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2015 AΩA Fellow in Leadership Awards

Leadership in medicine, medical education, and health care is more complex in the twenty-first century than ever before. Escalating costs, unequal access, less than ideal outcomes, and political challenges facing health care legislation have contributed to an unprecedented level of uncertainty in the delivery of health care and medical education. The medical profession and the country are in need of leadership that is inspiring, insightful, engaging, and humble—leadership that both understands and represents the needs of patients, physicians, and medical educators and trainees. Because of their unique knowledge of the practice of medicine and understanding of medicine’s core professional values, physicians are ideally suited to serve as leaders in this period of change. The integral parts of the professional life of a physician are the values affirmed in the Medical Professionalism Charter that emphasizes the principles of patient welfare, patient autonomy, and social justice (http://annals.org/article.aspx?articleid=474090).

The AΩA Fellow in Leadership Award recognizes and supports the further development of outstanding leaders exemplifying the qualities of leading from within, AΩA’s professional values, the concepts of servant leadership

The five essential components of the AΩA Fellow in Leadership Award are 1) self-examination, the "inward journey," leading from within; 2) a structured curriculum focused on topics related to leadership, including an understanding of the relationship between leadership and management; 3) mentors and mentoring; 4) experiential learning to broaden the perspective and understanding of leadership as it relates to medicine and health care; and 5) team-based learning and developing communities of practice.

We are pleased to announce the 2015 AΩA Fellows in Leadership, each of whom received a $25,000 award to be used for further development as future leaders:

  • Cynthia Arndell, MD, BSN, FACP—Associate Professor in Internal Medicine at the University of New Mexico Health Sciences Center
  • Ronald Robinson, MD, MPH—Medical Director of Surgical Services at Centura Health, Avista Adventist Hospital in Louisville, Colorado
  • Elizabeth J. Warner, MD, FACP—Medical Director of Continuous Improvement Support at Bronson Healthcare Group in Kalamazoo, Michigan


Left to right: 2015 Fellows in Leadership Elizabeth Warner,
Cynthia Arndell, and Ronald Robinson.

Fellows and members of the AΩA Board of Directors Committee on Leadership met at AΩA's national office in Menlo Park, California, for a four-day meeting that included a two-day orientation session during which fellows and committee members learned about the background, development, goals, and principles of the award; discussed fellows' goals for the fellowship; worked on refining the fellows' projects; and got to know each other. The final two days included the course The Science and Practice of Leading Yourself, led by AΩA Board of Directors member Dr. Wiley Souba of the Geisel School of Medicine at Dartmouth.

Attending the meeting were:

  • 2015 Fellow in Leadership Cynthia Arndell, MD, BSN, FACP
  • AΩA Executive Director Richard L. Byyny, MD, FACP
  • AΩA Leadership Committee Chair Eve Higginbotham, SM, MD
  • AΩA Leadership Committee Member Page Morahan, PhD
  • AΩA Board of Directors President Douglas Paauw, MD, MACP
  • AΩA Leadership Committee Member Alan Robinson, MD
  • 2015 Fellow in Leadership Ronald Robinson, MD, MPH
  • AΩA Leadership Committee Member Wiley "Chip" Souba, MD, DSc, MBA
  • AΩA Leadership Committee Member John Tooker, MD, MBA, MACP
  • 2015 Fellow in Leadership Elizabeth Warner, MD, FACP
  • AΩA Leadership Committee Member Don Wilson, MD, MACP


Orientation participants, left to right: Chip Souba, Cindy Arndell, Eve Higginbotham, Ron Robinson, Dick Byyny, Don Wilson, Elizabeth Warner, Alan Robinson, John Tooker, and Page Morahan.


Course participants, "The Science and Practice of Leading Yourself," left to right: Chip Souba, Alan Robinson, Elizabeth Warner, Doug Paauw, Page Morahan, Cindy Arndell, Dick Byyny, Ron Robinson.

 

Cynthia Arndell, MD, BSN, FACP
Associate Professor, Internal Medicine, University of New Mexico Health Sciences Center
Albuquerque, New Mexico

As an Associate Professor at the University Of New Mexico Health Sciences Center (HSC), Dr. Cynthia Arndell has been able to fulfill her passion for making a difference in the lives of marginalized individuals and communities. Through extensively researching best practice models and networking across disciplines, she has taken the lead role in the development and integration of the medical curriculum that addresses social accountability. Her successes include the following required educational activities: 1) the first two-week course, Health Equity: Introduction to Population Health which introduces all incoming medical and physician assistant students to social determinants of health, 2) the first-year medical and physician assistant student interviews with homeless populations, 3) third-year medical student post- discharge home visits with pharmacy students which address the challenges of transitions of care in patients experiencing low health literacy and scarcity of resources, and 4) the fourth-year medical student Comprehensive Ambulatory Care rotation which advances student skills in Interprofessional collaboration to address the needs of vulnerable populations. Additionally, in collaboration with faculty across disciplines and community partners, she developed and implemented the senior medical and pharmacy student Street Outreach and Respite four-week elective. Dr. Arndell serves as the faculty mentor for overseeing all medical student-led volunteer outreach clinics for the homeless and was the champion in developing the Interprofessional Student Clinic for Albuquerque Homeless Men’s Shelter.

