Advancing Health

We all have the power to advance health by offering the opportunity to others to support the important work we do. Being ambassadors for UC Davis Health System is a responsibility shared among leadership, faculty, researchers, staff, alumni, volunteers, donors, students, and patients and their families. The easy, first step in developing a philanthropic partnership with potential supporters is sharing the remarkable ways we are advancing health.

I’ve enjoyed becoming more involved in development work and am pleased to see a significant increase in success. Today, I gave a hard hat tour of our new Comprehensive Cancer Center building. It’s a thrill to share our story. Join me in getting more people involved by asking a simple question: “Would you like to learn more about UC Davis Health System?”

With this question, there are endless possibilities to match the interest of potential donors with the many ways we are advance health through research, patient care, education, and community engagement. Philanthropy is vital to the future of our health system and health care in general. The funding environment is changing in virtually every aspect of health care. We must all become ambassadors.

I look forward to hearing how philanthropy has helped you achieve your goals or if you’re a donor, how your donation has helped UC Davis Health System. You can write a comment below or send me an email.

As a follow up to my last post, I want to share with you some further thoughts on my presentation on the “Science of Team Science” last week in Washington, DC.  Team collaboration has been part of team science for a century. It’s not about “if” but about “how” for team science to happen, and happen well. Fortunately, there are good resources on how team science can be done well.

Teamwork outside of science is worth exploring, particularly in the fields of technology, sports, architecture, and in literature, to name a few. Collaborative team science incorporates a variety of perspectives, and it’s the tension between these differences and how they are coordinated that lead to innovation and new discoveries, not only in research but in clinical practice and education.

I thoroughly enjoyed working with the panel on team science in DC. Here is a great resource from the NIH Office of the Ombudsman on collaboration and team science, a field guide:

http://ombudsman.nih.gov/collaborationTS.html

I also want to share Amy Edmondson’s article, “Teamwork on the Fly,” from the Harvard Business Review earlier this month:

http://hbr.org/2012/04/teamwork-on-the-fly/ar/1

I look forward to hearing your thoughts on why some research teams succeed while others do not.

I’m heading to Washington, D.C. today for Translational Science 2012, a Society for Clinical and Translational Science conference. I’m presenting on “The Science of Team Science” panel which will be chaired by Melissa Begg, ScD, Columbia University Mailman School of Public Health.

Increasingly, advances in clinical and translational science depend upon the collaborative efforts of an interdisciplinary team. The success of any scientific team depends on the contributions of its members. Our session will address ways of preparing and supporting scholars to succeed in interdisciplinary team environments, with a focus on organizational challenges in academic settings.

My presentation is on “The Cultures of Team Science and the Value of Diversity: Views from Outside of the Scientific Community.” I’m personally interested in the tension of having different perspectives on teams. I believe it’s this tension that leads to innovation.

What do you think about team science? I’d like to hear your thoughts on what works and what doesn’t.

UC Davis Health System is highly regarded in many ways, most notably for being interprofessional and collaborative. This week, I asked Heather M. Young, Dean of the Betty Irene Moore School of Nursing, to share information about an exciting effort on a new topic–the inaugural Qualitative Health Symposium. Dean Young and I hope to see faculty, students and researchers from a variety of disciplines participate, including nursing, medicine, social sciences, and public health. Dean Young is a visionary leader and mentor, whose perspective I greatly admire.

In the words of Dean Young:

Dr. Meyers and I agree interprofessional collaboration is essential to advance and improve health care for individuals, families and communities. Teamwork is essential in the classroom and in clinical settings but also in the research necessary to fuel innovation.

Heather M. Young, Dean, Betty Irene Moore School of Nursing

Today’s complex health problems require creative and multidimensional approaches to generate and test solutions. This can be advanced both through interdisciplinary team science and through the inclusion of multiple methods in study design. Interdisciplinary research teams, including nursing, social science and biomedical experts, improves the study of health and illness and promotes discovery of creative solutions that are meaningful to society.

We at the Betty Irene Moore School of Nursing at UC Davis are excited to partner with our colleagues at the Clinical and Translational Science Center, the Center for Reducing Health Disparities and the Center for Healthcare Policy and Research to provide the inaugural Qualitative Health Symposium: Using Qualitative Methods to Advance Health Research at our Sacramento campus Wednesday, May 2.

