On the Same Page
"Reflections on 2010"
December 30, 2010
This is a time of year for individual reflection. Looking back over the past year, personally
and professionally, what can we learn from our achievements and mistakes?
The same applies to organizations like UF&Shands. Reflecting on the past year,
organizationally and as a community, what have we accomplished and what have we
learned? This issue of On the Same Page addresses this question. In the next issue, we will
take a look at the year ahead.
Before I proceed, I want to express my tremendous sense of honor and privilege for the
opportunity to play a role in charting the course for health care and health sciences at this
great University. I greatly appreciate the trust and guidance of President Machen, and the
support that I have received from so many across the entire Health Science Center and
Stands health system. The extraordinary talent and commitment of our faculty, staff and
students, and their flexibility and enthusiasm in responding to change, have been
responsible for the stellar progress we have made in such a brief period of time, and will
catapult us ahead.
Reflections on 2010
During this past year we created a new governance structure and completed a
comprehensive strategic plan, both of which have already yielded concrete improvements in
our clinical, research and educational programs.
Governance: In September, following a plan envisioned by President Machen and approved
by the UF Board of Trustees, the Shands Boards in Gainesville and Jacksonville agreed to
restructure themselves as "sister" entities. Until this point, Shands Jacksonville had been a
subsidiary of the Gainesville hospital, i.e., Shands Teaching Hospital and Clinics (STHC).
UF retains governance of both hospitals under the new arrangement. As the President's
designee, I was approved by both Boards as Chair of the Shands Jacksonville and STHC
Boards. New Board memberships for both sister hospitals have (or are being) established.
A Strategic Cabinet, presented to the UF Board in June 2010 and authorized by both
Stands Boards, is being convened to review and advise each Board on strategic issues
facing each entity and the system as a whole. Other linkages between the two sister
hospitals under the UF umbrella consist of common support services such as information
technology, human resources, purchasing, managed care agreements, development and
other areas in which common support service leads to system benefits.
This new governance structure has created a distributed model in which UF&Shands, the
University of Florida Academic Health Center, carries out its mission on two UF&Shands
campuses that are largely independent with regard to day-to-day operations and local
strategies, but which come together as a system under the UF umbrella. This distributed
model of governance promotes focus and nimble decision-making on each campus in a
coherent manner that closely coordinates the academic and clinical efforts of the HSC
colleges and hospitals.
The first comprehensive strategic plan for UF&Shands-involving all of its colleges, centers,
institutes and hospitals on both campuses-was completed during this past year, and
implementation has begun. The overarching theme is Forward Together, which emphasizes
the central importance of bringing faculty from the HSC colleges together with
administration and staff from the Shands health system to unlock the power of our
academic health center. A fundamental goal articulated by the Strategic Planning Cabinet
was getting from "us and them" to "we." Over the past year, I think that we've come a long
way toward achieving this aim. In addition, key drivers were identified for each our missions,
and metric were defined. Progress is already evident in each area. In addition to this
overarching document, individual strategic plans for each college, center and institute, and
for the Jacksonville regional campus, were also developed.
Patient care: With respect to our clinical mission, quality is the key driver. Efforts are being
marshalled from many different angles in a multiple-pronged attack against threats to
One important overall measure of safety and quality is the observed:expected (O:E)
mortality ratio, as measured by the University HealthSystem Consortium (UHC), a group of
98 peer hospitals across the nation. Given the distribution of diagnoses and risk profiles of
the patients in these hospitals, UHC calculates an expected rate of mortality, to which the
actual results are compared. At both campuses, significant attention has been devoted to
improving our care of patients as measured by this O:E ratio. A hospital-wide ratio of 1.0
means that it is performing as expected, i.e., about in line with peers. This is where Shands
at UF was during most of 2008 and through about September 2009. However, due to the
superb work of faculty and staff, the O:E ratio has steadily declined at Shands at UF, and is
now in the range of 0.7-0.8, i.e., 20%-30% better than expected. At Shands-Jacksonville,
the O:E mortality was lower than Shands at UF at the start of the period, and is now in a
similar range at about 0.8.
