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1Department or Presentation Title
Lydia Pleotis Howell MD
Professor and Chair
Pathology & Laboratory Medicine
The Past, Present, and the Future: Department of Pathology and Laboratory Medicine
2Department or Presentation Title
My second five-year chair review
A valuable opportunity to:– Reflect – Shine a light – Advocate– Get feedback– Become better than ever
3Department or Presentation Title
In this presentation, I will share:
- Vision and plans from 10 years ago.- Accomplishments today – a few examples among many!- How we have achieved these.- Future directions and plans
4Department or Presentation Title
10 years ago:Chair Search and Vision Presentation
5Department or Presentation Title
Vision is important to leadership
“Good business leaders: - create a vision, - articulate the vision, - passionately own the vision, - relentlessly drive it to completion.”
Jack Welch, former chairman & CEO, General Electric
6Department or Presentation Title
The chair is the CEO of a major enterprise
Academic pathology is a $120+M business at UCD Health:
- $8M grants/contracts- $8.2M professional fees- $4.3M purchased services for medical directors- $100+M clin lab revenue- Priceless: Education and community service contributions
7Department or Presentation Title
Vision then -- and now
To be acknowledged nationally as a department of the future
In other words: a department that:
Is at the cutting edge of its discipline, anticipates and leads the future thru its research and creative work,prepares others for the distant as well as the immediate future.
8Department or Presentation Title
Being future-oriented is our inherent obligation:
As a land-grant university:- Discover and share knowledge to
improve the lives of the people
Fits the Chancellor’s vision to “boldly go”
Fits our role as a core department with a major role in every mission.
This Photo by Unknown Author is licensed under CC BY
9Department or Presentation Title
If chosen as chair my duty is to be sure we meet this obligation by:
Facilitating research and discovery:- Future-oriented and multi-disciplinary.
Providing clinical care:- Efficient, high-quality, and cutting-edge- Brings innovations to the bedside to the benefit all members of our
community.
Educating trainees and practitioners: - Emerging methods and trends. - Critical thinking about the future.
10Department or Presentation Title
Departmental activities/themes: Derived from major forces of change in medicine
• Tests for personalized risk assessment, prevention strategies, treatment, monitoring.Proteomics and other
Biomarkers
• Digital and in-vivo imaging on gross and sub-anatomic and cellular level
• Quantitative image analysis New imaging technologies
• Integration of clinical and research info• Data-mining• Availability across wide geographic areas
Informatics and AI
• High quality, innovative, efficient care• New delivery sites: POC, home• Diminishing workforce, growing needs
Healthcare economics & reform
11Department or Presentation Title
The national context: NIH priorities
Example: NCI’s 2010 Professional Judgment Budget Request- Clinical proteomics & other resources: $75M- New imaging tools: $150M- Biomedical computation: $45M- Oncology tissue banks: $30M- CaBIG & BIG network: $100M
12Department or Presentation Title
NCI Budget Proposal 2021
Many similar themes today Opportunities specifically noted in the report:
– Microbiome– Artificial intelligence – often combined with imaging– Implementation science
13Department or Presentation Title
The national context, con’t
CAP’s 2010 Campaign to Transform Pathology includes:– Investigation in emerging technologies– Better integration across disciplines: laboratory, clinical & basic
science– New best practices & standards– Education not just for now, but for the future, too.
14Department or Presentation Title
Fits my own experience
• My leadership in American Society of Cytopathology and their focus on the future:
• Vice president (at that time – later president)• Past-president, ASC Foundation• Executive Board member x 5 years in 2010 – 10 years total.• Discussion facilitator at ‘09 ASC Future Summit
15Department or Presentation Title
Focus on innovation is especially important for today’s leaders
16Department or Presentation Title
Have we achieved the vision?
Are we an innovative and future-oriented department?
