The new vice chancellor for UCLA Health Sciences and dean of the David Geffen School of Medicine at UCLA addresses the role of UCLA and academic medicine in helping to advance healthcare reform.
For A. Eugene Washington, M.D., M.Sc., assuming the leadership of UCLA’s healthcare system and medical school in the midst of a national debate on healthcare reform is being in the right place at the right time. “As one of my mentors used to say, ‘If you’re not excited about what’s going on, it means you don’t know what’s going on – either that, or you are dead,’” Dr. Washington says with a laugh. “I am very excited to be here.”
Dr. Washington arrived in Los Angeles in February from UC San Francisco (UCSF), where he was executive vice chancellor and provost, and professor of gynecology, epidemiology and health policy. Colleagues have described him as personable and innovative. “He loves meeting people, working with people,” says Elena Fuentes-Afflick, M.D., chair of the UCSF Academic Senate and vice chair of the Department of Pediatrics. “He has this way of bringing out the best in people. He conveys the confidence that you have the skills and experience to do the job that needs to be done.”
Adds Nancy Adler, director of UCSF’s Center for Health and Community and vice chair of the Deparment of Psychiatry: “He’s really a consensus builder. His capacity to have a strong vision and bring people along to share in it, rather than impose it on them, is what characterizes him.”
Since Dr. Washington arrived at UCLA, his days have been packed, but he was able to find some time to sit down with UCLA Medicine for a conversation about healthcare reform.
Dr. Washington: When you look at it very closely, the healthcare reform bill that was passed in Congress and signed by President Obama creates a framework within which many different groups and academic health-science institutions can come together to help orchestrate this movement that will dramatically change the healthcare-delivery landscape in this country. And I believe that we at UCLA will, in fact, be an active participant in that small group that will be helping to shape the future of healthcare in the U.S.
Dr. Washington: It will be the academic healthscience institutions like UCLA that will develop the demonstration projects and pilot test various models to determine which are the highest-quality programs that add the best value at the most-reasonable cost.
Dr. Washington: When I think about the remarkable excellence we have already achieved in delivering the highest-quality care, as well as the opportunities for improvement still before us, I think of them in three dimensions. First is what goes on inside our hospitals,particularly related to innovations needed to continue improving quality of care. In this area, UCLA is at the forefront of a very elite group of institutions that are contributing important advances.
The UCLA operating system represents our organizational approach to performance management and improvement. By linking our mission and vision with goals, dashboard metrics and lean performanceimprovement efforts, we strive to continuously improve. One highlight of this approach is our C-ICARE project to improve the patient experience. As a result of engaging our staff and physicians in developing the C-I-CARE program, UCLA now ranks in the 96th percentile in customer satisfaction compared to all hospitals in the nation. This effort also underscores our unwavering commitment to patient safety and patient-centered care. Moreover, the success we currently enjoy reflects our steadfast culture of putting the patient first and honoring this concept in all we do. C-I-CARE is an example of where we at UCLA are solving a problem internally; however, the challenge of patient-centered care is also one that other institutions are facing. Other institutions are likewise facing the general challenge of consistent execution of best practices and ensuring that, at an operational level, people are on the same page, following all of the same protocols, and are very clear about their roles and responsibilities.
So an element of our contribution to shaping the future of healthcare is establishing mechanisms to effectively disseminate these innovations beyond UCLA in a timely manner. Such diffusion can involve simply telling our colleagues at other institutions about our experiences or sharing them with the world through presentations and publications. In other instances, this approach might involve more technological innovation and the creation of intellectual capital, and perhaps even the establishment of a company created to advance and disseminate some of these innovations that we identify.
Dr. Washington: The outpatient setting. Our UCLA Faculty Practice Group has about 76 office practices concentrated near our hospitals in Westwood and Santa Monica. While we are also providing highest-quality care in our practices, the opportunity before us is to continue to elevate this quality, in the same manner that we’ve done in our hospitals. We are currently pursuing this goal by promoting quality and service metrics and standards of excellence that are uniform across all practices, and performance improvement where we fall short. In doing so, we are positioning ourselves to be a leader in identifying best practices for the outpatient setting and to play a role in continuing to shape future best practices for us and for others.
