Dr. Greg Maynard: Two New Leadership Roles in Hospital Quality Improvement

Directing QI Initiatives for UC San Diego and the Society of Hospital Medicine

Dr. Greg Maynard Accepting new leadership positions in hospital quality improvement with UC San Diego and the Society of Hospital Medicine (SHM), Dr. Greg Maynard has stepped down as Hospital Medicine division chief effective July 1.

He will direct the UC San Diego Center for Innovation and Improvement Science (CIIS) and serve as Senior Vice President of the Society of Hospital Medicine’s new Center for Healthcare Improvement and Innovation (CHII).  |  Read the SHM press release >

“I’m excited about the opportunities for collaboration, improvement, and innovation afforded by each of these positions, as well as the potential synergy between them,” said Maynard.

A member of the UC San Diego Department of Medicine faculty since 2003, Maynard was the founding chief of the Division of Hospital Medicine when it was established in 2005.

“As division chief, Greg Maynard has developed one of the most respected and effective hospitalist programs in the country,” said Department of Medicine Interim Chair Wolfgang H. Dillmann, MD.

“I have no doubt that UC San Diego Health System and the Society of Hospital Medicine will make important advances in hospital quality and patient safety through his leadership.”

DrGregSeymannLongtime UC San Diego hospitalist Gregory B. Seymann, MD, SFHM, Health Sciences Clinical Professor, is the new Hospital Medicine division chief. For the past year, he has served as associate division chief with Dr. Bryan Huang.

“The Division of Hospital Medicine has benefited greatly from Dr. Maynard’s leadership.” Seymann said. “I will work hard during this transition to maintain the excellent patient care, teaching, and systems improvement efforts that our division has championed.”

Dr. Bryan Huang

Health Sciences Assistant Clinical Professor Bryan Huang, MD, will continue in his role as associate division chief.

Maynard will carry out his SHM duties largely from San Diego, with periodic visits to SHM headquarters in Philadelphia.

With a part-time appointment in Hospital Medicine, he will continue to be involved in the division’s clinical, teaching, and quality improvement activities.

He will also continue as chair of the UC San Diego Health System Patient Safety Committee.

Leading The Center in the Society of Hospital Medicine

The Society of Hospital Medicine (SHM) is the primary professional medical society for hospitalists. Its Center for Healthcare Improvement and Innovation, known as The Center, is a new division that gathers all quality improvement initiatives under Maynard’s direction.   |   Read the SHM press release >

Maynard has played influential roles in developing these initiatives. He has served as a leader in SHM collaboratives on venous thromboembolism (VTE) prevention, glycemic control, and transitions of care for older adults in the hospital.

A founder of the SHM’s Mentored Implementation Program, he has guided numerous hospital medicine programs through quality improvement processes that mirror what he and his colleagues have done at UC San Diego.

Now, as Senior Vice President of The Center, Maynard will oversee all QI initiatives and assist the SHM in designing its strategies for supporting and expanding its healthcare quality improvement efforts.

The Center provides a suite of QI tools and resources for hospitalists. Online collaboration programs offer expert guidance in VTE prevention, glycemic control, and transitions of care.

Through The Center, hospitalists can obtain mentored implementation programs, communicate with other QI program directors via a collaborative network, and access an online QI data repository.

The Agency for Healthcare Research and Quality recently recognized The Center as a Patient Safety Organization, which makes it possible for medical centers to submit protected health information to the SHM for analysis of patient safety events without violating HIPAA guidelines.

Leading the UC San Diego Center for Innovation and Improvement Science

UC San Diego Medical Center in Hillcrest The Center for Innovation and Improvement Science is a new entity that conducts quality improvement efforts in collaboration with UC San Diego Health System management, the Performance Improvement and Patient Safety Office, the Clinical and Translational Research Institute, and the Division of Biomedical Informatics.

As director of the CIIS, Maynard is leading UC San Diego’s efforts to address local and regional quality improvement goals:

  • Accelerating inpatient quality and safety initiatives and developing tools to assess their progress
  • Fostering QI skills in UC San Diego personnel and their collaborators and disseminating their successful QI tools through mentorship, consultation, and publication
  • Reviewing new technologies and fostering new research programs

One of the specific goals of the CIIS is to help other local and regional medical centers improve their quality of care, particularly in VTE prevention, glycemic control, anticoagulation management, and transitions of care.

