Last month we honored my personal superhero Dr. Martin Luther King, Jr. It was a vibrant UCSF celebration of his life that included music, poetry, and a keynote speech by Sheryl Evan Davis, executive director of San Francisco’s Human Rights Commission. Dr. King’s legacy of social justice and fighting for equality for all inspires me every day. As he said in 1967 before a group of students at Barratt Junior High School in Philadelphia, “Be a bush if you can’t be a tree. If you can’t be a highway, just be a trail. If you can’t be a sun, be a star. For it isn’t by size that you win or fail. Be the best of whatever you are.”
With this in mind, you’ll read about how the Differences Matter initiative, along with similar programs in each of the schools, continues to make our academic community more diverse, equitable, and inclusive. You’ll also gain more insight into the impact that design thinkers at UCSF are having on our neighbors, and, to round out this month’s issue, I’ve got an update on OATS – not the food but the Outside Activity Tracking System. If you are a faculty member earning income beyond your UCSF paycheck, it is really important that you read this update. Not knowing what is going on in this space could get you in serious trouble.
This month’s offerings:
- Inclusion as an Imperative: Differences Matter and other UCSF initiatives
- Getting Better All the Time: Health equity through design thinking
- Full Disclosure: Update on the Outside Activity Tracking System
Exsilio! Everyone enjoys an extra day this month. What will you do with yours? While not taking place on February 29, if you have time on February 3, consider attending the pre-release of “Human Nature,” a documentary discussing one of the biggest tech revolutions of the 21st Century: CRISPR. And, if you still have time in March, please register for either of the annual Promoting Student Mental Health and Assisting Students in Distress events hosted by Student Health and Counseling Services for faculty and staff on March 3 (Parnassus) or March 10 (Mission Bay).
How do you contribute to diversity, equity, and inclusion? I’d like to know. And I’m always open to other thoughts and ideas for a future installment of Expresso. Just drop me a line at [email protected].
Inclusion as an Imperative: Differences Matter and other UCSF initiatives
Our students challenged us in 2014 with the White Coats for Black Lives demonstration, spotlighting issues of health equity and driving home an uncomfortable point: while UCSF had improved its recruitment of underrepresented students and faculty, we had not yet shifted our culture to be a welcoming place for all. It catalyzed a process of intense soul-searching that led us to an audacious goal: make UCSF the most equitable and inclusive academic health institution in the country. Given the epidemic of health care disparities, it’s something we have to do. And, I hope it will be part of a national and even global movement.
Yes, UCSF leadership is dedicated to this important goal, and the Office of Diversity and Outreach has several successful programs, but there’s something to be said for local action. The four schools and UCSF Health are making great headway on their own.
It all began under the rubric of the Differences Matter initiative in our School of Medicine. The initiative has six pillars: leadership, climate and recruitment, education, clinical care, research, and one we call “pipeline, research, and pathways,” in which we work with our communities. Each pillar has both a quantitative and qualitative goal – both to increase the diversity of our community and to improve the climate for people who come from underrepresented groups.
To achieve this, virtually every clinical department in SOM has a senior leader who is charged and supported to measure, monitor, and continuously improve the culture and climate for all individuals. Catherine Lucey, executive vice dean for SOM and vice dean for education, says bringing that effort to the individual unit level is “a real sign of systems change.” Other major efforts include full-day workshops led by Michelle Guy for faculty and staff who interact heavily with learners. Attendees learn about structural racism, the impact of microaggressions on the learning environment, and ways people can be a part of the solution. To date, over 1,400 faculty and staff have been trained.
We’ve changed the way we assess candidates for medical residencies, increasing the number of underrepresented minorities from 14 percent in 2014 to 20 percent last year. Faculty in the undergraduate medical education curriculum are working to embed contemporary views of the impact of racism on the delivery of health care into their lectures and small group activities. In addition, UCSF Health and ZSFG have both developed health equity councils to measure important outcomes in health care delivery like quality, safety, and patient experience by race, ethnicity, gender, and sexual orientation. This allows us to ascertain whether health care disparities exist in our environment and then take steps to correct them.
Those are just a handful of the many things happening that Catherine views as implementing some really substantial changes in the way we operate. “The goal has always been to identify a strategy – implement, test, and refine it – and then figure out how to build it into the structure of the institution so that it endures beyond the end of the Differences Matters initiative,” she says.
