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Better Health for America - Tulsa - University of Oklahoma


									A Call to Action : You Matter in Building
Health Equity for Tulsa, Oklahoma and

Gerard P. Clancy, MD
President, University of Oklahoma - Tulsa

In these tense, polarized times,
I dare you to be an optimist ?

Because important things are actually getting

Really they are…
getting better.

We can accomplish great things…..

But we have some work to do so that all
may enjoy advances in our society ……we
need to bridge those gaps.

     This year’s health, medicine, and
     policy topics:
1.   Understanding consciousness
2.   New approaches to cancer
3.   Faster drug development
4.   The importance of “play” for the brain
5.   Heart disease and lifestyle changes
6.   Nutrition and new food labels
7.   Customized health care
    US Health Care – Are not these the
    things that matter ?

-   High cost and poor outcomes
-   98,000 deaths per year from
    medical errors
-   Physician shortages
-   Health disparities
-   Oklahoma among the most

Politics aside, we need honesty about
American health and the need for change:
Memorize these talking points…..
• Moral argument – the health of the poor is very
• Oklahoma’s future argument - Oklahoma is among
  those with the poorest health and the greatest
  health disparities.
• Cost argument – the cost of US health care is the
  highest in the world and is bankrupting our
• The safety and quality argument – there are
  numerous opportunities to improve the safety and
  quality of US health care.
Physicians cost 20% of total cost but
physicians decisions command 80% of costs.
Holding Back Oklahoma: Health Status

An Engineering Project =
“In the 20th century,
science and medicine
combined to create great
benefit for humankind
leading to a 30 year
expanded life expectancy.
The imperative of the 21st
century is the
democratization of those
          Mullan 2010        Democratize This !

               COMMONWEALTH FUND
State Scorecard Summary of Health System Performance

                                                       13   OK
The State’s Next Challenge - Securing Primary Care for Expanded Medicaid Populations
     Leighton Ku, Ph.D., M.P.H., Karen Jones, M.S., Peter Shin, Ph.D., M.P.H., Brian Bruen, M.S., and Katherine Hayes, J.D.

Although Oklahoma health status is very poor,
health spending per capita is in the top quartile.

                                  Dartmouth Health Atlas 2009
     Plotting Cost of Care vs. Quality of Care:
     Which states would you consider for a new
     business start up?

High quality, low cost                 High quality, high cost

Low quality, low cost                   Low quality, high cost

In 2011:
- 14 year difference in life expectancy North vs. South.
- North, East and West Tulsa; 40% of population, 4% of clinicians.
  Age-Adjusted Death Rate in Tulsa     Physician Density in Tulsa

Change is Coming - A pattern in America of industry specific
revolution, technology implementation
and cost reduction to benefit the masses.

A Case of Disruptive Innovation - July 23, 2011 |
Borders Holds Liquidation Sale , by: Natalie Maneval :

    The once famous and iconic bookstore is no more.
    After a long struggle to beat bankruptcy, Borders
    now faces liquidation as early as Friday. The
    bookstore will close the remainder of the
    company’s 400 stores, laying off 10,700 employees.

    With Borders stores closing around the country for
    the last few months, it comes as no surprise that all
    the stores will soon close.

    In the world of digital books, Borders fell under the
    pressure. The company released a statement
    saying, “We were all working hard towards a
    different outcome, but the headwinds we have
    been facing for quite some time including the
    rapidly changing book industry, eReader revolution
    and turbulent economy have brought us to where
    we are now.”
               W                                                             18
               e                                            “Faster, cheaper, easier”
    Change is Coming - A pattern in America of
    industry specific revolution and cost reduction……
•    Carnegie and steel….
•    Vanderbilt and railroads….
•    Rockefeller’s and oil….
•    Ford and automobiles….
•    Southwest and air travel….
•    Walmart and retail, pharmacy
     and now health care…I have been
     to Bentonville, Arkansas….

