As a trauma and critical care Army nurse, Kimberly Smith served around the world, caring for the most critical of patients in the most dire of circumstances.
After nearly three decades, she’s serving in a new capacity: change agent.
“Over 28 years in health care, it’s the central focus that we all strive for to keep your patients safe, to advocate for them, to heal them and comfort them,” she said. “In trauma and critical care, you train teams to focus on the object of saving a patient’s life and you do that through different processes. Those processes that we use in health care all translate into patient safety, performance improvement and doing the best for the most.
“With the D.N.P., you have more of an opportunity to perform on a bigger scale to affect more lives, to affect more processes throughout the big system instead of a small team, a small system.”
The School of Nursing’s D.N.P. program, created in 2010 and accredited in 2012, is a seven-semester doctoral program designed to teach students how to identify a health care practice gap and use the best evidence to change it. Before graduating, students must identify a problem within the health care system and create, implement and evaluate a solution. It’s a project that spans years, and culminates with a presentation to area health care leaders.
Dr. Smith’s project focused on palliative care. She developed a business case model to implement a palliative care program at Brooke Army Medical Center (BAMC), where she worked during the first half of her degree program as a quality director before she decided to focus full-time on her education.
Palliative care focuses on improving the quality of life of those who have chronic disease and get sicker over time. While it’s an emerging health care field throughout the nation, few military hospitals had adopted any formal palliative care programs, she said.
Working with a team of clinicians at BAMC, she created a proposal that explored successful business models of palliative care programs, demonstrated potential cost savings and showed how it could improve patients’ lives.
“It was a multipronged approach to capturing the hearts and the minds of the leadership through lots of discussion and stakeholder meetings and the pure raw numbers of potential cost savings through the care of really chronically ill patients,” she said.
Not only did the military hospital administrators agree, but they also decided to fund the program and create seven full-time positions. The program began in December, and although it’s too early to tell whether it will yield positive results, Dr. Smith said she has no doubts about its impact.
“The evidence would show that it’s going to be dramatic,” she said.
Dr. Smith is now the vice president of clinical outcomes at Methodist and Methodist Children’s Hospital. In that role, she and her team are responsible for everything related to quality health care and patient safety, from patient flow to performance improvement on a small and large scale.
“It feels good to be able to implement change and be able to make improvements,” she said.
Since 1999, when the first D.N.P. program was created in Tennessee, more than 11,500 students have received D.N.P. degrees nationwide. It’s growing in demand, said Carole White, Ph.D., professor in the School of Nursing, because of the need for expertise in translating evidence into practice to standardize and improve the quality and cost of health care.
“Patient care is challenging as people live longer and have more chronic conditions that are more complex to care for, and we need to be sure we’re treating them with the best evidence,” she said. “We need to have people who can assess that evidence and bring it to practice, not only at the patient level, but at a system and population level.”
Students identify a practice gap and gather the evidence they need to implement change. They learn how to translate that knowledge into practice.
“They gain confidence in leading change,” Dr. White said. “D.N.P. graduates leave this program prepared at the highest level of nursing practice.”
Dr. Smith said her work today isn’t very different from the work she did as an Army nurse. The vernacular may be different, and the style of dress, she laughs, but the mission is the same.
“The work is still centered around the best health care that we can give to our customers, the safest health care we can give—measuring processes to do better and to perform better and to get people engaged more, not just with one patient but in a big system.
“I’m very proud of the work I have done.”