17Department or Presentation Title
Research accomplishments:Discovery of new knowledge drives innovation improve clinical care
18Department or Presentation Title
NIH funding and rankings
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NIH Funding and Ranking, 2010-presentUCD Dept. of Pathology & Laboratory Medicine
NIH Funding, Dept. of Pathology & Lab Medicine
Ranking, Pathology & Laboratory Medicine
NIH funding:– $4.2M as of July 2019– Higher today
NIH rankings:– #68 in 2011 #42 in 2018– Mid-30s predicted for 2019
19Department or Presentation Title
Areas of strength
Neuroscience group: $16+M in NIH grants over past 5 yrs.
Vice Chair of Research Yvonne Wan: – Top 15 funded PIs at UCD School of Medicine– $7.5M total awards in the past 5 yrs.,
Anticipate more growth– New research-intensive faculty recruitments in progress.– On-going work by our current faculty
20Department or Presentation Title
Not all about rankings: We are acknowledged leaders of major multi-disciplinary programs
Multi-center personalized medicine studies: NIH-funded All of Us and WISDOM– Site PI: Sandy Borowsky MD
Neuropath Core, $13M NIH R01 “Oldest Old” Dementia study– Lee-Way Jin MD PhD
Microbiome Program, Cancer Center– Led by Yvonne Wan PhD– Recent collaborative seed grant program
Clinical trials, largest site for Roche Diagnostics– Nam Tran PhD
21Department or Presentation Title
New technology: Cool new tools for pathologists
Imaging: MUSE (Levenson/Fereidouni)– Involved lots of faculty and students
Awards– Astellas C3 Technology award– Chancellor’s Innovation Award– Innovation of the Year, Optical Society– 2019 Power List, The Pathologist
Validation as a lab-developed test is underway
22Department or Presentation Title
More cool tools – James Chan and colleagues
23Department or Presentation Title
Even more cool new tools: Artificial intelligence
Artificial intelligence/Machine Learning– Rashidi– Graff– Dugger
24Department or Presentation Title
Our research role is not just about us:- We support research across UCD Health
25Department or Presentation Title
Leaders of inter-disciplinary seed grants
2015-2016
• Inter-dept seed grant program Pathology.• Expanded from 4 to 8 departments: $80,000
2016-2017
• Pathology leadership continued• Expanded from 8 16 departments: $160,000
2017-2018
• Collaborative for Dx Innovation: $370,000• Gift + 11 depts, 3 Centers, SVM, PMB, OOR• 9 Pathology faculty involved in 10/17 projects
26Department or Presentation Title
Support research in the clinical lab
Clinical Research Oversight Committee Purpose:
– Create an effective “front door” to foster research in our clinical laboratory.– Ensure:
- Capacity (instrumentation and staff)- Workflows to protect turnaround time of clinical work- Appropriate pre-analytic specimen preparation - Compliance with CAP and other regulations- Payment for services rendered
– Minimize tension and conflict.
Outcomes (as of 12/2018)– 223 projects supported– Serves 108 principle investigators and 30 departments. – Improved satisfaction and attitude among clinical investigators and lab staff.
27Department or Presentation Title
Education accomplishments
28Department or Presentation Title
Undergrad programs
Medical Laboratory Technician
Clinical Lab
ScientistsCytotechs
Medical students
Residents Fellows
Continuing Education
for Practitioners
Educational breadth spanning the professions and level of learners
29Department or Presentation Title
New in education over the past 5 years
2nd year med student course (PMD410):– #1 rating in pre-clinical curriculum:
New electives for med students: – 3rd yr elective– Acting internship in AP– Increased capacity for 4th electives
New lab professional training: – Med Lab Tech– Cytotech – award-winning grads!!!
Clinical Informatics Fellowship
30Department or Presentation Title
Highlight: Two educational programs
31Department or Presentation Title
Residency program
High ratings in ACGME annual survey
Above nat’l average in recent engagement survey
Thanks to hard work by many after an external review.
