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Rx for the Future

  Rx for the Future  

By Dan Gordon • Illustrations by Otto Steininger • Photography by Ann Johansson

As the Robert Wood Johnson Foundation winds down its renowned Clinical Scholars Program, UCLA and three other universities band together to carry on that mission to train the nation’s next generations of healthcare leaders.

When UCLA launched a project, in 1975, to train young physicians about the organization, financing and delivery of health services, the program’s founding director firmly believed that its graduates would become the architects for the future of healthcare.

“It was absolutely clear to me that the clinical and basic science of medicine can go nowhere unless it is implemented efficiently and effectively — in a way in which we can afford to pay for it and at a high quality, so that the benefits accrue to the population,” says Robert H. Brook, MD, professor of medicine and health services at UCLA and co-director of UCLA’s Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program. But 40 years ago, many of Dr. Brook’s colleagues in medicine didn’t share his sense of urgency. “Any doctor who looked at these issues, as opposed to going into private practice or doing clinical or basic research, was widely viewed as not doing anything very useful,” he says.

If that seems unthinkable today — at a time when concepts such as evidence-based, value propositions and population health dominate the landscape of modern medicine — much of the credit for the changed mindset must go to the approximately 1,300 alumni of RWJF clinical-scholars programs across the country, including the 233 who have been trained at UCLA, both in the David Geffen School of Medicine at UCLA and the Jonathan and Karin Fielding School of Public Health in partnership with RAND. The RWJF graduates have become directors of major federal, state and local health agencies and departments; hospital CEOs; leaders in the fields of health-services research and health economics; foundation executives; and leaders in academic medicine.

Among that cadre, UCLA’s program is a recognized leader in the effort, training national leaders such as former U.S. Surgeon General David Satcher, current U.S. Department of Health and Human Services Assistant Secretary for Preparedness and Response Nicole Lurie and Joint Commission CEO Mark Chassin. Many of the UCLA-trained scholars lead clinical departments at major academic centers across the country, and there are dozens who have stuck close to home, at UCLA, where they have a significant impact on every department in the medical school and in steering UCLA Health.

  Rx for the Future  

But after so many years of success, the RWJF has decided to wind down a number of its human-capital programs, including Clinical Scholars. UCLA will step into the breech and, with Yale University, the University of Michigan and the University of Pennsylvania, launch a new National Clinician Scholars Program. Starting in July 2016, the four participating sites are continuing the work started by the RWJF Clinical Scholars Program to educate physicians and nurses for careers as leaders, researchers and change agents who will work toward eliminating health disparities, developing new models of care and achieving higher-quality healthcare at a lower cost. Eight physicians and two nurses have been selected for the UCLA-Southern California Clinician Leaders Program cohort for 2016 through 2018.

“We are excited to build on the 40-year legacy of the Robert Wood Johnson Foundation Clinical Scholars program by preparing leaders with the needed skills to transform healthcare delivery and, ultimately, the health of our nation,” says Carol M. Mangione, MD, co-director of the RWJF Clinical Scholars Program and of the new UCLA-Southern California Clinician Leaders Program and Barbara A. Levey, MD, and Gerald S. Levey, MD, Endowed Chair. “Through this program, we will continue to produce a cadre of leaders with the robust skill sets that will allow them to lead teams, analyze and develop programs and work collaboratively to address the most pressing health issues for UCLA Health, our region and nationally.”

AS A RESIDENT IN UCLA’S DEPARTMENT OF NEUROSURGERY, Jos’lyn Woodard, MD, became all too aware that she didn’t have answers to many of the questions her patients were asking. What was the prognosis, in both the short and the long terms, for the operation based on the track record for similar procedures? What was the level of risk? Given two different surgical strategies — one aggressive, one less so — how best to decide? Even among the attending physicians from whom Dr. Woodard was learning, it wasn’t unusual for her to hear two very different perspectives on the same case. She realized that was because most procedures had small sample sizes, and everyone’s experience was different.

“Neurosurgery has always been held to a high standard, because we are dealing with a patient’s most-precious organs — the brain and the spinal cord,” Dr. Woodard says. “For the same reason, the evaluation of our interventions should be held to a very high standard. For that, we need concrete evaluative tools that enable us to compare interventions for the field at large, so that neurosurgeons and neurologists can help patients make informed decisions about what route is best for them.”

With encouragement from her mentors, Dr. Woodard is entering the UCLA-Southern California Clinician Leaders Program as part of the inaugural cohort. She will be among the first from her specialty to be trained at UCLA as a clinical scholar, with the intention of creating tools that neurosurgeons can use to effectively assess their interventions so that future decisions will be more transparent. “I had big ideas in my head, but I didn’t know what to do about them,” Dr. Woodard says. “As soon as I learned more about the program, I realized this was the scaffold on which I could build my career.” A constant throughout the history of UCLA’s RWJF Clinical Scholars Program has been its encouragement of big thinking. “When you’re training to become a physician, it’s easy to become jaded and to get the sense that you will be just another cog in the wheel,” says Stanley Frencher, Jr., MD, MPH, a 2011 graduate. “This program gave each of us a sense that we could have a tremendous impact on the healthcare system and on health in general — not just in our one-on-one interactions with patients, but also as administrators, researchers or leaders who drive the way care is delivered by other providers.”

  Rx for the Future  
 

Dr. Carole M. Mangione: “We are excited to build on the 40-year legacy of the Robert Wood Johnson Foundation Clinical Scholars program by preparing leaders with the needed skills to transform healthcare delivery and, ultimately, the health of our nation.”

Dr. Frencher came to UCLA’s RWJF Clinical Scholars Program while in the process of going through his surgical residency at Yale. “I already knew I wanted a career that melded health policy and clinical practice, possibly including healthcare administration,” he says. “Through statistics, research methods and understanding how data can drive quality improvement in healthcare, the program provided me with the tools to be successful in those roles.”

