Collaborations and partnerships are creating new ways of teaching, new health care discoveries and better patient health outcomes, all with an eye on the bottom line.
Working partnerships between universities, colleges and health care centers in the Northern Virginia area represent the revitalization of an old concept made new again.
That partnership concept, which was actually introduced over 100 years ago as a reform of the health care system and resulted in doubling lifespans of humans in the 20th century, slowly came apart until being revisited again sometime in the middle of last century.
At first, hospitals were places where the infirm and the poor went to die. Then, advances in medicines—antibiotics, penicillin and others—meant people could live longer if they got ongoing treatment at a hospital.
More hospitals were built, more patients came and people began living longer. Doctors at first donated their time and, around 1920, hospitals became places where an illness could be treated and even cured.
But a model for financial success got pushed into the background because patients were staying at hospitals longer and still paying flat fees—or no fees—no matter how long they stayed. Doctors now expected to be paid, nurses began getting professional education and hospitals paired up with prestigious universities to attract talent. But hospitals stayed committed to a mission of treating all people—rich, poor, indigent alike.
Costs went up. Health care worker education couldn’t keep up, leading to a decline in the trained workforce. Hospital management, focusing on the altruistic goals of its work, ignored the oncoming consequences.
No one can pin down when hospitals and health care centers actually began to decline. But it’s generally attributed to the rising costs of health care around the 1960s, the drive for medical schools to provide their own brand of student, resulting in delayed acclimation to the specific needs of a health care center and generally poor administration on both sides of the partnership who didn’t see the value—and economic advantages—of working together more closely.
Hospitals were also slow to adopt technological discoveries, like modernizing medical records, which further raised costs.
Then there is the ongoing wild card of dealing with changing human health conditions, and the rise of other diseases never seen before. As the world became more crowded in some urban areas, viruses evolved and more international travel spread what used to be localized scourges. Prime example: the AIDS epidemic.
According to a 2010 report in The Lancet, professional education has not kept pace with the challenges of fresh health concerns from new infectious, environmental and behavioral risks “at a time of rapid demographic and epidemiological transitions,” and threatens the health security of everyone.
Hospitals have struggled to keep relevant and ahead of the health care need for services to patients, and many have had to become part of larger corporations just to survive.
For example, the Georgetown University Medical Center—the medical school opened in 1851 then combined with the hospital in 1853—was a stand-alone hospital, as were many of the hospitals in Northern Virginia and the suburbs of Maryland during most of their existence.
But on June 30, 2000, Georgetown Medical Center (GMC) became part of the MedStar Health system, a nonprofit community-based health system serving the Washington, D.C./Baltimore region, which came about because, from 1996 through 2000, GMC lost approximately $250 million, most of it in the clinical enterprise.
The George Washington University Hospital, affiliated with the George Washington University School of Medicine and Health Sciences, opened in 1904 after various iterations beginning in 1824. The hospital has been jointly owned by George Washington University and Universal Health Services, one of the country’s largest health care management companies, since 1997.
Adrian Stanton, vice president of business development and community relations at Virginia Hospital Center (VHC), says these hospitals had no choice but to partner up. “Either financially they are not doing well and they need to go with a system, or they can’t accomplish the capital ventures that they want to do or investments that they want to do and have to merge with a large system.”
VHC, a 394-bed not-for-profit teaching facility, has managed to stay independent for over 70 years of operation, while still growing—they are working on a 5.5-acre parcel of land adjacent to the hospital to develop inpatient capacity—and maintaining a robust partnership with area universities.
According to Dr. Jeff DiLisi, senior vice president and chief medical officer at VHC, which is now working with Georgetown University School of Medicine, VHC was one of the first hospitals to have an affiliation with the medical school and residency programs at the school. “Residents rotating through community hospitals is now part of most medical school experiences,” he says. “Back in the ‘60s, it was kind of a novel thing.”
He says that VHC had over 300 residents and medical students work through the hospital in 2017, with nurse practitioners coming from other schools in the area as well, rotating with the VHC doctors. “We have resident students in internal medicine, in obstetrics, in gynecology and in surgery that are rotating through here all year,” he says. “We attract a group of doctors that value education and love teaching. It’s really part of the fabric of who we are. We teach the future doctors of tomorrow.”
VHC has also developed a clinical affiliation with the Mayo Clinic, rated one of the best clinics in the country with nearly 4,000 full-time researchers, including 740 physicians actively involved in research.
That connection with health care centers was part of a strategic plan by Mayo 10 years ago to create affiliations with hospitals around the country, representing a huge opportunity for learning at VHC because now the doctors there have access to all of the best practice protocols, some of the best research and some of the top medical thought-leaders in the industry.
“Mayo is affiliated with the Apples and IBMs and other data analytics organizations and is at the top of the health care food chain,” DiLisi says. “And we find that we are culturally similar in that they do what is best for patients. That’s what we do as well. Making sure that we do that together is critically important.”
VHC also has a working partnership with Marymount University for nurses, where if a student already has a bachelor’s degree—any bachelor’s degree—they can get involved in an accelerated nursing program where they can earn a bachelor of science in nursing in just 18 months. “We are reaching toward a 2020 goal of having 80 percent of our nurses with a bachelor of science in nursing degree or higher,” Melody Dickerson, senior vice president and chief nursing officer at VHC, says. “We are working on attracting those students particularly with higher degrees that are often more mature and settled.
