On the Same Page

New Year's Reflections: A Look Ahead

Jan. 13, 2009

Last week I looked back at 2009 and summarized the many milestones and
accomplishments that were achieved at our academic health center. A foundation for
the future is being laid down. Momentum is developing.

This week I look ahead. 2010 will be a year in which we complete this foundation for
the future by fully developing our comprehensive strategic plan. In this process, we aim
to establish clarity about the overarching vision, goals and strategies of the UF Health
Science Center and Shands HealthCare. Moreover, each dean, center or institute
director and hospital CEO will work with their faculty and staff to define the goals and
strategies specific to their college, center, institute or hospital that gives distinct
expression to their individual strategic plan. We will not be able to implement the overall
plan for the academic health center successfully unless each employee of each unit has
an opportunity to provide input and feels engaged in an ongoing fashion. Thus, when
your dean, director or hospital CEO calls on you for your ideas, don't be shy!

Of course, we will not sit still while this planning effort is under way. We will continue to
build on the successes listed in the last newsletter by making sure we recruit and retain
the most talented faculty and staff, fill in gaps in education, research and clinical
programs, and continue to be nimble and opportunistic about situations that present
themselves in real time.

Overall, in 2010 we will try to leverage those things that make us distinctive what sets
us apart but also what allows us to make truly unique contributions for the betterment of
patients and populations who count on us for their health care. This includes our broad-
ranging research programs that are directed at improving health, and also our
educational programs that train the next generation of health care clinicians and
biomedical scientists. Let's take a peek at some key themes for the upcoming year.

Patient Care Quality and Safety
In the clinical arena, there is no more important component of our collective efforts for
the upcoming year than to make sure that we are focused on continuous improvement
in all aspects of patient care quality and safety. This is the No. 1 goal of our clinical
strategic plan as defined by the Strategic Planning Cabinet; as such, it will receive the
greatest amount of energy and attention. If we achieve this goal, everything else
follows. That is, making certain that every thread of our clinical culture and decision-
making is directed at improved patient care quality and safety is not only at the core of
our overall mission as an academic health center, and is quite simply the right thing to
do, but it is strategic. Creating an environment that is best for our patients will attract the
best health care providers to UF&Shands, attract the best students and postgraduate

trainees and attract patients, and thus generate more financial margin to allow
reinvestment in our clinical and academic missions.

To achieve continuous improvement in patient care quality and safety, we will enlist
your help to effect operational change at all levels of the organization: nursing and
medical practice, managerial functions, outpatient and inpatient operations, and the
work of our Board Quality Committees at Gainesville and Jacksonville and of the main
boards of these hospitals. An important step already accomplished is the launching of a
comprehensive electronic medical record system and recruitment of a chief information
officer for the UF&Shands academic health center. We are at the final stages of this
important recruitment. Other changes will come quickly. We will define benchmarks,
conduct an assessment of our current performance, and establish high-bar goals.
Please make suggestions and become engaged!

Clinical Facilities
The opening of the Shands Cancer Hospital in 2009 is a hard act to follow. And yet
critical strategic decisions must be made in 2010 about inpatient and outpatient facilities
in Gainesville and Jacksonville, and in other communities consistent with a rational
regional strategy that meets the needs of the population we serve.

With respect to outpatient faculty practice, the Emerson Medical Plaza in Jacksonville is
a unique University of Florida and Shands Jacksonville multiservice health-care center
that reaches the population in the eastern section of the city. Faculty at Emerson offer
initial evaluations, health screenings, imaging, noninvasive to minimally invasive
procedures and a wide variety of outpatient services in many medical specialties.
Development and expansion of this site will be important in creating a diversified patient
base for Shands Jacksonville. For the future, serious consideration will be given to
developing an additional outpatient campus in the growing northern section of
Jacksonville.

In Gainesville, the Strategic Planning Cabinet endorsed an overarching strategy that
involves concentrating future growth of faculty practice sites primarily on a single
UF&Shands campus. This will complement the existing ambulatory campus at NW 34th
Street and Hull Road, which might also undergo a modest expansion of specialties that
can coordinate well with its major presence in orthopaedics. Primary care sites might be
located on these two sites as well, but primarily at other locations throughout the region.
Our commitment to Gainesville will also be expressed in the form of interprofessional
teaching practices in new facilities located in areas of need, both East and West
Gainesville.