     Market forces, technology advances and Federal legislation have primed
     health care to be the next industry to undergo major revolution.
    Can we agree that we need a new type of college graduates
    for the future that guides this new version of health care to
    be equitable, safe and affordable…..(that’s you I’m talking about) ?
              W                                                               19
          Storm Clouds on the Horizon:
          2011 – 2016 Timeline in Health Care Delivery
               Fee For Service      “Rough Waters”         Shared Savings
                                     - Health Reform
                                     - Debt Ceiling
                                                          FFS, Capitation…
               Today Curve:                             Tomorrow Curve:
To Care
for Patients   • Hospital led                          • System - Physician led
               • Volume                                • Quality
               • Procedures                            • Transitions
               • Specialty Care                        • Efficiency
               • Hospital Care                         • Bundling of payment
               • FFS negotiations                      • Shared Savings

                       2010         2012       2014        2016
Dear Dan,
I messed with your Wordle. Sorry for being a “gooter.”
Love, Gerry

A Relevant Life….
Why are you important to this work ?
Why is this work important to you ?
What would we do without new funding ?

Why you matter….?
• Physician shortage….not enough of us to go
  around. We will be working as teams.
• If we don’t change things for the better –
  someone else will.
• It takes your intellect and heart to solve these

Warning - Although physician’s direct costs are
about 20% of overall health care costs,
physician decisions direct 80% of health care costs.
Why is this work important to you?
• Obvious answers – because this is your
  future and this is why you chose this
  career path.
• Less obvious answer - did you know it is
  also vital to your own well being?

The concept of contribution
• Good works for others as a central theme
  across religions:
  – Judaism - The Obligation of Tzedakah
  – Christianity – St. James, St. Augustine, salvation
    through care of others
  – Hinduism – The way of works - Karma Yoga, good
    begets good
  – Islam – faith and good works go hand in hand.

The concept of contribution
• Central theme across theories of mental
  – Sigmund Freud – deal with the stresses of the
    external world through defense mechanisms.
    Immature, neurotic and mature defense with
    altruism as a lead mature defense.
  – Alfred Adler – the importance of contribution to
    society for your own mental health….mental
    illness driven by disconnection from society.

Striving for Happiness or Fulfillment ?
Erik Erikson’s Stages of Psychosocial Development

Stage             Ages          Basic Conflict
1. Oral Sensory   0-18 m        Trust vs. Mistrust
2. Muscular       18m -3 yrs    Autonomy vs. Doubt
3. Loco-motor     3 - 6 yrs     Initiative vs. Guilt
4. Latency        6 - 12 yrs    Industry vs. Inferiority
5. Adolescence    12 - 18 yrs   Identity vs. Role Diffuse
6. Young Adult    19 - 40 yrs   Intimacy vs. Isolation
7. Middle Adult   40 - 65 yrs   Generativity vs. Stagnate
8. Maturity       65 - death    Integrity vs. Despair

Despair vs. Integrity

Basic Needs and Higher Needs
Using Abraham Maslow’s Hierarchy of Needs

  Self Actualization Needs – Act for Causes Outside their Skin
            Esteem Needs - Respect, Self Confidence
                    Needs for Love, Affection
                   Safety and Security Needs
         Physiological Needs - Oxygen, Water, Warmth

• Each level of pyramid dependent on previous level.
• Balance striving for highest capability but at times needing to
  revert back to basic needs.
• Leaders know that people are not always at the top of their
  game because of basic needs.

How should we act? Like
American heroes
the Marlboro Man and

The Concept of Contribution - Rugged
Individuals vs. Advanced Civilizations
                        The Rational Optimist, Matt Ridley 2011

Advancement Occurs When…
– Specialization of work within a
  broader team of individuals.
– Constant Exchange – ideas, goods,
– Innovation through trying, failing,
  learning from MISTAKES.
– Constant repackaging of ideas
  leading to innovations.
One of America’s best
performing health care
systems trains daily as a

Team, Team Team at North Shore Long Island School of Medicine at Hofstra
University - Former New York Jets Training Facility…they left the score
board up.

Some of Our Own Case Examples
   of Group Contribution…

OU College of Medicine, Tulsa 
 School of Community Medicine
Case I – Combined efforts of many over
decades…that matters.

 Four Goals for the School of Community Medicine:

1. Graduate physicians and physician assistants experienced
   that are committed to the underserved, AND…

2. Graduate physicians and physician assistants armed with the
   engineering skills to redesign the U.S. health care system to
   improve access and quality of care and reduce the overall
   cost of care.