Qualitative research contributes to a more robust understanding of health issues by allowing exploration of processes and assumptions behind more quantitative manifestations and results.  Qualitative research is ideal to explore underlying causes of behaviors or actions, examining why certain solutions work or do not work. Through qualitative research, we can achieve an in-depth understanding of human behavior and the social processes involved in health and illness.

Click here for more details.

We hope to see this event grow to be an annual gathering of researchers sharing best practices and discoveries and exploring potential collaborations and other ways team-based science can lead toward transformative solutions in health care.

Register for the free symposium by April 18 at sonrsvp.com.

Heather M. Young, PhD, RN, FAAN
Dean, Betty Irene Moore School of Nursing
Associate Vice Chancellor for Nursing, UC Davis Health System

I am impressed with every student at UC Davis School of Medicine. They are engaged in the greater community of UC Davis Health System and beyond, and many are active in advocacy efforts. This week, I want to highlight one student who is already making a difference in health-care leadership and policy, both critical components of advancing health.

Adam Dougherty, a second year medical student, recently won the American Medical Association (AMA) Foundation’s 2012 Leadership Award. This award provides special training to develop skills as future leaders in organized medicine and community affairs. As a way of congratulating Adam, I invited him to write a guest blog (as if he doesn’t already have enough to do). 

Adam Dougherty accepts his leadership award.

In the words of medical student Adam Dougherty:

It was an incredible honor to accept this award, and the training I received will benefit me greatly in future endeavors. The efforts and accomplishments of my fellow award recipients were inspiring, and will continue to motivate me as a leader. Since beginning medical school, I have accumulated a number of extracurricular responsibilities, including leadership roles in state and national organized medicine, organizing UC Davis students for the annual Sacramento Lobby Day for the California Universal Health Care Act (many thanks to Dr. Meyers and the Administration for their support and assistance!), writing for the local medical society journal, SSV Medicine, and a recent appointment to the Sacramento County Public Health Advisory Board.

I often get asked the question, “How do you do it all?” Medical school is, in itself, a full-time investment, and while my education is first and foremost, I understand the importance of extra-clinical development. Since obtaining a Master’s degree in Public Health and working for several years in health policy, I recognize that future physicians must take greater roles to educate, empower and lead. In an age of unsustainable growth in health care costs and major structural changes in the American health-care system, it is imperative for physicians to be a part of answering the toughest questions that we face through a combination of clinical perspective and health system governance. Through leadership positions and other streams of communication, I hope to continue to analyze, digest, translate, and steer developments in the increasingly complex health policy world while exposing my classmates and colleagues to the importance of health system reform, health policy, and advocacy.

The Spring 2012 edition of the Faculty Newsletter features an article on mentorship, something that is very important for all of us at UC Davis, particularly for those on an academic research trajectory. You can read the newsletter here: FacDevNLSpring2012.

I encourage everyone at UC Davis Health System to know the pathways available for yourself, and to guide those who would benefit from these resources. Everyone does better with mentoring and coaching.

Symposium attendees discuss Quality Improvement efforts at UC Davis Health System.

Last week, I was pleased to co-host the Integrating Quality Symposium: Linking Educational and Clinical Excellence with Dr. Ulfat Shaikh, associate professor of pediatrics and director of quality integration This was our second annual symposium.

With 200 attendees, 55 research poster presentations, 13 podium presentations and 2 keynote speeches from national leaders, it is clear that UC Davis Health System, as well as our partners at the Department of Veteran Affairs, Kaiser Permanente and community health groups, are “raising our collective I.Q.”

You can view the symposium presentations here in these two links:  Part1 and Part2. There are many points in the presentations that explain how Integrating Quality is about being student-focused and patient-centered. In particular, I want to call your attention to slide 3 of my presentation in Part 1. This chart details what health professionals learn in school (educational competencies) and the quality of care as defined by the Institute of Medicine (IOM). The Integrating Quality Symposium emphasizes how we bring together–and link–student learning and patient care.

It was an honor to hear from Brent James, M.D., M.Stat, the chief quality officer at Intermountain Healthcare and executive director of the Institute for Healthcare Delivery Research. As the NY Times Magazine stated in 2009, if healthcare is going to change, Dr. Brent James’ ideas will change it.  Here is that article, “Making Health Care Better.”

It was a thrill to hear from Kenneth W. Kizer, M.D., M.P.H., distinguished professor, UC Davis School of Medicine and Betty Irene Moore School of Nursing, and director, Institute of Population Health Improvement. Both keynote speakers talked about how Quality Improvement and Integrating Quality efforts are solutions to our looming national crisis in healthcare funding.

