Division of Research

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foreign

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[Music]

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health

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I am Dr Desmond Kelly the interim Chief

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academic executive officer at Prisma

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health and I'm joined on this panel by

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Dr Liz Hall who is the chief academic

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officer for Prisma Health in the

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Midlands and Dean of the University of

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South Carolina School of Medicine in

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Colombia

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Dr Marjorie Jenkins is Chief academic

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officer of prisoner Health Upstate and

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she is Dean of the University of South

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Carolina School of Medicine in

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Greenville and Dr Windsor Cheryl is our

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chief science officer at Prisma health

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and Associate vice president for

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research at Clemson University

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we are going to be discussing research

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at Prisma health and sharing with you

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information about our research

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infrastructure the activities of

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research here at Prisma Health which is

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focused on improving the state of health

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in South Carolina research is highly

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valued by Prisma health and we have

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developed and built an infrastructure to

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support that that is robust and

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expanding we have a broad group of

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researchers you might ask who are the

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researchers that starts with our

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patients we have actually over 2 800

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patients enrolled in research studies we

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have excellent clinicians who are

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curious about improving the delivery of

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Health Care to our patients we have

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medical and Health Care trainees and

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academic partners and investigators at

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our University academic partners that

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you will be hearing more about during

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this presentation thank you Prisma

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health is one of only 102 academic

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health centers in the country and our

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research is focused on prevention

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promotion of health and delivery of

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Health Care Services with less of an

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emphasis on basic science research we

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are about improving the health of our

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population we have built an

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infrastructure to support research here

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and we encourage you and all of our team

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members to be curious to ask those

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questions about how can I improve health

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how can I make this experience better

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for this patient that I'm interacting

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with and how can I improve the

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well-being of this patient and his or

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her family and all of the population

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that we serve I am going to now hand

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over to Dr Les Hall to discuss research

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as it relates to improving Healthcare

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delivery quality safety patient

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experience thank you Dev I hope

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appreciate the fact that Prisma Health

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has been a great emphasis on the

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importance of improving care using both

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patient safety and continuous learning

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with a commitment to continuous

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Improvement one of the champions of

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quality improvement Health Care in the

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country over the last few decades has

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been Dr Don Berwick and he famously said

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that all of us come to work with two

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jobs which is to take care of the

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patient we're seeing today in the best

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way we can but also to create even

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better ways of providing care in the

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future and I think what we're doing with

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our pulse program and other initiatives

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in Prisma Health right now are really in

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the spirit of that attitude both

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research and quality improvement are

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intended to improve care research is a

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systematic process of using the

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scientific method to create new

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knowledge that will benefit communities

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or individual patients the quality

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improvement is really about how do we

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take that knowledge that is Created from

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research and get it to the bedside or

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into the communities where it's make

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making a difference today we don't

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always have a great track record in

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healthcare of implementing findings of

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research quickly or effectively

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throughout the entire area of service

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and sometimes it takes years and years

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for those effects to actually become

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common practice and so quality

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improvement is one of the tools that can

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help to accelerate that process of

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ensuring we're offering the best care at

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the right time to the right individuals

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one of the models that helps to

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conceptualize that is the quadruple aim

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we're trying to improve the quality of

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care from the patient's perspective

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we're trying to make sure that the

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patient outcomes are actually improving

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as well we're trying to do that in a way

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that is cost effective because resources

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are not Limitless and fourthly we're

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trying to do that while honoring the

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health care providers who are actually

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doing that Improvement and contributing

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to their wellness and their joy and work

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at the same time

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there's an old adage in quality

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improvement that every system is

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perfectly designed to get the results

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that it gets and when you look at any

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health care System you'll find some

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things that are doing extremely well

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where we're hitting our targets you'll

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find other things in every Healthcare

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System where we have goals to be at a

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certain level of performance and there's

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a gap in where we currently are and

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where we want to be and then we have to

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decide how do we close that Gap some

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Health Care Systems will ask us to work

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harder or we'll say you need to care

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more about this they may even replace

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people and throughout the last several

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years as Healthcare Systems have tried

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to bring about Improvement in closing

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those gaps those often don't work well

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because the reality is the majority of

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those gaps are due to process issues

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there are processes that are not

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optimized and if we ask our health

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system workers

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to help us identify those and if we ask

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our patients to help identify what's not

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optimized for them they often can point

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us toward things where they've been

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working heroically to overcome things

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that weren't particularly optimal but

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yet there are real opportunities to make

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those things work better we're asking

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for transparency we're asking for input

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on a regular basis from our patients and

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from our health system Partners to try

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to help us understand where there are

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opportunities to make that better and

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then we're making that commitment to

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continuous learning as a learning

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organization that leads to continuous

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Improvement that's the package that will

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get us to the point that we aspire to

