Caring in the delivery

In my last post, I wrote about our focus on quality, on the quest for excellence. But whether it is a cutting-edge therapeutic or a process designed to minimize the risk of error, how we deliver that care—what happens outside of the clinics and procedure rooms—is just as critical. When things run smoothly outside, physicians, nurses, and APPs have more energy and attention to focus on the patient. When we can count on the rest of our team outside to be operating in concert with our efforts inside, we will be more effective, less distracted. Clinicians and staff should be able to use their unique talents to achieve the best possible outcome for our patients. In the coming months, you will hear more about and begin to see a new leadership structure being piloted in our main campus ambulatory clinics. The goal is to increase the amount of coordination among each clinic’s members, open new and effective channels for communicating, and establish consistency and predictability in how all the clinics operate.

In broad strokes, clinics will abandon the old model in which medical directors, nurse managers, and directors of ambulatory operations oversee only their respective areas and report to their respective leaders. Instead, each clinic will now share leadership among representative members of each of these three groups. A triad composed of a physician, nurse, and an administrator will form a clinic management team. They will be responsible for managing clinical operations, including alignment with institutional goals, patient access and efficiency, and financial performance, developing budgets, managing staff, and implementing any new operational initiatives. In turn, their oversight will come from the department chair, the department administrator, and another triad composed of current Chief of Staff Dr. Marta Van Beek, Nursing’s Melissa Gross, and Grant Worthington. This group will approve strategic plans, staffing requests, and proposed budgets and review space assignments and capital requests. Under this new structure, the department will have a bigger footprint in administration, but also one that is shared equally with our colleagues from the College of Nursing. These transitions will take time and will not come without hiccups, but we all should start to feel the positive benefits sooner rather than later.

We are no strangers to thinking about new and better ways to deliver health care. In fact, we have a global reputation for health services research, particularly within the Iowa City VA, when it comes to caring for people who live in rural areas, but also for its close relationship with UI Health Care. A recent arrival to our department, General Internal Medicine Research Assistant Professor Dr. Heather Davila, was drawn to Iowa from Boston because of that reputation. That, and encouragement from Dr. Samantha Solimeo to apply for an open Career Development Award focused on rural health care delivery, which Dr. Davila succeeded in obtaining. Now she will spend the next two years on 75% protected time working and training inside CADRE, a creative and nimble research team, one of the VA’s Centers for Innovation. Her current focus is how in-home care can be delivered to aging and rural veterans and disparities between urban and rural veterans. Research shows that the best outcomes result when people can age in place, but access to care for many living in remote areas is limited. Dr. Davila’s previous work has focused on outcomes disparities between men and women in long-term-care facilities, so she will be up to the challenge, especially in such a supportive environment as ours.

Training for health services researchers is built into much of the structure of the work here. For years our trainees have had access to the VA Quality Scholars program, currently led in part by Nephrology’s Dr. Melissa Swee and General Internal Medicine’s Dr. Hilary Mosher. The newly launched health services research fellowship, funded by the VA’s Office of Academic Affiliations and led by Dr. Michelle Mengeling and Dr. Michael Ohl, is about to begin recruiting its second class. Their first two fellows have just gotten started last month. Dr. Matt Smith just completed his infectious disease fellowship with us and will focus on epidemiology. Dr. Lexi Pratt recently completed her PhD in Occupational and Environmental Health at Iowa and will examine the intersection of public health and industrial hygiene. While their individual projects proceed under expert guidance, they will learn about everything from ethics, informatics, and systems science to implementation science, community engagement, and research methods. We in the department hope to recruit the next generation of physician-scientists from this program. If anyone is interested in joining next year’s class, Dr. Mengeling encourages them to visit their website.

About Isabella Grumbach, MD, PhD

Isabella Grumbach, MD, PhD; Interim Chair and DEO, Department of Internal Medicine; Kate Daum Endowed Professor; Professor of Medicine – Cardiovascular Medicine; Professor of Radiation Oncology

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