Our critical clinical work

In my last post I talked about the ways in which our approach to education makes us unique among our peers and even throughout the nation. We prioritize innovation in curricula and methods, we tailor our training programs to fit individual learner interest while ensuring the fundamentals are achieved, and we train up future education leaders so that clinician-educators remain central to the direction of our department. The parallels of those same principles can be found in our clinical mission as well. We work with clinicians to help them define the shape of the career they want to have. We are committed to searching for innovations and efficiencies that allow us more time for what is important. And there are opportunities for junior and mid-career faculty to help lead us toward the best possible future for our practices. For example, eight members in Internal Medicine (out of a cohort of 30) participated in THRIVE@Carver, one of the collegiate leadership development programs. These eight put together proposals for how University of Iowa Health Care can improve health disparities among at-risk populations through value-based health care reimbursement models. They will present their proposals over the next few weeks in “Shark Tank”-like presentations for institution leadership. Good luck!

If innovation is one of our guiding principles when it comes to the clinical mission, what are some other practical ways that this has been applied? Today I want to touch on some of the scope of our department’s clinical footprint and briefly address where I think the challenges for us are situated. First, I believe that even discussing where our department is delivering care is a radical and rapid shift from how most of us have thought of Internal Medicine’s patient care. Certainly outreach clinics have been a service to the state of Iowa and an area in which many members of our department were forward-thinking decades ago. But there is a difference between providing care for a day at a time in the community and making capital investments in permanent buildings that offer services year-round. Today, we are planting flags away from our long-term home base.

If you caught Dean Denise Jamieson’s “Stay in the Loop” town hall earlier this week, you have a good sense of what is happening at a couple of our locations. As we near the six-month mark at our Downtown campus, it is important to note just how much we have achieved and how quickly. Many of you in this department have shown superb leadership to ensure that the former Mercy Iowa City patient population does not go without necessary care. It will be some time before we have fully absorbed the costs of this move, and it is one that we should not let ourselves be too humble about. UI Health Care is no mercenary raider gobbling up competition; we stepped up with a promise of enduring loyalty at a time no one else would. To put it simply, people have jobs and they have health care because of what Iowa has done and will do.

And, as Dean Jamieson said, what we do downtown is only going to get better. Improvements to the infrastructure, everything from the roof to imaging equipment, are at the top of the list. Service expansions in family medicine and obstetrics are important areas for growth, but it is worth noting that in-patient beds have crept up from 55 to 65, thanks to the dedication of our Hospitalist team. Right-sizing our specialty services downtown, including GI, infectious diseases, and cardiovascular medicine, remains an ongoing area of concern at all levels of leadership.

Although our clinical operations throughout Iowa City understandably get a lot of our attention, we are also planning how Internal Medicine can play a role in the new North Liberty facility. It is likely that services such as ID and cardiology, and perhaps several others as well, will provide support when that facility begins operations in April 2025. Outside Johnson County, we are also closely watching our now well-established oncology practice in the Quad Cities as well as new services in endocrinology and cardiology. Also on the deck for 2025, we are assessing the needs and our capacity to play a part in the expansion into the Des Moines area.

Although, the challenges around staffing and space are ongoing, and perhaps always will be, our commitment to excellent care every time is being rewarded. We are once again ranked as the number one hospital in the state of Iowa and our cancer care is at #41 in the nation. Three of our subspecialties were ranked “high performing,” putting us in the top 10 percent of the country. Congratulations to pulmonology, gastroenterology, and cardiology for their well-deserved recognition. These rankings are an imperfect measure. They do not tell us who we are, but they are one of the only measures applied consistently to every medical center in the country and so we must recognize that they tell many others who we are.

Where are we headed next? The road to providing for patients from all four corners of Iowa may twist or double-back and likely include strategies to reach patients where they are located, through the extended network of an integrated healthcare system and through telehealth. Extending our geographic reach will require creative thinking and fresh ideas to fuel and sustain our growth. Other approaches for growth include becoming nimble in using billing code (G221) that can be applied in complex continuity of care interactions, as recently introduced by leaders in our Division of Immunology. Well done! I am also grateful to Grant Worthington, who joins us from hospital administration as our next interim clinical department administrator. His experience both in the C-suite as well as his successful years in the Department of Otolaryngology give me confidence in the sustainability of our critical work.