Gaining Momentum in 2011

Without question, 2010 was a busy year of strategic planning, and of laying foundations. In 2011, we will capitalize on these accomplishments and build momentum.

Clearly, this is an oversimplification. The research enterprise is already in a momentum-building mode, and some of our plans for education, and for strategic outreach in Jacksonville, are still in a foundation-laying phase. Moreover, such broad descriptors may seem like an abstraction, far removed from the day-to-day work at the core of our missions — seeing patients, teaching students and conducting research. That said, across the Health Science Center and Shands, on both our Gainesville and Jacksonville campuses, some strategic elements have now been well-articulated:

• The patient comes first;
• The mindset of "we" and "they" is replaced by "us";
• We advance Forward Together;
• We are part of a great university. Our job is to carry out the health-related educational, research and service missions of the University of Florida;
• Clinical services are run by faculty, and faculty take ownership of patient care services and outcomes;
• Shands at UF and Shands Jacksonville operate in close collaboration with the University of Florida HSC in a distributed model as two arms of the UF&Shands Academic Health Center, under the unified governance of UF;
• Faculty and hospital administration in specific service areas must be aligned with respect to quality of care, operational effectiveness and finance;
• Clinical programs must be aligned with clinical facilities;
• As part of The Gator Nation, and in recognition of our responsibility and commitment to Gainesville and Jacksonville and their surrounding areas, we must be sure to serve the health care needs of our employees at UF and at Shands. Gators treating Gators. It's special;
• In research, we reach for excellence;
• We are opportunistic in research faculty recruitment and retention. The best science trumps a pre-defined listing of needed fields of expertise;
• Excellence in fundamental science continues to receive strong support as we develop a balanced research portfolio that includes comparably excellent clinical and translational research;
• In education, we must move boldly toward innovative programs that prepare health professionals and scientists for the current and future landscape of health care delivery and scientific investigation;
• In the health professions, we must take advantage of our full spectrum of HSC colleges across our two campuses in constructing an interprofessional curriculum;
• New educational facilities and methods are needed to implement new curricula.

In 2011, for our future success, it is important to build momentum in all of these key building blocks.

We will make significant progress on an interprofessional curriculum that will be incorporated into the educational programs of the six HSC colleges, across Gainesville and Jacksonville. This effort is underway through a committee of the colleges' education deans, led by Dr. Richard Davidson. The committee is developing a set of common learning objectives and competencies for interprofessional education that each college will approve and add to its curriculum. Initial priorities include a focus on patient safety and quality, and on end-of-life care. The interprofessional patient safety and quality efforts began this past fall when 615 first-year students completed eight online lessons at the Institute for Healthcare Improvement’s Open School, and participated in case-based multi-college small group sessions addressing patient safety. An online course in end-of-life care, developed by multiple colleges, is undergoing final review. Additional elements of this new interprofessional curriculum will be piloted during the 2011-12 academic year, with full recommendations implemented beginning 2012-13.

In recent years, some colleges, such as the College of Nursing, have revised their teaching programs to reflect the future directions of the field. The College of Pharmacy continuously adjusts its curriculum to meet the contemporary needs of pharmacy practice. The COP has divided its curriculum committee into subcommittees to move curricular changes through more rapidly. The College of Veterinary Medicine is expanding its class size to address the shortage of veterinarians.

In the College of Dentistry, nearly $7 million in new grant awards from the Health Resources and Services Administration of the U.S. Department of Health and Human Services will fund curricular innovation to ensure that tomorrow’s dentists graduate with an understanding of how to treat a diverse patient population. A recently approved D.M.D./Ph.D. program will help grow the next generation of dental scientists, and a grant to expand and add new technologies to the dental simulation laboratory will help expand class size and more effectively teach dental surgical skills.