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where we're not only being effective in

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our work we are looked to as a positive

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example of a health system that's really

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effective in what they're trying to do

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at a national level one of the things I

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love about Prisma health is that we

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involve trainees in our quality

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improvement projects we have over 8 000

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Learners that walk through the halls of

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Prisma Health at some point during the

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year that's a lot of of people and many

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of them are touching patients while

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they're here they're involved in patient

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care process and many of them going to

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become part of the workforce of Prisma

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Health in the future it makes sense to

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involve them in our quality improvement

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efforts and most Health Sciences

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curriculums actually want to them

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learning health system science or

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system-based practice as part of their

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learning as well we also know that the

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data shows that if we do not model the

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correct behavior for those trainees we

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are actually potentially adversely

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affecting their performance as a health

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care professional once they leave if you

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are in a system that provides high cost

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care meaning that the average cost per

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patient is higher than expected but

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without an improvement in outcomes 20

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years later you're more likely to be

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delivering high cost care than if you

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were in a system that did not have that

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outcome if you're in a system that has

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high number of adverse patient events

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that are potentially preventable it

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impacts your risk of having a high risk

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practice in terms of Adverse Events and

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in the future so we kind of all know

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intuitively that people watch what we do

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and not what we say but it's a real

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opportunity and an obligation for us I

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think the model the kind of behavior for

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our trainees who are training within our

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Health Care system so that they actually

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build the right patterns into their

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life's work from the very onset of their

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Health Professions education the last

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thing I would say about the importance

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of quality improvement to our system is

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every Healthcare System is trying to

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figure out well how do we save money

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fortunately unlike some things in health

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care you don't have to spend a lot of

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money to improve your health Care

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Systems in fact it usually has the

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opposite effect just think about the

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example of an operating room that may

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have problems with patient flow or

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getting the right equipment there at the

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right time for the right case or room

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turnover is not optimized that's the

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most expensive real estate in most

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cities is the real estate in the

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operating room and if you can optimize

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that flow everybody wins the patient

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wins the providers win the Chief

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Financial Officer is happy because we're

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no longer are wasting resources and

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that's a typical scenario in quality

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improvement when we make systems work

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better everybody wins and that's why I

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think it's such an important Focus for

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us as a healthcare system right now

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thank you Dr Hall that's a excellent

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discussion and example Dr Jenkins would

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you please discuss and share with us the

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types of research performed at prisoner

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Hut yes so we have uh several types of

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research at Prisma Health we know as Dr

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Hall stated that research really

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elevates an organization it helps us to

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find the right way to do things to do

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things better to deliver Care at lower

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cost to increase access for our patients

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and as Dr Kelly said we are working at

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Prisma Health to develop a better state

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of health for South Carolinians so we

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have translational research and

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translational research means that we

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take research from the lab and we make

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that Continuum to the bedside as you

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think about a scientist in a lab with

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white coats and assistance and looking

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under a microscope but then taking what

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they find and applying it into that

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clinical setting to find answers for

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patients and for the community and at

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medical schools we tend to have PhD

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scientists that are performing bench

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research and translational research and

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they partner with clinicians to perform

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translational research and we do that

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here at Prisma Health we have 1100

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clinical Physicians here that are also

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clinical faculty at the medical school

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and partner with our PhD scientists and

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teach our students to perform research

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and then let's talk about clinical

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trials you've probably heard about

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National Institutes of Health that's a

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49 billion dollar budget that promotes

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Discovery research at the bench in the

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laboratory they fund translational

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research and also clinical research and

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community research and the NIH actually

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gives us a lot of information that we

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can utilize to ask the second question

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or the third question Chris has over 1

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000 clinical trials ongoing within the

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health system and most of these are

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industry sponsored and what that means

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is pharmaceutical companies and

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organizations are trying to develop

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Innovative Therapeutics and devices and

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better ways to do procedures so that

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they can bring that to Market so that's

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the difference between federally funded

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research and industry-sponsored research

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industry sponsored is working to get

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that to Market and the National

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Institutes of Health is funding multiple

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billions of dollars of research around

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the U.S and globally every year and then

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one that is near and dear to my heart as

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community-based participatory research

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that is where we go out into our

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communities and we engage our non-profit

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organizations and other organizations

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and our citizens to help us create the

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research questions what do you want to

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know what do you think think we should

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be studying and also create the process

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so we can enroll patients in these

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trials and we can find answers for a

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healthier community and last I will talk

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about applied research applied research

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is when we take our knowledge and we

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apply it to real world problems today

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and I think that's really where the

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rubber meets the road for us and

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improving care with research and that

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research can involve existing knowledge

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it can involve utilization of new

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products and Prisma health is a vibrant

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environment for Applied research applied

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research within Prisma health and the

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Health Care system and also applied

