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Breaking down silos


How do you break down silos to improve care to underserved populations and improve coordination between medical schools and teaching hospitals? What can we learn from Ghana? In this conversation, Chike Nzerue, M.D., chief medical officer of Nashville General Hospital, and associate dean for clinical affairs at Meharry Medical College and Dean Y. Li, M.D., Ph.D., chief scientific officer and vice dean of research, University of Utah Health Sciences discuss the challenges and opportunities of integration, how to find synergy and what we can learn from unexpected places.

Nzerue: I see a lot of patients. The first time I see them, I have to put them on dialysis. That's a failure of the system. I'm Chike Nzerue, I'm the Chief Medical Officer, Nashville General Hospital. I'm the Associate Dean for Clinical Affairs at Meharry Medical College in Nashville, Tennessee.

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Li: I'm Dean Li, I'm the Chief Scientific Officer of the University of Utah Health System and the Vice Dean of Research for the School of Medicine. So Chike, I was going to ask you, at Meharry there's a separation between the hospital and the School of Medicine.

Nzerue:  Yes.

Li: What challenges or opportunities do you see in that sort of an organization, compared to other places or other organizations that you know?

Nzerue: The challenge is, we have a system where strategic planning is done in two systems. And as a little bit of asylum mentality, the hospital does it's plan about how many new patients they want to see, what new service lines they want to launch. The medical school, academicians, they're thinking about innovations and curriculum. How to interface the curriculum with the clinical experiences of medical students and residents. And these two appear to be two parallel lines.

The opportunities to find more areas of cross cutting in planning, in strategic planning, new equipment, upgrading the cardiac cath lab, for example. Opportunities for introducing new surgical service lines, like obesity surgery. The hospital wants to do it, the hospital has to be in line with them before it can happen.

Li: What do you think are the critical barriers in terms of educating those who are on the hospital side and also those who are on the School of Medicine side for such an integration to potentially work?

Nzerue:  I think the biggest thing is they have two boards. The hospital board answers to the city, the Medical School Board answers to the Medical School Board of Regents. It would be nice if they had a joint board that controls both entities. Everybody feels accountable to their own boards and sometimes the interests and the major goals appear to differ. So again, there is lack of synergism. Which could be something they both could benefit from.

Li: So you were born in Ghana?

Nzerue: Mm-hmm.

Li: And have you ever seen ingenious, innovative solutions that occur in Ghana because of the financial constraint. That if we took the same ingenuity here, we could improve our system.

Nzerue: The only examples I can think of, not just in Ghana but in that entire West African region, is for example, community research. The Albert Schweitzer Hospital in Gabon is able to do research across communities and they engage the community.

Li: What does it mean when you say to reach out and engage the community?

Nzerue: We have a situation where what I see, practicing in the United States, we learn a lot about heart disease. We learn a lot about [inaudible 00:03:27]. When I practiced in the poor section of Nashville, Tennessee, where I see a lot of patients, the first time I see them, I have to put them in dialysis. That's a failure of the system. So you have a lot of people, the first time you see them, 45 years old, they have three vessel disease, they've never been [inaudible 00:03:45].

The knowledge is there, but taking this stuff from the bench to the community, this is not just bench to bedside, the third leg that's missing in poor communities, not just in Nashville, across the entire United States, is taking it into the community. Especially the urban inner city poor communities. I have 25 year olds having three vessel disease, that I'm scratching my head, I said, "What is wrong with this picture?" This is what's missing.

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