Currently, the College of Medicine is developing a new curriculum for its students, which will transform the current, traditional format of two years of basic science education followed by two years of clinical training. Instead, there will be a number of diverse educational pathways. All will build on common core competencies in medical knowledge, patient care skills, interpersonal communication, professionalism, system-based learning, evidence-based practice and teamwork. However, depending on students’ career interests (e.g., subspecialist practice, primary care medicine with a health-policy focus, academic medicine and biomedical research, etc.), they will choose one of several curricular pathways that provide an enriched curriculum tailored to their individual professional interests. The educational content of these pathways will be delivered in a manner that blurs the traditional year-by-year progress of medical education.

A new curriculum requires new facilities, since form follows function. The College of Medicine will emphasize small-group collaborative learning, team-based patient care with other health professions, and competency- and outcomes-based assessments. This requires specialized learning and assessment spaces, development of digital media, expansion of standardized patient and simulation programs, and application of new information technologies. Some of these spaces currently exist, but they are distributed across campus and are not optimally configured. In recent years, modern buildings have been constructed to further the educational programs of the colleges of Nursing, Pharmacy, Public Health and Health Professions, and Veterinary Medicine. A key goal for the upcoming year is to complete the design — and secure funding — for a new educational home for the College of Medicine and Physicians Assistant program, which will contain educational facilities that will also be used by the other Health Science Colleges and the graduate medical education (residency) training programs.

Similarly, the Dental Science Building, the main home of the College of Dentistry, opened in September 1975. The college has since expanded enrollment in the Doctor of Dental Medicine program, added 17 graduate and certificate programs, and has grown into one of the leading dental research institutions, currently ranking fourth of all U.S. dental schools in federal research funding. Dental education, patient care delivery and basic research have changed dramatically since the college was founded in 1972, and the facility has not kept pace with these changes. UF has recently agreed to fund a planning effort that will address future facility needs to support new ways students learn, how scientists conduct research and how patients experience their dental care. This investment will yield a plan that will enable the college to maintain its current high ranking, expand its research programs, provide excellent patient care and contemporary dental education, and continue to compete for the best and brightest students.

In Jacksonville, building on a story of success and innovation described in a recently completed White Paper (http://jax.shandsorg/history), 2011 will be a watershed year under the new governance structure summarized in the last newsletter. A new Shands Jacksonville Board will meet for the first time this month, and will immediately address its key strategic priorities: focusing on patient care quality and becoming a more broad-based health system that serves a larger cross-section of the Jacksonville community; developing more depth in clinical and translational research and adding to economic development in Jacksonville; building on the success of the Proton Therapy Institute with new, innovative programs; and serving UF students in Medicine, Pharmacy and Nursing with a learning experience that is fully integrated with the new curricula of these colleges, and in appropriate facilities.

Another important goal for 2011 is to reach out clinically to our communities more broadly to begin the process by which UF&Shands becomes the instinctive "go to" place for health care. In Jacksonville, this will require establishing clinical programs and facilities outside the main campus on Eighth Street. In Gainesville, this will require improved delivery of care to our colleagues and their families at the University of Florida and Shands, who comprise a significant share of the local population. This process is the appropriate stance for UF&Shands as a university-based academic health center, and it is vital to our current and long-term financial strength. Financial strength is a fundamental requirement as we face significant headwinds in reimbursement at the federal and state levels, and in the NIH budget that funds so much of our research.

How do we get where we need to be? By continuing our unrelenting focus on quality, strengthening the Forward Together partnership between the University of Florida and Shands, improving access and facilitating timely and humanistic interactions for each patient at each step along the way, embracing a culture in which faculty take ownership for the individual care and outcomes of all patients in our system, and in which all staff members — whether directly or indirectly involved with patient care — ask each day how they can improve each patient's experience. This is the concept of "I Promise." If we improve access to our talented faculty and staff, and demonstrate the benefits of being cared for in an integrated academic health center by working together relentlessly to improve the quality of each patient's experience and clinical outcome, UF&Shands will naturally across time be recognized by the residents of our communities as the first and best option for all health care.