Dr. Suzanne Eidson-Ton, associate professor, departments of Family and Community Medicine and OB/GYN, hangs a research poster.

I was inspired by our learners (we are ALL learners!), faculty and staff as they described their own quality improvement efforts here at UC Davis Health System. All podium presentations were noteworthy but I can only list two here. Betty Irene Moore School of Nursing masters degree student, Jennifer Mattice, demonstrated her group’s work in addressing medication errors in a just culture. Simon Wu, a second year medical student, described how he and his mentor assessed and improved the quality of diabetes care at the student-run Paul Hom Asian Clinic.

I want to thank everyone who contributed to the success of this symposium. It’s important to recognize that the 60 plus projects represented by posters and at the podium are the result of many months of work, including faculty and clinicians who encourage and mentor learners, as well as the scholarly work conducted. There are the individual and team efforts, which altogether create an institutional and systemwide effort to improve the quality of care we deliver. Our collective effort, along with Dr. James’ Intermountain Healthcare and other institutional efforts, will lead our country to transform care.

I hope you were able to follow the tweets from UC Davis Health System’s Twitter account. More pictures are available at the UC Davis School of Medicine Facebook page. A more descriptive account of the Symposium will be shared on our internal website, the Insider, and a video of the Symposium will be available in a few weeks.

The Symposium committee meets Mon., March 12 to discuss plans for 2013. I welcome your thoughts and comments here. Stay tuned for a save-the-date announcement. 

I thought you’d like to hear from a national guru in professionalism, Dr. Hendry Ton, Health Sciences Associate Clinical Professor, Department of Psychiatry and Behavioral Science. These few years we’ve worked together, I’ve been so impressed with Dr. Ton. He’s taught me so much, and he’s an all around nice guy.

In the words of Dr. Ton:

It has been nearly two decades, but I vividly remember my first formative experiences as a medical student. It was in Human Anatomy as my classmates and I huddled around our cadaver. Our instructor gently fingered the coarse stitching that laced along the middle of the cadaver’s chest and declared, “Something important is waiting for you in there.”

 Over the next months, my partners and I studied his body in detail, discovering things about him that he likely never knew about himself. Then came time to undo the stitches in his chest. We proceeded to uncover his heart with anticipation. What was waiting for us in there? Then we saw what our instructor had alluded to–evidence of an aborted coronary bypass surgery. Coagulated blood covered his chest wall, and blood vessels that seemed out of place were stitched to his heart. These were the signs of the last moments of his life. Our instructor confirmed that he had died on the operating table.

I was taken back in time. I imagined what it must have been like for him to speak with his family before the operation. Maybe he reassured them that he would be okay, or perhaps confided in them about his fears of dying. I marveled at the trust and hope that he must have placed with his physicians and nurses as he drifted off to unconsciousness in the OR. I empathized with what it must have been like for his doctors who held his heart in their hands it struggled with its last beats. And I was humbled that despite everything that must have been going on with him, he had thought about his future students and trusted us with his body. He was my first patient and medical teacher.

My experience with him highlights the incredible privileges that society has entrusted to us as health care providers. Few others are allowed so many opportunities to touch the deep and dark parts of the human experience, to celebrate a new life brought into the world, or to attend to the passing of an existing one. We must use these privileges responsibility in the interest of our patients and the public to promote healing and alleviate suffering. Professionalism represents this commitment.

At UC Davis, we have embarked on an effort to develop a professionalism curriculum that spans the four years of medical student education. In a collaborative of faculty, staff, residents, and medical students, we have redefined the professionalism graduation competency and mapped out milestones across the four years that will serve as anchor points for our curriculum. Central to this is the idea that developing professionalism involves not just adhering to a set of acceptable behaviors, but also developing altruism, humanism and ethical understanding, improving the ability to manage conflicting professional responsibilities and interests, and enhancing self reflection and communication skills. Professionalism is quality improvement. Professionalism lapses are similar to other forms of medical errors, in that they happen more often than we know, that they range from being inconsequential to being life threatening, that systems and personal issues may contribute to them, and that good doctors can have professionalism lapses.

