Year 3. September 9. Fulfilling Our Commitment to Faculty and Staff Wellbeing.
The most important asset in our department are its people. For nearly three years, the department has increased its focus on addressing burnout in our faculty. We formed a wellness committee, appointed a chief wellness officer and have enshrined faculty and staff well-being into our department’s strategic plan. We have made progress, but much work remains to be done. Over the past few weeks we have continued our annual wellness townhalls, and I appreciated visiting with faculty across our department and look forward to the remaining townhall focusing primarily on research faculty that will take place in November. I want to provide a summary of the events that we have hosted thus far and to highlight specific initiatives that have been launched, but represent work in progress that the department of medicine (DoM) has undertaken to increase wellbeing of our faculty.
We have hosted four events across the Southern California region with hundreds of faculty and staff participating to learn about and discuss new wellness initiatives in the UCLA Department of Medicine. These meetings also provided an important venue for department leadership to hear directly from you. I would like to express my gratitude to all who have contributed to shaping our department’s wellness efforts since we began this work in 2022. Your enthusiastic participation has been critical towards creating effective policies, programs, and sustaining momentum as we seek to exemplify our commitment to wellness in academic medicine.
Let me share highlights of some of the topics discussed.
InBasket Support
The burden of managing and keeping up with InBasket messages continues to be a major driver of burnout in our clinically active faculty, particularly in the outpatient arena. During the townhalls we reviewed and provided updates on programs such as the IMPACT Pilot and REST Program. The DoM Inbasket Task Force launched in November 2023 and is dedicated to evaluate the initiatives across DoM and the health system that could alleviate the InBasket burden for many of our providers. This task force includes leaders from DoM Wellness, Clinical Operations, Quality, Pharmacy, and ISS, and they have been working collaboratively to enhance clinical support and streamline processes. For example, we are looking at methods to better triage InBasket messages using AI and support staff to ensure that messages that do not require physician input can be effectively addressed by non-physician staff. To equip support staff with tools to support our faculty, ISS has developed an Inbasket Manual that we are using for training our staff. Under the LEADERShip of the Ambulatory Operations Team, we have started piloting this training with clinic managers, supervisors, and staff, beginning with one Santa Monica site and extending to three Westwood sites through “Train the Trainers” sessions. We are working on creating a training video by the end of the year and optimizing this program, and look forward to participating in the upcoming health system AI Scribe Pilot.
Growth of the Pharmacy Refill Program
We have heard that a big dis-satisfier is time spent by providers to refilling their patient’s routine prescriptions in the electronic medical record. In response, we have been working to expand the Pharmacy Refill Program, which now incorporates a new prioritization algorithm that seeks to benefit all providers. The goal is to deploy more pharmacy staff to take care of these tasks. We have begun to deploy this across offices, and are working to ensure that all faculty will ultimately have access to these services. This program added 37 new physicians this past year and currently support 170 providers. A second program, the APCIP program, has also been launched by Pharmacy to support the ordering of specialty medications across various clinics, including infectious disease, pulmonary, GI and others that need prior authorizations, a process which takes up significant provider time. The goal is to have prior authorizations conducted by the APCIP team, who will also provide patient education and ensure delivery of these prescriptions to patients in a convenient and cost-effective manner.
Expansion of DoM Professional Coaching
Based on feedback that we received in prior years, we initiated a pilot program of professional coaching for our faculty.
Our professional coaching pilot study has shown that faculty participating in one-on-one or small group coaching experienced notably reduced emotional exhaustion and burnout. 79 faculty have participated thus far, and the outcomes are very impressive. We plan to expand these coaching opportunities through the Office of Wellness.
Policies that Support Wellness
As a department, we have also been mindful of examining current policies and implementing new ones by evaluating them through a lens of wellness.
Some of these significant policy updates include: the implementation of Sustainability Blocks, the creation of Wellness Days, flexibility for CME education time, allowing CME time to be used for maintenance of certification, updating how productivity expectations are pro-rated to account for lactation needs, and modifications to our tiered compensation thresholds. Given many questions that arise regarding compensation policies, we will be holding a compensation webinar this fall and encourage you to sign up to participate.
