New Year’s Reflections: A Look Ahead

Last week I looked back at 2009 and summarized the many milestones and accomplishments that were achieved at our academic health center. A foundation for the future is being laid down. Momentum is developing.

This week I look ahead. 2010 will be a year in which we complete this foundation for the future by fully developing our comprehensive strategic plan. In this process, we aim to establish clarity about the overarching vision, goals and strategies of the UF Health Science Center and Shands HealthCare. Moreover, each dean, center or institute director and hospital CEO will work with their faculty and staff to define the goals and strategies specific to their college, center, institute or hospital that gives distinct expression to their individual strategic plan. We will not be able to implement the overall plan for the academic health center successfully unless each employee of each unit has an opportunity to provide input and feels engaged in an ongoing fashion. Thus, when your dean, director or hospital CEO calls on you for your ideas, don’t be shy!

Of course, we will not sit still while this planning effort is under way. We will continue to build on the successes listed in the last newsletter by making sure we recruit and retain the most talented faculty and staff, fill in gaps in education, research and clinical programs, and continue to be nimble and opportunistic about situations that present themselves in real time.

Overall, in 2010 we will try to leverage those things that make us distinctive — what sets us apart but also what allows us to make truly unique contributions for the betterment of patients and populations who count on us for their health care. This includes our broad-ranging research programs that are directed at improving health, and also our educational programs that train the next generation of health care clinicians and biomedical scientists. Let’s take a peek at some key themes for the upcoming year.

Patient Care Quality and Safety

In the clinical arena, there is no more important component of our collective efforts for the upcoming year than to make sure that we are focused on continuous improvement in all aspects of patient care quality and safety. This is the No. 1 goal of our clinical strategic plan as defined by the Strategic Planning Cabinet; as such, it will receive the greatest amount of energy and attention. If we achieve this goal, everything else follows. That is, making certain that every thread of our clinical culture and decision-making is directed at improved patient care quality and safety is not only at the core of our overall mission as an academic health center, and is quite simply the right thing to do, but it is strategic. Creating an environment that is best for our patients will attract the best health care providers to UF&Shands, attract the best students and postgraduate trainees and attract patients, and thus generate more financial margin to allow reinvestment in our clinical and academic missions.

To achieve continuous improvement in patient care quality and safety, we will enlist your help to effect operational change at all levels of the organization: nursing and medical practice, managerial functions, outpatient and inpatient operations, and the work of our Board Quality Committees at Gainesville and Jacksonville and of the main boards of these hospitals. An important step already accomplished is the launching of a comprehensive electronic medical record system and recruitment of a chief information officer for the UF&Shands academic health center. We are at the final stages of this important recruitment. Other changes will come quickly. We will define benchmarks, conduct an assessment of our current performance, and establish high-bar goals. Please make suggestions and become engaged!

Clinical Facilities

The opening of the Shands Cancer Hospital in 2009 is a hard act to follow. And yet critical strategic decisions must be made in 2010 about inpatient and outpatient facilities in Gainesville and Jacksonville, and in other communities consistent with a rational regional strategy that meets the needs of the population we serve.

With respect to outpatient faculty practice, the Emerson Medical Plaza in Jacksonville is a unique University of Florida and Shands Jacksonville multiservice health-care center that reaches the population in the eastern section of the city. Faculty at Emerson offer initial evaluations, health screenings, imaging, noninvasive to minimally invasive procedures and a wide variety of outpatient services in many medical specialties. Development and expansion of this site will be important in creating a diversified patient base for Shands Jacksonville. For the future, serious consideration will be given to developing an additional outpatient campus in the growing northern section of Jacksonville.

In Gainesville, the Strategic Planning Cabinet endorsed an overarching strategy that involves concentrating future growth of faculty practice sites primarily on a single UF&Shands campus. This will complement the existing ambulatory campus at NW 34th Street and Hull Road, which might also undergo a modest expansion of specialties that can coordinate well with its major presence in orthopaedics. Primary care sites might be located on these two sites as well, but primarily at other locations throughout the region. Our commitment to Gainesville will also be expressed in the form of interprofessional teaching practices in new facilities located in areas of need, both East and West Gainesville.

