Your Cornerstone and Keystone

Starting a new year usually involves at least some conversation about things that we can do or do better in the coming year. Maybe we should consider what is most important to us and decide if we need to change pathways. After we have come to some conclusions, we must decide how to proceed for the upcoming year to accomplish these goals. Our approach to the wound care profession should be the same. If we have been taking care of patients for a long time, maybe we have settled into a comfortable routine. Perhaps it is time to examine our approaches to treatment and see if they are still the best available.

The first thing that any organization needs is a cornerstone; it is the first part of the foundation. It is considered to be something basic, essential, and indispensable¹ and provides the anchor for all that follows. What would you consider to be the cornerstone in a wound treatment practice? For me, it’s your goals for the center or practice. Do you want to be a place to provide care for patients with wounds, to be a center where wound healing is the desired goal, to be a center for research to develop and evaluate new treatments, to be a center for education, or all of the above? The goals you choose will determine what is built on top of the cornerstone.  

For the management of wounds, the first things that must be placed on your cornerstone are guidelines and approaches you feel are best for each type of wound. These should be up to date based on current, evidence-based information. It is critical that all who are involved in the treatment of wounds understand the guidelines and be able to provide the care desired. For instance, it doesn’t do any good to have a guideline about debridement if providers in the practice are unable to properly perform the debridement. How patients with varying payment plans or no payment plans will be managed must be decided ahead of time. If you choose to be a center of healing, you must be able to provide the services required. Do you have in place or have access to the technology necessary to conduct the required evaluations to decide on an appropriate treatment? Do you have access to consultants to help achieve your goal? If you choose to do research, do you have the necessary facilities and funding? If you want to be a center of education, have you built a strong educational wound treatment base so that others will turn to you for this information? All of these need to be placed on your cornerstone to build the program you desire.

The next thing that is needed is a keystone. A keystone in construction is a strong piece that locks the other pieces in place and provides support for them.² In the wound center setting, this has to be a person who is invested in the program or practice and keeps everyone and everything pointed toward your goals. The program can’t have everyone “doing their own thing,” or else the goals will be quickly forgotten and abandoned. Who will be the keystone in your wound center?

As we reevaluate last year and look forward to the new year, I encourage you to strongly consider what you truly want to accomplish. Once this is done, find your cornerstone, start your construction, and be sure to have a keystone to help ensure your success.

Terry Treadwell, MD, FACS

Editor-in-Chief, Wounds

woundseditor@hmpglobal.com