If you have news to share, comments or suggestions about Findings, we want to hear from you. Send us your news by clicking here.
Kotagal Honored for Efforts to Transform Health Care
Published December 2009
Uma Kotagal, MD, is officially senior vice president for quality and transformation and director of the Center for Health Policy and Clinical Effectiveness at Cincinnati Children’s Hospital Medical Center.
Or, you can just call her the “change czar.”
That’s because Kotagal, over the course of her four decades in the medical profession, has been a tireless advocate for quality improvement at UC Health University Hospital, Cincinnati Children’s and across the entire spectrum of clinical care. In recognition of her efforts, she was one of 65 new members elected to the Institute of Medicine (IOM) in October.
Election to the IOM, considered one of the highest honors in the fields of health and medicine, recognizes individuals who have demonstrated outstanding professional achievement and commitment to service. New members are elected by current active members (now 1,610).
“I’m more pleased about it for us as an organization and for the quality improvement movement than for me personally,” says Kotagal, “because I think it’s more about the acknowledgement that this kind of science has a legitimate role if we are to solve some of our desire for ending suffering and making the health of people better.
“There are hundreds and hundreds of front-line nurses and residents and therapists and doctors that have done the work.”
Kotagal, who is also a professor of pediatrics and obstetrics and gynecology at UC, has been a force for change and an advocate for evidence-based care since receiving her medical degree from the University of Bombay in 1970.
All but five years of her medical career have been spent in Cincinnati, where she’s headed neonatal intensive care units at University Hospital and Cincinnati Children’s and has been part of the senior management team at Cincinnati Children’s since 2002.
Through it all, she’s been guided by one mantra: “What works?”
Metrics Matter “A lot of times when people talk about their doctors, they say, ‘Just believe me, he’s really good,’” she says. “But they take for granted that their doctor is telling them to do the right thing and prescribing the right medicine. Despite evidence to the contrary, they still say, ‘My physician’s better.’
“And despite evidence to the contrary, physicians say, ‘I do better than other people do.’ So metrics are very important, both from that standpoint and because they are quantitative and can be statistically examined.”
Kotagal’s passion for evidence-based care took hold when she was a follow in neonatology at the UC College of Medicine in the mid-1970s, freshly arrived in Cincinnati after four years as an intern, resident and fellow at Detroit General Hospital and Children’s Hospital of Michigan.
“My attending physician was the world expert on calcium metabolism in the newborn infant,” she recalls. “But he could not help me answer the question, ‘At what Ca level should I treat this premature infant?’ And I was struck by that—it wasn’t that I thought the research wasn’t important; it was that no one could answer my question which came up several times a month on the service.
“It seems that a lot of energy and money went into the acquisition of new knowledge, and rightfully so. But somehow the energy to apply that new knowledge never seemed to have the same force.”
The problem dogged Kotagal through the 1980s as she rose through the faculty ranks and was heavily involved in neonatal intensive care. She enjoyed working with newborns, but found that her lack of improvement skills was a hindrance to overall quality improvement.
“I was working harder and harder and getting less and less gain,” she says, “and I was driving both myself and everybody else crazy. So I went back to school.”
“Back to school,” in Kotagal’s case, meant the Harvard School of Public Health where she earned a master’s in epidemiology (clinical effectiveness) in 1996. Studying full time over two summers, she learned quantitative skills for clinical research, took courses in epidemiology and biostatistics and immersed herself in discussion of quality issues with faculty and fellow students.
“I came back with the theory that there was a lot to do and still a lot to learn,” she says. “And then I was very lucky—there were some amazing people around me that said, ‘You’re not as crazy as you sound.’”
Among those people were James Anderson, president and CEO of Cincinnati Children’s, and Lee Carter, then chair of the board. And with Kotagal as director of health policy and clinical effectiveness, the opportunity for change was there.
“With his background in the manufacturing world, Jim Ander-son saw enormous opportunities in this organization for efficiency and improved processes,” Kotagal says, adding with a chuckle, “He was my boss and partner in crime.” (Anderson will step down and be replaced by Michael Fisher effective Jan. 1, 2010.)
A major milestone was landing a $1.9 million grant from the Robert Wood Johnson Foundation in 2002 to participate in “Pursuing Perfection: Raising the Bar for Health Care Performance.” (An additional $300,000 was awarded in 2004.)
Those resources have helped Cincinnati Children’s closely monitor its care and services, making measurable improvements such as reducing wait times, implementing more than 20 evidence-based clinical practice guidelines and giving patients and their families online access to their own medical information.
Medical Family Becoming a physician was an easy choice for Kotagal when she was growing up in Bombay, the daughter of an ophthalmologist and granddaughter of an obstetrician.
“I didn’t know there was another option,” she jokes.
She knew she wanted to be a neonatologist from her first day of medical school, when she walked into a classroom and saw a professor holding a newborn and talking about the transition from fetal to neonatal state. But with limited opportunities in the intensive care field for neonatology in India, she came to the United States and began her career in Detroit.
It was in Detroit that she met her husband, Shashi Kant, MD, a professor of medicine at UC and director of dialysis and extracorporeal services at University Hospital. They have two daughters: Kalpana, an attorney, and Meera, a first-year surgery resident in Seattle.
In her free time, Kotagal enjoys cooking in her North Avondale home, traveling and spending time with friends and family.