Another goal is to disseminate UC San Diego’s findings and achievements, establishing UC San Diego more firmly as an innovative center and a leader in hospital quality and patient safety.

About Dr. Maynard

Dr. Greg MaynardGregory A. Maynard, MD, MSc, SFHM, Health Sciences Clinical Professor, has led the development of patient safety and hospital quality improvement protocols that have gone on to widespread implementation through the Society of Hospital Medicine, the Agency for Healthcare Research and Quality, the Institute for Healthcare Improvement, and the American Society of Health-System Pharmacists.

For their work in venous thromboembolism (VTE) prevention, Maynard and his colleagues received the SHM Team Approaches in Quality Improvement Award in 2008 and the Venous Disease Coalition’s Venous Research Award for Quality Improvement and Implementation of Best Practices in 2009.

Maynard received his MD degree at the University of Illinois and completed his residency and chief residency in Internal Medicine at Good Samaritan Regional Medical Center in Phoenix, Arizona.

Thereafter, he directed the Good Samaritan Hospital Medicine program and served as Senior Associate Director of the Internal Medicine Residency Program.

He earned his MSc in Clinical Research Design and Biostatistics from the University of Michigan in 1993.

Since Maynard came to UC San Diego in 2003, the Hospital Medicine program has expanded from 4 faculty members covering Thornton Hospital to 30 faculty hospitalists covering both Thornton Hospital and the UC San Diego Medical Center in Hillcrest.

Maynard has served as chair of the Inpatient Glycemic Control Committee, the Patient Discharge Process Improvement /Transitions of Care Committee, and the Patient Safety Committee. He has been leader of the VTE Management Task Force and co-leader of the Inpatient Osteoporosis Identification and Management Task Force.

The American College of Physicians named Maynard a Top Hospitalist in the United States in November 2008. This year, he received the UC San Diego School of Medicine’s Leadership and Innovation in Patient-Centered Systems Award.

About Dr. Seymann

Dr. Greg SeymannGregory B. Seymann, MD, SFHM, received his MD degree from UCLA in 1994 and completed his residency training in internal medicine at UC San Diego in 1997. Upon his graduation, he joined the UC San Diego Department of Medicine faculty as an assistant professor.

Seymann helped to found the original group of hospitalists at UC San Diego in 1998.

Seymann’s clinical and research interests are in community-acquired and healthcare-associated pneumonia, performance measurement for hospitals and physicians, systems-based quality improvement, and perioperative consult medicine.

In 2008, the San Diego County Medical Society and San Diego Magazine named Seymann to the “San Diego’s Top Doctors” list. In the same year, graduating housestaff honored him with their annual teaching award.

This year, he received the Medicine 401 Excellence in Teaching Award.

In the Society of Hospital Medicine, Seymann chairs the Academic Practice and Promotions Task Force and is a member of the Academic Hospitalist Committee, the Performance and Standards Committee, and the Ethics QI Research Subcommittee.

He is a member of the UC San Diego Patient Safety Committee. In the Department of Medicine, he is a member of the Committee on Advancement and Promotions, the Peer Review Committee, and the Executive Committee. He chairs the Division of Hospital Medicine Peer Review Committee.

Seymann is a member of the UC San Diego ORYX Core Measures Team for Community Acquired Pneumonia. ORYX is an initiative of the Joint Commission for Accreditation of Healthcare Organizations.

About Dr. Huang

Dr. Bryan HuangBryan Huang, MD, Health Sciences Assistant Clinical Professor, received his MD degree from UC San Francisco. He has been a member of the Hospital Medicine faculty since his graduation from internal medicine residency training at Stanford University in 2006.

Huang has special interest in the areas of prevention and management of delirium, prevention of falls, transitions of care, VTE prevention, and treatment of pneumonia.

He has completed additional training in quality improvement through the mini-advanced training program offered by Intermountain Healthcare in Salt Lake City, as well as the SHM Leadership Academy.