An important aspect of quality is ready access to care, which we began to facilitate last year through the GatorAdvantage program. GatorAdvantage, including both Gainesville and Jacksonville, will be extended to the entire University of Florida community by March. In parallel, once our patients arrive at their appointments, an important part of quality is to provide welcoming, timely and helpful customer service. An emphasis on enhanced customer service, including specific training, will be an important dimension of our focus on quality during the upcoming year. And, of course, continued efforts to improve our inpatient safety and quality metrics at our Shands hospitals in Gainesville and Jacksonville is an uppermost goal each day. Teams jointly populated by faculty and hospital administration in key areas of quality improvement are hard at work to improve the patient experience and outcomes in our hospitals.

Speaking of teams, 2011 is the year in which our Interdisciplinary Clinical and Academic Programs (ICAPs) will be launched in Gainesville and Jacksonville. ICAPs represent a faculty-led effort in specified clinical areas (e.g., cancer, cardiovascular disease, children and women, neuromedicine, and organ transplant) to create a process of care that maximizes quality, operational performance and financial results. Teams of faculty and hospital staff with aligned incentives will assess baseline metrics in quality, operations and finance, and then allocate or reallocate faculty and hospital resources in a manner that will lead to the greatest improvement in these metrics. In parallel, we will begin aligning clinical programs and facilities. In Gainesville, we will open the Pediatric Emergency Department and the Chest Pain Center at Shands at UF, and complete the design of the new primary care facility in East Gainesville and a multi-specialty facility on 39th Avenue. In Jacksonville, we will plan and begin to implement outreach to inpatient and outpatient facilities that complement the main campus on Eighth Street.

Throughout 2010, we have been rolling out our electronic medical record ("Epic") at the Gainesville faculty practices, one by one. A different electronic medical record ("Allscripts") has been in place in Jacksonville for a number of years. Due to the flexibility and patient understanding of our faculty, and to the stellar work of our Epic staff under the leadership of CIO Kari Cassel, we will launch the first phase of Epic for inpatient services at Shands at UF in the Spring, and at Shands Jacksonville this summer. The implementation of our electronic medical records supports our quality goals in patient care, improves our research capabilities and overall operational performance, and will be embedded in our educational curricula for our students.

On a regional basis, taking into account UF&Shands in Gainesville and Jacksonville and our evolving affiliations in Central and North Florida, we must be proactive and nimble in 2011 in positioning ourselves for health care reform. There is considerable flux in Washington and Tallahassee, and nobody knows what changes in health care delivery and reimbursement systems will actually occur. We must position ourselves to care for populations as a whole, thinking through the implications of prevention and wellness, primary care, a shift from inpatient to outpatient care, referral networks, regionalization of highly specialized services and efficient use of ancillary services.

2011 will be an exciting year for research. In June, we will break ground on the Clinical and Translational Research Building on the HSC campus, which will include the Institute on Aging and the Clinical and Translational Science Institute (CTSI). Construction and scientific planning for the Academic and Research Center in Lake Nona will continue. To further the momentum of research on the Jacksonville campus of UF&Shands, 2011 will be a year of planning for the programmatic design of a clinical research building and of securing its funding. As part of the commitment of the CTSI to enhance research infrastructure, we will conclude searches for the inaugural chairs of two new departments — biostatistics and epidemiology — each of which will bridge the College of Public Health and Health Professions, and the College of Medicine. A number of CTSI infrastructural programs that will provide benefit across the HSC research portfolio will launch in 2011. These include an enhanced biorepository; an electronic system for online clinical trial data capture; the research component of Epic and an associated integrated data repository, which gathers data from both clinical and research systems; and an online system for IRB protocol submission and review (Click Commerce). All of this will build on continued support for our basic and clinical researchers, who are working in a very challenging environment to renew existing grants and secure new grants, including those that result from ARRA projects.

2010 was the year we put into place key foundational elements. 2011 will be our year to gain momentum. As part of the University of Florida, we have a unique set of resources in health care services and sciences, and an extraordinarily talented faculty and staff committed to the goal of making UF&Shands a truly great academic health center. We will make it happen.

Forward Together,

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