They called him the "psych on a bike", the nom de endearment by which Dr. Gerard Clancy was known in Iowa City, Iowa where he was a faculty member and Vice Chairman of the Department of Psychiatry at the University of Iowa.
David Brooks and his daddy was a lot like Doogie Houser M.D. (yeah, the late 80's TV show), but more about that later.
He is simultaneously intense and genial, and if you look at him in just the right way you might think his head was transparent: he's a first rate intellect--you can almost see the gears rotating in his head.
He keeps busy. He is president of the University of Oklahoma-Tulsa, a practicing faculty member at OU where he teaches psychiatry, a former Air Force flight surgeon, a trained hostage negotiator, a wide field innovator/contributor to a host of local operations including the Oklahoma Innovation Institute, and the current board chair of the Metropolitan Tulsa Chamber of Commerce, which is the reason for this Cover Story.
He might just be the right guy at the right time to analyze Tulsa. And, most importantly, deliver a prognosis on how we can roll back our epic chronic disease challenges, find a leapfrog path to a much healthier community and deftly leverage the extraordinary employment and development yields that leading edge biomedicine can yield for Tulsa.
Clancy can be a really funny guy -- here is part of what he said last January, during his installation as Metro Chamber chief:
"Now I know the question on all of your minds -- was it by design or even need that a psychiatrist was voted in as the Chair of the Chamber? Answer: I don't think so, but I may need to get back with you on this one. As you heard in my formal introduction, I do have other skills that could also be helpful if this job gets more difficult. I am a graduate of the USAF Survival School and have been trained by the US Secret Service in hostage negotiations . . . So, here I am . . . from the State government . . . and I am here to help."
He also has a serious, almost missionary side. A business man I know, calls Clancy a "mash up man", meaning the doc applies the outlook of a dedicated academic medicine doc with a profound dedication to social justice and the managerial moxie of a turnaround consultant.
"...It was recognizing the important contributions of education and healthcare in making Tulsa a vibrant, growing region. I think we all recognize that to compete, we need a healthy, well-educated workforce...", again, from Clancy's installation speech at the Metro Chamber on why he accepted the chair. The doc's hung his shingle in T-town since 2001. He came originally as OU's choice for dean of what was then called the OU Medical School/Tulsa. Michael Woods, a current faculty member at OU on the selection committee, remembered that almost everyone on the hiring panel sensed that Gerard Clancy was amazingly calm, a powerful communicator with insight into a variety of fields including psychiatry, his specialty area, but also healthcare policy and rural medicine.
The Urbies and the Aggies: A Love Fest
Rural medicine requires that docs be extraordinarily agile, a sort of "hind cast" of what's mostly missing from American medicine today, and it's now getting a lot of attention.
Woods' goes on to describe Clancy as somebody who understands the day-to-day obligations, responsibilities and depth of knowledge, the generalist skills, required to be an effective practitioner in this diverse region.
Clancy, for his part, says Woods, a specialist in rural medicine and director of an OU micro clinic in Ramona, a village just northwest of Tulsa, is his favorite medical professional and a real star at OU-Tulsa.
Generalist physicians have become increasingly valuable in a healthcare environment strongly driven by specialization, big money and high profile clinics for the rich and well insured. But as chronic disease and prevention become heavy priorities, GPs are the foot soldiers in the trenches.. Peter Orszag, President Obama's former budget director, opined in a recent essay in Foreign Affairs magazine that a medical workforce packed with generalist docs (and a vastly greater number of highly talented nursing and allied pros to extend their capacity) is a nearly magical key to slowing the explosive growth of Medicare, Medicaid and private insurance outlays.
Clancy's experience as a psychiatrist, Woods says, makes him a very effective negotiator and project manager. This training may benefit us all as he and crew continue to navigate an extreme range of human personalities, relationships and social situations: ¬think north, south, east and west Tulsa, the TU & OU faculties, City Hall, state officials, the Feds, the hospital and health care communities and philanthropic donors.
Another source of effectiveness may be his planned, seemingly compulsive real world exposures: Clancy has spent lots of time in kinetic field situations where he has intimate, direct encounters with patients, working medical peers, community stakeholders and neighborhood folks at the surprisingly numerous OU micro-clinics in Green Country.
His intense dedication to the soon-to-open Wayman Tisdale Specialty Health Clinic in north Tulsa is one result of his on-the-ground connection to all sectors. Indeed, it was former Tulsa Mayor Kathy Taylor who praised both his commitment to transforming local medicine and his steely resolve to clean sweep third-world-like health dynamics in Green Country.