Recently, I had dinner with a primary care physician who talked about the challenge that she and her colleagues experience when trying to provide mental health care in rural settings. In her system, PCPs cannot be reimbursed for treating mental health diagnoses such as major depressive disorder, whereas they would if they diagnosed the patient with nonspecific insomnia or somatic problems. Does the physician treat the depression despite not being reimbursed? Or should she falsify the diagnosis to get reimbursed? And what is the overall impact of this issue on their ability to address emotional suffering?

The nature of our work, our responsibilities, and the systems within which we operate generate professionalism dilemmas everyday. Some are easily addressed, but many are not. By equipping ourselves with the skills, knowledge, and attitudes necessary to understand and maintain professionalism in the context of an increasingly complex health care system, we honor the privileges and responsibilities with which our patients and society entrust us.

- Hendry Ton, M.D., M.S., Health Sciences Associate Clinical Professor
Director, SOM Cultural Competency and Professionalism
Psychiatry Clerkship Director
Medical Director, Transcultural Wellness Center
Director of Education, Center for Reducing Health Disparities
Department of Psychiatry and Behavioral Science
UC Davis Health System

(Pictured left to right in back row) Alexis Gaskin and Leon Cushenberry, 4th Year School of Medicine students honored at the dinner; Walter Suggs, Chapter President, Tuskegee Airmen, Inc.; (seated) George Porter, SMGSgt, USAF (Ret.)

My wife, Linda, and I were honored to attend the Student National Medical Association- UC Davis (SNMA) 5^th Annual Candlelight Dinner on Feb. 10, 2012, and to celebrate “Mentorship Building Community.” Our Black and African American students hosted an evening for well over 100 attendees from several schools and backgrounds such as nursing and the Graduate School of Management — another example of interprofessional cohesiveness at UC Davis. We have out grown the MIND Institute auditorium!

George Porter SMSgt, US Air Force (ret), one of the original Tuskegee Airmen, gave an impassioned talk on the importance of education and mentorship as foundations to building our communities. Accompanied by Walter Suggs, a Vietnam Veteran and Chapter President of the Tuskegee Airmen Inc., we were reminded that mentorship builds generations of strength. Stay tuned at this blog to hear about the UC Davis School of Health Mentorship Academy as an example of mentorship building community.

George W. Porter, SMSgt, USAF (Ret.), of the Tuskegee Airmen, Inc., addresses Candlelight Dinner attendees.

Emotions and spirituality ran high all evening as we also heard from Terry Moore, truly an electrifying performer/poet, and Dr. Karen Hart, the keynote speaker. The students honored our own Felicia Miller, School of Medicine Outreach Officer, who collaborates with high schools on programs that guide disadvantaged and under-represented students towards careers in medicine.

 The SNMA needs our support as do all of our student organizations that strengthen the fabric of our community.

Thank you, Dr. Latimore, Kevin, Leon, Alexis, Monique, MC Tracy Burns, the staff and undergraduates who did all the heavy lifting, and the Imani clinic for supporting our valued friends in the Oak Park neighborhood, to call out just a few of the stars of the night.

With the now seemingly permanent reduction in state funding, California’s public universities must continue to find innovative ways to provide excellent education with less resources. We must meet the high national standards of the Liaison Committee on Medical Education (LCME), the accrediting organization for all schools of medicine and train the health professionals our state needs. These standards call for substantial, ongoing quality improvement of our medical school, such as the use of active learning and problem solving in all coursework, a major shift from traditional lecture-based medical education.

Last week, with the understanding that our environment has changed and our success relies on adaptation,  University of California Senior Vice President of Health Sciences and Services, John “Jack” Stobo, M.D., visited UC Davis to discuss the vision and strategy of UC Health (http://health.universityofcalifornia.edu/). UC Health represents 5 academic medical centers and 10 hospitals through the University of California Office of the President (UCOP) located in Oakland.

I was re-invigorated by Dr. Stobo’s resolve to use our coordinated intellectual resources to solve the common problems faced by the 5 UC academic medical centers. One possible example is for faculty to develop online curricula, freeing up class time for active learning. 

A similar philosophy helped launch the UC Biomedical Research Acceleration, Integration, and Development (UC BRAID) program  (http://www.ucbraid.org/), a system-wide collaboration to enhance clinical and translational research efforts, and to identify policy changes and areas of collaboration to accelerate research across all 5 medical research campuses.

Our strategic plan emphasizes interprofessional education as a lead goal to enhance health sciences education, translated to improve quality of care. I welcome comments and suggestions on how we will adapt to this new environment.