News

12.24.2012

2012: A Year of Pain, and Promise

To fully appreciate where UHealth and the Miller School are heading after a tumultuous year of change, watch Mahdi Harb toddle into alex’s place, the pediatric hematology-oncology clinic that opened at Sylvester Comprehensive Cancer Center in May, just as hundreds of employees were losing their jobs amid rising costs and plunging revenues.

Hungry and unable to eat before his MRI this month, the three-year-old who was diagnosed with rhabdomyosarcoma, a soft-tissue tumor, above his right eye in June, heads for the play kitchen to “cook” breakfast, frying eggs, microwaving fruit and baking “putcakes” for his parents. “He walks in like he owns the place,” his mother Shereen Harb observes with a laugh. “But he is at home here. It’s so cheerful and he loves the staff and is always excited to see them.”

With the generous support of donor Alexander Daly, alex’s place director Jeannette Garcia-Slanker, ARNP, and her staff have created a warm and inviting refuge enhanced by interactive technology where children with cancer and blood disorders can dance on pulsing lily pads, search the web for music and actually have fun – and help with homework – while undergoing infusions and other treatments or tests.

Though “fun” is hardly the way most adults would describe a visit to a hospital or doctor, UHealth leaders have their eye on a future where every patient who sees a UHealth provider on campus or at any of the 30 satellites across South Florida feels as welcomed, as comforted and as wowed by the ambience and service – and stellar care – as Mahdi’s parents do.

That future entails investing in infrastructure and people, defining and repositioning the UHealth brand, breaking down inter- and intradepartmental silos, and diversifying the Miller School’s partnerships beyond Jackson Memorial Hospital, which Jack Lord, M.D., Chief Operating Officer, acknowledges is a source of friction among faculty who are rightfully committed to the Miller School’s legacy mission. But there is also considerable tension over the enduring resistance to change.

“We have allowed things that are not contemporary to persist because we were comfortable with them, and because we did not want our own microenvironments to change,” said Lord, who remembers that Cedars of Lebanon Hospital was state-of-the-art when President Nixon dedicated what is now UM’s flagship hospital in 1973. “When we don’t change regularly and stay contemporary, when we kick cans down the road, we end up with something catastrophic like the layoffs, which were a consequence of our resistance to change. The more we insulated ourselves, the further behind we got.”

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Few people understand the need to adapt more than Stephanie Grosso, RN, who landed her dream job in University of Miami Hospital’s cardiac ICU in May. Three months later, on her way to work, she lost four fingers and the use of her right hand in a roll-over car accident.

As she desperately applied a tourniquet to her severed hand, Grosso was sure her career was over, but when she woke up at a Broward hospital ICU, among the first people she saw were representatives from UMH’s department of human resources. They were determined to help a valued nurse who had excelled in her ICU residency return to work, and they succeeded.

After four surgeries, Grosso joined UMH’s Regulatory Compliance staff in October, where she is walking proof of UMH’s commitment to investing in both the future of its employees and in improving patient care, as outlined in the historic union contract the hospital and 1199SEIU United Healthcare Workers East signed in June.

“There is such good energy here,” Grosso said. “I feel very fortunate to work with such an open-minded, forward-thinking and empowering staff. Before I came here I was at a larger healthcare system, but I thought there would be more growth potential at a teaching hospital tied to a university and it’s been a great experience, despite what happened.”

Now responsible for helping review and implement core accreditation measures, Grosso also can see what surveyors with the Joint Commission saw when they spent five days at UMH earlier this month: The hospital, which earned teaching hospital status from the state this year, is headed toward its ambitious goal of becoming one of the best academic teaching hospitals in the world, a goal CEO Dan Snyder and his core team adopted after he assumed leadership of the facility in February.

“The survey is an impartial and objective temperature check on the organization, and the feedback from the surveyors was very encouraging,” said David Zambrana, Chief Operating Officer and Chief Nursing Officer. “They see the metamorphosis of the organization occurring, and said if we stay on the current trajectory they have no doubt we will achieve our goal of being in the top tier of academic organizations.”

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As 2012 closes, many chairs, faculty and staff are optimistic about the Miller School’s trajectory, too. Yet they feel the weight of the layoffs and the absence of staff who tracked billing and shepherded grants, and provided other key support functions that are now centralized, with mixed results. They know anxiety is high and morale low in some quarters, but they see a positive trend.