Another key UHC measure of patient care quality and safety is the number of events that
would qualify as a "patient safety indicator (PSI)" in a given month. These are events-such
as central venous line infections, pressure ulcers, patient falls, and the like-that should be
as low as possible. At Shands at UF, due to the efforts of patient care teams that have
focused on reducing the number of events in each of these categories, the overall number
of PSls per month has fallen from about 30-35 to 15-20 in the past year. At Shands
Jacksonville, the number of PSls was again lower than UF at Shands at the start of the
measurement period, and is now in the range of 15-20 per month as well. There is much left
to do in our march toward zero PSls; at both campuses, we will continue to focus on
creating a culture of patient care quality and safety as job 1, extending to every member of
our hospital and HSC community, in both Gainesville and Jacksonville, which will naturally
yield continued improvement in the O:E mortality ratio, PSI scores and other key measures.
In ambulatory care, quality begins with ready access. In August, we launched
GatorAdvantage, which gives employees and family members expedited access-including
next-day appointments-to medical providers at UF Physicians and Shands at UF. Stands
Jacksonville has had a similar system in place for some time, which will now be extended.
This program is being rolled out in stages: Shands at UF employees on Aug. 23, 2010,
HSC faculty and staff on Nov. 15, 2010, and UF "main campus" faculty and staff in February
2011. The flexibility shown by our faculty and staff in such a short time frame has been truly
remarkable, and the appreciative response by our employees has been overwhelming-
many, many positive testimonials and very few reports of difficulty. New patient
appointments from the groups thus far in the program (Shands and HSC) are up 20%-25%.
Also important in the highest-quality experience for our patients is the alignment of clinical
programs with clinical facilities, both inpatient and ambulatory. In May we announced plans
for the Shands Hospital for Children and Women, a reshaping of existing space in the North
Tower to create a contiguous four-floor, 175-bed, family-friendly hospital with its own
entrance, lobby and emergency department. The first phase of this project is the Pediatric
Emergency Department, which will open in July 2011. This project is part of a larger idea in
which space for each inpatient specialty program is integrated in a contiguous area and
aligned with clinical practice. This has already been accomplished for oncology patients in
the Shands Cancer Hospital, and plans are underway for our patients who require
neuromedicine, cardiovascular, musculoskeletal and organ transplant services.
The strategic plan calls for two approaches to ambulatory care-aggregation of specialty
services at UF&Shands central locations, and distribution of primary care sites throughout
the community close to where people live and work.
We recently announced that we will build a new UF&Shands primary care center on
Gainesville's east side, on North Main Street near Northeast 16th Avenue, replacing and
expanding the Family Medicine practice location at Southeast 4th Avenue. Additional
primary care centers are being considered in other parts of the community. These primary
care centers will foster improved outpatient management of chronic conditions, giving our
patients the tools to maintain their health and stay out of the hospital.
One area of specialty service aggregation will take place on our 39th Avenue parcel near 1-
75, where we already operate Shands Vista and Shands Rehab Hospital. We will begin with
a 100,000-square-foot medical office building that will house nine specialty practices,
including cardiology, dermatology and skin cancer, geriatrics, neurology, pain, plastic
surgery, psychiatry, reproductive endocrinology and in vitro fertilization, and women's
health. Design is in progress and construction will begin in September 2011.
In Jacksonville, a third building was added to the suburban Emerson campus. This 30,000-
square-foot building expands the Emerson campus to 90,000 square feet of clinical space.
A new state-of-the-art imaging center was opened in the spring and an expanded women's
center was opened in the summer. The Emerson campus houses a joint-ventured surgery
center and numerous other UF&Shands clinical services. The primary care network in
Jacksonville continues to grow. Six locations in the urban core were awarded medical home
certification by the NCQA. These are the only academically affiliated primary care locations
in Florida to achieve this certification.
