The Year Ahead

2012 was a year of continued momentum, as summarized in the last two issues of OTSP. Each college, center, institute and hospital will now maintain — and even accelerate — this momentum in 2013 in its own unique way, while in pursuit of our common goals. Our shared vision reflects the specific needs and opportunities of each component of our academic health center, as well as the objectives outlined in our overall Strategic Plan.

The key strategic elements of our vision have been articulated in detail, and also summarized in list form. They bear repeating in a discussion of goals for 2013:

We have made considerable progress in each of these areas. If 2013 is to be a year in which we maintain — and even accelerate — the momentum of 2012, we will need to focus actively on those things that will be the key catalysts: dean recruitments, patient-care quality, GatorCare and GatorAdvantage, clinical and research facilities, research productivity, philanthropy and new curricula. As well, we need to work hard to defeat or mitigate key threats — i.e., state and federal legislative actions that may significantly impair our education and safety net missions.

Recruitment of New Deans: To achieve our goals as an academic health center, it is critical that we recruit the very best leaders to each college, center, institute and hospital. In 2013, three college deans will be appointed to lead the colleges of Nursing, Pharmacy and Veterinary Medicine. These deans will be able to build on the superb work of Deans Kathy Long, R.N., Ph.D.; Bill Riffee, Ph.D.; and Glen Hoffsis, D.V.M.; respectively, and will have an exciting opportunity to forge new ideas. Search committees for the three college deans are hard at work identifying and interviewing candidates, and each search is proceeding with broad faculty input. The reputation of the University of Florida, of our academic health center, and of the specific colleges has drawn excellent candidates to these searches. Thus, 2013 will be a year in which we pause to recognize and honor the achievements of the deans of Nursing, Pharmacy and Veterinary Medicine, and in which we welcome new leaders to these colleges.

Patient Care Quality, and the Patient Experience: Quality is Job 1. This is the centerpiece of the entire strategic plan. As our quality of care has improved, so has the excitement about our education and clinical missions. Thanks to the efforts of faculty and staff throughout every component of our ambulatory and inpatient service, in both Gainesville and Jacksonville, we have made substantial progress in most of our safety and quality scores based on University HealthSystem Consortium (UHC) metrics. For the upcoming year, in addition to continued quality and safety initiatives related to medical outcomes such as mortality rates and patient safety indicators, we will begin the process of improving the behavioral aspects of interactions with our patients across UF&Shands.

Such interactions are summarized in quality scorecards by a patient assessment called “patient satisfaction.” This is really a summary geschält of their overall experience. That experience reflects their perception of the service provided by each of the people with whom they have interacted, and their sum-total view of the hospitality afforded them. “Hospitality,” “hospital” and “hotel” all have the same latin root: hospes, which relates to the idea of a “guest.” Our patients have illnesses for which we aspire to provide the best medical care possible, but they are also guests in our clinical offices and hospitals, and should be shown a level of hospitality that is just as exemplary.

Toward this end, 2013 will be a year in which we work with Human Resources in both UF and Shands to develop uniform approaches to orientation of new faculty and staff, and to the training of existing employees, in service and hospitality. GatorCare and GatorAdvantage: Both of these programs are about Gators taking care of Gators. 2013 is the year in which GatorCare, a self-insurance program for health services, will be launched for employees in our affiliated organizations not directly employed by UF (such as Shands), or in groups employed by UF who were previously self-insured (e.g., graduate students and medical faculty). Also, 2013 will be a year of continued improvements in access and customer service in the GatorAdvantage program, which is designed for UF employees who are insured under the state’s health plan. In both programs, the goal is to reach out even more to our colleagues and co-workers at UF and at Shands, and provide them with great service and expert, compassionate care. As we do this through GatorCare and GatorAdvantage, we will gain the confidence of increasing numbers of faculty and staff; word-of-mouth will grow, a tipping point will be reached, and momentum will accelerate. This is happening already, but we must be vigilant in all aspects of our care-delivery system, especially in the service and hospitality aspects.