Having opened the Shands Cancer Hospital, which extends an already robust effort in
cancer that includes the Jerry W. and Judith S. Davis Cancer Pavilion for outpatient
treatment and the Cancer-Genetics Research Complex, careful thought must now be
given to the evolution of other critical inpatient services. These include facilities for
children's and women's health care, neuromedicine and musculoskeletal and
cardiovascular services. The goal is to coalesce the diverse components of each of

these services into integrated facilities so that form follows function to optimize the
quality and safety of patient care.

Education
The overarching strategic goal for education as defined by the Strategic Planning
Cabinet is to establish the University of Florida as a national model of interdisciplinary
education in the health science professions. We have a nationally unique opportunity to
accomplish this goal, which will require a coordinated effort among all six HSC colleges.
Significant revisions in the curricula of many of our colleges will be necessary. The need
for such curricular change dovetails well with the planned recruitment of key leaders in
education. We can also take advantage of our national leadership in simulation to
create innovative educational programs that extend across the educational continuum,
from undergraduate education programs in each of our colleges, to graduate training
programs in diverse clinical specialties, to postgraduate education for practicing
clinicians.

As in clinical care, to accomplish our goals in education we must integrate form and
function. The Strategic Planning Cabinet has endorsed the need for a new building.
Fundraising for such a building will be the primary objective for our development office
in the area of education, along with student scholarships.

Research
Patient care is a core responsibility for our region, and serves as an economic engine
for the missions of our academic health center. Our education mission is forward
looking, training future clinicians and scientists, primarily from Florida but with a wide
reach nationally and internationally. Our reputation as an academic health center,
however, depends primarily on recognition for our research. To achieve our goal to be a
truly distinguished academic health center, we must be recognized for the excellence of
our research. Sometimes, as in NIH and US News & World Report rankings, research
volume (i.e., total research dollars) is substituted for excellence. Indeed, total NIH
funding is often used as a proxy for research excellence, even though other federal
funding (NSF, CDC, AHRQ, Department of Defense, BARDA, etc.) is equally
competitive, as is funding from prestigious Foundations. Thus, we must pay close
attention to NIH funding in each of the Health Science Center colleges. In some cases,
such as dentistry, we are already at the very top of the rankings; in others, such as
medicine, we are in the middle of the pack; in all cases, however, we must grow at a
rate significantly greater than our peers to gain in rankings and recognition.

The next two years will be pivotal in establishing a steep upwards trajectory at UF in
NIH funding. The goal is to build on the CTSA and on two-year NIH stimulus funding
provided by the American Recovery and Reinvestment Act of 2009. Such funding, of
course, was distributed nationally, but we attracted more than our share of funding
(given our relative NIH rank). With focused efforts to maximize the likelihood that ARRA
grants will be converted to longer-term funding through leverage of CTSA
infrastructure, scientific oversight of grant progress, improved use of cores, strategic
recruitment of investigators to fill scientific gaps, and other strategies the goal is to

maintain the momentum provided by the ARRA stimulus and emerge in two years with a
durable research platform across the HSC enterprise.

As in the clinical and research missions, new facilities will be needed in research. Over
the past decade, significant research capacity has been added in basic science
laboratory space the McKnight Brain Institute, the Cancer-Genetics Research
Complex, and the soon-to-be-opened Emerging Pathogens Institute and Biomedical
Sciences Building. As growth in basic science grants continues, the density of this
space (funded dollars per square foot or per person) will increase as well. Renovations
of existing laboratories will no doubt also be necessary.

Of note, the last three major NIH grants to UF the CTSA and grants in aging and in
computer networking totaled $110 million over the next five years and are all in
clinical and translational research. Moreover, many clinical research programs are in
leased space or literally have recently received funding for expansion with no clear
space in which to expand. Highly relevant to this evolving circumstance is that Dr.
Marco Pahor has secured $15 million of ARRA funding to build a facility for the Institute
on Aging. The Strategic Planning Cabinet will soon be considering a recommendation to
expand the building substantially to create a true academic home for clinical and
translational research across the health sciences.

Diversity
In all that we do patient care, education, community health and research we will
be more effective if our faculty, students, residents and staff are reflective of the gender,
racial and cultural diversity of the populations we serve. Those of us who are not
members of underrepresented minority groups can better become culturally competent
if we are working and learning side by side with such underrepresented minorities. Such
cultural competence must permeate all of our missions our educational curricula
(both undergraduate and graduate), patient care, research and community health.