Dr. Arndell’s curricular innovations have gained national and international recognition resulting in numerous prestigious awards and guest speaker invitations. Her experience in interprofessional education curriculum development has led institutional leadership to appoint her as the University of New Mexico School of Medicine Interprofessional Coordinator. She has, subsequently, taken a lead role in securing the support of HSC deans across disciplines to agree upon the implementation of an interprofessional longitudinal community-engaged curriculum for all HSC students.

Integrating Interprofessional Education (IPE) into an Academic Health Sciences Institution—What are the key challenges we face in faculty engagement?—As a native New Mexican living and working as a health professional in a state that ranks forty-eighth in the nation for poverty, I have witnessed, firsthand, the impact of social determinants on population health; i.e., how the array of social, economic, political, and built environments shape individual and societal health resulting in gross inequities between and within populations. As a nurse, physician, and community volunteer, I have served our state’s communities for over thirty-five years. And I find myself struggling more and more with the inability of our fragmented healthcare systems to meet the needs of our populations, particularly those that are the sickest and most marginalized. As a faculty member at University of New Mexico Health Sciences Center, I have had the privilege of developing, implementing, and teaching the medical school curriculum that addresses the social determinants of health. A coordinated team of multiple disciplines is necessary to improve the health outcomes of individuals and their communities. As a result, I have collaborated with professions both within and outside of our health sciences institution to begin developing interprofessional educational opportunities for our students. Although the University of New Mexico Health Sciences Center has given top priority to the integration of interprofessional education, our institution faces similar challenges to other academic centers in securing faculty buy-in and interest.

In recognition of the crucial role faculty engagement plays in successful interprofessional education implementation, my scholarly project will focus on the development of a cross-disciplinary strategic plan for grounding institutional faculty development and commitment.

I am confident that this fellowship will serve to advance my work in continuing to align the education of our future healthcare workforce with our societal contract to improve the health of all.

Ronald Robinson, MD, MPH
Medical Director of Surgical Services, Centura Health, Avista Adventist Hospital
Louisville, Colorado

Dr. Ronald Robinson currently serves as managing partner of High Plains Anesthesia Consultants, and as medical director of surgical services at Avista Adventist Hospital, a Denver-area community hospital. He received his MD and MPH from the University of Texas Medical School at Houston in 1993, and completed his anesthesiology residency at UT Houston in 1997. He has practiced anesthesiology continuously since graduation in underserved rural and community hospital settings.

In addition to private practice, Dr. Robinson has served as a flight surgeon for both NASA’s Johnson Space Center and the Texas Air National Guard. He has educated medical students and residents as clinical faculty at the University of Texas at Houston, and Lake Erie College of Osteopathic Medicine at Bradenton. He has participated actively in research, and is published in the fields of physics, aviation medicine, and pain medicine. Dr. Robinson has also owned and operated multiple small businesses involving aviation, finance, and real estate.

Concurrent with his clinical practice, Dr. Robinson is pursuing an MBA through the University of North Carolina’s Kenan-Flagler Business School. In addition to his experience in business and medicine, Dr. Robinson is currently studying leadership with the Greenleaf Center for Servant Leadership, and anticipates completion of their certificate program in June 2015.

Charting the course for servant leaders in community practice—My project will target one of the thorniest issues in modern medical care: the rapidly increasing cost of invasive procedures, which is largely unaccompanied by an improvement in outcomes. The focus of the project will be reducing variability in clinical practice, and optimizing resource utilization, in laparoscopic hysterectomies performed at Avista Adventist Hospital.

Women’s services are a critical component of the care that is delivered at our institution, and we provide a wide spectrum of services from obstetrics to advanced urogynecology. Analysis of the service line, however, reveals extensive variability in clinical practice and resource utilization in laparoscopic hysterectomies performed at our institution relative to comparable institutions, resulting in underperformance of the service line as a whole. The goal of this project is to reduce variability, implement best practices, and improve the performance of the service line to a level exceeding that of our competitor institutions.

This project provides the opportunity to apply traditional management techniques, such as revenue cycle analysis and supply chain optimization, within a collaborative servant-leadership framework. Success in this project requires developing a team of physicians, nurses, and administrators that can meld the various stakeholders’ viewpoints, and deconflict competing priorities, to increase the performance of the service line while maintaining a community of care centered on the fundamentals of physician and patient autonomy, and state-of-the-art clinical practice.