Clinical Facilities: We have maintained that improvements in patient-care quality as Job 1, and improving access, will create a path to our door. Indeed, this is occurring and we are testing the capacity limits of our facilities. With increased clinical volumes, being appropriately mindful of costs, Shands at UF is now producing financial margins sufficient for reinvestment, expansion and support of the academic mission. We continue to create the Shands Hospital for Children at UF. Renovations have been ongoing and this process will accelerate in 2013, with the construction of a new façade, a new entry pavilion, a new dedicated lobby, a new NICU and new ICUs. In parallel, significant upgrades and renovations are occurring in the obstetrical units and this work will continue as well. UF&Shands Family Medicine at Main, UF&Shands at Jonesville and UF&Shands at Springhill are now all operational; 2013 will be a year in which these facilities will be increasingly used to accommodate our ambulatory services in primary and specialty care.

In Gainesville, the robust partnership between faculty and hospital administration and staff has led to a level of patient volume that often approaches our capacity. All projections point to continued growth. In 2013, with input from our Strategic Cabinet, Board, and faculty and staff, we will be making decisions about how best to build patient-care facilities that will accommodate this growth in clinical volume. This is a forward-looking exercise, being thoughtful about our high-bar aspirations as an academic health center while being mindful that there will be significant downward pressures on clinical revenues to support this growth because of likely changes in health care reimbursement at the state and federal levels.

In Jacksonville, 2013 will mark the beginning of construction of the new multispecialty ambulatory facility in North Jacksonville, a key step in the long-term plan to take advantage of areas of population growth and new markets in the community. As well, under the leadership of hospital CEO Russ Armistead, M.B.A., and Dean Dan Wilson, M,D., and with input from chairs, faculty and staff, focused attention will be paid to renovations of the main facility to improve the patient experience. This will begin with facility solutions to matters such as patient registration, laboratory services, scheduling, imaging services and related matters. In addition, since a large proportion of the overall clinical activity at Shands Jacksonville flows through the Emergency Department, we will be making renovations to the E.D. that will decompress clinical volumes, improve waiting times and enhance the surroundings.

Research Facilities: The brand new, and quite beautiful, orange-and-blue UF Research and Academic Center at Lake Nona is now open. This is an extraordinary facility that include educational space for the College of Pharmacy, specialized clinical and laboratory research space for the colleges of Medicine and Pharmacy and space for clinical trials for the Institute on Aging. Construction on the Clinical and Translational Research Building is virtually completed and will open in the March to April time frame. This will house the Institute on Aging, the Clinical and Translational Science Institute headquarters, the General Clinical Research Unit, the Department of Epidemiology and the Department of Biostatistics and several specific clinical research programs. The Animal Care Services facilities has been significantly enhanced by the recent renovation of its infectious disease facility, which will afford investigators within the colleges of Medicine and Veterinary Sciences the opportunity to carry out important infectious disease research. Research Programs: 2013 will bring tremendous opportunities to solidify and expand how we work together across our education, research and health-care enterprises to make the UF Academic Health Center one of the best venues for fundamental discoveries, and for diagnostic technologies, medical treatments, health interventions and policies that will improve health across Florida.

The great growth that has occurred in the research base of the UF Academic Health Center presents us with a tremendous opportunity to build on this momentum in 2013. With the recruitment of Dr. Patrick Concannon to head the Genetics Institute, we will see an even greater linkage between genetics, genomics and medicine. In the Institute on Aging, researchers are studying the effects of physical wellness and active lifestyle on healthy cognitive aging. Complimenting the strong clinical area of addiction medicine within the UF Academic Health Center, there is a strong foci of investigators exploring the fundamental basis of addiction. Researchers from multiple UF Academic Health Center colleges are working on the impact of neuromuscular disease on respiratory function. Recent hires in the areas of infectious disease, immunology and innate immunity are expanding our understanding of key pathways to inflammation and cancer. Building on our strong foundation in virology research we are making significant strides in the treatments options for HIV, HSV, HCV, HPV and others. Indeed, 2013 will be a year of great discovery.