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research to help create healthier

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communities so Dr Kelly that is our

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types of research thank you very much

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that's a great overview and I think just

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that gives a sense of the the broad

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range of research here at prisoner

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health and the opportunities for those

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of of you who are curious to become

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involved in research and we'll tell you

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more you'll learn more about how to get

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started our clinicians are busy our

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Healthcare Providers primary role is in

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treating patients and improving Health

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they have those research questions on

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their minds but without the

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collaboration with our academic

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investigators at our academic partner

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universities it is difficult for them to

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really formulate those research

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questions to complete the studies to get

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the funding that they might need in

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order to do that and then to get those

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findings out to the public I ask Dr

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Windsor Cheryl to discuss more about our

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academic partners and the range of

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support that we have from them

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thank you Dr Kelly

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as Dr Kelly has said they're just a few

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academic health centers in our country

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and indeed Prisma health is a very

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unique academic Health Center we've got

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decades old very strong Partnerships

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between Prisma and the university

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Partners USC Clemson and Furman are

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critical Partners the relationships that

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we have in place are those that

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facilitate impactful research applied

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health research facilitating both

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formally and informally this is so

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important to the university partners for

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the University's Prisma health is the

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clinical research environment this is

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the place where our faculty and our

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students connect to patients and the

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delivery system and likewise for Prisma

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partnership with the university provides

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access to Unique research methods and

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research expertise of academic faculty

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but we know that although the goals of

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the universities and the health systems

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are complementary they're not identical

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the health system has to focus on

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day-to-day clinical operations the

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University faculty are more focused

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often on educational programming and

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research funding so our goal is to work

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together to make those goals in Mission

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synergistic so that our collaborative

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research together elevates each entity

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one of the most important tools we've

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used here at Prisma Health in

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partnership with the universities is

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what we call embedded scholarship for

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the past few years we've been very

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intentional at the universities in

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developing models of embedded

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scholarship programs like faculty

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fellowships sabbaticals recruiting

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post-doctoral Scholars and research

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faculty to work within the clinical

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system to be based within the clinical

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system so that their research ideas are

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informed by clinical needs their

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research questions are the questions we

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need to answer to transform care we work

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working together between Prisma and the

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universities to develop a new kind of

15:53

Health researcher one who again

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understands the delivery system one

15:58

whose worked in health research is

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informed by the delivery system on the

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health systems side we're working on

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specific tools and processes to

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facilitate this important work providing

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our faculty with access to data and

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administrative support for their

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research our goal is to facilitate

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transformative health research the tools

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that will enable this are Partnerships

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between what we call clinically informed

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researchers and research-informed

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clinicians and as research leaders we

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want to support the important work of

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both groups what faculty care about is

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that their research makes a difference

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what clinicians care about is better

16:38

care for their patients with research

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Partnerships between Prisma health and

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our universities we're engaged in

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facilitating the kind of translational

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research church that makes a difference

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in our state we do think that we're a

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very unique academic Health System here

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at Prisma and we're committing to

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leveraging the work of both our

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academicians our faculty researchers as

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well as our clinical researchers our

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collaborative help research the

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scholarship we achieve together makes a

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difference for our state and we can

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achieve more together than we can

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achieve as individual organizations

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thank you Dr Cheryl and thank you to all

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of our panel members I think that you

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have and I hope that you have learned

17:22

more about the breadth of research the

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types of research and the importance of

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research and Prisma Health recognizes

17:30

that and has invested in research so we

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have offices of research support to help

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those engaged in clinical trials to

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provide the data support that Dr Cheryl

17:44

mentioned in assisting our investigators

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focusing their research question

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developing methodology that's going to

17:52

help them answer that question accessing

17:55

the data in order to address that

17:59

question and then analyzing that data

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and arriving at those answers that we

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then will share internally we are very

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much about implementing as Dr Jenkins

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talked about applied research our goal

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is improving the delivery of Health Care

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in the health of our patients so our

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research findings we really focus on

18:21

implementing those improvements and

18:23

those Innovations as soon as possible as

18:26

well as sharing our findings nationally

18:28

and improving our own reputation of

18:30

prisoner Health as an excellent place

18:32

both to have access to cutting-edge

18:35

medications maybe through clinical

18:37

trials as well as those experiences in

18:40

that Healthcare delivery that's going to

18:42

improve their health there is a type of

18:44

research called comparative

18:46

effectiveness research that's where

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we're asking are we providing the right