All of the schools are working hard to recruit more underrepresented faculty, staff, and students – from translating their websites into multiple languages and making them digitally accessible to supporting researchers in recruiting more diverse groups of patients for clinical trials. Here are a few highlights:
- In 2015, the School of Dentistry named George Taylor associate dean for Diversity and Inclusion. Since then, SOD has incorporated content on diversity-related topics into all four years of the pre-doctoral curriculum, and has also adopted the HEALS approach in the pre-doctoral curriculum and faculty training. In 2018, George led a SOD-wide climate survey that confirmed the need for the work and identified specific areas for improvement. Michael Reddy, SOD dean, is committed to making its report a working document that will be used as a guide in implementing interventions guided by a strategic response team – and not have it sit on a shelf. And, most recently, activist and thought leader Melanie Tervalon presented at the SOD faculty retreat last fall to teach about cultural humility. Cultural humility is an awareness that we don’t always know what another person’s life experiences are or the background behind their perceptions, the way they communicate, or how they develop and learn. Once this is recognized, we become more open to the value of differences and power imbalances in interactions. “It affects the way we receive information, the way that we engage with and learn from others,” George says. “It’s a lifelong journey of self-reflection and self-critique to improve patient care and education of learners. There’s never an end to developing that humility.”
- Shortly after becoming School of Nursing dean in 2017, Catherine Gillis launched development of a strategic plan that included a diversity pillar and in 2018 named Judy Martin-Holland as associate dean for Diversity and Inclusion. However, more than a decade ago, the Diversity in Action Group (DIVA), a group of faculty, staff, and students in the SON, developed a fantastic program called HEALS designed to identify and ameliorate uncomfortable situations that arise in the classroom. In 2016, HEALS was revised slightly and has been shared with various campus groups and units, including the SOD. “Sometimes faculty struggle to facilitate discussions around race or gender identity when they come up in the classroom,” Judy says. When something comes up, Halt the conversation; Engage with the issue; Allow people to share opinions and perspectives; Listen to each other; and Synthesize the importance of the discussion.
- As vice dean in the School of Pharmacy, Sharon Youmans ensures the success and continuing development of the SOP academic programs, in particular the Doctor of Pharmacy (PharmD) degree program, and programs intended to strengthen SOP diversity and its culture of understanding, inclusion, equity, and respect. Through the UCSF Interprofessional Health Post-Baccalaureate Program, a long-running collaboration with SOD and SOM, SOP gives grants to underrepresented minority learners for a one-year post-bachelor’s program to expose them to pharmacy and make them competitive applicants for pharmacy school. Sharon notes, “They come with a passion for pharmacy and uncertainty about the future, but with the comprehensive programming, mentoring, and personalized support in preparing their applications, 90 percent get accepted at pharmacy schools. It’s been most transformative for the students.”
I’m also glad to report some progress toward making sure all of our events, programming, activities, and meetings are accessible. We’re spreading the word to UCSF event planners about including required language regarding accommodations and contacts.
There will be no end to our efforts to improve diversity as well as promote equity and inclusion wherever needed. We’re taking the long view.
Getting Better All the Time: Health equity through design thinking
Last month, I wrote about how UCSF is using the principles of human-centered design to improve health care delivery. This month, I’ll describe how we’re supporting the initiative with rigorous research and incorporating it into our educational offerings.
Let’s start with what looks like a classic San Francisco startup, in a nondescript brick building in a still-gritty section of Potrero Hill. Enter through the back door, climb a drab stairwell, and discover a warren of offices lined with brightly colored sticky notes, where a cadre of smart, energetic people are diligently trying to bring cutting-edge ideas to one of the oldest and most basic human enterprises – health care. “From soup to nuts, top to bottom, there is no other industry that needs human-centered design more than health care, and on an exponential scale,” says Amanda Sammann, a UCSF trauma surgeon at ZSFG and the leader of The Better Lab, that startup-like enterprise based in Building 100 on the ZSFG campus.
It’s no accident that this lab – with its neon colors and ultra-hip feel, right down to Amanda’s stylish hexagonal glasses – is at ZSFG. The high end of health care has already discovered beautiful design, with membership-based companies like One Medical providing spa-like offices and attractive, user-friendly mobile apps. Amanda and her colleagues want to help those most underserved by the health care system. “We can only achieve health equity through design equity,” Amanda explains.
Something as simple as the intake process can be redesigned to ensure patients’ unique needs are met. Many of the women seeking perinatal care at ZSFG have complicated histories, often involving mental health issues or abusive experiences. Every time they have to tell their story to a new provider, or complete a patient survey or consent form, they’re potentially re-traumatized. So, The Better Lab is creating a universal consent form that can reach multiple touchpoints and spare these patients from re-living a painful ordeal.
By the way, it’s called The Better Lab because it’s about constant improvement. Amanda acknowledges, “We’ll never get to perfect. Everything in health care is an iterative process.” She knows for this work to have real impact, it needs to leave the lab and spread far and wide. To do that, it needs to be published in both the academic and consumer literature, so she’s added a layer of research rigor, documenting the process and the victories in a way that they can be replicated elsewhere.
If you read last month’s Expresso, you know the importance of IDEO, the iconic Silicon Valley design firm. It’s no coincidence that Amanda, after earning her MD, spent two years there on a fellowship. Similarly, hospitalist Rita Nguyen, yet another design thinker at UCSF, actually worked at IDEO completing her design fellowship at Stanford’s cutting-edge d.school (d for design).