32Department or Presentation Title
Award-winning residents
George Gao– Best poster, USCAP– Two leadership awards: ASCP, USCAP
Ying Liu – Certificate of Congressional
Recognition for volunteerism with ACS
Ananya Datta Mitra– UCDH High Value Care Competition
33Department or Presentation Title
Outcomes, con’tInstituion Fellowship(s)
City of Hope Hemepath
Emory Molecular pathology
Johns Hopkins Gyn pathology
MD Anderson Cancer Center
Surg path
San Diego Coroner’s Office Forensic pathology
Stanford Transfusion
Univ, of Alabama Molecular pathology
Univ, of Massachusetts Dermpath
UC Davis Cytopath, Hemepath, Surg Path
UCLA GI path
UCSD Neuropath, Bone/soft tissue
Univ. of Washington GI path
Outstanding fellowship placement
34Department or Presentation Title
Edmondson Summer Research Internship: ~35 yrs
Encourage careers in science, pathology, lab medicine
Develop diverse pipeline– Prep Medico partnership x 3 yrs.
Survey for 2002-17– 93% strongly agreed/agreed:
“Important to career development.”– 25%: Doctoral degree (PhD, MD, other)– 10%: Masters or other health
professional degree
35Department or Presentation Title
Faculty: National leaders in education
Test Development Advisory Committee, American Board of Pathology – Hooman Rashidi (Hemepath)– Max Fung (Dermpath)
National Executive Board, Alpha Omega Alpha Honor Society– Regina Gandour-Edwards
Test Material Development Committee, United States Medical Licensing Examination (USMLE), National Board of Medical Examiners– Regina Gandour-Edwards
2015 Excellence in Advising Award (Faculty Advisor category), Region 9 of National Academic Advising Association– Hwai-Jong Cheng PhD
36Department or Presentation Title
Education innovators
PMD 410A&B: – Techniques from humanities education:
Essay questions
Artificial intelligence applications– Histology education– For early identification of students
experiencing academic difficulties
37Department or Presentation Title
Clinical Accomplishments
38Department or Presentation Title
Our clinical role: Testing for our region
• We enable care for an underserved region.
• Sacramento County • Moderate access to health coverage
• San Joaquin County • Lowest access to health coverage• Life expectancy 69 years for poor vs. 90+ years for all others• Higher percentage (23.4%) of uninsured nonelderly adults ages 18-64
compared to state as a whole
• High incidence of cancer in the surrounding counties
39Department or Presentation Title
Our clinical role: Make care available to all in our region
Cost-effective lab tests
More patients served• Including those who can’t pay
Healthier community and region
40Department or Presentation Title
Points of Pride: Financial stewardship
$11M savings, 2015-16: Negotiated capital equipment expenditure for new automation line
$1.1M savings, 2015-16: Converted four reference labs to 3rd party billing.
$660K new revenue, 2018: Created new billing codes for opiate testing.
New Lab Utilization Committee, to be launched in 10/2019:– Chaired by non-pathologist physicians– Charter and P&P created by the department to get multi-disciplinary provider buy-in on
test menu and controlling use of expensive send-out tests
41Department or Presentation Title
Points of Pride: New, better, faster tests in the Clinical Lab
Earlier treatment
Betterworkflow in Emer
Dept.
Early dx of fibrosis
and cardiotox
• Among 1st labs nationally to implement high-sensitivity troponin (hsT)
• 2 hrs faster!!• More sensitive
for myocardial damage
42Department or Presentation Title
New better, faster, more efficient tests: mPOC for sepsis detection
mPOC for high-risk pts (burn unit)
Early dx (28.7 hrs) of meth-sensitive S.
aureus infections
Reduced unnecessary
empiric vancomycin tx
35% decrease: Vanco-induced acute kidney
injury
• UC Davis Health: 1st in the nation to implement molecular POC pathogen detection in this high-risk group.
43Department or Presentation Title
Anatomic Pathology: Department’s biggest challenges
Non-automated testing -- dependent on human effort and subject to human variability.
