"I think that's how you start it," Rosen says. "You start it man-on-man. You start it very focused and small where there are maybe some little politically charged issues, and then your vertical silos start interacting with each other. I think back to the cardiac world. You know, a cath person used to hate the surgeon. If you had to send someone to open-heart surgery instead of putting stents in, that was a failure. But now every good cardiac program has complete integration of the services, and if the patient does well and everybody's service line does well, that's a success."
Beyond physician relations, a key initial step was to review the definition of women's health to encompass evidence-based care in three areas:
Perhaps the trickiest in terms of clinical services integration is the latter. Better evidence on gender-based clinical guidelines has helped. Rosen and her team make sure the information is disseminated throughout the women's health organizational matrix so emergency physicians, OBs, and other disciplines that come in contact with women know, for example, that heart disease is still the No. 1 killer of women, and that a woman may present different symptoms than men will.