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Never has there been a time when the Commencement Ceremony for the University of Texas Health Science Center at San Antonio School of Health Professions marked such a seminal moment in healthcare. Today, what has always been the case, i.e., that each of you is an integral and critical member of the healthcare team, has become obvious to everyone. The eight disciplines represented by the School of Health Professions are critical to the future of excellence of healthcare in the 21st Century and you individually are critical to the continued transformation of modern healthcare.
Transformation and Reformation
Healthcare does not so much need reform, as our healthcare system and our healthcare delivery need to be transformed. “Reform" comes from external pressure, while "transformation" comes from an internalized passion and dynamic. Anything can be reformed - reshaped, made to conform to an external image - if enough pressure is brought to bear. However, reshaping healthcare under pressure can fracture the system in such a way as to permanently alter its structural integrity. Additionally, once the external pressure is eliminated, old ways are resumed as nothing has fundamentally changed.
Being from internalized principles and vision, transformation results in change which is part of the nature of the system. The act of transformation creates a dynamic which is generative, i.e., it creates within the system being transformed the energy, the will and the necessity of continued and constant change and improvement. Transformation is not dependent upon external pressure; it is sustained by an internal drive which is energized by the evolving nature of the organization. In transformation, creativity and change generate more creativity and change, and it does this without external reward or coercion.
Rather than attempting to impose change as in reform; transformation initiates behavioral changes which become self-sustaining, not because of rules, regulations and restrictions but because the images of the desired changes are internalized by the organization, which then finds creative and novel ways of achieving that change.
Healthcare Team
One of the tools of healthcare transformations is “team.” As a team, those of us who welcome you into the healthcare profession, no longer welcome condescending and patronizing terms such as ancillary providers, technicians, physician extenders, or mid-levels. In a team, we are all colleagues and collaborators. Today and increasingly in the future, each of you will know more about your area of expertise than most of the nurses, NPs, PhDs, physicians and other healthcare providers with whom you will work. You will be invited to add your knowledge to the collective competence of “your team.” The excellence of care which patients will receive will be dependent upon all members of the team. When that team works at its peak, the results will exceed the sum of each individual’s contribution. Together, we will be more than we could be working in isolation.
About the value and experience of a team, one company CEO observed:
“Most of us at one time or another have been part of a great ‘team,’ a group of people who functioned together in an extraordinary way - who trusted one another, who complemented each other others’ strengths and compensated for each others’ limitations, who had common goals that were larger than individual goals, and who produced extraordinary results. I have met many people who have experienced this sort of profound teamwork - in sports, or in the performing arts or in business. Many say that they have spent much of their life looking for that experience again. What they experienced was a learning organization. The team that became great didn’t start off great - it learned how to produce extraordinary results.”
Personal Mastery
The knowledge and expertise of the team is imperative because for the first time in history, humankind has the:
- Capacity to create far more information than anyone can absorb,
- To foster far greater interdependency than anyone can manage
- To accelerate change far faster than anyone’s ability to keep pace.
To surmount these challenges, the team through its members will need “personal master,” which goes beyond competence and skill. It means approaching one’s life as a creative work, living life from a creative, as opposed to a reactive, viewpoint.
People with a high level of personal mastery share several basic characteristics. To the degree that you achieve personal mastery you will strength your team and you will contribute to the transformation of healthcare. Those who have personal mastery have:
- They have a special sense of purpose that lies behind their vision and goals. For such a person, a vision is a calling rather than simply a good idea.
- They see current reality as an ally, not an enemy. They have learned how to perceive and work with forces of change rather than resist those forces.
- They are deeply inquisitive, committed to continually seeing reality more and more accurately.
- They feel connected to others and to life itself.
- Yet, they sacrifice none of their uniqueness.
- They feel as if they are part of a larger creative process, which they can influence but cannot unilaterally control.
- They live in a continual learning mode.
- They never ARRIVE!
- (They) are acutely aware of their ignorance, their incompetence; their growth areas.
- They are deeply self-confident!
Each Department and each Discipline in the School of Health Professions is unique and critical to our common transformative mission.
- Clinical Laboratory Sciences
The balance of technology and humanity in the 21st century is one our greatest challenge. Those of you who are prepared to support healthcare delivery with valid and relevant data from the laboratory are pivotal to clinical medicine. As we activate and engage patients to participate in their own healthcare, you provide the foundation for the bargain we must make with those patents, i.e., “if you make a change in your lifestyle and habits; it will make a difference in your health.” Without your data, we cannot communicate to our patients - yours and mine - the opportunity each person has for improving their health.