Having opened the Shands Cancer Hospital, which extends an already robust effort in cancer that includes the Jerry W. and Judith S. Davis Cancer Pavilion for outpatient treatment and the Cancer-Genetics Research Complex, careful thought must now be given to the evolution of other critical inpatient services. These include facilities for children’s and women’s health care, neuromedicine and musculoskeletal and cardiovascular services. The goal is to coalesce the diverse components of each of these services into integrated facilities so that form follows function to optimize the quality and safety of patient care.

Education

The overarching strategic goal for education as defined by the Strategic Planning Cabinet is to establish the University of Florida as a national model of interdisciplinary education in the health science professions. We have a nationally unique opportunity to accomplish this goal, which will require a coordinated effort among all six HSC colleges. Significant revisions in the curricula of many of our colleges will be necessary. The need for such curricular change dovetails well with the planned recruitment of key leaders in education. We can also take advantage of our national leadership in simulation to create innovative educational programs that extend across the educational continuum, from undergraduate education programs in each of our colleges, to graduate training programs in diverse clinical specialties, to postgraduate education for practicing clinicians.

As in clinical care, to accomplish our goals in education we must integrate form and function. The Strategic Planning Cabinet has endorsed the need for a new building. Fundraising for such a building will be the primary objective for our development office in the area of education, along with student scholarships.

Research

Patient care is a core responsibility for our region, and serves as an economic engine for the missions of our academic health center. Our education mission is forward looking, training future clinicians and scientists, primarily from Florida but with a wide reach nationally and internationally. Our reputation as an academic health center, however, depends primarily on recognition for our research. To achieve our goal to be a truly distinguished academic health center, we must be recognized for the excellence of our research. Sometimes, as in NIH and US News & World Report rankings, research volume (i.e., total research dollars) is substituted for excellence. Indeed, total NIH funding is often used as a proxy for research excellence, even though other federal funding (NSF, CDC, AHRQ, Department of Defense, BARDA, etc.) is equally competitive, as is funding from prestigious Foundations. Thus, we must pay close attention to NIH funding in each of the Health Science Center colleges. In some cases, such as dentistry, we are already at the very top of the rankings; in others, such as medicine, we are in the middle of the pack; in all cases, however, we must grow at a rate significantly greater than our peers to gain in rankings and recognition.

The next two years will be pivotal in establishing a steep upwards trajectory at UF in NIH funding. The goal is to build on the CTSA and on two-year NIH stimulus funding provided by the American Recovery and Reinvestment Act of 2009. Such funding, of course, was distributed nationally, but we attracted more than our share of funding (given our relative NIH rank). With focused efforts to maximize the likelihood that ARRA grants will be converted to longer-term funding — through leverage of CTSA infrastructure, scientific oversight of grant progress, improved use of cores, strategic recruitment of investigators to fill scientific gaps, and other strategies — the goal is to maintain the momentum provided by the ARRA stimulus and emerge in two years with a durable research platform across the HSC enterprise.

As in the clinical and research missions, new facilities will be needed in research. Over the past decade, significant research capacity has been added in basic science laboratory space — the McKnight Brain Institute, the Cancer-Genetics Research Complex, and the soon-to-be-opened Emerging Pathogens Institute and Biomedical Sciences Building. As growth in basic science grants continues, the density of this space (funded dollars per square foot or per person) will increase as well. Renovations of existing laboratories will no doubt also be necessary.

Of note, the last three major NIH grants to UF — the CTSA and grants in aging and in computer networking — totaled $110 million over the next five years and are all in clinical and translational research. Moreover, many clinical research programs are in leased space or literally have recently received funding for expansion with no clear space in which to expand. Highly relevant to this evolving circumstance is that

has secured $15 million of ARRA funding to build a facility for the Institute on Aging. The Strategic Planning Cabinet will soon be considering a recommendation to expand the building substantially to create a true academic home for clinical and translational research across the health sciences.

Diversity

In all that we do — patient care, education, community health and research — we will be more effective if our faculty, students, residents and staff are reflective of the gender, racial and cultural diversity of the populations we serve. Those of us who are not members of underrepresented minority groups can better become culturally competent if we are working and learning side by side with such underrepresented minorities. Such cultural competence must permeate all of our missions — our educational curricula (both undergraduate and graduate), patient care, research and community health.

