Guest Editorial: Engagement 101: Getting Involved to Improve Care

   Recently, I became an American citizen. Every morning, I wake up with Mahatma Gandhi's words in my mind: "We must be the change we wish to see in the world."

As such, I see it as my duty to question the status quo and try to change what doesn't make sense, to be entrepreneurial, and to never take no for an answer. I was, therefore, honored when I was asked to speak at this past spring's Symposium on Advanced Wound Care about how healthcare providers have to engage in the political process (whether they want to or not). It gave me an opportunity to encourage others to share my vision and mission.

   I direct the National Nursing Centers Consortium (NNCC). The NNCC was established in 1996 - the first association of nurse-managed health centers in the United States. The mission of the NNCC is to strengthen the capacity, growth, and development of nurse-managed health centers in order to provide quality healthcare services to vulnerable populations and to eliminate health disparities in medically underserved urban and rural communities. Currently, 37 NNCC-member nurse-managed health centers across 12 states provide comprehensive primary healthcare services to more than 50,000 patients and offer health promotion programs to 500,000 individuals in their network.

   Nurse-managed health centers, like many other healthcare providers and organizations, struggle to keep themselves fiscally sustainable. On any given day, 50% of those seeking care at some of these centers are uninsured families without adequate healthcare coverage. Everyday is and will continue to be a fight for survival unless a dramatic change occurs in the way healthcare is reimbursed and funded in this country. These struggles are not all that different from those faced by caregivers for people with chronic conditions such as wounds or incontinence. Like the nurses and other healthcare providers working in nurse-managed health centers, they ask, Why do we spend more money treating, as opposed to preventing, expensive wounds, especially when the healthcare system lacks adequate reimbursement for quality services? My advice to the wonderful audience at the Wound Care Symposium is similar to what I say to my constituency of nurse-managed health center providers: Get involved in politics. You can accomplish this on your own or through your professional associations.

   The following is my top ten list of the 101 ways to get involved. All of the tips relate to one premise - a credo espoused by President Lyndon B. Johnson: "It is not who you know. It's who you get to know."
   1. Get to know the political process - it is a dance that requires persistence and patience. In Pennsylvania, it took certified registered nurse practitioners more than 20 years to get prescriptive authority. Last year, they succeeded. The major reason for their success is that they rallied all nursing groups together, worked as a united front, beat the opposition, and, most importantly, never gave up.
    2. Get to know your legislators or, even better, their staff, at local, state, and federal levels. Many healthcare providers seem to be intimidated by legislators. Remember: They work for you. They are elected to represent the interests of those they serve. However, they can achieve little when they are unaware of the realities or lack the knowledge to render sound decisions. Healthcare providers are responsible for conveying the news from the front lines.
   3. Get to know local, state, and federal agencies that deal with healthcare credentialing, licensing, and financing. They can make or break you. Because the executive branches of government have responsibility for interpreting bills and legislation that evolved through a process requiring a great deal of compromise and, often, confusion, your familiarity with the staff members who are in charge of writing and interpreting legislation and regulations is crucial. Again, the better you know people in these key positions, the more likely your opportunity to be heard.
    4. Establish relationships with legislators, legislative staff, health commissioners, local, state and federal department heads, key staff, and the like. It is all about "who you know." President Johnson said this the best way. No one can ever underestimate the power of getting to know the right people in power.
    5. Don't be shy about using your relationships when necessary. In politics, everything is quid pro quo. What President Johnson did not say is that you also need to know what to ask of the right people in power, as well as knowing when it is appropriate to ask and how to compel them to work on your behalf.
   6. Become a resource to staff in the executive and legislative branches. You are the expert in your own field. Your opinion is worthy of respect. Few legislators are nurses, doctors, or other health professionals. Given the size of state and national healthcare budgets, legislators need experts, either on staff or on an advisory level, to assist in making the best decisions. Don't be shy! Offer your assistance! Once you start to work with legislators, their staff, and government officials and you establish a mutual sense of trust, your knowledge, expertise, and wisdom will be requested regularly.
   7. Develop broad base support for your issue. Involve students, patients, and community members. Time is always of essence in the healthcare field, so learn how to structure an issue you want to raise. As an example, at the Wound Care Conference, I met many providers who owned and operated wound care clinics. However, I understand no association exists that supports these clinics; as a result, they are poorly positioned politically and receive little funding. These clinics are in a situation similar to that of nurse-managed health centers a decade ago. To staff and directors of these wound care clinics I say, If you want to succeed, you have to make yourself more visible by developing support for your work - from your patients, from the community in which you work, and from healthcare providers and students. Get your concerns on the radar screen of the healthcare universe. Engender the interest of local newspapers. Have patients, staff, students, friends, and colleagues write to state and federal legislators about the important work you do. Encourage them to question shortfalls in adequate reimbursement for healthcare services.
   8. Place key financial political supporters on your board of directors and/or trustees if you are in a leadership position. If you are an owner, administrator, or leader of a healthcare organization, institution, or facility, make sure your board comprises key individuals who can give you access to politicians. This includes individuals from law firms that often donate to political candidates.
   9. Share information with staffers about important healthcare issues as often as you can. According to an old saying, if an issue is put in front of elected or appointed officials, eventually they'll own it. I use this strategy often. If you are committed and persistent, eventually your issues will be addressed because the individuals you deal with will realize you are not going to go away.
   10. Because the political process is a dance, you can't get comfortable when you are successful in changing a regulation, getting better reimbursement, or advocating for your patients. Adversaries are always lurking, hoping to change back what you were successful in achieving.

   In sum, if you are successful in getting something changed, a new legislative cycle in the next year can easily undo your accomplishment. Be aware of future challenges and stay on top of issues. Good luck and have fun being truly politically correct.