He served as the Thornton site director for the Core Clerkship in Internal Medicine in the School of Medicine until this June, and will continue to serve on the Medicine 401 course committee.

Huang served on the SHM Early Career Hospitalists committee from 2007 to 2010.

Together with Dr. Greg Seymann, he has served as associate division chief of Hospital Medicine for the past year. His responsibilities have included workflow redesign, scheduling, budgeting, recruitment, and working with the Internal Medicine Residency Program.

Appreciation and a Fond Farewell to Dr. Ken Kaushansky

Kenneth Kaushansky, MD, MACPOn July 19, Dr. Ken Kaushansky officially begins his work as Senior Vice President for Health Sciences and Dean of the School of Medicine at Stony Brook University in New York.

When he announced his departure to the faculty and staff of the UCSD Department of Medicine on June 7, he described his new position as an opportunity to implement, on a larger scale, the successful programs that the Department of Medicine has instituted under his leadership here.

He called his years at UCSD a time of “incredible transition in our faculty, our leaders, our teaching programs, and our clinical impact.”

During Dr. Kaushansky’s tenure as Helen M. Ranney Distinguished Professor and Chair, the Department of Medicine expanded from 253 to over 420 faculty members, added four divisions, and recruited 11 division chiefs. Its annual budget grew from $86 million to nearly $150 million.

Dr. Robert Schooley“Dr. Kaushansky has been an outstanding Chair for this department,” said Dr. Robert “Chip” Schooley, Professor and Chief of the Division of Infectious Diseases and Vice Chair for Academic Affairs in the Department of Medicine.“

During his eight years as Chair, the medical house staff program became one of the most highly regarded programs in the country. New divisions in Hospital Medicine, Biomedical Informatics, Geriatrics, and Global Public Health were developed and research programs thrived throughout the Department,” Dr. Schooley said.

“In response to increasing interest in international medicine among the medical house staff, Dr. Kaushansky launched the Department’s Global Medicine Residency Program in 2009,” he said.“Dr. Kaushansky worked with his counterpart at the Universidade Eduardo Mondlane to establish a model program in international cooperation that has revitalized postgraduate medical training in the Republic of Mozambique.”

Dr. Kaushansky with Drs. Marisa Magaña, Emilia Noormahomed, and Robert Schooley in Mozambique Dr. Kaushansky on a global medicine planning trip to China.Dr. Kaushansky with Drs. Marisa Magaña, Emilia Noormahomed, and Robert Schooley in Mozambique (left); on global medicine program planning trip to China (right).

Since 2002, the Department’s NIH research funding has grown from $60 million to $113.6 million. It has more than twice as many complex multi-investigator program-project grants and career development awards granted to the junior faculty and fellows.

The Department has also boosted its showing in the “America’s Best Hospitals” rankings from U.S.News & World Report. In 2002, two subspecialty clinical programs ranked in the nation’s top 50: respiratory at 9th and cancer at 41st. In the most recent rankings, five subspecialties ranked in the top 50, including one (HIV/AIDS) in the top 10.

Dr. Greg Maynard“Ken was directly responsible for building up the strength of clinical care at UCSD,” said Dr. Greg Maynard (right), Health Sciences Professor of Medicine and Chief of the Division of Hospital Medicine.

“He recruited me here about 7-1/2 years ago, and in that time, the Hospital Medicine program has grown from 4 hospitalists to nearly 30, as just one example of that.”

“Dr Kaushansky nurtured my career here at UCSD,” said Dr. Pradipta Ghosh (below left), physician-scientist and Assistant Professor of Medicine in the Division of Gastroenterology.

Dr. Pradipta Ghosh“As a product of the Physician-Scientist Training Program,” she said, “I am one of those few who enjoyed special access to this busy department chair. His doors were always open. I recall having multiple consultations with him at various stages of my career as it grew here at UCSD.

“When the time came for me to choose where to spend the first decade of my young career as an independent investigator, it was his support and a match in our visions which tilted my decision in favor of UCSD,” she said.

“His tireless efforts at instilling the physician-scientist culture here in the Department of Medicine, both from top-down and bottom-up, have paved the path for many young folks like me to craft a career for themselves as physician-scientists,” Dr. Ghosh said.

