What is your hometown?

Johnston, Iowa

How/when did you become interested in science and medicine?

I always liked science, but I suppose my interest really took off in junior high school. My mom was a nurse, and I liked the concept of helping people. My interest grew in high school as I took a lot of science classes. I even started a “Health Careers Club” that ran for my junior and senior years.

What interested you to pursue a career in medicine and medical education?

A love of science and the love of helping people. I grew up in a business family and began college as a business major, but switched to medicine after six weeks. There just wasn’t enough personal value in what I was doing. I got both a BA and MA in Biology before medical school. It’s interesting that now I focus on administrative applications of clinical medicine through my work with the Iowa Healthcare Collaborative.

Please highlight your major career achievements, awards, discoveries.

• Practiced Family Medicine in my hometown from 1986 through 1998.
• President of the Iowa Academy of Family Physicians.
• American Academy of Family Physicians involvement in the House of Delegates and serving on the Committee on Health Care Services.
• President of the Iowa Medical Society.
• American Medical Association Congress of Delegates.
• American Medical Association New Leadership Program.
• Coordinated a diabetes project with the Iowa Health System that was awarded the Joint Commission on the Accreditation of Healthcare Organizations’ Ernest A. Codman Award.
• Coordinated work at Iowa Health in Health Literacy that was recognized by the American Medical Association.
• Co-chaired a statewide task force for the Iowa Hospital Association and the Iowa Medical Society that eventually evolved into my current work with the Iowa Healthcare Collaborative.
• Coordinated a statewide survey of Iowa hospitals with regard to deployment of the National Quality Forum’s 30 Safe Practices.
• Founded the Iowa Healthcare Collaborative in 2005.
• Serve on the Board of Directors and the Executive Committee of the National Patient Safety Foundation.
• Faculty with the Institute for Healthcare Improvement, with specific focus on the national 100,000 Lives Campaign.

Is there a teacher, mentor or Carver College of Medicine faculty member who has helped shape your education?

There have been several, but the one that stands out is then Family Practice Department Chairman Robert Rakel, MD. Dr. Rakel had the ease and practicality of a country doctor with an academic twist. As a teacher, he challenged me to ask “why?” As a mentor, he challenged me to ask “why not?”

How or why did you choose the UI for your education and medical training?

It was the best fit. I am from Iowa, wanted to stay in Iowa, and was confident in the academic tradition of the medical school. Though I was accepted at other schools, I didn’t feel the need to go anywhere else.

Please describe your professional interests?

I have worked within both the physician and hospital communities to improve clinical performance. I believe healthcare can do better. It certainly isn’t because we aren’t working hard, but the complexity, overregulation, and lack of communication we deal with on a daily basis cause us to lose focus. I love working with physicians to identify new clinical goals, and then exceed them. I worked to engage providers in discussions of common metrics and measures for measuring clinical quality. Recent projects have included promoting Lean manufacturing in health care work in promoting Health Information Technology in the physician community. I am also a strong patient advocate, and very interested in the prevention of adverse events. The complexity of our day and the culture in which we deliver care, can result in unintended consequences that cause harm or even death. I enjoy efforts to improve the system of care by addressing problems with the processes of care delivery. Over the past five years, I have worked to bring providers together to address problems with the outpatient use of anticoagulation medications, Health Literacy, Medication Reconciliation, an improved Culture of Safety and Healthcare Associated Infections.I have also served as chief medical officer for both a large physician group and a health system. I enjoy most aspects of the health care industry, and the challenge of providing care to our patients in a complex and often ambiguous, environment. 

What are some of your outside interests?

My special “outside” clinical interest is sports medicine, a love I developed on the Ortho rotation in my 3rd year of medical school. I spent 18 years on the sidelines for my hometown football team. I now follow around my sons who play Division III football.I also enjoy cycling, reading, and church activities.

Do you have an insight or philosophy that guides you in your professional work?

I have a strong faith, and work to live according to it every day.

If you could change one thing about the practice or business of medicine, what would it be?

Our healthcare system’s ‘currency’ is work units rather than effective care. We track our progress and productivity in DRGs or RVUs rather than effective, evidence-based parameters. How often do we really execute on the things we know improve clinical outcomes? Do we track, report or share that information? If I could change one thing, it would be to move our focus from how many widgets we generate to clinical outcomes.  Another change I’d make is the ‘siloing’ of communication. Healthcare workers are sincere and work to do the right thing, but doctors, nurses, pharmacists, and administration all have their own rules for communication and engagement. Our traditional roles and communication often get in the way of good patient care. I would love to breakdown those walls and work together better to improve patient care.  I think that if we could communicate better, there would be fewer unintended consequences, our execution on clinical performance targets would improve, our healthcare culture would be more collaborative and positive,we would all have more fun, and might not have manpower shortages for nurses or physicians.

What do you think are the biggest challenges/opportunities facing hospitals and health care providers today?

I believe our reimbursement system is hopelessly flawed and will not sustain the increases we’ll see as the baby boomers ‘come of age’. We need to design a new reimbursement system that recognizes value and effectiveness before the current system is completely overwhelmed. The current system will continue to penalize small states, whether they perform well or not. I believe provider supply will be a huge issue in the next decade or two. This, too, will not bode well for Iowa.  I believe the new era of transparency and accountability we have entered will put significant stress on our systems. There is an expectation for release of performance information to the public that is coming much sooner than any of us anticipated. The bad news is that we’ll have to retool many processes of care to gather the data and improve performance. That transition will be painful. The good news is that we’ll be much better prepared for a reimbursement system that rewards based on performance. I think the future system will reward those who make this jump sooner rather than later. There will be a mind-boggling amount of change required over the next ten years; reimbursement system, information technology, evidence-based clinical score cards, not to mention the simple technical and clinical advances. 

What is the biggest change you’ve experienced in medicine since you were a student?

When I was in medical school, we talked about how someday we’d focus on a world driven by clinical quality and outcomes. It seemed every year though that someday never came. Even through the Quality Assurance and managed care days, quality wasn’t quite ready. Someday is officially here. With CMS, JCAHO and the National Quality Forum all working to develop common measures, there is a convergence of thought on best practice and what constitutes effective care. With that settled, metrics can be established. The biggest change I’ve encountered is the realization in the healthcare mind that the time has really come to build a new world. As a physician friend of mine has said, “We are now about redefining professionalism.”

How have your many leadership roles changed the way you view the practice of medicine?

I have a much broader view. I look at things from a system, state, national or world view now.  I’m more likely to question why we can’t make changes for the better and I’m less likely to be satisfied with ‘the way it is’. I’m more likely to push toward a new place.

What advice would you give to today’s medical students? Be nimble. This generation will experience more change than any before. Their flexibility will be an asset. Be ready to change, and be ready to move quickly. Keep your patient’s first. The doctor-patient relationship is still the cornerstone to the delivery of care. We have a sacred trust with the patient. If you take care of them, physically and emotionally, and answer their questions clearly and honestly, you’ll seldom go wrong.

What do you see as ‘the future’ of medicine?

It is very exciting…and a little intimidating. It will be a great adventure. We are in the process of redefining our medical world. I believe that physicians should assume a leadership role through this period of change. The future will be a special time in healthcare as the system works to re-invent itself. We live in a time of great promise and opportunity.  We can succeed or fail based on how we choose to address these challenges. I believe physicians twenty years from now will laud us or damn us for the decisions we make. It’s time for physicians to lead.