New Small Animal Hospital: As described in my last newsletter, UF's new Small Animal
Hospital at the College of Veterinary Medicine opened for business Nov. 1. This $58 million,
100,000-square-foot full-service hospital is wonderful example of alignment between clinical
facilities and clinical programs. It is not only a beautiful building, with a three-story atrium
serving as the reception area for animal patients, but a world-class clinical and educational
facility that contains specialty service areas with state-of-the-art technology and numerous
innovative designs for education, such as rounds rooms adjacent to each specialty service.
As Dr. Glenn Hoffsis, dean of the College of Veterinary Medicine, states: "Just as in human
medicine, when we deliver on our commitment to excellent patient care and an exceptional
client experience on each and every visit, every other objective, such as great teaching and
research, falls into place."
Regional strateqv: As a quintessential college town, Gainesville is a wonderful place to live
and work. Through the lens of health care reform, however, we must broaden our
perspective to plan for the regionalization of health care delivery, and create partnerships
that will benefit the population we serve. From this perspective, we developed partnerships
with two health care entities this past year: Health Management Associates (HMA) and
After giving careful consideration to our three rural hospitals-Shands Lake Shore, Shands
Live Oak and Shands Starke-which we had run since 1996, we reluctantly concluded that
we did not have the capital availability or level of management focus needed to operate
these hospitals effectively, and that operation of these hospitals was not part of our core
mission as an academic health center. Therefore, with support of the Shands Board, and
under the leadership of Shands CEO Tim Goldfarb, we divested 60% of these hospitals in
August to a joint venture company in which we share ownership with HMA, a company that
is known for its excellence in the operation of rural hospitals. This has worked out well for
HMA and Shands, and more importantly, for the patients and communities served by these
three hospitals. For example, since the transaction was finalized, there has been significant
capital investments in these hospitals-including imaging equipment (an open MRI and a
CT scanner), a new telemetry system, surgical equipment and a new fetal monitoring
system-which we could not have done had we continued full ownership.
Another important step in regional strategy was the Memorandum of Understanding
announced with Orlando Health to pursue an affiliation around key areas of clinical
service-pediatric and women's health, cardiovascular, neuromedicine, organ
transplantation and cancer-as well as clinical and translational research, health science
education and graduate medical education. Teams made up of physicians and
administrators from both health systems are now giving shape to this affiliation. The overall
goal is to make best use of the resources of both health systems to provide a rational
approach to regionalized health care for the communities we serve.
Research: In research, the driver is to reach high. In working with the deans in all the HSC
colleges, and with the center and institute directors, we have focused on providing research
infrastructure that leads to greater scientific productivity among our existing faculty, and on
recruiting high-impact investigators who bring established research programs with them to
Florida and who then develop these programs further.
The early results are quite spectacular, although we must be cautious because some of the
grant funding is from the time-limited ( two-year) American Recovery and Reinvestment Act
of 2009 (ARRA), and because the future of NIH funding in general is uncertain. In FYO9,
total NIH funding across all HSC colleges (including Jacksonville) was $112 million, of
which $104 represented the base of ongoing funding and $8 million was from ARRA. In
FY10, total NIH finding zoomed up to $171 million, representing a base of $118 million, plus
$53 million from ARRA. We have examined carefully the funding of grants that will continue
beyond the end of ARRA and estimate that base NIH funding in FY11 will continue to climb,
probably to a range of $130 million to $135 million. This represents tremendous effort and
achievement from our research faculty, and we will do everything we can to help them
continue successfully their investigational programs in what will no doubt be an increasingly
challenging environment at NIH.
Alignment of facilities and programs is also critical in research. On the heels of opening the
Emerging Pathogens Institute in 2009, in May 2010 we dedicated the new Biomedical
Sciences Building, a 163,000-square-foot facility that brings together researchers from the
colleges of Medicine, Public Health and Health Professions, and Engineering. It houses five
interdisciplinary programs: the Center for Translational Research in Neurodegenerative
Disease, the Diabetes Center of Excellence, the J. Crayon Pruitt department of biomedical
engineering, the Rehabilitation Research Program in the department of physical therapy of
PHHP, and the UF Howard Hughes Medical Institute for Undergraduate Science Education.
