David Shulkin's unorthodox healthcare career got started with worms.
As an undergraduate at Hampshire College in Amherst, Mass., Shulkin studied anti-aging drugs in nematodes (worms commonly used as experimental models) as part of a science curriculum he designed. An inventor out of necessity, Shulkin devised his own pre-med sequence because Hampshire, founded in 1965 as an experiment in countercultural higher education, had no formal courses or even grades.
Some of his experiments yielded results worthy of publication in peer-review scientific journals, a heady accomplishment for a college student, says Shulkin, now 38. But the thrill of discovery and the rewards he tasted from making the unusual work seem to have been the lasting lessons.
"What I find interesting is going in directions that are new," he says.
Shulkin, who went on to earn his medical degree from Medical College of Pennsylvania in 1986, continues to chart new territory as chief quality officer at University of Pennsylvania Health System, Philadelphia, and chief medical officer at Hospital of the University of Pennsylvania and Presbyterian Medical Center.
A trailblazer in healthcare quality improvement and outcomes management, Shulkin has attracted national attention for his ability to improve clinical care and raise patient satisfaction-while managing costs.
At HUP and Presbyterian, Shulkin is responsible for a laundry list of functions from medical affairs and graduate medical education to social work and community health, quality assessment and disease management. He's bent on changing how UPHS delivers care piece by piece.
Shulkin has spearheaded the development of a uniform infrastructure for capturing clinical outcomes data. Building on that foundation, Shulkin created a concurrent case management system to implement best practices, which he cites as one of the most important breakthroughs influencing how UPHS delivers care. Shulkin pushed to merge the systems' social workers and traditional quality analysts into a corps of roving quality gurus who work directly with physicians as they make decisions.
By communicating and reinforcing the latest care initiatives, these quality troops have been instrumental in translating ideas for improvement into reality.
"They're rounding with the physicians and on floors with the nurses in what's equivalent to an administrative loudspeaker system," Shulkin says.
Most recently, Shulkin has seized on disease management as a powerful tool for improving outcomes by standardizing best practices across the continuum of patient care. He's determined to see 80% of the system's patients handled through disease management protocols by the year 2000.
Despite his sometimes rather radical notions, Shulkin has mastered the delicate art of building employee buy-in-especially with doctors.
Planning, careful consultation with constituencies inside the health system and tireless education have been important ingredients, he says.
"I'd rather see management study and adapt ideas to physicians than go in with a stick and say, `This is good for you, do it,' " Shulkin says.
His accomplishments and wisdom beyond his years have made their mark at UPHS.
"I've noticed people come to David for advice," says David Bernard, M.D., a 55-year-old nephrologist who is now in charge of disease management under Shulkin. Bernard was associate dean of medical affairs at Boston University School of Medicine before taking a one-year fellowship in quality improvement under Shulkin in 1995. Bernard stayed on, entranced by Shulkin and the opportunities for change at UPHS.
"Here's this young guy who has been able to articulate a vision*.*.*.*and it's become one of the highest priorities for the health system," Bernard says. "He's been absolutely brilliant in taking it from idea to reality."
Just under way since July is another Shulkin initiative, a detailed report card that grades staff from the chief executive on down on important quality indicators such as access, clinical performance, value and patient satisfaction.
To make it stick, employee pay is linked to the grade.
"This is not easy stuff to do," Shulkin says, adding dryly, "As soon as you start messing with somebody else's pay their level of attention goes up dramatically."