Taylor also said Clancy's tenacious temperament allowed him and a multi-agency team to put together a network of school-based clinics in Tulsa public schools despite intense ideological, practical and institutional reluctance at OU and elsewhere.
A Different Breed.
Interestingly, Clancy decided to name the school project "Bedlam" clinics, a reference to the monster rivalry football game that OU and OSU play. Tulsa social/healthcare planner, Russ Burkhart, said the naming was an attempt to bring OSU (which he said was resisting joining the project) into the effort. It was a gambit that, by some accounts, was a rare defeat--Clancy never got OSU to sign up but was stuck with a name that is also the former moniker for a psychiatric facility in London.
But the humor of the moment is exactly what Tulsa needs to lighten up while we still can, and get moving in a positive direction. Certainly, the city's policy wonks see it that way.
". . . He was the right man, in the right job, for the right time . . . a person with a strong personality and powerful ideas," says Jan Figart associate director of the Community Service Council (CSC) of Tulsa. She is a deeply experienced nursing professional, a social researcher and a deft project developer. She is also a legendary advocate for a whole raft of childcare, imaginative healthcare, and infant and mother support projects in Tulsa.
She went on to describe him as an exceedingly persistent, hyper-focused person who rarely takes no for an answer. Figart said her experience with Clancy in the course of putting together the Bedlam clinics in Tulsa schools as a project with unending roadblocks. Clancy's leadership helped the team systematically navigate around the barriers -- often to the surprise of programmers who had attempted similar efforts over the course of the last decade.
Right Place At The Right Time
Clancy has a reputation as a visionary--he is ramrodding the creation, or actually an outsized expansion, of the OU School of Community Medicine (OUSCM).
OUSCM in its expanded rendition (imagine the class of 2014 already hard at it) is designed to give med students an unusually broad spectrum of public health, biomedical and social dynamic exposures--what Scientific American last month called, "a convergent science" experience. To wit, a deeply integrated learning path that will tie classic anatomy, biochemistry and life science coverage together with extraordinary exposure to field diagnostics, computing, social psychology, nutrition and food economics, preventive/behavioral medicine, team building and applied statistics.
The OUSCM course work is also designed to impart deep practical agility including an emphasis on routinely garnering insight into the everyday conditions of patients, the difficulties they face in keeping healthy and complying with medical advice, their eating and exercise habits, and the character of the communities they live in.
Clancy's OUSCM super project is being launched in a time when medicine ritually rewards hyper-specialization and does little in the way of compensating medical practitioners with great diagnostic skills or the generalist outlook of an effective family, internal or general medicine practitioner.
The expanded OUSCM School is actually a joint venture between the University of Oklahoma and the University of Tulsa. TU will provide faculty and programs in economics, bioengineering, info systems, and social/behavioral science and in management and team dynamics. When it opens, OUSCM will add 60 to 70 additional slots to the existing 162 student openings at the reshaped school.
OUSCM will employ the current OU medical campus at the Schusterman Center on 41st and Yale plus laboratories and other facilities at the old TU engineering campus on North Lewis. The graduates of the new doc factory will be highly attuned to the chronic maladies that bedevil hundreds of thousands of adults and children in Oklahoma. Obesity, smoking, cardiovascular disease and poor nutrition truncate lives, degrade the quality of life for vast numbers of Oklahomans and create countless employment problems, excessive healthcare outlays and tough outpatient challenges.
Redefining Med School: How Different?
What is community medicine -- the flagship notion at the center of Clancy's vision? Some experienced wonks think it is an improbable conflation of orthodox medicine, aggressive public health, a kinetic kind of social service, applied social analysis and an unholy alliance with wild hybrid fields like bioinformatics and what IBMer's call "service science".
CSC's Jan Figart supplemented this definition with what she calls a focus on the whole person, his immediate environment, and "lived" social and economic circumstances.
Taylor says it's a healthcare model that deals with humans and their actual lives and not organs, diseases and abstract treatments.
Since Clancy and his posse want to spend hundreds of millions of state, federal and private charitable dollars on community medicine in Green Country--and will be betting the farm on getting it right--it's best to get a tight handle on it.
Fundamentally, it's having doctors, physician assistants, nurses and what John Silva, CEO of Morton Comprehensive Health Services, calls "lay navigators", seamlessly guide patients through the maze of insurance rules, qualifying requirements, and evidence-laden notions of what needs to happen for themselves, for their children, their aging parents and sometimes for their entire neighborhood.
It's about imbuing nurses, field operatives and docs with the confidence and the enormous tenacity needed to routinely push rigorous exercise, dramatically altered diets and convulsive behavioral change into the daily mix of care that patients receive.