Dr. John Carethers“Ken was the reason why I eventually accepted the GI Chief job at UCSD,” said Dr. John M. Carethers (right), now John G. Searle Professor and Chair of the Department of Internal Medicine at the University of Michigan.

When Dr. Kaushansky joined the UCSD faculty, Dr. Carethers was an associate professor of medicine in the Division of Gastroenterology. Dr. Carethers became division chief in 2004

“Ken … gave me enough autonomy to help grow the GI Division, gain a GI Center grant, coordinate well with the Cancer Center and other divisions, and allowed me to grow personally,” Dr. Carethers said. “The GI Division flourished under that mantra.

“We went to a clinical service chief structure, developed a new hierarchy for our administrative staff, started a robust web site, grew our fellowship, and survived many challenges over that time because of his support,” he said.

“Ken provided invaluable advice on my career,” Dr. Carethers said. “He was a great sounding board, not pretentious; encouraging, but never overprotective. I think he understood the value of growth and opportunity, something that is hard to come by these days.”

Dr. Patricia FinnDr. Patricia Finn (left), Professor and Chief of the Division of Pulmonary and Critical Care Medicine, described Dr. Kaushansky as “a tireless advocate for his faculty.”

“He is accessible 24/7 to offer support and guidance, which is huge to a new faculty member just moving cross country,” she said.

“On a personal note, when I had barely arrived here he was already nominating me for positions and committees to help me advance my career.”

Dr. Kirk Knowlton“His integrity, fairness, and open-mindedness built an environment of trust that allowed the substantial growth of the Department of Medicine during his tenure as Chair,” said Dr. Kirk U. Knowlton (right), Professor of Medicine and Chief of the Division of Cardiology.

“I am struck by how he has been able to hold the respect of so many people with widely disparate interests,” Dr. Knowlton said.

“This included people who were fully engaged in basic science and those who were busy taking excellent care of their patients; medical students and residents and post-graduate research fellows; administrators and faculty; and others over whom he might have had influence or who crossed his path.

“The people he has worked with knew that they could count on him to represent their interests in the context of the institution’s goals in a considered and reasonable manner while at the same time maintaining his vision of the future of the Department of Medicine.”

“He is a rare breed,” Dr. Maynard said. “I guess I’d call him a quadruple threat. An outstanding scientist, a superb clinician, a great educator, and an incredible leader and administrator to boot.

“While he is not really replaceable,” he said, “he has left an enduring legacy that stresses clinical and operational excellence, as well as research contributions.”

Dr. Finn said, “In addition to [his] world-class scientific reputation, Dr. Kaushansky is most respected for his character and vision.”

“He makes his department and faculty a priority, while striving to always do the right thing for the patients,” she said. “He will be most remembered for his infectious enthusiasm, upbeat attitude, and steady, insightful guidance of students and faculty.”

“He leaves an 8-year legacy that advanced the Department of Medicine in many ways,” said Dr. Carethers, “including growing faculty, changing the way residents learn, obtaining key recruitments for division chiefs and faculty, enhancing VA relations, and being an all out cheerleader for the Department.”

On June 21, Dr. Kaushansky was honored at a farewell reception hosted by David Brenner, M.D., Dean of the UCSD School of Medicine and Vice Chancellor, Health Sciences. In his remarks there, Dr. Kaushansky expressed his appreciation for “eight and a half years of good friends, challenges, and teamwork.”

Observing that he had been involved in recruiting many of the faculty members in the room, he said, “Everything at UCSD works toward recruiting great people.”

“It’s easy, at UCSD, to build things and to make a difference,” he said. “Everybody makes everyone else stronger.”

Dr. Kaushansky praised UCSD’s “incredible richness” of people, science, teaching, and clinical programs. “I’ve never seen more devotion to the three missions,” he said.

And now he looks ahead.

“In academic medicine, you get to re-craft yourself every ten years,” he said. “I’m looking forward to my newly-found steep learning curve.”

Dr. Kaushansky was honored at a tribute from the senior leaders of the Department of Medicine on July 11. There will be a tribute from all departmental staff, faculty, and house staff on a date to be selected.