During the upcoming year, we will first assess the current status of our faculty, students, residents and staff with respect to gender, and to their ethnic, racial and cultural backgrounds. We will also assess the extent to which cultural factors are included in each mission area. This is not a small undertaking. We will then compare these data against national benchmarks and define goals for the future. In parallel, we will determine from our current community of minorities and women the barriers that may exist for recruitment, retention and promotion, and develop strategies to overcome these barriers. By this time next year, I will be able to report comprehensive data on our baseline in 2010, and the steps we are taking to improve the diversity of our health center community.

Community Health

Ultimately, although as clinicians many of us are trained to focus attention on the prevention or treatment of disease one patient at a time, the goal of our research, educational and direct clinical efforts is to improve the overall health of the populations we serve. This is a tall order: It is difficult to measure the “health” of a population, and many of the summary metrics — such as life expectancy, infant mortality, percent overweight or obese or percent smoking — are reflective of variations in socioeconomic status and other structural community factors. Nonetheless, the University of Florida Health Science Center and Shands HealthCare are prominent entities in our community and region, and we have a responsibility to use the skills and resources available to understand the determinants of population health status in our community and to effect positive changes in these determinants to the extent possible by working with our community partners.

Community health is part and parcel of each of our other missions. Factors that impact the health of populations must be emphasized in our health science educational programs, alongside factors impacting the health of an individual. Research methods for studying both population and individual health should be strengthened. In an era where comparative effectiveness research is being emphasized and funded at the national level, to do otherwise would be short-sighted. Indeed, there are a number of NIH- and CDC-funded CER projects focused on community and regional outreach across the HSC. These involve smoking cessation, obesity management, child health, addiction, cancer screening and several other areas. And finally, a key part of our clinical mission is to provide access to needed health care for all members of the Gainesville community and in underserved areas of Florida. Thus, we will continue to locate clinical practices involving faculty in nursing, dentistry, medicine, pharmacy and the health professions in those areas where access may be limited. Good examples of existing initiatives that can serve as models include Archer Family Health Care, the Eastside Clinic, our partnership with ACORN Clinic and the UF Statewide Network for Community Oral Health, a significant source of oral health care for the underserved in Florida.

Funding Plan

The Strategic Plan can only be implemented to the extent that there are identifiable funding streams to support it. As critically important as a given clinical, educational, community-based or research program may be, we can only fund it if there are funds available. We cannot, and will not, make commitments that lack a source of funding, and we will factor in commitments over time in assessing the affordability of new commitments.

That said, the future looks bright for UF&Shands in successfully accomplishing an ambitious strategic plan, despite the economic downturn and uncertain implications of health-care reform. Our commitment to quality and safety, new clinical facilities and plans for an ambulatory campus should generate the clinical financial margins needed to invest in our clinical and other missions. We will work with our philanthropic supporters on aspects of the strategic plan about which they are passionate. We will work with our scientists to identify opportunities for center and program project-level grant funding and for technology commercialization. And we will continue to work with our legislators to ensure that the State of Florida supports our academic programs at current or increased levels in recognition of the tremendous benefit that its investment to date has reaped.

This past year, we realized a series of important achievements and collectively committed to a new era of working together, building stronger bridges across our academic and clinical enterprise. When you think about it, in the past six months we have come far, and we have a lot to be proud of. When I first arrived at UF, I talked about the need to focus on connection and communication, and on transparency. About how we would craft a shared vision together. Thanks to your efforts, we are doing just that, building on the momentum we have established, and charting our course with clear goals and clear vision for the future.

We end the old calendar year and begin the new one with much optimism, and with an eye toward the opportunity that change, handled thoughtfully, can bring. My hope is that you share the spirit embodied in the Forward Together theme for our strategic planning effort. Because together we discover. Together we teach. Together we care for our patients and our communities. And together we will achieve even more.

Sincerely,

David S. Guzick, M.D., Ph.D. Senior Vice President, Health Affairs President, UF&Shands Health System University of Florida