosocial, and financial needs. However, for those patients with very complex diseases who need to navigate a very complex organization with very complex processes, care coordination is crucial.

“We believe that care coordinators are the glue that hold really complex processes together,” he said. “This allows patients to really focus on being well and getting well and restoring their health and not have to worry.”

Care coordinators are the link between the surgeon, medical oncologist, and radiation oncologist. Coordinators advocate for patients and are the first point of contact for them and their families; troubleshooting in real time. Coordinators answer the questions patients didn’t quite have the ability to articulate or ones that came to mind as soon as the physician left the room.

“It’s terrifying to hear a diagnosis of pancreatic cancer. It’s bewilderingly and complicated to listen to anything after you hear troubling news like that,” Dr. Sielaff said. “One of the roles of the care coordinators is to be in the room and listen to the conversation among the surgeon, medical oncologist, and radiation oncologist as to what the different management options are.”

Such a complex conversation can make it difficult to illicit the patient’s true care preferences. Ensuring the patient and his/her family understand the issues at hand, the trade-offs, and, in turn, have been able to express their care preferences, creates the best possible treatment plan for the patient.

“The interactions that we have with individuals in the clinic room and in the pre-op area before radiation, those are the interactions that really make the care of cancer patients, and other individuals with complex disease processes, so rewarding for the care-givers.”

Turning Knowledge Into Health

One of Allina’s most important missions, promoting healthy communities, seems to run counter to the objective of a prime healthcare system: creating a sustainable business. Dr. Sielaff doesn’t agree with that sentiment.

“Well, maybe there is a perception that there is a conflict between delivering great care, promoting health, making the business run, and creating a margin for all healthcare delivery systems,” he said. “The reality is that there are always going to be sick people, and we need to take phenomenal care of those people. That’s the work we already know how to do.”

Caring for people with illnesses, whether episodic or chronic, is the calling for many in medicine. However, Dr. Sielaff believes a shift is occurring in the world, one of taking what we learn from caring for sick individuals and populations and turning the knowledge in to health.

“It’s our imperative to do it, we have to do it. Society needs us to provide value in healthcare and we are the best people to define it,” Dr. Sielaff says. “The answers are in front of us; the people that are in the clinic rooms, in the operating rooms, in the hospitals with our patients, those folks have the answers; we need to help them by empowering them with data and with an ability to ask the right questions.”

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