“Although one could cite metric after metric by which his unceasing efforts strengthened the Department,” said Dr. Schooley, “what many of us think distinguished his tenure most was the way in which his ‘bottom up’ style of leadership brought out the best in all of us.

“The Department will benefit for many years to come from things he set in motion – as will each of its members from what we learned from his multifaceted demonstration of scholarship, integrity, imagination and dedication to his Department.”

Drs. Ken Kaushansky and Wolfgang Dillmann   Drs. Ken Kaushansky and Wolfgang DillmannDr. Kaushansky with newly designated Interim Chair Wolfgang Dillmann, M.D.

In the Media: Dr. Greg Maynard

Dr. Greg Maynard and the UCSD Hospitalist Program are featured in the story, “Prevention Prowess: 3 hospitals recognized for VTE prevention innovations,” in The Hospitalist.

Gregory A. Maynard, MD, MSc, is Health Sciences Professor and Chief of the Division of Hospital Medicine.

Dr. Gregory A. Maynard Is Named a Top Hospitalist in the U.S.

Dr. Greg MaynardDr. Gregory A. Maynard, chief of Hospital Medicine at UCSD, is one of the top 10 U.S. hospitalists in a new ranking from the prestigious American College of Physicians.

The honor was announced in November. It recognizes Dr. Maynard’s outstanding contributions in improving the quality of hospital care and mentoring hospitalists in the U.S. and abroad.

Dr. Maynard has led the UCSD hospitalist team in developing nationally-recognized patient safety and quality improvement programs.

These efforts have advanced two crucial aspects of patient safety in the hospital: venous thromboembolism prevention and glycemic control.

Dr. Maynard is also an active mentor in the developing field of hospital medicine.

He’s advising a number of institutions as they develop hospital medicine programs. Among these is the Pontificia Catholic University of Chile in Santiago, where Dr. Maynard helped conduct the first-ever Chilean hospitalist meeting last November.

Dr. Maynard and the other “Top Hospitalist” honorees are profiled in the November 2008 issue of ACP Hospitalist.  |  Read the article

UCSD’s advances in patient care quality improvement

Gregory A. Maynard, M.D., M.Sc., joined the UCSD faculty in 2003 as head of the new Hospital Medicine division.

Since then, the division has expanded to 23 faculty members and has won national awards for its achievements in hospital care quality improvement.

In 2008, the Society of Hospital Medicine honored Dr. Maynard and the UCSD hospitalists with the Team Improvement Award for their venous thromboembolism prevention program.

The program was developed with funding from the Agency for Healthcare Research and Quality.

Dr. Maynard and his colleagues developed a risk assessment tool that allows healthcare professionals to identify quickly and accurately the most appropriate venous thromboembolism prevention measures for each hospitalized patient.

As a result, the UCSD Medical Center is among the leaders in the U.S. in preventing venous thromboembolism in its inpatients.

At the UCSD Medical Center in Hillcrest alone, the program prevents approximately 50 cases of venous thromboembolism each year.

The tool, now part of the Venous Thromboembolism Resource Room on the Society of Hospital Medicine website, is now in use at medical centers around the nation.

UCSD’s hospitalists also play a major part in the Society of Hospital Medicine’s Inpatient Glycemic Control Task Force, which is headed by Dr. Maynard.

The work of the task force was presented recently in a special supplement issue of the Journal of Hospital Medicine (JHM).

“Most of the work on the SHM website, this supplement, and the SHM QI pre-courses features contributions and lessons learned from the hospitalists at UCSD,” Dr. Maynard said.

The term “hospitalist” was first used in 1996 in a New England Journal of Medicine article that highlighted the importance of inpatient-focused care in healthcare today.  |  Read the article

The role of the hospitalist

In creating the “Top Hospitalists” list, the American College of Physicians is recognizing the increasing importance of the new specialty of hospital medicine.

Hospitalists dedicate themselves to improving the quality of care for hospitalized patients. Their efforts range from creating new disease management protocols to revamping hospital information systems.

According to the Society of Hospital Medicine, there are an estimated 20,000 hospitalists in practice today.