This is the catalytic stuff, that informed analysts say is at the core of the preventive care revolution that should reshape every facet of American medicine -- not just for poor folk and elderly people -- but for all the rest of the lazy, indiscipline butts among us.
It's about equipping physicians and allied professionals with a knack for routinely employing computer models, environmental sensors and digital maps that would show, for example, the red hot nexus between asthma and respiratory dysfunction among children, their schools and homes, refineries, factories, fuel depots, truck routes and other aerosol sources that have a marked effect on the health of children and our elderly.
It's about giving healthcare professionals the mental tools needed to work with architectural/design professionals who can design/build supported living spaces and homes, and "intelligent" special lofts and townhouses that give frail people and elderly folks the capacity to live semiautonomous lives -- lives that don't require radical dependency on adult children and don't require signing up for nursing homes.
For Care's Sake.
"Com med" is also about rethinking perverse incentives and overlong prep practices at the core of U.S. doctor prep. The new OUSCM doc school and its graduates will be the beneficiaries of a couple of other initiatives that Clancy and others here in Tulsa are pushing very aggressively.
One of them entails continued aggressive use of a special fund created by the George Kaiser foundation to defer the medical school debts of OUSCM graduates who agree to serve as general practice or family medical practitioners in area hospitals and clinics with substantial numbers of modest income patients.
Huge school debt is not only a crushing burden for new medical school graduates but also a powerful choice driver--big debt inclines new medical school graduates toward highly paid specialty fields that are plainly inconsistent with the general medical doctor volumes so badly needed in Oklahoma and much of the country.
The rural gene was deposited by Clancy's Irish-born father who, as a young lad of 16, was selected for a special accelerated medical school program: allowing the elder Clancy to become a practicing medical professional at the age 22--think of a slightly older Doogie Houser M.D. His dad's medical education is something that Clancy has talked about on more than one occasion and it is a partial model, he believes for a regimen that will deliver high-quality docs in as little as five years while also reducing their debt load substantially--something that might drive up family, internal and general practitioner counts.
Clancy is a persuasive advocate for diversity -- social, cultural, racial diversity in Green County -- something he emphasizes in many of his speeches as Metro Chamber chief.
He has talked repeatedly about the singular importance of diversity as a competitive strategy for Tulsa, but it turns out that Clancy has actually done more than talk.
Tulsa lawyer/publisher Jim Goodwin's Oklahoma Eagle has written about the sizable minority contractor crewing in the new Tisdale healthcare clinic: 20-25 percent of the workforce on this multifaceted medical specialty clinic in deep north Tulsa is made up of people of color -- a highly unusual share.
Goodwin said that Clancy is "catching on to the job and economic impacts that healthcare projects can have in Tulsa north." And Clancy's tentative plan to make big use of the modest-income-oriented clinics managed by Morton Health for the post grad residency program at the OUSCM doc school is also a lot of "walking".
Having docs who can fly like birds in Tulsa's increasing multihued cultural aviary is key, some observer's say, to securing dramatically better healthcare outcomes in Tulsa.
The Good, the Bad, the Future
Paul Starr's The Social Transformation of American Medicine is a nearly counterfactual look at what might have happened had American doctors not become the big players, the sovereigns in the American system. Imagine, as Starr does, an alternative healthcare system where "super nurses", not docs managed, oversaw and led medicine.
Starr's book won the 1984 Pulitzer Prize and the Bancroft Prize for top-flight history book. It painted a prescient future for healthcare in places like Oklahoma -- ideas that look a lot like Clancy's out-of-the-box notions about doctors, healthcare training and a bevy of radical new working relationships, practices and team concepts--what he and others call "systems of care".
Oklahoma is a state with a terrible helping of some of the worst health metrics in the United States. An Oklahoma State Health Department briefing revealed that Oklahoma is home to the poorest consumers of fruits and vegetables in the U.S.
Data shows Oklahoma is often No.1 in all of the bad stuff or No.50 in all of the stuff that experts consider "good" from a health standpoint. The Lewin report, a local influential examination of healthcare in metro Tulsa and a project fostered by Gerard Clancy, almost screams about another terrible reality for Oklahoma: we have very few doctors and very few nurses. We have the lowest number of docs per person in America.
Clancy and company have attacked these challenges in what some policy wonks say is an inventive, cost conscious fashion--producing a bunch of high quality physician assistants via a joint venture with TU--and proposing to shorten the prep time for doctors. They are also pushing for an outsized cadre of general practice docs that hark back to the home visit docs of years past.
Clancy, his crew at OUSCM, and a surprisingly well-aligned group of leaders from the state and local public health departments, Morton clinics, Tulsa's health service and social project development community and some of Tulsa's hospitals are on board for this huge transformation.
