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I trust that most of you had a meaningful Thanksgiving break and were able to spend quality time with family and loved ones. I hope that for those who traveled, the journeys were relatively uneventful and that there is in place a clear strategy to manage left overs. This week, I focus on early steps that we are taking on implementing our department of medicine (DoM) strategic plan and provide two recent examples of ways in which existing clinical and training programs are already aligning with our plan in the domains of clinical care, community engagement, and training and education.

Introducing our Strategic Plan Implementations Leaders

As I shared in my recent reflection, now that we have defined our strategic plan, the work to implement the plan begins. Our strategic plan will become a reality through its implementation, as we translate the plan into action to achieve our stated goals and vision.

We have established a governance structure to provide oversight and leadership for implementation of our strategic plan. I am pleased to announce that the following have agreed to lead our strategy implementation for each mission pillar:

RESEARCH
(Faculty Co-leads & Staff Lead)

EDUCATION
(Faculty Co-leads & Staff Lead)

PATIENT CARE
(Faculty Co-leads & Staff Lead)

COMMUNITY ENGAGEMENT AND INVESTMENT
(Faculty Co-leads & Staff Lead)

Our strategy implementation leadership teams will prioritize strategies for implementation, based in part on recommendations from the strategic planning steering committee and ongoing resource needs analyses. They will develop timelines for implementation; evaluate new strategies that may help us meet our goals and and build teams to assist with implementation of specific strategies and tactics.

It will take each one of us, working together as LEADERS, to achieve our DoM vision to lead in innovation, transform care, and advance health for all. Please look for more information and opportunities to participate in the weeks to come.

Palliative Care: Patient-Centered, Team-Based Care For Those With Serious Illness

There are few areas in medicine that exemplify a whole-person, interdisciplinary approach as clearly as palliative care. At UCLA, we are fortunate to have an exceptional palliative care team, consisting of physicians, nurses, social workers, chaplains, administrative support staff, a music therapist, a child life specialist, and volunteers dedicated to enhancing the lived experiences of persons with serious illness and their families.

As we conclude National Hospice and Palliative Care Month, I celebrate this team which is united by a shared vision—all UCLA Health patients with serious illness will receive the best possible patient-centered, goal-concordant healthcare that relieves suffering and promotes quality of life. Their mission is two-fold: 1) to deliver comprehensive, interdisciplinary, high-quality, specialty palliative care and 2) to advance the delivery of both generalist and specialist palliative care through innovative research, education, quality improvement, and community engagement.

The UCLA Palliative Care Team with additional members pictured below.

Palliative Care Strategic Priorities

The six Palliative Care Strategic Pillars are aligned with UCLA’s clinical institutional goals and fall within the domains of quality, access, sustainability and wellness. They map the team’s efforts to an inclusive, mission-driven framework of advancing patient-centered, serious illness care at UCLA. For example, the patient experience, strategic growth, quality and safety, and education and cultural transformation pillars are working to address inequities in the quality of and access to serious illness care through community engagement, patient and caregiver interviews, service expansion, educational interventions, and targeted outreach. The quality and safety pillar is working to define and evaluate quality measures, to develop a comprehensive dashboard for data collection, reporting, and assessment, and to promote quality improvement initiatives across UCLA Health. Additionally, the strategic growth, our people, and financial health pillars are balancing short- and long-term goals with respect to both service growth and provider wellness. Importantly, involvement in strategic pillar efforts is completely voluntary and yet most of the team members are eager to participate, highlighting the team's genuine desire to advance their shared mission, eliminate inequities, learn from outcomes, and approach efforts through the lens of sustainability.

Palliative Care: Interdisciplinary, Team-Based Approach 

Palliative Care is centered around an interdisciplinary approach to the care of patients with serious illness. As such, the team strives to be highly functioning, dynamic, and resilient, founded in strong leadership, a shared vision, open communication, and trust. Through annual retreats and satisfaction surveys, quarterly team functioning discussions and wellness newsletters, monthly facilitated process groups, and daily team wellness practices during inpatient rounds, the team remains committed to fostering a culture of inclusivity, reciprocal transparency, and respect. For nearly two years, their Goals and Values Committee met monthly to identify the team’s core values and to ensure efforts were aligned with these values. For the past three years, their Appreciation Workgroup has acknowledged two team members each month by summarizing meaningful moments, sending hand-written cards, creating individualized word clouds, or featuring the individual in the Palliative Care Appreciation Newsletter. Most recently, the team formed a 360-Degree Feedback Workgroup to further promote a culture of feedback and engagement.

Clinical team members strive to approach each patient encounter with curiosity, cultural sensitivity, and humility, aiming to hear and understand the patient’s core values, goals, priorities, and preferences to ensure there is alignment with the clinical plan of care. Team members engage in honest, candid discussions about prognosis and mortality, utilizing expert communication skills to help patients and families navigate acute grief, existential distress and other complex emotional states. Critical to their success, team members seek out opportunities to improve the delivery of clinical care through case review, education, and policy development. As an interdisciplinary specialty, they strive to incorporate perspectives from diverse disciplines in all aspects of their work.

Palliative Care: Recent Accomplishments

Over the past five years, the Palliative Care team has seen tremendous growth, with an impressive 85% increase in inpatient consult volume and 527% increase in outpatient encounters! They are continuing efforts to increase their capacity to meet the growing demand, with ongoing regional clinic expansion and the planned addition of a third team at RRMC. At the same time, the team has remained dedicated to ensuring a whole-person approach to care, refining services to include formalized life review (Dignity Therapy), the From the Heart patient fund to support underserved patients facing financial challenges in the context of serious illness, personalized bereavement cards, the Celebration of Life annual event dedicated to families of deceased patients, a specialized comfort care unit at Santa Monica Hospital for patients at end of life, specialized music therapy and Child Life Services, and a range of dedicated volunteer services.