As experienced attending physicians who are continuously available on the wards, hospitalists also play a central role in training students, residents, and fellows.

More Information

Leading Other Centers in Preventing Blood Clots in Hospital Patients

UCSD is setting a national standard for protecting hospital patients from the risk of developing blood clots, thanks to a dedicated effort of the Division of Hospital Medicine.

During any hospital stay, a patient has a significant risk of developing a blood clot in a limb (deep vein thrombosis, or DVT) that may travel to the lung (pulmonary embolism). Pulmonary embolism is considered the leading cause of preventable death in hospitalized patients.

The overall term for this phenomenon is hospital-acquired venous thromboembolism (VTE).

Careful measures can reduce the risk of hospital-acquired VTE substantially. These include activity, support hose, sequential compression devices, and blood-thinning medications such as heparin.

On average, hospitals across the nation are offering adequate blood clot prevention measures to about half of the patients who stay in the hospital.

That was UCSD’s level of performance before the Division of Hospital Medicine started a “Partners in Patient Safety” project funded by the Agency for Healthcare Research and Quality (AHRQ) of the US Department of Health and Human Services.

Now, just two years later, over 95% of UCSD inpatients are receiving adequate clot prevention regimens, setting a new national benchmark. The number of UCSD patients who develop hospital-acquired clots has dropped by about 35%.

Heading the UCSD blood clot prevention project is Dr. Greg Maynard, Chief of the Division of Hospital Medicine and a national leader in the field of patient safety.

The two-year study is titled “Optimal Prevention of Hospital Acquired Venous Thromboembolism” under AHRQ grant 1U18HS015826-01. Its purpose is to find the best ways to prevent hospital-acquired blood clots, and build tool kits that enable others to do the same.

Other major contributors include Dr. Tim Morris, Associate Professor of Clinical Medicine and Director of Pulmonary Clinical Programs at the UCSD Medical Center – Hillcrest) and pharmacists Robert Schoenhaus, Pharm.D., and Douglas Humber, Pharm.D.

Dr. Maynard and his coworkers have developed a VTE prevention protocol, tested it, found it highly successful, and published it for other centers to use.

Under the new protocol, every new or transferred patient is quickly evaluated for his or her risk of developing a blood clot, and the appropriate measures are ordered. Nurses act as another line of defense, and can help identify patients who might otherwise have slipped between the cracks as their bleeding risk or clot risk changed.

Whether the risk is low, average, or high depends on a patient’s age, medical condition, reason for hospitalization, and other factors.

The task called for Dr. Maynard and his colleagues to develop a quick, accurate, reliable way for nurses or other medical staff to screen each patient for blood clot risk. He said existing methods were discarded because they failed to be useful in actual practice.

“We needed a reliable tool that we could apply to any patient of any description in 10 seconds or less,” he said.

The tool kit is now housed at the Society of Hospital Medicine (SHM) website, where it is the centerpiece of a SHM VTE Prevention Collaborative involving 30 medical centers from all over the country.

About the VTE Prevention Collaborative, Dr. Maynard says, “We’re using tools, largely developed here, to help guide other medical centers through the process. We’re mentoring other hospitalists to be leaders in hospital improvement in general, not only as pertains to VTE.”

As part of the Collaborative, Dr. Maynard is one of two mentors who work with hospitalists around the country. By telephone and email, he advises hospitalists at about a dozen centers who download and use the patient care protocols he has helped to develop.

He sees this as part of the mission of hospital medicine. “We identify the best practices and try to build them into a protocol on the front line of use so that every patient is exposed to that treatment practice,” he says. “And we enable others beyond our local environment to do the same thing.”

Dr. Maynard has been a major figure in national efforts to improve the quality of inpatient care for many years. He is a leading member of the Society of Hospital Medicine, and has also worked nationally on inpatient management of diabetes and other common inpatient problems.

At UCSD, where he has headed the Division of Hospital Medicine since 2003, Dr. Maynard is Chairman of the Patient Safety Committee.

The UCSD Division of Hospital Medicine focuses on the special issues that affect the health and care of patients who are hospitalized at UCSD. Its mission is to improve the quality and safety of inpatient care.