After completing his residency, Dr. Frencher accepted a position emblematic of the new program’s emphasis on establishing partnerships between UCLA and the community to address health concerns, particularly where there are the greatest health disparities. He is medical director of surgical outcomes and quality for the new Martin Luther King, Jr., Community Hospital (MLKCH), charged with the strategy, delivery and growth of surgical specialties at the facility. But as part of a hybrid position created by Elaine Batchlor, MD, CEO of MLKCH, and Mark S. Litwin, MD (FEL ’93), chair of UCLA’s Department of Urology and himself a UCLA RWJF alum, Dr. Frencher also maintains a faculty position at UCLA. He is providing the infrastructure that enables him to conduct community-based research that aims to identify the best approaches to improving the health of the traditionally underserved population served by the new hospital. “Stan represents the type of multidimensional leader with research and leadership skills and the passion to make a difference that we are trying to create for our community and our institution with the new program,” Dr. Mangione says.

FUNDAMENTAL ELEMENTS FROM THE RWJF PROGRAM will remain unchanged in the transition to the UCLA-Southern California Clinician Leaders Program. Those include rigorous master’s-level research training in health policy and management, a tailored curriculum and a strong focus on implementation science and evaluation of real-world interventions. The broad network of scholars also is being retained; there will be national meetings to bring together scholars from the four sites, along with alumni and community partners.

  Rx for the Future  
 

Dr. Jos’lyn Woodard: “Neurosurgery has always been held to a high standard. ... For the same reason, the evaluation of our interventions should be held to a very high standard.”

The RWJF also has agreed to allow graduates of the new program to be part of its clinical-scholars alumni network. “It’s incredible to look at all of the leaders in healthcare from around the country and see how many of them are RWJF clinical scholars,” Dr. Frencher says. “There’s not a time when I show up at a meeting or give a talk that people don’t come up to me and say they were in the clinical-scholars program, and they always turn out to be people who are in a unique or leadership position in healthcare.”
In two important respects, the new program is venturing into novel territory. One is the focus on inter-professional training — preparing postdoctoral nurses and physicians to serve as full partners in health-system transformation. “Historically, leadership training for nurses and physicians has been siloed,” says Dr. Mangione, who is co-directing the new program with Linda Sarna, PhD, RN, interim dean of the UCLA School of Nursing.

“Educating them in the same curriculum, with group projects on which they collaborate, will contribute to a deeper understanding of each other’s professions and provide a contextual framework for how we can be more effective in partnering with leaders from other disciplines,” Dr. Sarna says.

And, although the UCLA RWJF Clinical Scholars Program had shifted toward more community-partnered research over the last decade, the new program moves more emphatically in that direction, with much of the research and projects undertaken by the scholars conducted in the communities they serve. UCLA is being joined by a consortium of partner institutions that will be providing platforms for the project-based learning at the heart of the program, including the Los Angeles County Departments of Health Services, Public Health and Mental Health; Kaiser Permanente Southern California; Cedars-Sinai Health System; Charles R. Drew University of Medicine and Science; and the Greater Los Angeles Veterans Health System. Partners at each institution will work directly with each scholar to identify and develop projects to solve current, real-world problems and to cultivate the scholar’s unique research and leadership skills.

When Mitchell Katz, MD, was looking to make major changes after taking the top job at the L.A. County Department of Health Services in 2011, he told Dr. Mangione that the trainees going through the UCLA RWJF Clinical Scholars Program were the type of people he needed to meet his goals of improving the quality of services and making the county health system more customer-friendly Dr. Katz, himself an alumnus of the Stanford-UC San Francisco RWJF Clinical Scholars Program, has gone on to hire a number of the UCLA program’s graduates and is funding slots as well as mentoring scholars in the new program. “I knew that to transform the system, we needed to find really smart people who are value-driven,” he says. “The graduates of this program understand how you make change in an organization. They have leadership skills, and when they articulate what they are trying to do, others want to follow them. And they recognize that to make a difference, you have to address all of the elements that affect care.”

  Rx for the Future  
 

Dr. Stanley Frencher, Jr.: “This program gave each of us a sense that we could have a tremendous impact on the healthcare system and on health in general ... as administrators, researchers or leaders who drive the way care is delivered by other providers.”

Meanwhile, as UCLA looks to transform healthcare delivery in its own system, it has turned to a UCLA RWJF Clinical Scholars Program alum. Robin Clarke, MD (RES ’10), MSHS, an internal-medicine physician, was hired as the UCLA Faculty Practice Group’s medical director for quality after completing the program in 2012. He is responsible for measurement, reporting and improvement programs for the group’s 2,000 physicians, with a focus on quality, value and the patient experience.

Thanks to the investigations of RWJF clinical scholars at UCLA and elsewhere, it has been clearly shown that there is much inefficiency in healthcare delivery and that advances published in the literature often are slow to be adopted, Dr. Clarke notes. As a clinical scholar, he learned about the complex factors — economic, psychological and otherwise — that work against healthcare change and how to eliminate the barriers that stand in the way of more efficient and effective healthcare delivery.

“From day-one on my job, I’ve used what I learned as a clinical scholar,” Dr. Clarke says. “The program has allowed me to practice as a provider, helping one patient at a time, while also helping me to think more broadly about systems of care — whether at the community level, the regional level or within one particular delivery system. The vast majority of physicians in this country don’t get the opportunity to think about the larger variables that drive the quality of care, but that is the kind of thinking that is needed to achieve our ultimate goal of a healthier population.”

Dan Gordon is a regular contributor to U Magazine.

For more information about the National Clinicians Scholars Program, visit nationalcsp.org

 

 





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