Foresight Engine

Critical Imagination in response to:

What urgent challenges will UCSF face in 2025?

UCSFâ€™s reputation still recovering from 36 hr period in 2013 when patient care stopped while clinicians played a game

played over 6 years ago by Alex Smith

Critical Imagination in response to:

What urgent challenges will UCSF face in 2025?

By investing in basic sciences far more than social determinants of disease, UCSF falls behind other leading schools.

played over 6 years ago by Alex Smith

Momentum in response to:

UCSF's rep will soar from the 36hr period in 2013 when patient care was supplemented with real-time patient survey by docs playing a game.

:) Fair enough! Let's hope that's the case. #teamaging

played over 6 years ago by Alex Smith

Investigation in response to:

...at the same time, we cannot let care for the aged drain resources from children.

FASCINATING issue - what is a just distribution of health care resources? Divide equally over life-course or to most in need? #teamaging

played over 6 years ago by Alex Smith

Momentum in response to:

Should the focus be on social determinants of health?

The promise of genomic medicine has not materialized. proven interventions exist for social determinants, but are not funded!

played over 6 years ago by Alex Smith

Momentum in response to:

I think they should have called this an exercise instead of a game.

Yes, might have better "optics" than a game. Maybe in the press release should be called an exercise.

played over 6 years ago by Alex Smith

Momentum in response to:

No institution can lead in health care in the 21st century without dealing with the aging population -- highest HC utilizers #TeamAging

UCSF invests heavily in aging, including education, research, and clinical care. #teamaging

played over 6 years ago by Alex Smith

Critical Imagination in response to:

What urgent challenges will UCSF face in 2025?

Explosive growth in China Basin leads to balkanization of UCSF, as staff/faculty stop interacting across sites.

played over 6 years ago by Alex Smith

Investigation in response to:

No institution can lead in health care in the 21st century without dealing with the aging population -- highest HC utilizers #TeamAging

Are the elderly "entitled" to health care as part of a social contract? Or distribute resources equally across lifespan?

played over 6 years ago by Alex Smith

Adaptation in response to:

No institution can lead in health care in the 21st century without dealing with the aging population -- highest HC utilizers #TeamAging

Current grade of transitions from hospital to nursing homes: F. Lot's of room for UCSF to lead! #teamaging

A game runner marked this card Super Interesting.

played over 6 years ago by Alex Smith

Positive Imagination in response to:

How can UCSF lead the way in 2025?

In 2025, UCSF defeats Stanford in football! #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

Anyone know what the current amount of time UCSF students spend in nursing homes? 0%?

Pathetic! How can we develop enthusiasm for working in nursing homes?

played over 6 years ago by Alex Smith

Adaptation in response to:

Anyone know what the current amount of time UCSF students spend in nursing homes? 0%?

Requirements will be one piece, but not enough. Need to generate interest. #teamaging.

played over 6 years ago by Alex Smith

Adaptation in response to:

No institution can lead in health care in the 21st century without dealing with the aging population -- highest HC utilizers #TeamAging

Leading the way with an academic nursing home training site is a terrific idea Lynn. Lots of good sites in SF - VA, Laguna Honda, #teamaging

played over 6 years ago by Alex Smith

Investigation in response to:

Provide equal patient access to all disciplines for practice, education and research.

Not sure what access means - can you clarify?

played over 6 years ago by Alex Smith

Adaptation in response to:

UCSF offers greater work flexibility for researchers and clinicians who aren't able to work traditional hours #cpc

Great idea - but from a practical perspective, how would oversight work? #teamaging

played over 6 years ago by Alex Smith

Investigation in response to:

In 2025, UCSF can generate its own power supply.

What would supply the power? #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

Revolutionize nursing education to train them to provide high quality advanced primary care & give them more power to make health decisions

LIke this idea- but wresting the power from physicians would require a cultural shift among docs. How to make that happen? #teamaging

played over 6 years ago by Alex Smith

Investigation in response to:

Collaborate with other UC health science campuses/ORUs instead of working in isolation, and duplicating efforts. #Team/squirrel

What is an ORU? #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

Imprinting "high touch" techniques into patient care provisions will need to be incorporated into tech solutions.

Can you give an example of a high touch/high tech intervention? #teamaging

played over 6 years ago by Alex Smith

Antagonism in response to:

More on line courses open to the world. Charge fees for credits if credits are needed. Ucsf certifies on line course content in health area

But recent MOOC test scores were pathetic - how to overcome those challenges? #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

Please don't say telemedicine for frail elders! Re brand nursing homes for one thing. Cradle to Grave rotations?