“Maybe it’s the holiday blues, but there is a lot of worry that the change hasn’t paid off,” said Ralph L. Sacco, M.D., M.S., Miller Professor and Chair of Neurology and Olemberg Family Chair in Neurological Disorders, who singles out the IT and other central systems for being too weak to fill the gaps left by departed personnel, especially in tracking grant spending. “Yet our budget is so much better this year. The fiscal year 2013 budget is on track, even slightly ahead of plan. That to me means that some of the changes did pay off financially, but the strain on the staff and faculty and the effect on morale is of great concern and taking a toll.”

Still, Sacco and many other department chairs are buoyed by the tangible evidence that the vision of Dean Pascal J. Goldschmidt, M.D., to create a top-tier research institution continues to move forward. They’re excited by the fact that 1,000 more applicants applied to the medical school this fall over last, by life-changing research underway at The Miami Project to Cure Paralysis and the Interdisciplinary Stem Cell Institute, by the new brand campaign to re-energize faculty and staff, and the many notable milestones over the past year. The calendar year began with Stephen D. Nimer, M.D., a renowned researcher and clinician at Memorial Sloan-Kettering Cancer Center, accepting the director’s post at Sylvester Comprehensive Cancer Center, and is ending with the Miller School’s continued climb, to No. 38, in the amount of NIH funding awarded to medical schools across the nation.

Contributing to the improved ranking were the initial rounds of funding that came from the NIH’s recognition of the Miller School as Florida’s first and only Center for AIDS Research (CFAR), and the award that established the Miami Clinical and Translational Science Institute (CTSI) and placed the University among an elite consortium of 60 nationally prominent research institutions charged with accelerating the translation of biomedical discoveries.

“Steve Nimer and No. 38 are really big deals,’’ said Sylvia Daunert, Ph.D., Pharm.D., professor and Lucille P. Markey Chair of the Department of Biochemistry and Molecular Biology, which in two years has risen from No. 76 to 37 out of 105 peer departments. “Is it where we want to be? No. But it is very noteworthy that we are moving forward, rather than backward in these very tough times, when the entire nation is suffering. Three of our own basic science departments are now in the Top 30, but it is not just us.

“Look around,” Daunert continued. “We have the CFAR, the CTSI, the first clinical trial for Schwann cells at The Miami Project, Josh Hare’s amazing stem cell work, new money for BioNIUM and from the military, all the groundbreaking work at the Hussman Institute, Bascom Palmer, the Diabetes Research Institute, the Gordon Center, the Miami Transplant Institute. The list goes on, and it’s all thanks to Pascal’s vision. If you want to move up, you have to take risks and his risks are paying off in terms of research. We cannot let criticism and distractive behavior from a few make us lose sight of what we have achieved and can achieve.”

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Michael Levy, M.B.A., is in “The Business of Bettering.” The vice chair for administration in the Department of Medicine even has that motto inscribed on his iPad. So every day he asks how he can make the organization better, how he can break down department walls and put the right people in the right place with the right processes to enhance patient care.

He and Department Chair Mauro Moscucci, M.D., M.B.A., who also heads the cardiovascular division, count among their successes the new cardiovascular medicine clinic at UMH, where a multitude of subspecialists, such as pulmonologists, neurologists, and gastroenterologists, work side-by-side to treat patients with multiple comorbidities or hard-to-diagnose symptoms.

The overall goal is finding efficiencies that provide greater value to patients. As Moscucci notes, other medical centers, including the University of Michigan’s, where he pioneered a benchmark quality improvement program for clinical outcomes, are just now facing their own revenue shortfalls and painful restructuring – which places UHealth ahead of the game.

But to stay there as Obamacare takes effect, as the new economy takes deeper root, as the medical landscape continues changing, will require constant evolution with a focus on providing both stellar care, and service.

“This is a patient-centric world now, and if we can’t control the stress of our patients before they even walk in the door, if we can’t hold ourselves responsible for getting them in to UHealth in a timely and accurate fashion, we’re putting them behind the eight ball and they will go elsewhere,” said Levy, who always ends his twice-weekly administrative staff meetings with the same message.

“I say, ‘The way we look today is not going to be the way we look tomorrow.’ That’s the message because change never stops – if we aspire to be great, change cannot stop.”

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