During the upcoming year, we will first assess the current status of our faculty, students,
residents and staff with respect to gender, and to their ethnic, racial and cultural
backgrounds. We will also assess the extent to which cultural factors are included in
each mission area. This is not a small undertaking. We will then compare these data
against national benchmarks and define goals for the future. In parallel, we will
determine from our current community of minorities and women the barriers that may
exist for recruitment, retention and promotion, and develop strategies to overcome
these barriers. By this time next year, I will be able to report comprehensive data on our
baseline in 2010, and the steps we are taking to improve the diversity of our health
center community.

Community Health
Ultimately, although as clinicians many of us are trained to focus attention on the
prevention or treatment of disease one patient at a time, the goal of our research,
educational and direct clinical efforts is to improve the overall health of the populations
we serve. This is a tall order: It is difficult to measure the "health" of a population, and

many of the summary metrics such as life expectancy, infant mortality, percent
overweight or obese or percent smoking are reflective of variations in socioeconomic
status and other structural community factors. Nonetheless, the University of Florida
Health Science Center and Shands HealthCare are prominent entities in our community
and region, and we have a responsibility to use the skills and resources available to
understand the determinants of population health status in our community and to effect
positive changes in these determinants to the extent possible by working with our
community partners.

Community health is part and parcel of each of our other missions. Factors that impact
the health of populations must be emphasized in our health science educational
programs, alongside factors impacting the health of an individual. Research methods for
studying both population and individual health should be strengthened. In an era where
comparative effectiveness research is being emphasized and funded at the national
level, to do otherwise would be short-sighted. Indeed, there are a number of NIH- and
CDC-funded CER projects focused on community and regional outreach across the
HSC. These involve smoking cessation, obesity management, child health, addiction,
cancer screening and several other areas. And finally, a key part of our clinical mission
is to provide access to needed health care for all members of the Gainesville community
and in underserved areas of Florida. Thus, we will continue to locate clinical practices
involving faculty in nursing, dentistry, medicine, pharmacy and the health professions in
those areas where access may be limited. Good examples of existing initiatives that can
serve as models include Archer Family Health Care, the Eastside Clinic, our partnership
with ACORN Clinic and the UF Statewide Network for Community Oral Health, a
significant source of oral health care for the underserved in Florida.

Funding Plan
The Strategic Plan can only be implemented to the extent that there are identifiable
funding streams to support it. As critically important as a given clinical, educational,
community-based or research program may be, we can only fund it if there are funds
available. We cannot, and will not, make commitments that lack a source of funding,
and we will factor in commitments over time in assessing the affordability of new
commitments.

That said, the future looks bright for UF&Shands in successfully accomplishing an
ambitious strategic plan, despite the economic downturn and uncertain implications of
health-care reform. Our commitment to quality and safety, new clinical facilities and
plans for an ambulatory campus should generate the clinical financial margins needed
to invest in our clinical and other missions. We will work with our philanthropic
supporters on aspects of the strategic plan about which they are passionate. We will
work with our scientists to identify opportunities for center and program project-level
grant funding and for technology commercialization. And we will continue to work with
our legislators to ensure that the State of Florida supports our academic programs at
current or increased levels in recognition of the tremendous benefit that its investment
to date has reaped.

This past year, we realized a series of important achievements and collectively
committed to a new era of working together, building stronger bridges across our
academic and clinical enterprise. When you think about it, in the past six months we
have come far, and we have a lot to be proud of. When I first arrived at UF, I talked
about the need to focus on connection and communication, and on transparency. About
how we would craft a shared vision together. Thanks to your efforts, we are doing just
that, building on the momentum we have established, and charting our course with clear
goals and clear vision for the future.

We end the old calendar year and begin the new one with much optimism, and with an
eye toward the opportunity that change, handled thoughtfully, can bring. My hope is that
you share the spirit embodied in the Forward Together theme for our strategic planning
effort. Because together we discover. Together we teach. Together we care for our
patients and our communities. And together we will achieve even more.

Sincerely,

David S. Guzick, M.D., Ph.D.
Senior Vice President, Health Affairs
President, UF&Shands Health System
University of Florida