Successful completion of this project will demonstrate the cooperation that is possible between managers and clinicians under a servant-leader model. Application of the servant-leader model in this context will demonstrate that high quality care can be provided in a cost-constrained environment, utilizing modern medical and management practices, without increasing governmental regulation. The project will provide valuable experience in team-based learning for all participants, and it will facilitate similar projects in other service lines at Avista. It is my hope that success in this project will chart the course for other institutions that wish to follow suit.

Elizabeth J. Warner, MD, FACP
Medical Director, Continuous Improvement Support, Bronson Healthcare Group
Kalamazoo, Michigan

Dr. Elizabeth J. Warner currently serves as Medical Director of Continuous Improvement Support, Bronson Healthcare Group, Kalamazoo, MI. Upon completion of her internal medicine residency in 2001, she developed as a primary care internist, where she practiced with passion and purpose for the health of her patients. This passion guided her to a leadership role as Primary Care Medical Director from 2012-2014.

Born and raised in Cedar Rapids, Iowa, her higher education began in the University of Minnesota, Minneapolis, MN where she graduated Summa Cum Laude with a Bachelor of Arts in International Relations, and a French minor in 1994. She was inducted into Phi Beta Kappa for her efforts. Dr. Warner received her Doctorate of Medicine from Michigan State University, College of Human Medicine in 1998, where she was honored with membership into AOA, and completed her Internal Medicine residency at the Kalamazoo Center for Medical Studies (KCMS).

Her formal and informal training are ongoing. Active in the Michigan Chapter of ACP, she received LEAD certification from ACP (2010), and Fellowship status with ACP (2009). She is actively pursuing her Certified Physician Executive certification with educational guidance from the American Association of Physician Leaders, of which she is a member. She received lean certification with University of Michigan (2/2014) and continues to develop this practice.

Her strengths include public speaking on a wide range of topics from Obesity, Leadership and Teamwork skills, Motivational Interviewing, to Rediscovering Personal Sense of Purpose in Medicine. She speaks about Balance, Spiritualty, and Resilience, even as she strives and struggles to achieve it for herself. As an involved community member, parent and human, Elizabeth is inspired to practice the principles of lean thinking, including respect for people, continuous improvement, and leading with humility, throughout all aspects of her life.

Transformational Lean Management System—As Medical Director of Continuous Improvement Support at Bronson Healthcare Group, I serve as physician champion advancing the work of lean tools and principle-based organizational excellence. This work is anchored in the principles of Respect for People and Continuous Improvement with the explicit intent of improving the value and sustainability of the care we deliver to the patient. Bronson’s definition of lean is taken from the work of Jeffery Liker (Developing Lean Leaders at All Levels, LLI, 2014) and is as follows: a strategy for operational excellence based on clearly defined values to engage people in continuously improving Safety, Morale, Quality, Cost and Productivity. With the uncertainties and external pressures in the American health care system, and changing reimbursement models, we need clarity of vision, constancy of purpose, to develop reliable structures and nimble pathways to identify problems. Health care systems need to problem solve them as close to the work as possible, and to anchor these behaviors in the principles which drive operational excellence.

Our organization has doubled in size over the past five years, and we are experiencing the “growing pains” of these mergers and acquisitions. This is challenging us to consistently deliver on the value proposition of high quality patient experiences and lowest cost. I hypothesize that lean problem solving discipline and scientific thinking will help us experiment our way to an improved patient care, and sustainable systems for caregivers. Our lean work to date has yielded some great pockets of success, and now we need to develop aligned systems to build upon this work. We have identified critical ideal state components of our organization’s future, including:

  1. Building integrated and engaged healthcare teams across the continuum of care.
  2. Developing a culture that embraces the idea that improving the work is the work.
  3. Consistently showing respect by developing our people.
  4. Celebrating finding problems and applying disciplined rigor with simple tools to close these gaps.
  5. Cultivating leaders who embrace personal growth and learn to manage by process rather than managing by objective.

I propose to develop and deploy a principle-based Management System founded in lean thinking and grounded by the pillars of Continuous Improvement and Respect for People. This includes a leadership system, built to inspire and provide clarity to the frontline worker, as well as help leaders practice leading with humility, a delivery system intended to align the work in service to the patient, and to learn from the frontline workers, and an improvement system build to deliberately empower & develop our people to deliver and improve patient care. Conceptually developed from the work of the Toyota Production System, and further informed by the trailblazing work of Virginia Mason, ThedaCare, and others, I will partner with colleagues throughout my organization to understand, develop and practice a new way of seeing, doing and improving the work of patient care. The leadership, delivery and improvement systems will reinforce behaviors which get us closer to the ideal state components listed above.

Updated on September 10, 2015.


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