- Cytogenetics
Buck Rogers gadgets were science fiction a generation ago but are clinical science today. Those of you trained in cytogenetics will help lead that same science-fiction parade into the future of mainstream medicine. The genome will increasingly transform science fiction into science fact. Your work will increasingly be critical to our success in applying currently unknown evidence-based medicine into clinical practice.
- Dietetics
At SETMA a critical aspect of our care of patients is nutritional education. Whether Diabetes Self Management Education, medical nutrition therapy, dietary training for weight management, renal disease, hypertension and the DASH diet, or dysplipidemia, you are one of the hubs of the future of healthcare. The details of your expertise in nutrition science expands the understanding of your clinical colleagues into transformative plans of care and treatment plans for the health of our patients.
- Emergency Health Sciences
Those of you trained in emergency health science are the “healthcare first responders.” Your knowledge and skills, your courage and passion are the key to survival for people in crisis. Conferences are held about transitions of care but no care transition is more important than that from the site of an accident, from home sites and many other locations, to the emergency-care facility or trauma center. Your science will grow and with it your contribution to the welfare of our entire community.
- Occupational Therapy
Perhaps no discipline in the School of Health Professions is in greater need of a change of name as is Occupational Therapy. Your role in restoring autonomy, self respect and quality of life to our friends and neighbors is critical. You need to be involved in patient care sooner and longer than currently recognized. Your position on the healthcare team is secure and will increasingly be recognized for the critical role you have. In the future, OT will not be an afterthought, but a first thought in the care of patients.
- Physical Therapy
In writing about how to survive a hospital stay, I have said, “You need to eat up, get up, and get out.” Often in the hospital, we put patients to bed; we stop feeding them, and we wonder why they deteriorate. We then keep them in the hospital longer than we should. Like OT, PT needs to be in the first set of orders for most patients. Physical Therapists are primary-care providers and you need to be involved in a patient’s care from the first day they enter the hospital, as the sooner a patient is mobile, the sooner they will recover. Whether it is de-conditioning, neurological deficit, or other disability a person is facing, you and the occupational therapists are key to recovery. No medicine or procedure will do the patient as much good, long term, as your skills.
- Physician Assistant Studies
The primary healthcare workforce is seriously under manned. We have learned from visionaries about “disruptive innovation” and with it the concept of “precise medicine.” Where goals and treatments are standardized, the unique perspective and skills of Physician Assistants contribute a significant benefit to the healthcare team. The life experiences which lead healthcare professions into the role of a physician assistant will help relieve the workforce shortage in America. And, like the Occupational Therapist whose role may be more clearly understood if the name is changed; soon, the day will come when the role of the PA will be such that to do honor to that role their name will need to be changed.
- Respiratory Care
Lung mechanics and function are theoretically understood by physicians, but the skills and knowledge of the Respiratory Therapist can help improve the quality of life as well as the longevity of those with primary pulmonary illnesses. Pulmonary rehabilitation is an essential part of the treatment of millions of people who suffer from asthma, chronic bronchitis and emphysema or from other causes of decreased lung capacity. No one performs pulmonary rehab as effectively as RTs. The OT, PT and RT are individually and collectively valued members of the healthcare team.
These brief observations about your professions and careers are inadequate, but they are an acknowledgment of your expertise as we welcome you to the healthcare team.
The End of the Beginning
As you receive your diploma today, which recognizes your academic achievement, receive it as your invitation to a life-time of learning and a life-time of contributing to the collective health of the society you serve. Receive it, knowing that more than any other generation, that what you have already learned will be broadened and deepened as you and your colleagues expand the scope and practice of your profession. Receive this diploma both as an honor for your achievement and as an invitation to your “continuous professional development.”
As I have the honor of addressing you today, I affirm to you that while as a physician, I may be thought of as the team leader, or as the captain of the ship, those honorifics are accepted by me with the acknowledgment:
- That we are mutually dependent upon one another.
- That our only hope of excellence is in our collaboration.
- That I have a great deal of respect for you and admiration of the value you bring to our team.
Congratulations. I look forward to working with you; and, as today, I look back upon my own graduation forty years ago, that in forty years, when you will look back upon your career, that you will be fulfilled and satisfied that you have done well for others, for your school, for your family, for your nation and for yourself.
God bless each of you and God speed to you all.
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