18:50

treatment to the right patient at the

18:52

right time population health and

18:55

community-based participity research

18:56

really focused on improving wellness and

18:59

well-being and preventing diseases and

19:02

addressing the challenges faced by

19:04

patients who have chronic health

19:05

conditions and a really important focus

19:08

is a patient-centered outcome and we are

19:12

very fortunate in the resources we have

19:14

to have access to the patient engagement

19:16

Studio housed and supported through our

19:18

medical schools that really engage

19:20

patients right at the front end and in

19:22

that research because after all it's not

19:25

for us to tell patients what we think

19:27

they need we need to hear that from them

19:29

and then to engage them and to answer

19:31

those questions to improve their

19:33

experience and to improve the quality

19:36

and the safety of that experience so we

19:40

hope that you will be interested in

19:42

learning more we have a robust website

19:45

and I'm sure you will have the link to

19:47

that website that talks more about our

19:50

research offices about research

19:52

development activities and about

19:54

Investments and I'm going to mention one

19:56

development is our seed Grant programs

19:59

every year we fund and the most recent

20:02

year over six hundred thousand dollars

20:04

for small seed grants that are designed

20:08

to engage a prisoner Health clinician

20:11

with an academic partner is Dr Cheryl

20:14

described in addressing a research

20:16

question that is aligned with the

20:19

priorities of the health system as we've

20:21

discussed earlier and many of those

20:23

projects have gone on to both change

20:26

Healthcare delivery at Prisma health and

20:29

to secure external funding to enable

20:33

larger research projects so lots going

20:36

on and I would just encourage you to be

20:39

curious to learn more about research and

20:41

Prisma health and in closing I'd ask our

20:44

panel members if they have any pearls

20:46

that they'd like to share to add to this

20:48

discussion thank you

20:50

well you know I'd like to share that

20:53

Prisma is the largest integrated

20:54

Healthcare delivery system in South

20:56

Carolina actually gives us great

20:59

opportunity to be National thought

21:02

leaders and how to deliver high quality

21:05

Care at a lower cost and to increase

21:07

access we want to get answers to those

21:10

issues and those diseases that are

21:13

causing High morbidity and mortality for

21:16

South Carolinians things such as cancer

21:19

heart disease and stroke outcomes of

21:22

research like that which is being

21:26

performed at Prisma will help us find

21:28

these answers it will help us take

21:30

better care of our communities it will

21:32

help us answer those questions for even

21:35

the national as a national example and I

21:38

think that research ensures that we

21:42

provide evidence-based care to our

21:44

patients on a daily basis so we don't

21:47

leave patient care to chance we we

21:51

actually have evidence that tell us what

21:53

is the best treatment the best device

21:55

the best procedure to offer to patients

21:58

at the time they are needed

22:01

I also do want to just add around

22:04

clinical trials I mentioned a thousand

22:07

clinical trials are ongoing at Prisma

22:09

but we also are in a state that is rich

22:12

in diversity and we need diversity in

22:15

clinical trials because clinical trials

22:17

gives us answers for the population that

22:20

is studied and in South Carolina being

22:23

such a diverse State and Prisma taking

22:25

care of such a diverse patient

22:27

population we are thinking about

22:30

diversity at the front end of our

22:32

clinical trials so that we can ensure

22:35

the answers that we find out will be

22:38

applicable to all of South Carolinians

22:41

thank you Dr Kelly thank you that's such

22:44

an important point

22:45

[Music]

22:47

under Kelly

22:48

encourage folks to be curious to get

22:51

engaged in research at Prisma and Dr

22:54

Jenkins mentioned that we are the

22:55

largest integrated delivery system in

22:57

the state of South Carolina but we're

23:00

also enough where any researcher any

23:03

student medical student or resident can

23:05

become engaged in impactful research so

23:08

as we said today we're trying to design

23:10

those programs and support the

23:12

administrative structures to facilitate

23:14

your work and we welcome your work as we

23:17

work together the university and the

23:20

health system to change Health outcomes

23:22

through research and scholarship

23:24

well I've always been a fan of research

23:26

but I must admit that this last year the

23:29

importance became more personal to me

23:31

when I had a family member who was

23:33

diagnosed with cancer and the treatment

23:35

she received was based upon research

23:39

that had been done over the last five

23:41

years and produced dramatically

23:43

different outcomes than would have been

23:46

possible before that research was done

23:48

ultimately that's the motivation for

23:51

research research saves lives it

23:53

improves quality of lives it reinvents

23:56

the future for people who did not know

23:59

if they even had a future before that

24:01

research was done if that doesn't get

24:03

you up in the morning excited to be

24:04

involved in this work I'm not sure what

24:06

will it really

24:08

made it come home to me to have somebody

24:10

that I cared about so deeply in my own

24:12

family benefit from the new knowledge

24:15

that have been gained through research

24:16

that it made me even more enthusiastic

24:18

about supporting research going forward

24:20

in the future

24:22

wow thank you Dr Paul I think you get a

24:24

sense of our passion and energy around

24:27

research and we encourage you to join us

24:30

on this journey thank you

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[Music]

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foreign

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[Music]