A Call to Action : You Matter in Building
Health Equity for Tulsa, Oklahoma and
America
Gerard P. Clancy, MD
President, University of Oklahoma - Tulsa
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In these tense, polarized times,
I dare you to be an optimist ?
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Because important things are actually getting
better….
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Really they are…
getting better.
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We can accomplish great things…..
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But we have some work to do so that all
may enjoy advances in our society ……we
need to bridge those gaps.
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This year’s health, medicine, and
policy topics:
1.
2.
3.
4.
5.
6.
7.
Understanding consciousness
New approaches to cancer
Faster drug development
The importance of “play” for the brain
Heart disease and lifestyle changes
Nutrition and new food labels
Customized health care
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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
challenged
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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
poor.
• 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
country.
• The safety and quality argument – there are
numerous opportunities to improve the safety and
quality of US health care.
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Physicians cost 20% of total cost but
physicians decisions command 80% of costs.
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Holding Back Oklahoma: Health Status
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An Engineering Project =
“Democratization”
“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
benefits.”
Mullan 2010
Democratize This !
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COMMONWEALTH FUND
State Scorecard Summary of Health System Performance
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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.
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Although Oklahoma health status is very poor,
health spending per capita is in the top quartile.
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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
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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
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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
e
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“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,
W safe and affordable…..(that’s you I’m talking about) ?
e
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Storm Clouds on the Horizon:
2011 – 2016 Timeline in Health Care Delivery
Fee For Service
Revenue
To Care
for Patients
“Rough Waters”
- Health Reform
- Debt Ceiling
Today Curve:
FFS, Capitation…
Tomorrow Curve:
• System - Physician led
• Hospital led
• Volume
• Procedures
• Specialty Care
• Hospital Care
• FFS negotiations
2010
Shared Savings
• Quality
• Transitions
• Efficiency
• Bundling of payment
• Shared Savings
2012
2014
Years
2016
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Dear Dan,
I messed with your Wordle. Sorry for being a “gooter.”
Love, Gerry
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A Relevant Life….
Why are you important to this work ?
Why is this work important to you ?
What would we do without new funding ?
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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
problems.
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Warning - Although physician’s direct costs are
about 20% of overall health care costs,
physician decisions direct 80% of health care 25
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?
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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.
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The concept of contribution
• Central theme across theories of mental
illness.
– 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.
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Striving for Happiness or Fulfillment ?
Erik Erikson’s Stages of Psychosocial Development
Stage
1. Oral Sensory
2. Muscular
3. Loco-motor
4. Latency
5. Adolescence
6. Young Adult
7. Middle Adult
8. Maturity
Ages
0-18 m
18m -3 yrs
3 - 6 yrs
6 - 12 yrs
12 - 18 yrs
19 - 40 yrs
40 - 65 yrs
65 - death
Basic Conflict
Trust vs. Mistrust
Autonomy vs. Doubt
Initiative vs. Guilt
Industry vs. Inferiority
Identity vs. Role Diffuse
Intimacy vs. Isolation
Generativity vs. Stagnate
Integrity vs. Despair
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Despair vs. Integrity
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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.
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How should we act? Like
American heroes
the Marlboro Man and
Maverick….?
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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,
services.
– Innovation through trying, failing,
learning from MISTAKES.
– Constant repackaging of ideas
leading to innovations.
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One of America’s best
performing health care
systems trains daily as a
team…..
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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.
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Some of Our Own Case Examples
of Group Contribution…
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OU College of Medicine, Tulsa 
School of Community Medicine
Case I – Combined efforts of many over
decades…that matters.
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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.
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OU IMPACT Team
Samson and OU pet therapy
Sand Springs
Community School
Clinic
Examples of our nontraditional patient
care, public health,
research and
education settings
Laureate Institute
for Brain Research
Roy Clark Community
School
Public Clinic
Housing Clinic
Rosa Parks Community
School Clinic
American
Therapeutic
Riding Center
Tulsa Day Center for
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the Homeless
Unique Experiences
for Our Students
•
Explicit in Our Commitment to Serve
the Underserved through
“Community Medicine.”
– Student learning environment across
the region.
•
Recruit for Altruism
•
– Learn early to utilize these
technologies to improve health
•
First days of Medical School –
Summer Institute
– 6 day intensive course to learn the
“anatomy of the community” before
the “anatomy of the body.”
•
•
Student Academy
Masters of Public Health and
Certificate of Public Health
Leadership
– 9th year of student-led free acute
care and free chronic clinics for the
uninsured.
– Surveys show we are maintaining
altruism
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Health Information Technology
Sophistication
•
Teamwork
– Student clinics organized as teams of
medical, nursing, pharmacy, social
work students.
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Engineering and Project
Development
– Students practice real time reengineering of health care delivery.
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Wayman Tisdale Clinic
Case II – Great efforts from
numerous individuals over
several years….that matter.
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Groundbreaking Day…..
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Governor Fallin signs
the last beam.
Focused work to “improve
health” with our region in
greatest need: North Tulsa
President Boren signs
the last beam
$20,000,000 OU Wayman
Tisdale Clinic in North Tulsa
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“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?”
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Tulsa’s History is Relevant (1921)
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24% local construction
Recruited new
Pharmacy next door
Early Childhood
Education Center
Taste of North Tulsa
Focused work in North
Tulsa to “improve health”
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Plan for 36th Street North and Hartford
Linking Public Health
and Urban Planning in
North Tulsa
OU Urban Design Studio
- Gray are existing buildings
- White are planned new buildings
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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…..to do that
work.
– Recruits and maintains altruism and energy…
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Let’s GO !.....Let US go !!!!
 30 inches of snow in a week…no
problem.
 30 degrees below…no problem.
 113 degrees all week…no
problem.
 14 year difference in life
expectancy…no problem.
 Way short on physicians…no
problem.
 Take some shots – Pit bulls and
Pimps ..no 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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