And the third dimension involves what I see as one of the ultimate objectives of health reform – more focus on population health. At UCLA, we have a health system that incorporates both our inpatient hospitals and all of our outpatient practices to provide direct care of exceedingly high quality. In fact, we deservedly rank among the world’s best. With a successful model of integrated outpatient and inpatient care, we are also well positioned to become a health system in the years ahead whose reach extends well beyond the care we are providing in our hospitals or clinics. The aim here is to augment our high-quality, patient-centered care, which will remain indispensible, with additional programs and interventions that we know promote health and prevent disease. In pursuing this aim, we will be working to keep more people out of our hospitals and clinics by educating and counseling them about best practices to stay healthy.
Dr. Washington: In my role as dean of the David Geffen School of Medicine at UCLA, I am focused on educating and training the next generation of health-science leaders – physicians and researchers and educators. And it is these future generations who will be carrying these reforms forward. In addition, I work with colleagues to create new knowledge and new approaches to patient care and disease treatment through rigorous investigation. In the research arena, we have decided that one of our priorities will continue to be translational medicine – taking advantage of what’s become available through unprecedented scientific discovery to accelerate its translation into public benefit. And as vice chancellor for UCLA Health Sciences, I work with the leadership of our hospital system and our UCLA Faculty Practice Group to advance healthcare innovation, which we already have discussed.
Dr. Washington: It’s not going to be dramatic, and it’s not going to happen overnight, and we’re not going to see big shifts in the next five years. But there are aspects of the reform legislation that are going to prompt changes in how we approach our educational mission. Most of our training now is about cure – diagnosis and treatment – which is obtained on specific rotations in the hospital or clinic. But increasingly, we are going to pay much more attention to health promotion, disease prevention – to addressing behaviors that can lead to or exacerbate illness.
We are also going to have to pay more attention to systematic care coordination for the chronically ill. In all of these areas, encounters in the examination room may, in many cases, become much more focused on decision making assisted by state-of-the-art technologies, which will require a different approach for the physicians that we train. To some extent, it will require emphasizing the physician’s role within the healthcare system. In addition, some of the counseling that physicians offer currently is not performed very well because we have not traditionally been trained sufficiently, and we don’t have the time. It might be better, then, to have allied health professionals take on more of this role. While I believe we will see an expansion in this pool of professionals, I suspect that there are going to be roles within some healthcare systems and organizations in regard to counseling, education and shared decision making that we don’t think of today as central to the physician/patient encounter, that will fall to physicians. So physicians will require commensurate training.
There will also be a greater emphasis on training primary-care providers. The need in this area is already acute, but it is going to be even greater under healthcare reform, as the expansion of health insurance to another 32-million Americans will increase demand. The good news is that the legislation calls for an increase in reimbursements for primary-care physicians, which is specifically designed to expand the population of primary-care doctors. Most experts who look at healthcare agree that, going forward, for our national healthcare system to work well, it will require that we have a greater primary-care delivery base. The allied health professionals will be an integral part of that base, but we still are going to need an expansion of primary-care physicians. There will also be money for primary-care physicians to improve their working conditions, which have not always been as attractive as they are for specialists, by underwriting improvements to information technology.
Finally, I think that there will be more respect for primary-care practitioners. Given a health-oriented system with a greater emphasis on the primary-care provider as a leader on the team, there is likely to be broader recognition that he or she will greatly influence the degree to which the system is successful.
Dr. Washington: It depends on what we decide regarding the role we want to play, and I think we will have answers to this question in the coming months. Right now, we play a pivotal role as the best of the best in providing primary, secondary, tertiary and quaternary care. And we will definitely continue to play a leadership role in regard to training primary-care physicians, especially given society’s needs. But the degree to which we will expand in this area is undetermined.
Dr. Washington: It is an area where I think we can do much more. At UCLA we should be thinking about the messages and the information and knowledge that we want to help convey in this region about healthcare reform. And we should develop a more coordinated effort so that we now are helping to educate the public on these issues. The objective would not be for recruitment or to generate more patients; it would be because we are a leader, and we have amazing intellect and expertise in this area. Therefore, we should be directing those things toward the public discussion, as a public service, to educate our community. I have to admit, the voice of the academic community has been too muted on this issue, and we should work to turn up the volume.