Like "crade to grave"! Telemedicine has it's place, but more frustrating than fruitful from my perspective. #teamaging

played over 6 years ago by Alex Smith

Antagonism in response to:

LIke this idea- but wresting the power from physicians would require a cultural shift among docs. How to make that happen? #teamaging

Not sure about that - I think primary care docs aren't comfortable with ceding power to NPs, PAs, CNSs. #teamaging.

played over 6 years ago by Alex Smith

Adaptation in response to:

LIke this idea- but wresting the power from physicians would require a cultural shift among docs. How to make that happen? #teamaging

Although agree that culture change is most likely if public leads the way.

played over 6 years ago by Alex Smith

Adaptation in response to:

Totally agree! We need to invest as much in our people as in bricks and mortar. #TeamAging

Agree - but should we divert resources for building buildings to pay for salaries?

played over 6 years ago by Alex Smith

Adaptation in response to:

BOTH buildings and people are important investments, but current model is too skewed toward fundraising for buildings. #teamaging

We need to create more excitement about legacy or philanthropic work investing in people. Need creative thinking - more than named chair.

played over 6 years ago by Alex Smith

Adaptation in response to:

Named departments seem to work in some places - Herzberg center (MSSM), etc. But agree area ripe for innovative thinking. #teamaging

We need to figure out how Standford raised so much in 1 year. #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

Present an outstanding model of moral courage when communicating with the aging about their health care choices and end of life wishes.

Agree Denise - but what is moral courage? And how do we overcome real world obstacles, like the "death panels" fear-mongering? #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

& Boomers want preventative, anticipatory, foresighted care themselves - not reactionary care they often see for their parents. #teamaging

Interesting idea - that boomers may have insights previous generations lacked, because they are caregivers more so than previous generation

played over 6 years ago by Alex Smith

Adaptation in response to:

Previous generations did not live to be as old, and women now far outlive spouses, relying on children (boomers) for care

Perhaps we should make a health center directed toward the boomer generation? As both patients AND caregivers? #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

UCSF needs to provide affordable elder care for faculty and staff familes along with child care. - #TeamCLS #family #wellness

Child care is a major issue already; to my knowledge UCSF hasn't even approached the issue of elder care. opportunity to lead! #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

Bring all the expertise together to collaborate Big Tent style.

Perhaps we should have a UCSF-wide conference about how we will prepare for this century of aging? #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

Maybe the Program for the Aging Century at UCSF can sponsor such a conference. Needs buy-in from UCSF leadership. #teamaging

First step is identifying funders for a conference, call it UCSF2025 and the Aging Century, and key stake holders.

played over 6 years ago by Alex Smith

Antagonism in response to:

Agree, and inclusive of bench to bedside, academics to industry. #teamaging

Have ethical concerns still about ties between industry and academics though. Lot's of potential for undue influence. #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

True- though one does wonder if there is a "cost" to playing this game. Perhaps not in terms of patient care, but grants, papers...

Could be a cost in terms of patient care - bleary eyed physicians stumbling in tomorrow - time for me to go to bed! #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

major problem with most datasets that they don't include #golasofcare essential for care of #aging #teamaging

Agree - need a new international dataset of older adults that includes patient preferences/values. #teamaging

played over 6 years ago by Alex Smith

Momentum in response to:

can we use standardized instruments accessible internationally as a starting point? #global #teamaging

This is actually a terrific idea. If UCSF led an effort to create an international dataset of older adults by 2025 we would lead the world.

played over 6 years ago by Alex Smith

Momentum in response to:

Another major issue is funding. It's hard to find funding for international projects. #teamaging

National Institutes of Health actually funds most of the international research conducted by American scientists. #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

UCSF faculty and researchers on campus can come together to make this work #teamaging

Major issue is at UCSF the centers of aging are "balkanized." #teamaging

played over 6 years ago by Alex Smith

Investigation in response to:

Major issue - how do we create common infrastructure or umbrella for all centers of aging across UCSF? #teamaging

You mean including Division of Geriatrics, IOA, CADC, SFVAMC centers? #teamaging

played over 6 years ago by Alex Smith

Momentum in response to:

Needs to have some financial incentive for collaboration across sites/divisions. #teamaging

Agree, has to be a win-win across sites. #teamaging

played over 6 years ago by Alex Smith

Investigation in response to:

Yes, need to have academic-community partnerships #teamaging

Can you name some successful models of academic community partnerships in aging? #teamaging

played over 6 years ago by Alex Smith

Momentum in response to:

Could have interprofessional learning with pharmacy, medical, dental students - in nursing homes! And the geriatric hospital we proposed!