“The nice thing about the Marymount program is that many of the nursing students are from this area, and are planning to stay here long term,” Dickerson says. “Nationwide, the Northeast has the highest turnover in the country. In particular, the Arlington area has a higher cost of living. So there are individuals who come and start here. But then, as they get to where they want to buy their first house, they might move out of the area and that makes the commute challenging to get to some of the area hospitals.”
She said that nursing graduates have more options today, such as working for insurance companies or in the public sectors as nurse practitioners. “What we can control and what we focus on here is the work environment,” Dickerson says.
Reston Hospital Center (RHC) created an academic partnership with both George Washington University and Shenandoah University, along with 24 other schools, including Northern Virginia Community College, covering everything from pharmacy to respiratory, to nursing and physical/occupational therapy. “We see these schools as a great feeder for our recruitment needs, particularly with nursing,” Mary Giordano, director of hospital education at RHC, wrote in her email response to questions.
“We meet with the schools routinely to discuss opportunities for both parties. We also feel it contributes to keeping us more current with regards to best practice and provides our staff with mentoring opportunities, which they find rewarding,” she says in a separate interview.
Part of the onboarding process for nurses at RHC is to bring the students into a specialized program that is a five to seven week didactic (a specific scientific teaching method), followed by another six to eight weeks for hands-on training. A residency program follows for the remainder of that whole first year, she says. “They do some clinical hands-on with their instructors from their schools. Or in their last semester of nursing school, they might have a weekly check-in with their school instructor, but then be with us working 12-hour shifts a week, usually at the end of their nursing program,” she says. “We definitely then would love to see them stay on with us.”
Partnerships between hospitals and academia are progressing to the point where major new developments in medical treatments or clinical programs are enriching the complete health care picture. This is sort of the holy grail of these partnerships—bringing together great minds from different disciplines to create great discoveries to benefit all of us.
One example is the Inova partnership with the University of Virginia, which also includes George Mason University, bringing together academic, financial and medicine’s brain power working collaboratively in a massive project that could literally change the world of health care.
Under construction right now is the Global Genomics and Bioinformatics Research Institute (GGBRI), where UVA, GMU and Inova will recruit up to 32 new investigators to work in collaborative teams on genetics and genomics, bioengineering, developmental biology and computational biology with the goal of making scientific discoveries that can be turned into new treatments, drugs and devices to improve the health of patients around the world.
The GGBRI will be located on the former 117-acre Exxon Mobile headquarters campus, across the street from the Inova flagship hospital, as part of the Inova Center for Personalized Health (ICPH) campus now in development on the site.
It will be housed in a 220,000-square-foot building that is being gutted now and readied for build out. Renovations to this building are expected to be completed by the end of 2018, with the GGBRI expected to be up and running by fall 2019 or the first quarter of 2020. “We anticipate that the majority of scientists there will be UVA faculty,” Dr. David Wilkes, dean of the UVA School of Medicine, who also calls himself a physician scientist, says. “We anticipate that other universities, including GMU, may recruit individuals into that space.”
This GGBRI is what the promise of closer and more intense collaborations between academia and health care centers can accomplish using the power of their resources. It will bring together researchers and Ph.D. investigators and physician scientists who will be bringing teams to work on areas for themselves, Wilkes says, but also cross-fertilize with what the other teams are doing. “It’s those interactions where the ‘aha’ moments will happen,” he says. “You go where science takes you, so in the area of let’s say epigenetics (the study of changes in gene function), understanding how the genome is regulated, so much work has been done but there is so much more that we don’t know. We don’t know what that magic moment might look like because it’s not completely obvious what initially occurs. It takes time to put some of those discoveries in context of a broader picture.”
The entire ICPH campus will continue to be developed over the next few decades. An additional 5 million square feet has already been negotiated for the first phase, and other rezonings from Fairfax County adding more square footage are planned to house clinical research, education and technology assets.
UVA, in addition to being a research partner at the GGBRI, will be bringing medical education to the ICPH campus by 2020 or 2021. ICPH administrators are also in discussion about partnerships with Virginia Commonwealth University (about opioid research) and Virginia Tech (about bioinformatics). “We have an open invitation, if you will, for others to participate,” Todd Stottlemyer, CEO, ICPH, says.
The plan for the campus includes creating amenities for people to live and work there as well. “It’s a long-term use,” Stottlemyer says. “Because this is an ecosystem with Inova being an anchor and the University of Virginia being an anchor, and the ability to attract other universities and other academic medical centers, commercial companies, life sciences, biosciences and medical technology assets to build out this ecosystem. You can build this out and have the right partners that attract talent, which attracts more talent that attracts other assets. So you really get to build out this economic cluster of strength. That is what we are trying to do.”
Technology is foundational to everything that is being done in health care, Stottlemyer says, and that is what makes the ICPH a perfect fit for this area. “In this area, we have great technology assets, particularly software, information technology and data analytics,” he says. “So that presents an exciting opportunity to leverage those technology assets and capabilities into health care, biosciences and life sciences, and really allows us to do things like predictive analytics.”
Critics of the American health care system call it inefficient, ineffective, expensive and ripe for disruption. It needs a new model for success or a number of new models about team-based care and interprofessional education.
Maybe high-tech discoveries will fix that; augmented reality discoveries. Maybe collaborations between academia and health care facilities will enable that; better patient outcomes, less expensive treatments, cures for diseases. In other words, what we all hope for from medical science.
Whatever comes next—and it looks like facilities in Northern Virginia are on the cutting edge of positive change, especially as the ICPH develops—it’s nothing but good news for health care in this country.