Building Community
We recognize the value of building community to support faculty well-being. As such, we have allocated financial support to each division/unit to support community building activities and gathering. We have invested approximately $100 per Faculty FTE in wellness funds to divisions to support these activities. I was pleased to learn that this year’s events have included team-building activities like ropes courses, Zoom yoga, and social gatherings such as picnics and paint nights.
Division Wellness Champions
Importantly, we recognize the need to have greater grassroots representation to advance and promote our wellness initiatives.
As such, we are very pleased to introduce our new DoM Wellness Champions. These dedicated faculty members, will play a crucial role in advancing wellness initiatives at the division level by setting specific goals, leading focus groups, and organizing community-building events. Their leadership will be vital in ensuring effective communication and support for wellness across divisions, contributing to a thriving and supportive environment for all.
Thank you for your continued engagement and commitment to our collective well-being. These updates represent a sample of the many initiatives that are underway. Stay tuned for more updates as we continue to enhance our wellness programs and policies.
I will use the second part of this newsletter to congratulate some DoM faculty whose leadership continues to provide important support of our many clinical missions.
DoM Faculty Appointed Senior Quality Officers for UCLA Health
I am pleased to announce that DoM faculty members Erin P. Dowling, MD, and Arpan A. Patel, MD, PhD were recently selected as senior quality officers (SQOs) for UCLA Health. Both Dr. Dowling and Dr. Patel have already impacted our own quality initiatives and research within the department, and we are excited to see them step up as LEADERS in the broader health system.
“SQOs are the vanguard of health system work on patient flow,” said Christopher S. Saigal, MD, a leader in the UCLA Health Quality Program. Officers work on a series of interlocked quality improvement projects throughout the year to help ensure patients get the right care at the right place and time.
For Dr. Dowling — a hospitalist who is part of the DoM’s Core Quality Team — one focus will be clinical care pathways development, an effort that builds on the inpatient work of DoM Quality and the ValU Care Redesign Department. Pathways projects are especially valuable because they bring together multiple specialties and members of interdisciplinary teams, she said.
“When you are able to anticipate the hospital course for a patient, to some degree, you are able to provide a timelier and more planned out discharge and handoff back to ambulatory care,” Dr. Dowling said. “Ideally, this allows the patient to continue to receive care in the ambulatory space and not be readmitted to the hospital.”
Dr. Patel is a hepatologist and digestive diseases health services researcher. His laboratory conducts research at UCLA and the VA on ways to measure and improve the quality of care provided to people with chronic liver diseases, a vulnerable and high-risk population. Much of his research has revolved around the delivery of palliative care in such patients, which he views as synonymous with high-quality, patient-centered care. The SQO role is a natural fit with these interests, he said.
“I believe the best lesson my research has taught me is how to listen and learn from the experiences of others,” Dr. Patel said. “Similarly, I am hoping to listen and learn from multiple stakeholders to support pathways at the health system level by taking on the SQO role.”
Dr. Patel hopes that this opportunity will allow him to build skills in analyzing health system data and in designing interventions that can best support patients, their caregivers, and the clinician teams that care for them.
“I am looking forward to supporting this group of patients at the health system level and learning from the experiences of other officers as well,” he said.
Dr. Dowling is eager to take the work of the DoM’s Quality Program and amplify, adjust and share it with the entire interdisciplinary health system, calling it “a great honor and challenge.” She’s also excited for more opportunities for teaching, mentorship, and learning.
“You don’t become a physician unless you love learning, and I’m excited to be in that learner role as an official part of my job,” Dr. Dowling said.
Please join me in congratulating Dr. Dowling and Dr. Patel on what I am sure will be a rewarding step in their careers!
Fred Kass, MD Receives Inaugural Healing Through Compassion Award, Named in His Honor
Next, I am excited to share that Frederic C. Kass, MD, JD, MA — a member of the UCLA Division of Hematology and Oncology who is based at Santa Barbara Cancer Care — was recognized for his commitment to treating the holistic needs of patients with the inaugural Healing through Compassion Award from the Breast Cancer Resource Center (BCRC) of Santa Barbara. The award is also named in his honor.
“It is a high honor to receive this recognition, and I am grateful to have had the opportunity to learn from so many immensely talented colleagues over the 40 years that I have had the privilege of practicing cancer medicine,” Dr. Kass said.
