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Breaking Down Boundaries, Scaling Up Opportunities

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The retreat "boundary spanner" panel featured (from left) moderator Jennifer Grandis, MD, Nevan Krogan, PhD, Sheila Antrum, RN, MHSA, Elissa Epel, PhD, Atul Butte, MD, PhD, Monica Gandhi, MD, and Joe DiRisi, PhD (not shown).
Photos: Mark Wooding

Report from the 2016 UCSF School of Medicine Leadership Retreat

By Mitzi Baker

“None of today’s complex medical problems can be solved by a single mind, operating in a vacuum and few can be solved by a single discipline or department,” said School of Medicine Dean Talmadge E. King, Jr., MD, in his opening remarks at the 2016 UCSF School of Medicine Leadership Retreat. “All require integration within and across mission areas.”

Breaking down the boundaries that divide the many separate entities of UC San Francisco and its community partners was the focus of the retreat, held on January 7 and 8 in the Presidio.

King pointed to a number of factors intrinsic to UCSF that weaken connections, including size, geography and overspecialization. For instance, the School of Medicine has grown from 300 full-time faculty in 1969 to nearly 2,300. There are more than twenty large and small campus sites in San Francisco county, along with a growing presence in Oakland and a campus in Fresno. Meanwhile, increasingly specialization has created further “silos.” King emphasized that people can only have a limited number of close connections; beyond that, it is difficult to bond with others in meaningful and valuable ways.

Vice Dean for Education Catherine Lucey, MD (center) explores new ideas with Marguerita Lightfoot, PhD, and Bobby Baron, MD.

Designed by a team led by Vice Dean for Education Catherine Lucey, MD, the retreat drew 158 top leaders across UCSF sites to brainstorm ideas on how to maintain productive connections within the ever-expanding university. The desired outcome, said Lucey, was for participants to understand the role relationships play in the organization and to devise creative yet specific ideas for the school to foster internal and external relationships.

"UCSF’s greatness stems from our ability to support the work of creative, talented and committed individuals who are working on unlocking scientific mechanisms, caring for diverse populations and educating the next generation of health professionals," said Lucey. "Our future success will depend on our ability to continue to support the individual while building powerful networks of faculty, staff and learners who cross mission, discipline and geographic boundaries to tackle big problems and realize great advances."

Toward Breakthrough Solutions

These annual retreats are the biggest gathering of UCSF leadership and include faculty and deans from beyond the School of Medicine, including the Schools of Dentistry, Nursing and Pharmacy, and the Graduate Division. The event provides an opportunity to step away from day-to-day responsibilities and gain new perspectives on how to advance health and health care, science and education.

The big picture was presented in the plenary talk by an expert in relationship building in complex organizations, Jody Hoffer Gittell, PhD, professor of management and executive director of the Relational Coordination Research Center at Brandeis University. Gittell emphasized that “the kind of breakthrough solutions that are needed to solve the problems UCSF has taken on with its mission are not possible without building connections across expertise, geography and more.”

Gittell had participants break into a dozen groups to create “relational maps” to visualize the bridges and barriers inside UCSF and with our communities. These maps were the foundation of a later exercise to identify specific strategies and tools to “think big” and help solve major healthcare challenges by the year 2026 through increased collaboration.

Challenges addressed ranged widely, from social and environmental factors affecting health, to mining Big Data to addressing mental health, aging, chronic disease management, HIV and acute infectious diseases. The goals ranged from eliminating disparities in care to using precision diagnosis and therapy. The common theme was building relationships—between people, communities, programs, financial means, technology, physical space, organizational structure and communication modes—to solve complicated medical problems.

Lowell Tong, MD, Angela Sutkaitis, Atul Butte, MD, PhD, and Valy Fontil, MD, work on a relational mapping activity at the retreat. 

Scaling Across Campus and Beyond

Earlier in the day, a panel of six “boundary spanners” had presented a summary of their own experiences, which ranged from using cutting-edge technology to connect basic research with the real patient problems of the clinic, to the simple act of fostering good relationships with colleagues.

“Pilot funding opens doors,” said behavioral and social scientist Elissa Epel, PhD, in explaining how she engaged Nobel Laureate Elizabeth Blackburn, PhD, in a collaboration that has now led to real and important changes in the health of our employees. Epel also talked about the importance of engineering interactions such as small, creative interdisciplinary think tanks “chewing on one question and figuring out how to test the resulting ideas."

Fellow panelist Atul Butte, MD, PhD, illustrated the potential scope of breaking through boundaries.

“We need to think how to scale across our own campus – who can help me with this paper or research or grant and how could I help them? - but also use the rest of the University of California to help you scale. It is the most under-appreciated resource,” said Butte, who leads the UCSF Institute for Computational Health Sciences. He noted that the UC health system includes 5 academic health systems, 17 health professional schools, 11 hospitals, 4.2 million outpatient encounters, 159,000 inpatient admissions and 14 million patients with some electronic health record data, all of which could be used to validate findings.

Butte added that UCSF researchers should be looking to scale up with external partners as well, especially with our neighbors in the Silicon Valley and Bay Area, and that sharing one’s work widely through social media can open doors to ever-expanding synergistic projects. “You don’t have to invent or solve everything yourself,” he said.

Attendees were asked to wear ribbons that identified their role at UCSF, illustrating how each person has a unique skillset to offer as a collaborator.

The retreat committee will analyze evaluation data and will propose strategies to pilot in the upcoming year. “One of UCSF's greatest strengths has always been its teamwork and collaborative culture, but this strength is increasingly challenged by some enormous centrifugal forces, due to the geographic spread of our campus, the increasingly specialized nature of our science, and the fact that everybody is awfully busy,” said Robert Wachter, MD, who is currently serving as interim chief of the UCSF Department of Medicine, after the event. “The retreat was a wonderful opportunity to problem solve about how to build bridges across these various silos, and I think there will be tangible actions flowing from the day that help all of us work better together.”