Notably, their efforts extend far beyond direct patient care, as the team is spearheading efforts to advance the field and to increase access to high-quality generalist and specialist palliative care through innovative community outreach, education, quality improvement, and research initiatives. Multiple members of the Palliative Care team have received national recognition for their work and hold national leadership roles in research, quality, and advocacy. In the past five years, team members have been invited to present at 40 national conferences and have contributed over 60 peer-reviewed publications. 

In terms of community outreach, current efforts include: the Hearing their Voice project to promote advance care planning among unhoused patients; the Hospice Under the Bridge effort to provide hospice for the unhoused patient population; and palliative care educational classes for community cancer groups including the Cancer Support Community and the WeSPARK Cancer Support Center. In terms of education, the team has developed novel educational models for training Palliative Medicine fellows and rotating internal medicine residents. Consequently, their fellowship program matches extremely well, and as of July 2023, a Palliative Care rotation is required of all UCLA internal medicine residents. Further, team members facilitate communication skills training workshops for various disciplines and specialties throughout UCLA, facilitate and co-chair monthly Schwartz Rounds, and lead formal debriefings to assist medical students, residents, fellows, faculty, and staff process and learn from challenging cases. Additional efforts include: initiatives to standardized early palliative care for patients undergoing liver transplant evaluation, requiring ECMO, or diagnosed with metastatic gastrointestinal cancers; a multicenter study evaluating an early integrated palliative care model for patients with advanced illness presenting to the Emergency Department; and an informatics-enabled approach to ensuring patients with pancreatic cancer have documented goals of care and access to specialty Palliative Care as part of the Canopy Cancer Collective.

Partners in Care: UCLA DoM and Kern Medical Advancing Health for All in the San Joaquin Valley

For over 40 years, UCLA has partnered with the Kern Medical Department of Medicine Residency Program. There are currently 24 UCLA Health Sciences series DoM faculty at Kern Medical, which is a 222-bed safety net tertiary care hospital in Bakersfield. These UCLA DoM faculty make important contributions to training Kern Medical Department residents and providing high-quality care to the community of the San Joaquin Valley. Recently, Dr. Gregory Brent, senior executive academic vice chair at the DoM, and Dr. Soma Wali, vice chair for affiliate programs at the DoM and chair of medicine at Olive View-UCLA Medical Center, both served on the search committee for the Kern Medical Chair of Medicine. The committee was led by Kern Medical’s Chief Medical Officer Dr. Glenn Goldis. After a national search, Dr. Ralph Garcia-Pacheco, previously chief of the Pulmonary Critical Care Division at Kern Medical, was chosen as the new leader of Kern Medical’s Department of Medicine.

Drs. Brent, Wali, and Larsen shared with Kern Medical leadership about ongoing DoM initiatives, including the DoM Strategic Plan, the new UCLA DGSOM HEALS curriculum and structure of the internal medicine clerkship, and current programs in support of DoM affiliate institutions. Dr. Wali described a range of programs at Olive View-UCLA Medical Center, several of which provide partnership opportunities with Kern Medical in training and research.

“It has been a privilege to build relationships with the Kern Medical leaders, learn from their innovation and teamwork in clinical care and training, and identify areas where we can work together,”

states Dr. Brent.

On the Kern Medical side, Drs. Goldis, Berjis, and Garcia-Pacheco shared their vision for expanding clinical and educational programs at Kern Medical, which includes the addition of residencies and fellowships, and opportunities to partner with UCLA DoM in training programs for medical students, residents and fellows, as well as faculty recruitment and research.

“Kern Medical greatly values UCLA as a strategic partner. Through our mutual collaboration we envision a future where UCLA plays a key role in developing our academic and clinical programs in support of our medically underserved community,”

states Dr. Goldis.

Dr. Goldis also shared about their innovative A-Team Program which includes a group of pre-med or pre-resident students who, during a gap year in their training, take on the responsibility of working directly with our physicians, nurses, and IT personnel to improve Kern Medical’s electronic health record form and function, assist providers with workflow, and educate incoming medical staff. The A-Team plays a pivotal role in helping improve the usability of the EMR while networking with Kern Medical staff as they prepare for a future career in healthcare.

A town hall was held for Kern Medical UCLA DoM faculty and trainees to share about new initiatives for faculty, as well as an opportunity to learn about accomplishments and needs at Kern Medical. Following the town hall, Dr. Goldis and the other Kern Medical leaders took the visitors on a tour of the facilities at Kern Medical which included an impressive learning center for medical students, a state-of-the-art simulation center, and a suite for the team rooms in which each room was fully equipped with teleconferencing capabilities.

The UCLA DoM team was impressed with the many accomplishments of Kern Medical, their long-standing commitment to provide outstanding care to the underserved population in the San Joaquin Valley and their vision for the future health of their community.

“Strengthening engagement and collaborations with those providing care to medically underserved communities is a central feature of the UCLA DoM Strategic Plan. We look forward to establishing short-term and long-term goals to work with, and learn from, Kern Medical across clinical, education and research domains,”

states Dr. Brent.

Later this week, we will learn the results of our Fellowship match. I look forward to celebrating what I believe will be another outstanding subspeciality match day for us.

Dale

P.S.

Like most of America, my wife and I went shopping on Black Friday. We were looking for a rug and not a new plane.

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