Dr. Kass has been part of the BCRC since its creation 27 years ago, after being invited by Susan Love, MD, a beloved former UCLA oncologist who passed away last year, to get involved with a new group that aimed to support local women with breast cancer. The center provides emotional support, complementary therapies, guidance on practical resources and more to patients with breast cancer and other breast health issues.
Prior to joining UCLA Health, Dr. Kass worked alongside Dr. Love at the Dana Farber Cancer Center, in Boston. He was recruited by the Cancer Foundation of Santa Barbara in 1990 and later played an instrumental role in the founding of the Sansum Clinic’s Ridely-Tree Cancer Center, where he served as medical director until joining UCLA Health in the fall of 2021.
Dr. Kass has also served on the boards of many healthcare non-profits over his career and is currently a board member of VNA Health. He received the American Cancer Society Physician of the Year Award in 2016 and was named Grand Champion among the Pacific Business Coast Times’ Champions of Health Care in 2015.
The BCRC isn’t the only organization recognizing Dr. Kass this month. In fact, he’ll be getting two awards in one week: The Santa Barbara County Medical Society recently named him Physician of the Year for 2024 and will present him with his award on September 26th — the night before he is honored by the BCRC at its annual Pink Lounge Gala.
The Dr. Fred Kass Healing through Compassion Award aims to recognize those who have exhibited exceptional dedication to compassionate healing, advocacy, medical excellence, interagency collaboration, and volunteerism in the context of breast cancer treatment. Given all that Dr. Kass has accomplished for breast cancer patients, it is easy to see why this award takes his name. Please join me in congratulating Dr. Kass and thanking him for his devotion to patient care. LEADERS like him inspire us every day!
Adam Cavallero, MD Named Champion in Healthcare by Pacific Coast Business Times
I am also delighted to share that Adam F. Cavallero, MD, a LEADER in the central coast and northwest valley, was recently named one of eight 2024 Champions in Healthcare by the Pacific Coast Business Times.
This much-deserved recognition highlights Dr. Cavallero’s dedication to meeting the needs of central coast region communities for decades to come. As the Pacific Coast Business Times describes, he has worked tirelessly to integrate UCLA Health into local communities as we expand our presence there, recruiting new doctors to treat an aging population and to improve continuity of care. Despite his many responsibilities, he still finds time to develop opportunities for medical education: He helped create a program on the University of California Santa Barbara campus to instruct, mentor, and inspire pre-medical students on how to become the next generation of physicians.
While Dr. Cavallero’s clinical practice is primarily in Thousand Oaks, he remains closely involved with UCLA Health’s growth in the central cost. His longstanding link to the region — first as a pre-medical student and ophthalmic technician during his time as an undergraduate at Westmont College, then later upon his return to the Santa Barbara area to work as a primary care physician and hospitalist — make the Champions in Healthcare award a “full circle” moment for him.
“I am honored to serve as the Regional Ambulatory Medical Director, helping to bring medical education, physician access, and world-class healthcare to this incredible community,” he said.
Dr. Cavallero exemplifies many of the core values at UCLA Health. Thank you for your service to our patients and our mission!
UCLA Health Selected to Test Medicare Model for Dementia Care
The Centers for Medicare & Medicaid Services recently announced that UCLA Health was selected to test its new Guiding an Improved Dementia Experience (GUIDE) model, an alternative payment program that offers patients with dementia and their caregivers access to services that may dramatically improve their quality of life. This designation has special significance to the DoM as it seeks to enable UCLA Health to help reduce the burden of dementia on families. The GUIDE program is based partly on findings from pioneering work that took place within our own UCLA Division of Geriatrics.
A bit of history on how we got here: Back in 2011, a patient inspired the geriatrics division to launch the UCLA Alzheimer’s and Dementia Care Program, a unique approach that includes patients and caregivers as members of one team with a singular goal of providing them with comprehensive dementia care. The program was awarded a large grant from Medicare that allowed it to expand from 250 to 1000 enrollees — and, in turn, the experience of the program provided valuable and rigorous evidence on the impact of high-quality dementia care on patients and caregivers, controlled expenses incurred by Medicare. After the Medicare grant ended, support for the program was provided by the Department of Medicine, UCLA Health, and local philanthropy.
Data from the UCLA program became the basis of many of the guidelines included in the CMS’ GUIDE model, which was announced last year and officially launched in July.
