Integrating Quality Symposium a success

Posted by Fred on March 12th, 2012 in General | No comments »

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. 

 

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On professionalism …

Posted by Fred on February 28th, 2012 in General | 5 comments »

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

 

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    Comments

  • Michele Long

    What an amazing reflection! Looking at medical challenges from all perspectives, and searching for the most professional path– that is the true challenge. Doctors face this every day, and I as one of them am ALWAYS learning (as I just did from your post.) Thanks! -Michele Long

  • Mark Servis

    I like the idea of professionalism as a quality improvement activity – and professionalism lapses as opportunities to improve. As faculty we need to be more transparent to students and residents about our own struggles to always be the professional we want to be.

Mentoring building community

Posted by Fred on February 13th, 2012 in General | 3 comments »

(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) 5th 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.

 

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  • Mark Servis

    What a fantastic evening that celebrates values that the UC Davis School of Medicine holds dear: diversity, community and interprofessional education. Thank you for sharing. I’m happy to hear that so many attended.

  • CNA Training

    Nothing like pouring into the lives of the next generation. Glad to see these men get honored like this, especially after the movie about them came out recently. Glad schools are having mentorship programs available for students, it’s the best way for people to learn.

A new theme emerging: Social Darwinism

Posted by Fred on February 9th, 2012 in General | No comments »

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. 

 

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Advancing health in San Joaquin Valley

Posted by Fred on January 30th, 2012 in PRIME program | No comments »

Last week, the advisory board of the San Joaquin Valley PRIME program met for the first time and were introduced to the program’s first five students (affectionately named The Valley Five). The SJ Valley PRIME is the sixth PRogram in Medical Education (PRIME) in the University of California system created to educate physicians to serve particular underserved areas and populations in the state.

The first five SJ Valley PRIME  students recently completed the first block of their first year in Medical School, with a special commitment to understanding the unique healthcare needs of California’s Central Valley. You can read more about the program here: http://www.ucdmc.ucdavis.edu/mdprogram/sjvprime/about.html

 I was inspired to hear from Christina Thabit, one of the students, who grew up in the farmland of Tulare. Christina joined the SJ Valley PRIME program to give back to the region she considers home. She plans to practice medicine in the Central Valley and conquer the problems of access, education and trust and to inspire California’s children to also pursue an education in healthcare.

The San Joaquin Valley PRIME is the first step of offering medical education in the Central Valley, from Sacramento to Bakersfield and every where in between. Medical education in this area has been needed for a long time, not only to provide more opportunity and hope for students who want to become a physician but also to focus on the particular public health needs and social determinants of the area.

The board is comprised of the leaders from UC Merced, UC Davis and UCSF-Fresno and The California Endowment senior program officer, Sarah Reyes. Chancellor Dorothy Leland from UC Merced co-chaired the discussion with me. She and I are promoting the San Joaquin Valley PRIME program to raise awareness of this program with community partners, such as United Healthcare which funded the program’s launch. This program is currently not funded by the legislature. Philanthropy is needed to achieve our mission to to reduce the financial burden for our students.

The students took a leap of faith to be the inaugural class of a still under-development program. I am grateful to everyone who brought this program to fruition.

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Raise your I.Q.: Improve the Quality (IQ) of care and of health by integrating education with implementation science

Posted by Fred on January 24th, 2012 in General, Integrating Quality | No comments »

I want to share with you how we can be a community that is simultaneously student focused AND patient centered. You know my background in cancer medicine and palliative care. I have always been deeply committed to improving my own competencies and those of other life-long learners. But we have all learned that to be educated is necessary but not sufficient to achieve excellence in clinical care. For example, knowledge of cancer therapy is important but must be translated into safe, timely, effective cancer care, delivered by an interprofessional team. I believe that effective palliative care education must be delivered as effective palliative caring throughout illness.

Life-long learning must be accompanied by active participation in the continual process of improving the quality of health care and of the health of populations we serve. A culture of quality at academic health centers such as ours can only be inculcated through active engagement of ongoing, interprofessional collaborations in quality improvement processes. This is the epitome of systems-based practice and case-based learning. Trainees and students learn to incorporate implementation science into their daily work and then to mentor future generations of learners.

This week, an interprofessional committee will review abstracts recently submitted for either a poster or podium presentation at the March 6, 2012, Integrating Quality Symposium: Linking Education and Research.  Details about this symposium are available here: http://healthsystem.ucdmc.ucdavis.edu/rsvp. This symposium is open to all students and employees at UC Davis Health System.

The symposium is one of several IQ initiatives and will feature two nationally recognized speakers — Dr. Brent James, Executive Director, Institute for Healthcare Delivery Research, and Vice President, Medical Research and Continuing Medical Education, Intermountain Healthcare, and Dr. Kenneth Kizer, Director, Institute for Population Health Improvement, and Professor, Emergency Medicine, School of Medicine, and Betty Irene Moore School of Nursing.

I am personally inspired to hear from students, trainees and those who work closely with them to enhance care:

“As a medical student, it’s fascinating to take a step back from patient care and treatment and examine how processes work, or don’t work,” said Lily Cheng who, mentored by Dr. David Wisner, as a third-year medical student in 2009-10, investigated pulmonary embolisms and deep-vein thromboses. “Small things that we can change consistently in the practice of medicine can have real benefits for preventing deaths and reducing complication rates.”

In the coming weeks, I will write more about raising your I.Q.

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Welcome from Fred Meyers

Posted by Fred on January 9th, 2012 in General | No comments »

Welcome to the Advancing Health blog. In this first post, I’d like to introduce myself and the goal of this weekly blog. I’m Fred Meyers, executive associate dean of UC Davis School of Medicine. My primary role is to focus on the value of UC Davis Health System through the integration of research, education, clinical care and community engagement.  I am also the chief operating officer of the UC Davis School of Medicine, department chairs and center directors. I enjoy many more roles which will be shared in this blog over time.

My goal is to enhance communication by writing a few paragraphs each week on one topic related to advancing health. Over the last few months through town hall forums on the Strategic Plan and other gatherings, I’ve heard that more communication and transparency is preferred at UC Davis Health System. This blog is one way to share thoughts and ideas –as a short summary of challenges, exciting discoveries or what’s happening in health in our society. I invite you to join me on Linkedin where you’ll receive notifications every time I post a new blog.

I’ll end this first chapter about the importance of communication, with quotes on the diversity of ideas. At the heart of true communication is debate and dialogue with different perceptions, which allow innovative ideas to form and become reality:

“Ideas come in pairs and they contradict one another; their opposition is the principal engine of reflection.” – Jean-Paul Sartre (1905-1980)

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