3. Develop a new health care delivery system that is equitable,
   safe and affordable.

4. Align with other disciplines to carry out this work.

                       Samson and OU pet therapy     Laureate Institute
                                                     for Brain Research
                   Examples of our non-
Sand Springs       traditional patient
Community School   care, public health,
Clinic                                             Roy Clark Community
                   research and
                                                   School Clinic Clinic
                                                    Public Housing
                   education settings

                                                   Rosa Parks Community
                                                   School Clinic

Therapeutic                                         Tulsa Day Center for
Riding Center                                                        40
                                                    the Homeless
Unique Experiences
for Our Students
•   Explicit in Our Commitment to Serve      •   Health Information Technology
    the Underserved through                      Sophistication
    “Community Medicine.”                         – Learn early to utilize these
     – Student learning environment across          technologies to improve health
       the region.                           •   Leadership
•   Recruit for Altruism                          – 9th year of student-led free acute
     – Surveys show we are maintaining              care and free chronic clinics for the
       altruism                                     uninsured.
•   First days of Medical School –           •   Teamwork
    Summer Institute                              – Student clinics organized as teams of
     – 6 day intensive course to learn the          medical, nursing, pharmacy, social
       “anatomy of the community” before            work students.
       the “anatomy of the body.”            •   Engineering and Project
•   Student Academy                              Development
•   Masters of Public Health and                  – Students practice real time re-
    Certificate of Public Health                    engineering of health care delivery.

Wayman Tisdale Clinic
Case II – Great efforts from
numerous individuals over
several years….that matter.

Groundbreaking Day…..

                             Governor Fallin signs
                             the last beam.

Focused work to “improve
health” with our region in
greatest need: North Tulsa

 President Boren signs                     $20,000,000 OU Wayman
 the last beam                             Tisdale Clinic in North Tulsa
  “Is Tulsa North Being Pimped by OU?’
                                            Oklahoma Eagle, January 2010
“To Tulsa north’s “rescue,” Oklahoma University has come.”

“Unquestionably, medical care is needed in Tulsa north. Why then, pose such a negative
   question when OU appears to be doing the right thing?”

“Our answer….Pimps use the bodies of women to make money. For whatever reason, the
   women are vulnerable. The residents of Tulsa north are very vulnerable because of their
   poor health outcomes. Hundreds of millions of dollars will be spent ostensibly for better
   health care for Tulsa north residents. Who gets the money for such an endeavor? OU will.
   Who receives $20 million dollars for building the facility? Manhattan Construction has been
   selected as the contractor.”

“If a healthy community is the goal of OU, does it not recognize that a healthy community
     involves more than improving traditional healthcare facilities and services? A healthy
     community must have a good economy and a chance for good jobs for its residents. Tulsa
     north’s personal sense of well-being and its ability to thrive socially and economically are
     tied together. It is impossible to have a healthy community without a strong educational
     and economic engine in its midst.”

“Why do we pose the question, “Is Tulsa north being pimped by OU?” Do not pimps use bodies
   to get income? OU will receive income from treating sick bodies. When will OU learn that
   the elimination of healthcare disparities among population groups is not a zero sum game?”

Tulsa’s History is Relevant (1921)

24% local construction
                                                              Recruited new
                                                              Pharmacy next door

                                                              Early Childhood
           Taste of North Tulsa                               Education Center

                                  Focused work in North
                                  Tulsa to “improve health”
                                                     Linking Public Health
Plan for 36th Street North and Hartford              and Urban Planning in
                                                     North Tulsa

                                                      OU Urban Design Studio

                 - Gray are existing buildings
                 - White are planned new buildings

A Call to Action -- Be part of a movement that …

   – Is Honest - Understands the current state of affairs for the
     underserved in Oklahoma and cares to do something
     about it as a national model.
   – Seeks Democratization - Is deeply involved in changing
     how health care is delivered such that future care is
     equitable, safe and affordable.
   – Partners – with the best academic colleges and institutions
     in Oklahoma, across discipline lines.
   – Is Adding - To the economic vitality of Tulsa
   – Is Ready - To build upon existing educational and clinical
     investments in place in Tulsa.
   – Believes - clinicians are at the heart of improving health in
     Tulsa, Oklahoma and across the US and therefore requires
     a focus on the training of these clinicians… do that
   – Recruits and maintains altruism and energy…
Let’s GO !.....Let US go !!!!

 30 inches of snow in a week…no
 30 degrees below…no problem.
 113 degrees all week…no
 14 year difference in life
  expectancy…no problem.
 Way short on physicians…no
 Take some shots – Pit bulls and
  Pimps problem….because…..

   …..A small body of determined
   spirits fired by an unquenchable
   faith in their mission can alter the
   course of history - Gandhi

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