Rita, whose primary appointment is with the San Francisco Department of Public Health, led what she calls a “comprehensive food intervention for patients” to make patients feel they are receiving a valuable service, rather than a free food handout, and created the concept of the “food pharmacy.” Patients now come to clinics where they find a farmers’ market-style experience. They get healthy food, and also recipes, olive oil, spices, knives, and cutting boards. They learn to empower themselves to eat healthier, and they’re part of a community of folks doing the same thing. Through design thinking, Rita and her team reframed the nutrition discussion from a message of restriction to making food a source of joy.
Rita also brings these concepts to the educational arena by speaking to first-year students every fall about the importance of design. “Students have grown up knowing about design in general,” she says. “And there’s a lot of potential to further influence that understanding and incorporate its power into their definition of what health care is, and can be, as they begin their medical training.”
I hope this look at the UCSF application of design thinking inspires you to examine how you might bring it into your own practice, research, and work. It’s definitely opened up my mind to an aspect of the world that I’ve not fully taken in…
Full Disclosure: Update on the Outside Activity Tracking System
If you are a UCSF faculty member, you know that you’re required to disclose your outside income and activities, and this information about you is public. In fact, the nonprofit journalism outlet ProPublica recently conducted a national public records request for this material, and all UC campuses received it.
(ProPublica produced two stories. One is about how the University of California has stringent rules on turning over outside income, even though much of it is ultimately returned to the faculty member, and the other highlights the overall challenge of finding the information nationally. ProPublica also produced a database of professors’ disclosures around the country.)
I wrote about this requirement last year and am happy to report that UCSF, along with most of its UC sister institutions, is making the process of filing your financial disclosures much easier and more streamlined.
The new system is called OATS, for Outside Activity Tracking System. Already in use at the David Geffen School of Medicine at UCLA, the OATS system was expanded and enhanced to meet the needs of the nine UC partner campuses. This online system marks a vast improvement over the formerly used paper method, which caused a lot of confusion as to where to send the documents. You may remember getting those emails, which Brian Alldredge, vice provost for academic affairs, says included “minimal guidance and a link to a complicated policy.” OATS, instead, aims to educate and guide you while you complete the form.
The system is designed to make sure that the time spent on outside work does not impose too many conflicts with the work faculty are required to do at the University, and that UC retains any revenues to which it’s entitled.
Of course, being a new system, we’re still working out some bugs, and we recognize that this is a transition for many people, but there’s no going back. My overall impression is that it’s going extremely well thus far. The online form should quickly become very straightforward for you to use. However, should you have trouble, definitely let your school’s academic affairs unit know, because we still have an opportunity to tweak it. All activity that took place in the last fiscal year, from July 1, 2018 to June 30, 2019, was due in the OATS system on September 30, 2019. Our team is now looking to see if anyone missed that filing and to make sure we’re all in there. For the current fiscal year 2019-2020, you can update OATS anytime. When the year closes on June 30, the final form will be pre-populated with information you provided throughout the year.
Again…this is a requirement for all UC campuses. It’s a condition of employment. We all need to do it. (Thanks to ProPublica, it’s easier than ever to find our disclosures online.) Importantly, you need to fill out the form even if you don’t have any outside activity – and we have to reach 100% compliance.
Cynthia Leathers, our assistant vice provost, notes that OATS will show you where your activity rates, from an honoraria for an occasional lecture that doesn’t need to be disclosed because it helps fulfill our mission of spreading knowledge, to “category one” activities that need to be cleared with UCSF before you can start working on them.
When you fill out the form, you may get some unhappy news, namely that some of that outside income that you thought was yours actually belongs to UC. However, that’s not a new policy; we all signed a UC employment agreement, and we need to uphold our end.
As I stated in a letter to faculty in October 2018, and as the ProPublica reporting only reinforced, compliance with conflict of interest and conflict of commitment policies “is imperative as faculty and academic institutions face heightened scrutiny of their activities by a number of regulatory agencies as well as the public.” Yes, it seems like yet another imposition of bureaucracy, but the justification is clear, and we’re trying to make it as painless as possible!
Dan’s Tip of the Month
What is joy? How is it found? Can it be kept? Can it be spread? Is it a birthright and even more fundamental than happiness? If you have asked these questions as I have, The Book of Joy: Lasting Happiness in a Changing World is for you. Essentially, it is a conversation between two old, loving friends – Tenzin Gyatso, His Holiness the Dalai Lama, and Desmond Tutu, Archbishop Emeritus of Cape Town – who have learned about the nature of joy over the course of their long lives. Deftly narrated by Douglas Abrams, the book is a series of rich, down-to-earth, often humorous, and easy-to-read discussions about joy – not as something to learn but rather as something to live – within deep, loving, and generous relationships. Definitely a must-read in cultivating a peaceful, joyful, and compassionate life. I wish everyone in the world could read this book.