Several initiatives in 2013 will advance our leadership role nationally in strengthening the linkage between health research and patient care. First, the UF Consent2Share project, which offers patients an opportunity to share tissue leftover from their health-care visits for research and/or to be contacted about future research studies, will be expanded to our entire health-care system. Second, UF will continue its leadership in spurring the implementation of personalized medicine in our own health system and beyond. Third, we will strengthen our evolving focus on “implementation science,” an emerging field that is being increasingly supported by the National Institutes of Health, the Centers for Disease Control and Prevention, the Patient-Centered Outcomes Research Institute and other national agencies, and by the Global Fund, World Bank and the World Health Organization internationally. As defined by the Annual NIH Conference on Implementation and Dissemination, implementation is the use of strategies to adopt and integrate evidence-based health interventions that change practice patterns and improve health. Implementation science emphasizes outcomes that consumers, practitioners and communities value, and thus takes a patient- and community-centered approach.

Other initiatives will help spur both basic and clinical research. UF will lead the launch of a regional integrated metabolomics center, a collaborative effort of the National High Magnetic Field Lab, UF CTSI, UF Department of Chemistry and numerous investigators with potential metabolomics applications across the UF Health Science Center and UF Institute of Food and Agricultural Sciences. Exciting new partnerships at Lake Nona are in development with Orlando Health, Sanford-Burnham and others.

Philanthropy: Funding streams from the state of Florida for our educational and research programs have been declining in the past few years. While this process has hopefully bottomed out, we cannot rely on significant expansion in the future. A similar statement can be made for NIH funding. Philanthropy, therefore, becomes more important than ever to fill in the gaps and spark growth. Despite the economic downturn, during calendar year 2012 cash gifts (including cash payments on pledges) to the colleges and hospitals that comprise UF&Shands totaled $36.5 million, and new pledges totaled $47.7 million. This shows that our donors are excited about developments at UF&Shands and wish to support our efforts. For 2013, our goal is to continue this substantial show of support, with a focus on major gifts and building development programs in all of the units that comprise UF&Shands.

New Curricula: Interprofessional education (IPE) remains a key element in the UF HSC strategic plan, with the mission to train health professionals together to promote collaborative care that is high-quality, safe, and patient-centered. The UF HSC has been recognized for its national leadership and innovative practices in IPE during the last year by the JH Macy Foundation and the Educational Advisory Board, a Washington, D.C.-based educational consultant group. This year we have implemented a second large-scale learning experience using team-based learning for more than 750 students, including more than 100 faculty and students from the Jacksonville campus. An applied quality improvement activity for senior level pharmacy, medicine and health administration students was started with the assistance of UF&Shands patient safety experts. This coming year will be an exciting one, with projects utilizing the electronic medical record to demonstrate different disciplinary perspectives between professions, and continuing work toward a summative simulation experience to assess collaboration between senior learners and its impact on quality of care. A Macy Foundation grant will help develop online curricula that will be used to provide a comparable educational experience for our students at our geographically distant campuses.

State and Federal Legislative Actions: The Governor’s budget proposal includes a number of provisions that will significantly reduce payments to safety net hospitals, including Shands at UF and Shands Jacksonville. We are actively working in Tallahassee to push back against drastic Medicaid cuts harmful to our patients, providers and communities. We will remain engaged in the legislative process as the House and Senate Committees develop and reconcile their budget proposals in the next few months. 2013 will also be a year in which the Legislature will decide whether and how to incorporate Medicaid expansion, a key provision under the Affordable Care Act that would provide funding for almost 1 million people in Florida whose incomes are under the poverty line but who are not currently eligible for Medicaid. This program will be 100 percent funded by the federal government for 2014-2017, with the subsidy gradually reduced to 90 percent by 2020. In Washington, D.C., 2013 will bring more funding threats to our academic missions. Medicare Graduate Medical Education payments and NIH research grants are particularly vulnerable to cuts. We and other academic health centers will work persistently to mitigate any federal funding reductions.

In summary, 2013 promises to be an exciting year: building on established strengths, breaking new ground and responding to multiple challenges with creativity, commitment and innovation.

I wish you all a year of personal and professional momentum and growth.

Forward Together,

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