UCSF Sustainability Stories

Deborah Fleischer, Green Impact, November 2012

A Conversation with Dr. Niraj Sehgal

SeghalGail Lee, UCSF Sustainability Manager and I had the opportunity to have a conversation with Dr. Niraj Sehgal, MD, MPH, Associate Professor of Medicine and Associate Chair for Quality and Safety, Department of Medicine. The Department of Medicine at UCSF is the largest department in the School of Medicine, with nearly 600 faculty and more than 300 trainees and provides clinical services at medical centers across multiple campuses.

A New Focus:  Quality and Safety

If you look at most academic departments, they focus on the patient care, educational and research missions and leadership structures reflect that.  A relatively new role for UCSF’s Department of Medicine is Dr. Sehgal’s position—to focus on quality and safety. Dr. Sehgal’s work focuses on better aligning the clinical and educational enterprises in the context of quality and safety activities. This includes an emphasis on innovation, scholarship, and providing outstanding clinical care to diverse patient populations across multiple campuses. One aspect of his work is identifying opportunities to cut waste and reduce costs of care while improving overall quality. 

“How can we be proactive in the setting of healthcare reform and shift our energy to providing the highest value for care rather than the simply most costly, particularly with unnecessary testing?” asked Dr. Sehgal.

Radiology Utilization Awareness Campaign

Dr. Sehgal and a project team designed a two-phase intervention focused on providing information about cost and radiation exposure for commonly ordered radiology tests. The goal was to determine whether providing this information would influence ordering practices for hospitalized patients. Faculty were also provided with an educator’s facilitation guide to jump-start conversations with trainees during rounds.

Teams were encouraged to discuss and reflect upon whether recently ordered radiology tests were in fact indicated, whether test results changed their clinical management and how big is the problem of over-ordering radiology tests. The cost awareness phase of the project led to reduced radiology test ordering in five of six studies evaluated. 

The UCSF Department of Medicine’s recent strategic planning retreat focused on “Choosing Wisely”, which reflects a broader commitment to embedding cost consciousness and high-value care into patient care, education, research, and policy missions.

The Link to Sustainability

The three legs of sustainability are people, planet, profit.  While choosing tests more wisely reduces costs, it also improves the overall quality of care, connecting the concept of cost consciousness back to healthier people.  In addition, at its core, it is about reducing waste.  A recent article in JAMA summarizes that getting serious about six categories of waste—over treatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud, and abuse—at a minimum could save 20% of U.S. health care costs.