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HarvardBusinessSchool9-898-070Rev.November29,2000MichelleToth,MBA'95preparedthiscaseunderthesupervisionofProfessorJodyHofferGittellasthebasisforclassdiscussionratherthantoillustrateeithereffectiveorineffectivehandlingofanadministrativesituation.Copyright©1997bythePresidentandFellowsofHarvardCollege.Toordercopiesorrequestpermissiontoreproducematerials,call1-800-545-7685,writeHarvardBusinessSchoolPublishing,Boston,MA02163,orgoto—electronic,mechanical,photocopying,recording,orotherwise—withoutthepermissionofHarvardBusinessSchool.1TransitionalInfantCareSpecialtyHospitalWhenSusanOlsongavebirthtoprematuretripletsonJune13,1996atLatrobeCommunityHospitalinsuburbanPittsburgh,sheandherhusbandRobhadnoideawhattheywereabouttoexperience.Todd,JeremyandThomasweretransferredtotheNeonatalIntensiveCareUnit(NICU)ofPittsburgh’sMageeWomen’sHospitalwheretheyreceivedthefullspectrumofcriticalcare,includingtwoweeksonrespirators.Attenweeksofage,theboysweretransferredfromtheNICUbacktoLatrobeCommunityHospitalfortheongoingcareoflungproblemsandfeedingproblems.Overthenextsixweeks,thefamilyexperiencedsevendischargesandemergencyreadmissions,andmultiplecrisesathome,includingSusanhavingtoresuscitateherowninfantsonsixseparateoccasions.“Ithoughtitwasnevergoingtoend.Wewerejustgoingdaybyday,evenminutebyminute,justtryingtogetthroughthis.Ihadnosenseofmyselfasamother—thatfeelinghadbeentakenawayfromme,andIwasjusttryingtosurvive.”Butafterweeksofcrisisaftercrisis,theybroughttheir16-weekoldtripletstoTIC.Onadmission,TIC’swell-trainedinterdisciplinaryteamrecognizedthattheboys’lungproblemsrequiredadifferentapproachandalsoidentifiedpreviouslyundetectedcomplications.WithintwoweeksToddwashomeforgood,andwasfollowedtwoweekslaterbyhisbrothers,JeremyandThomas.Theyhaveneverbeenreadmitted.AccordingtoSusanOlson,“TICbroughtclosuretoanightmarethatseemedtobegoingonforever.’”HistoryofTransitionalInfantCareTheearly1980swereaperiodofexplosivegrowthinneonatalhealthcareanditsabilitytohelpprematurelybornchildren.Hospitalsaroundthecountrywereaddingorexpandingnurseryspacetoaccommodateinfantswho,adecadeearlier,wouldhavedied.TransitionalInfantCare(TIC)specialtyhospitalwasfoundedduringthisperiodundertheauspicesoftheChildren’sHomeofPittsburgh,anon-profitinfantadoptionagencywitha100-yearhistoryofservinginfantsandtheirfamiliesinPittsburgh,Pennsylvania.TofoundTIC,theChildren’sHometeamedwithDr.Ron898-070TransitionalInfantCareSpecialtyHospital2David,aneonatologistatMageeWomen’sHospitalinPittsburghwithavisionofanalternativewaytocareforprematureandhigh-riskinfants.Dr.Davidexplained,Myvisionwastocreatea“hospitalindisguise”tooffertransitionalcareforinfantsgoingfromtheneonatalintensivecareunitsoflocalhospitalstohome.Thisideawasrevolutionaryatthetime.Iwantedtoputintopracticetherecommendationsofanemerginggroupofpracticingresearchers,‘environmentalneonatologists,’whowereprovingthatthephysicalandsocialenvironmentforcedonaninfant,aswithanypatient,canhaveextremenegativeeffectsifthereisanoverloadofstimulisuchaslight,soundandtouch.Andwedidhavesomedata—itwasfairlynewatthetime—showingthatifyouputanadultinanintensivecareunitinthatkindofenvironment,theydevelopwhatiscalledICUpsychosis,andtheirrecoveryisverymuchaffectedbythisexperience.AndsoIwondered,couldthatnotbehappeningtobabies?ThroughmyworkwithfamiliesIalsorealizedthatparentswhoexperiencedneonatalintensivecare—ahigh-tech,intimidatingenvironment,tosaytheleast—wereleavingill-equippedtomanagetheirbabies’careathome.Irealizedthatwewerefosteringakindofdependencythatwouldinevitablyhavetheseparentsrunningbacktomeforthelittlestthing.Ithought,theremustbesomewaythatwecanofferadecompressionexperiencesothatwhentheysurfacetotherealworld,theydon’tgetthebends.SoIwantedthisnewhospitaltoincorporateparentteaching,toputthefamilyunitatthecenterofthehospitalandtothinkaboutthebaby’slong-termneedsforcompetentcarefromhisorherparentsandfamily,notjusttheimmediateneedsbeingmanagedbythenurses.And,Ithought,wouldn’titbegreatiftheparentscouldactuallylivewiththebabieswhiletheylearn?Andtheideadevelopedandcontinued,tobecomewhatisTICtoday.ThefoundingmembersoftheTICstaffincludedfifteennurses,onesocialworkerandonedevelopmentalspecialist,allveteransoflocalneonatalintensivecareunitswhoworkedtogethertomakeRonDavid’svisionareality.Accordingtooneofthenurses:Itwasawonderfulexperiment.Asnurses,forthefirsttime,wehadrealpower.Exhilarating!Weweredoingwhatfeltright;tryingtocorrectthingsthatweknewfromourpreviousexperiencewerewrong,notjustforthebabiesandfamilies,butforourselves.TICwasanincredibleworkinprocessthen,anditstillis.TheFirstDecadeTICopeneditsdoorsin1984withsixhospitalbeds.Itprovidedcareforinfantswithawidevarietyofmedicaldiagnosesassociatedwithprematurityandbirthdefects.TICstaffprovidedacutenursingcare,minorsurgicaltreatments,respiratorytherapy,physicalandoccupationaltherapy,speechtherapy,socialservicesandinfantdevelopmentservices.InitiallyTICfocuse