Same Ol', Same Ol' Ain't Gonna Do It
American medical practice is undergoing convulsive change. An epochal reweaving has taken place over the course of the last 10 years, authoritative observers say.
Stanford economist Alain Enthoven, a healthcare systems maven writing in the Wall Street Journal earlier this summer conveys the situation: " . . . Health care in America is extremely wasteful. A 2005 report by the National Academy of Engineering and the Institute of Medicine found that 30-40 cents of every dollar spent on health care are spent on costs associated with "overuse, underuse, misuse, duplication, system failures, unnecessary repetition, poor communication, and inefficiency. Medicare is especially vulnerable to waste, fraud and abuse."
Healthcare is at the center of how effectively the society functions -- sick workers, poorly managed healthcare systems, and monster costs hobble the competitive character of American firms.
Steven Rattner, who was President Obama's "car czar" writes exhaustively about the challenges in his recent book Overhaul. Rattner claims that the corrosive impact of excessive healthcare costs and predatory insurance systems nearly destroyed the American automotive industry. A significant part of the restructuring of Chrysler and GM, he writes, centered on reducing healthcare costs via a combination of new healthcare management practices, a preventive care effort and union concessions. We have similar problems in Oklahoma if recent Metro Chamber reports of big firm healthcare outlays are any indication.
Clancy and his allies in Tulsa are a fascinating fusion of technocratic reformers and throwback docs who believe that generalist and family practitioners should be at the top of the hierarchy. And they appear to be part of a new wave who believe medicine is a calling and not simply one of the most highly compensated professions in American society.
Clancy and crew essentially see American healthcare as magical, but decidedly inefficient. Incredibly, the absence of effective, computer-based medical record-keeping is at the living heart of America's problem and is a big part of Tulsa's challenge as well.
Excitingly, our town is a platform for one of a dozen frontier electronic medical records projects in the U.S. selected by the Feds almost two years ago. The effort, called "the Beacon project", seeks to reduce admin errors which produce a huge waste of dollars and human talent --errors entailed in everyday medical appointments, duplicate testing, unproven procedures and therapies, and errant drug prescriptions.
Tulsa's winning submission is headed up by Dr. David Kendrick of OU, an advocate for using frontier, data centric approaches to drive healthcare and medical practice.
Prior to his OU position, Kendrick worked at Archimedes, a bi-coastal health systems mathematics firm -- a compelling example of the sort of venture that might spring from what could be a biomedical big bang in Tulsa.
Clancy and OU president David Boren recruited Kendrick, according to Taylor.
"Clancy has got this incredibly strong inner compass," Taylor said. "He knows a lot about putting projects into play and has great diplomatic and persuasive skills. The Beacon effort, that we helped shepherd, is a really important example."
The T-town version of Beacon, called "MyHealth Access Network", is a giant demonstration effort designed to get a functioning digital records system up and running in the metro area. With $12 million in funding and active support from Tulsa's private healthcare community, the project hopes to use digital strategies to push down the 30 to 35 percent error rate associated with everything from writing prescriptions to instructions for outpatient procedures to details guiding intricate surgical, radiation and chemotherapy regimens for eradicating cancer.
Tulsa is also primed to be a party, if we continue on our current reform trajectory, for a host of federal trial projects that could dramatically alter fee-for-service medical payments----a system wide, epic cost booster that Stanford economist Alain Enthoven and others, say is a key toxin at the heart of the explosive growth of medical costs in the U.S. As it happens, Clancy and company is already exploring some of the crucial organizational innovations that may be essential to changing these long standing fee practices.
RX For Grand Health & Accelerated Growth?
Tulsa is undergoing a historic wave of healthcare innovation, medical workforce refashioning and a vast rethink of how preventive medicine, and healthcare team re-imagining might produce a dramatically healthier Tulsa. And in the bargain we might score a lucrative leadership spot for Green Country in biomedicine, next generation healthcare/allied workforce training and up stream "industries" like personal therapeutics and bioinformatics.
All this is happening, ironically, in a red state seemingly determined to reject Obama's health care legislation--the genesis, together will an intellectual revolution in healthcare and medical practice, for much of the movement here.
Gerard Clancy is not responsible for all the accelerated healthcare/medical kinetics in T-town but, just now, he seems to be playing the same ecology-altering, game-changing role that Apple's Steve Job has played in the computing/consumer device and entertainment realms.
The City's movers and shakers, some of the more thoughtful policy drivers in T-town, and our powerful foundation community have hand-picked a great team leader--the "Clancy project" will help us to seize the moment----and take us toward a big part of what we might call the "Next Tulsa".
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