The Biomedical Sciences Building is notable for being the first Gold-level, LEED-certified
building at UF, an achievement that recognizes the commitment of UF to assuring that its
buildings are sustainable and energy-efficient, and provide a healthy environment for their
Another interdisciplinary building is now under construction at the Lake Nona "Medical City"
campus in Orlando. On Oct. 4, we broke ground on the new UF Research and Academic
Center, a $44 million, 100,000-square-foot LEED Gold building that will contain three
components: (1) an education wing for the Orlando campus of the UF College of Pharmacy,
which currently enrolls 200 students taught by 20 faculty members, now housed at the UF
IFAS Mid-Florida Education Center in Apopka; (2) a clinical research wing, to be occupied
by satellites of the UF Institute on Aging and the UF Clinical and Translational Science
Institute, to run clinical trials with participants in the Orlando area; and (3) the UF Institute of
Therapeutic Innovation (ITI), an interdisciplinary program that will house faculty from the
colleges of Pharmacy, Medicine and perhaps others such as Engineering. Faculty in the ITI
will have appointments and collaborations in scientific departments of the UF colleges, but
will live and work in Orlando. This initiative will complement the emerging drug discovery
programs at the Sanford-Burnham Medical Research Institute. The goals of the ITI will
include identification of new therapeutic targets and optimization of drug candidates for the
treatment of the most devastating human diseases, including cancer, cardiovascular
disease, diabetes and brain disorders, which can then be tested in human populations
through clinical trials supported by the CTSI.
During the past decade, we have been extremely fortunate to add more than 1 million
square feet of space for wet-lab investigation in newly constructed research buildings. While
we will certainly maintain our commitment to fundamental science and early translational
investigation, space is now also needed for the many large clinical research grants that
have been received in the recent past, and for funded plans to build infrastructure through
our NIH Clinical and Translational Science Institute (CTSI). Approved by the UF Board of
Trustees in May, the Clinical and Translational Research Building (CTRB) will be the
academic home of clinical and translational science at UF. This 120,000-square-foot
building, to be constructed on the site across from Wilmot Gardens on Mowry Road,
includes the Institute on Aging, the CTSI headquarters, the Clinical Research Center,
faculty members working in biostatistics, epidemiology, health policy, and health services
research, and clinical research programs such as those focused on type 1 diabetes and
muscular dystrophy. It is being designed to exceed Platinum LEED certification.
Construction will commence in June 2011.
Education: In education, the driver is to use our unique combination of colleges and other
resources to become a national model for education in the health sciences and health
professions. The Strategic Planning Cabinet wanted to ensure that discipline-specific
curricular needs for each college are addressed in focused areas of scientific knowledge
and patient care skills. Moreover, in graduate study the Cabinet wanted to ensure that our
trainees can take advantage of the applied and translational opportunities for biomedical
discovery and clinical application. In the planning process that was completed this past
year, the Cabinet recognized that many other areas of professional education represent
common objectives across colleges.
There is a great opportunity to create a curriculum that provides our students with the
experience needed to master key cross-college competencies: interpersonal
communication, professionalism, teamwork, system-based knowledge and the evaluation of
scientific and clinical evidence. Richard Davidson, M.D., a professor of medicine, was
appointed associate vice president, health affairs-interprofessional education. Dr.
Davidson is now leading a committee, consisting of the associate deans for education in the
six colleges, who are developing an interdisciplinary curriculum for students across the
Health Science Center. With students being educated in all of the health sciences and
professions, we have a unique opportunity to develop a national model for how to achieve
the interprofessional competencies.
As 2010 draws to a close, let me extend my very best wishes to you and your family for the
New Year. In the next edition of On the Same Page, we will take a look at the goals and
challenges that lie ahead for UF&Shands in 2011.
David S. Guzick, M.D., Ph.D.
Senior Vice President, Health Affairs
President, UF&Shands Health System