Also home-based services, like palliative care, house calls, and home based primary (as at the SFVAMC). Good examples. #teamaging

played over 6 years ago by Alex Smith

Momentum in response to:

Also home-based services, like palliative care, house calls, and home based primary (as at the SFVAMC). Good examples. #teamaging

(from Nieta at VA - VA computers keep kicking people off) "SF VAMC geriatrics is a model for geriatrics around the #globe." #teamaging

played over 6 years ago by Alex Smith

Antagonism in response to:

Could have interprofessional learning with pharmacy, medical, dental students - in nursing homes! And the geriatric hospital we proposed!

Although, I thought the data on successful interprofessinoal learning was not so rosy. #teamaging

played over 6 years ago by Alex Smith

Antagonism in response to:

Data on teams outside healthcare industry is over 30 years old and strong! #teamaging

Not sure if data from outside healthcare industry is directly translatable to the healthcare setting. #teamaging

played over 6 years ago by Alex Smith

Momentum in response to:

Students graduate competent in established domains of interprofessional practice to collaborate effectively across care settings #teamaging

Agree - but do the TRAIN/LEARN together? Or do they train separately, then learn to practice together? #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

to be truely interdisciplinary training together is key! #interprofessional #teamaging #education

Agree - but not clear if the evidence is there for the training piece. #teamaging

played over 6 years ago by Alex Smith

Momentum in response to:

Studies show learners enter health professions w/ status notions re self/others - how do we best address this to aid learning? #TeamAging

Fascinating - so right off the bat the docs feel superior to nurses and pharmacists? How to break down heirarchies to make effective teams.

played over 6 years ago by Alex Smith

Momentum in response to:

We bring all together on day one to explore these notions and continue to reflect on this throughout the curriculum#teamaging

Makes sense - meet these preconceived notions head on. But still, docs are taught to LEAD the team, reinforcing hierarchies. #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

all-inclusive care of the elderly a great model of care for patient experience across care continnum #teamaging #palliative #geriatrics

PACE is a great model, but it takes a certain type of patient. I've talked to PCPs who say their patients refuse to go. #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

Why don't they go? #teamaging

Patients with robust social support tend not to go. We found this in our study of On Lok - hard to locate caregivers for On Lok patients.

played over 6 years ago by Alex Smith

Adaptation in response to:

Interesting - PACE has such a unique history and funding stream - special carve out from CMS - not clear how to disseminate.

Much of Medicaid is state level - perhaps work with California gov to create PACE models for nursing home eligible elders - save the state $

played over 6 years ago by Alex Smith

Momentum in response to:

Interesting idea - bring the QI experts into Geri clinics and have them collaborate in real time to improve care. What does "better" mean?

Better means better value - better quality care at lower costs.

played over 6 years ago by Alex Smith

Adaptation in response to:

I think that's the SGIM mantra - Creating Value for Patients #teamaging

What is the role for the generalist physician in improving care for the elderly? #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

What is the role for the generalist physician in improving care for the elderly? #teamaging

Generalist physicians are making a small comeback, but still have difficulty articulating their mission. #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

If FCM cares for all patients & internists for all adults, this is essential. Needs to be much greater part of training. #TeamAging

General Internal Medicine at UCSF been the nation's leader for years. Maybe new role for leadership in care of aging. #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

How do we ensure geriatrics training for all? Median days of required instruction in geriatrics = 20 days for internal medicine #TeamAging

Need carrot and stick - require 1/3 training days in geriatrics; pay higher salaries for SNFists, ACE attendings, etc. #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

could it be used to teach geri to practicing physicians and not just fellows - nationwide call-in CPC style discussion, earn CME #teamaging

What about palliative care - another major area of expertise at UCSF. #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

could it be used to teach geri to practicing physicians and not just fellows - nationwide call-in CPC style discussion, earn CME #teamaging

For last 40 minutes, let's focus on the push your thinking theme. #teamaging

played over 6 years ago by Alex Smith

Momentum in response to:

care where you work, live, play #teamaging

Amazing advances in longevity are balanced by realization that people are living longer with chronic diseases and disability. #teamaging

played over 6 years ago by Alex Smith

Momentum in response to:

Despite amazing progress with virtual visits, patients rebel and demand high touch care that can only be delivered in person. #teamaging

The undergraduate medical education shifts away from a focus on biological sciences a more liberal arts approach. #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

2025 Larry Page Foundation created - 50/50 split between high touch and high tech care. #Teamaging

Major philanthropic support - as donors realize they must invest not just in technology, but people. #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

UCSF2050 - UCSF becomes first school to have satellite campus in space. #teamaging

UCSF2100 - Death is finally accepted as an inevitable - and even necessary - part of the human condition. #teamaging

played over 6 years ago by Alex Smith

Adaptation in response to:

UCSF2200 - Harvard finally accepts satellite UCSF campus status. #teamaging

UCSF2300 - UCSF Chancellor SDH IV creates first interspecies school for health professions. #teamaging

played over 6 years ago by Alex Smith

Played

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