Lack of automated quality monitors in LIS: – Manual data collection is required– Custom builds required
Critical shortages of lab professionals negatively impacting recruitment– 2 year vacancies for AP manager and pathologist assistants
Requires continual work on relationships
44Department or Presentation Title
Anatomic Pathology: Points of Pride
In-sourced renal pathology: Kuang-yu Jen MD, Mingyu Cheng MD– Better service, education, clinician satisfaction– Grew volume
Digital pathology:– Implemented in 90% of all tumor boards in 2018– Telepathology for frozen section and consultations
Key to accreditation of the new Rectal Center of Excellence– Special commendation from site visitors
Frozen sections:– Low discrepancy rates: ~0.50% since 2014 (nat’l benchmark =1.10-3.25%) – Fast turnaround time
45Department or Presentation Title
How have we achieved so much?- 2 strategic plans – but it takes more than just a plan
46Department or Presentation Title
Advice that has resonated with me for many years
#1: Surround yourself with good people
Am J Med 2012; 125:315-319
47Department or Presentation Title
So proud of our great people!
Lots of new recruits – 2/3rd of faculty are new in the past 10 years– 21 new faculty in the past 5 years!
- 13 replacements- 8 new positions
– Retention rate better than AAMC’s national average
New faculty section leaders in the past 5 years– Nam Tran PhD: Chem/POC/Tox– Anna Romanelli PhD: Microbiology – Grace Monis MD PhD: Apheresis– Sarah Barnhard MD: Transfusion– Dorina Gui MD PhD: Surgical Pathology– Kuang-yu Jen MD PhD: Renal Pathology
Lots of great new admin and clinical lab staff on our team
48Department or Presentation Title
Celebrate our staff and faculty, and honor each other
49Department or Presentation Title
Advice, con’t
#2: Serve the interests of the faculty
Am J Med 2012; 125:315-319
Faculty come here because UCD is a great university they expect to have great careers here.
50Department or Presentation Title
Supporting faculty research
Seed grants– Department-initiated and leadership in collaborative grants– Department-only grants
Continual attention to our administrative services– Mandatory PI effort confirmation in Cayuse.– Improved monthly budget reports– Continued training of Business Office Staff in research admin.– More staff: Added part-time effort from Gabriela Lee MBA – Open houses to build relationships with Business Office.
Advocating for space: 2000 sq ft. deficit.
51Department or Presentation Title
Faculty DevelopmentDevelopment Program Participants (Year)
ASCP Leadership Institute Barnhard, Jen, Tran, Romanelli (2018)
APC Pathology Leadership Academy
Vali Betts, Dugger (2019)Rashidi, Olson (2017)Wan, Gui (2016)
USCAP Course for Emerging Leaders
Barnhard (2017)
UC Women’s Initiative for Professional Development
Olson (2017)
UCD Health Mentored Clinical Research Training Program
Graff (2017-19)Grimsrud (2016-18)
AAMC Minority Leadership Program
Martinez-Cerdeno (2019)
~1/3rd of our faculty have participated in development programs
Almost all were Assistant or Associate Professors
52Department or Presentation Title
Outcomes: Success in academic advancement
% of successful actions:– 90% promotions– 95% merits
% of actions with Step Plus or Accelerations– 30% promotions– 20% merits
Why so successful?– Strong mentoring– Good advice– Resources and opportunities0
5
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1 1.5 2 Denied Accelerated
Faculty Academic Advancements by Step,
AY1516 - AY1819Pathology & Laboratory Medicine
Merit Promotion
53Department or Presentation Title
Advice, con’t
#3: Perfect the art of compromise
Am J Med 2012; 125:315-319
54Department or Presentation Title
Reflects our values– Collaborative
environment– Importance of
relationships
Compromise means:– Negotiation – Partnership
This Photo by Unknown Author is licensed under CC BY-NC
55Department or Presentation Title
Compromise, negotiation and partnerships: Examples
Improvements to billing and collections– Dept billing central billing unit– Outcome: More $$ to the
department.
Partnerships with Radiology and Academic Affairs for shared services.