David B. Reuben, MD, chief of the UCLA Division of Geriatrics, has led the UCLA Alzheimer’s and Dementia Care Program since its launch, cried tears of joy the morning the new program was revealed.
“I wept not for what we had done, but for the kind of benefits that people with dementia all over the country and their caregivers were going to get,” he recalled.
UCLA’s influence is imprinted throughout the GUIDE Model. Its nine required components, mirror services that have been delivered by the UCLA Alzheimer’s and Dementia Care Program from their inception. With this wealth of experience, UCLA was chosen as one of 96 participants to participate in the GUIDE model under an “established track” program, as opposed to “new track” programs that will be built from the ground up at another 294 institutions. While new track programs will need a year to ramp up, established track programs can begin seeing patients under the GUIDE model right away.
With a full decade head start through the UCLA Alzheimer’s and Dementia Care Program, it’s natural to assume that launching the GUIDE program would be “like falling off a log,” as Dr. Reuben put it. But it wasn’t quite that easy: Working with the federal government means lots of new administrative tasks, from changing job descriptions and hiring new employees to figuring out exactly where the program fits in the department’s reporting structure. Twenty-four people across several departments — including the UCLA Department of Medicine, the Office of Population Health and Accountable Care and the UCLA Faculty Practice Group — have been checking off tasks to implement GUIDE since April.
That effort is now paying off. UCLA has seen 45 patients under the GUIDE program since mid-July, with another 53 scheduled. That includes patients without caregivers and at-home visits, two requirements of the GUIDE model that were not previously part of the UCLA Alzheimer’s and Dementia Care Program.
It also will include patients who would typically be excluded from the program were it not for the foresight of UCLA Health. At other institutions that are piloting the GUIDE model, only patients who have fee-for-service Medicare and are enrolled in Part A and Part B are eligible for the program — meaning it excludes all managed care Medicare patients and those who have commercial insurance. But UCLA has agreed that it will provide one type of dementia care service to all, so even patients and caregivers outside the GUIDE program will benefit.
“Regardless of payer, if you are a UCLA patient who has dementia, you will get the same services,” Dr. Reuben explained. “When I’ve told people at other places around the country about this, their jaws drop. This is one area in which we’ve been far ahead of the curve.”
We are very excited to help shape the future of dementia care and are especially grateful to Dr. Reuben and the UCLA Division of Geriatrics. Their work demonstrates how putting patients and their families first truly changes medicine for the better.
Let me close by acknowledging some our staff professionals, and share my recent opportunities to directly acknowledge this in person.
Staff Appreciation: Our Staff Takes Home the Gold!
Purchaser Power
Our Purchasers in the UCLA Health Department of Medicine have spent the past few months cutting down a mountain-sized backlog of invoices, and their efforts have dramatically improved our operations. I recently had the privilege of joining 45 members of the team for a special appreciation luncheon in UCLA’s Botanical Gardens that featured food, fun, and even prizes. Thank you for your steadfast dedication to your work — we truly could not succeed without you!
Fund Managers are Champions
When it comes to turning ideas into groundbreaking research findings, Fund Managers are the teammates who keep Team DoM at the top of the podium. On August 15, we celebrated their achievements with a special Olympics-themed luncheon, complete with a “torch relay”. All your hard work doesn’t go unnoticed, and we are proud to have you on our roster!
Welcoming New Faculty to the DoM
Please join me in welcoming the UCLA Health Department of Medicine’s newest faculty members. Last month we introduced you to colleagues who have joined us as of August 12th. These new faculty have joined us as of September 9th. Click below to learn about their specialties and where they’re from.
Be well!
Dale
P.S.
I hope that you managed to keep cool during the heat wave last week.
One of our joys this summer was watching the result of my wife’s experiment in growing home-grown tomatoes in pots. She planted seeds from an heirloom tomato that we got last summer from a colleague’s summer garden. I was skeptical that they would have survived, as they germinated in November! And we had to nurse them through the winter. Now we are rapidly harvesting a bounty, but wildlife have also discovered them. Not sure if the evidence is from rats, racoons or a skunk. We would appreciate any input in how to protect our produce.
In the meantime, we had to keep them cool, when the temperature got hot enough to cook them in place. We think they will make it and keep on providing fruit! The heat seemed to have scared off whoever was eating our tomatoes.
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