Health policy scholarship prepared by Dr. Robert Cima to take leadership role in shaping U.S. healthcare system
In his summary report, Dr. Robert R. Cima, Rochester, MN, the ASCRS/ American College of Surgeons/Brandeis University health policy scholarship winner for 2010-2011, offers some very interesting observations on his experience and the making of health care policy, excerpted here:
“In the early 1980’s when I first started medical school at Stanford, health policy was the arena of the economists and political science departments on campus. I remember the one or two lectures by Alan Einthoven, a famous health care economist, who had to come ‘out’ to the medical center from the main campus to teach the medical students about health care policy. His lectures were not part of any specific class but rather a lunchtime seminar series on assorted health related topics like traditional Chinese herbal therapies.
“Since it was a pass/fail course and of no “use” to us modern clinicians who were focusing on the emerging role of molecular biology in medicine, the primary driver for attendance was the unlimited free pizza and soda. Fast forward six years to my surgery internship year in Boston. While I was just trying to keep my head above water and avoid the wrath of my chief, the academic hospitals were trying to figure out how to respond to managed care and hospital consolidations. It was clear that something my classmates and I had dismissed as not really impacting us was beginning to influence even the once ‘untouchable’ major academic medical centers.
“Twenty years later, while molecular biology has greatly influenced our understanding of health and disease, the real issue facing the health of our population is how to deliver quality health care in a sustainable and affordable fashion. As a surgeon in one of the largest multi-specialty practices in the country, rarely a day goes by that the issue and impact of health economics and policy does not get discussed. Against this backdrop, I applied for the American College of Surgeons/American Society of Colon and Rectal Surgeons health policy scholarship.
“The week at Brandeis [Waltham, MA] provided me a framework to understand the structure of the American health care system. The early lectures highlighted the historical and contemporary forces that are shaping U.S. health care. In particular, there was an emphasis on the interplay between understanding the influence of the economy on health care delivery models and policy and, interestingly, the inverse of that relationship, where different types of delivery systems impacted governmental decisions.
“What I found most interesting and unexpected was the second half of the week. The lectures emphasized understanding the role of organizational and personal leadership skills.
“Initially, I was confused by this juxtaposition of lectures. However, over the course of this last year, as I have become more involved in the policy areas both within my organization and nationally, those skills are clearly essential in order to influence the actions of people and thus the directions of policies.
“The importance of this intersection of policy and leadership skills was clearly on display when I attended the American College of Surgeons Professional Association PAC visit to Capitol Hill. While our discussions were about policy, dollars, and quality of care, it became obvious that relationships between the policy makers and health care providers, and the negotiations between them, were the real issue and the driver of moving forward the required changes in our system. The lecture on negotiation, which I thought was directed at how one would respond to some labor relations challenge at the local hospital, took on a new light sitting in the Senate office of one of my state’s U.S. Senators.
“When I came to Brandeis, I was serving as the lead in our organization for quality and safety in our surgical practice. While always important, these issues have become a cornerstone in the rebuilding of our healthcare system. For me, this has meant leading the organizational effort across our enterprise, which covers five states and 15 hospitals. Furthermore, this issue is of keen interest to the Departments of Health in the different states and regulatory and accrediting bodies such as the Joint Commission.
More recently, I was named to the National Quality Forum Surgical Performance Measures Steering Committee to evaluate the quality and process measures used for public reporting and CMS reimbursement. Also, I was asked to lead a team in a national collaborative between the Joint Commission and the American College of Surgeons to reduce surgical site infections after colorectal surgery. Both of these require an understanding of the health care landscape and the interplay of the many stakeholders in this space. My experience in Waltham clearly has helped me perform and achieve more in all of these efforts.
Overall, the health policy scholarship has prepared me to continue working, and hopefully acting, as a leader within and outside of my organization to shape the direction of the modern U.S. health care system.