Off-loaded responsibility for core research services:– EM lab Anatomy & Cell Bio;
$300K savings– Flow cyto core lab Med
Microbio; $50+K savings
56Department or Presentation Title
Advice, con’t
#4: Be transparent
Am J Med 2012; 125:315-319
(for all the things that aren’t confidential!!)
57Department or Presentation Title
Transparency
Regular updates:– Financial – Council of Chairs– Association of Pathology Chairs
Finance Advisory Committee: – Rules-based compensation plan
“Lunch with Lydia”This Photo by Unknown Author is licensed under CC BY-SA-NC
58Department or Presentation Title
Advice, con’t
#5: Give others responsibility and authority
Am J Med 2012; 125:315-319
59Department or Presentation Title
Divide the work and conquer -- get more done!!
Delegation of authority to lab directors:
Vice Chairs:– Modelled after Dean’s office structure– Requires formal reviews
60Department or Presentation Title
Advice, con’t
#6: Never accept the status quo
– “If a day has gone by without a threat to the well-being of your department, you probably have not been paying attention.”
Am J Med 2012; 125:315-319
61Department or Presentation Title
Avoiding threats Planning for the future
62Department or Presentation Title
Future: Research
Keep our research programs growing!– Address areas of current scientific interest and need.
Opportunities:– Complete recruitments for 3 tenure-track research faculty:
- Stowell Chair in Experimental Pathology- Microbiome- Neuropathology
– Leverage new recruits to expand dept-based collaborative programs, especially immunology.
63Department or Presentation Title
Future: Research, con’t
Be a leader re: new diagnostic technologies – Develop, evaluate, implement – AI, imaging, and more– Create new pertinent quality programs, too.
Support translational pathway establish a Center for Diagnostic Innovation (CDxI)– Organize, brand, and market our activities under a single umbrella– Refine our plan based on feedback from external reviewers.– Submit to Dean and Vice Chancellor for support– Seek funding: internal and external.
64Department or Presentation Title
CDxI: Clinical Validation Laboratory
Clinical Implementation
(including provider education)
CLIA/FDA Regulated Validation
Method Development
Cost and Value Analysis
CAP Accredited Biobank CLIA and CAP accredited Lab
Feedback from clinical practice
65Department or Presentation Title
Future: Education
Undergrad programs
Medical Laboratory Technician
Clinical Lab
Scientists Cytotechs
Medical students
Residents Fellows
Continuing Education
for Practitioners
Mature and sustain our many new programs.– Medical student electives– Clinical informatics program
New subspecialty focus for surg path fellowships. Curriculum reform for medical students
66Department or Presentation Title
A few new things to think about
On-line continuing education for practitioners:– CME/CE, SAMs for our Lab Best Practice blog and Case of the Month
More use of educational technologies for training programs:– Less “sage on the stage”– More on-demand delivery at the learner’s convenience
Create educational programs within Center for Diagnostic Innovation– Grow cross-disciplinary literacy between medicine, computer science,
and engineers.
67Department or Presentation Title
Future: Clinical Service
Partner with Radiology Path-Rad integration– Integrated reports and more– New opportunities with a new Chair of Radiology
Refine our AP subspecialty team model:– New and better teams?– Integrate clinical partners into teams?– Frozen section “hospitalist” role??
Quality programs– Leverage LIS– ?Cross-dept monitors– Client satisfaction
68Department or Presentation Title
Future: New financial model
How will new funds flow model influence:– Faculty staffing in all subspecialty areas (AP and CP)?– Salaries and Z-payments?– Departmental funding for education and research programs
69Department or Presentation Title
Lastly, to paraphrase the Presidents
Being a chair:
– “is a glorious burden”- George Washington
– “is a splendid misery”- Thomas Jefferson
– “has made every person who occupied it bigger than s/he was -- and no matter how big, not big enough for its demands.”
- Lyndon B. Johnson
70Department or Presentation Title
But it’s the best job I’ve ever had!
Thank you all for a great 10 years You make our department what it needs to be I look forward to your feedback during my review