By: Maria E. Luna Issue: Rebuilding Our Infrastructure Section: Academia
The Expansion of Inter-Professional Education, Research and Service
ltimately the construction of a cutting the edge building project at the University of Colorado, Anschutz Medical Campus, one can find a deliberative and successful twist on what could have been a lost opportunity. On a campus that fosters collaboration between students, researchers and clinicians stands one of the campus’s newest expansion projects, the School of Dental Medicine. The building’s extension will provide an additional 20,000 square feet and 68 more dental operatories for both clinics to accommodate more patient care and increased educational opportunities for students. Dean of the School of Medicine Denise Kassebaum, D.D.S, M.S. and Associate Professor and Chair Daniel E. Wilson, D.D.S spoke with ICOSA on how, “Opportunities multiply as they are seized,” Sun Tzu.
ICOSA: The school was in the process of growing. Part of that was going to be accomplished by adding building space; however a game changing situation arose. How did the funding for the first building expansion plan fall through?
Dr. Kassebaum: The School of Dental Medicine was in a public/private partnership. We had a relationship and formalized partnership agreement with a particular entity. Due to some business circumstances, it became evident that it would be most appropriate to terminate the partnership without cause. We went forward from that point and haven’t looked back. We’ve had a lot of opportunities to move forward and reconsider some things.
ICOSA: What were your first thoughts, once the news broke, that there would be insufficient funding?
Dr. Kassebaum: When you think about a funding stream as a dedicated component of your revenue picture, then of course we thought, what do we do now? What steps would be appropriate now? We appreciated the partnership we had with this organization. We looked back and said what did we learn from it? What did we gain from it? We took stock. When you move forward, you look at your opportunities. You have to look at yourself and say we are one of the most selective dental schools in the country. We have one of the most enormous applicant pools with great training programs. How are we going to take those next steps? We did look at best practices for resident training programs which are the advanced dental education parts of our operation. We said how do they do things? So we modified some of the ways we were doing things. We generated more clinical revenues in those programs and gained efficiency. As we’ve moved forward, we looked at that as an opportunity to change the way we did things. Now we’ve accomplished a great deal since that time and feel very positive about it.
When you look at a dental school’s primary revenue stream, you have to think that there’s tuition from academic programs, there’s clinical earnings because we have advanced dental education programs as well as the doctor dental surgery program. We are providing care, gifts and other sources of revenue. Looking at those three components of revenue streams, we asked what could we do to enhance those and we looked at programmatic offerings. Can we change the programs a bit? Can we increase the amount of care we are providing? We did both of those. We looked at how we can increase offerings to students and also increase care we can provide to patients.
ICOSA: What next steps were taken?
Dr. Kassebaum: Decisions are made from being in a constant process of strategic planning and an analysis of data. All the decisions we make are based on evidence gained periodically. It was an opportunity to reflect on what had happened. We moved forward with the same level of commitment we had before. We’re going to get this done, and we’re going to do it fine. We combined the leadership strength of the dental school, plus the university was very supportive as well, and tried to work out a new business plan.
ICOSA: What new goals are /were reached by the completion of the alternative infrastructure, and if any, which ones were unfulfilled?
Dr. Kassebaum: I don’t think any goals were lost. I think when you look at how we decided we would increase revenues; it would instead allow us to increase things. We’re providing more care than ever before. We don’t look at goals lost; we look at goals and opportunities gained. So I think we moved forward with the intent to do more with less and to do better than we’ve ever done. And it’s worked.
ICOSA: What is the perception of the dental school?
Dr. Kassebaum: Internally I think everybody is excited…if they see the construction, it is exciting. Our facility and students are excited about the growth. It is change and it’s exciting. The dental community around us – the Aurora community, they see this too and it’s pretty amazing- the number of cranes, the number of things going on. They’re excited by the development in this area. We look at it as good for the Aurora community. We look at it as good for our students. It gives us a chance to offer more to the patients.
ICOSA: What are the positives and negatives of the development compared to the original plan?
Dr. Kassebaum: We accelerated the plan, and for me, I think of it as a win-win. I look at it as an opportunity to help the surrounding area. Think of the jobs that we create – just the number of people in our building in the wee hours of the morning because we try to get the construction done, a lot of it done, when we’re not here because it’s so noisy. We were actually benefiting from construction costs being lower in the amount of time the construction will take to complete and the decreased cost in actual personnel. We looked at this as seizing the opportunity. We can be a growth opportunity for the economic development around here. It will help us at the same time because it will be less outlay of funds to get the same amount of square yards.
Dr. Wilson: In reality we expanded the scope of the original process. Originally it was going to be a four floor addition, and we were able to do a renovation on the third as well, really with the same money we had budgeted. That was a great opportunity for us. The third floor was a terrace and was underutilized for a number of reasons, so we boxed in the terrace. Our building was staggered before, and it remains staggered; it just goes up one floor. So we have a significant 42 chairs, plus office expansion on the fourth floor plus we pick up 24 more chairs and some support space on the third. So it’s a significant chunk of real estate. Dr. Kassebaum: It really allowed us to think of new things that the fourth floor wouldn’t allow us to do with that expansion. Now we have different programmatic ideas for the third floor expansion. It was the fourth floor and the third floor that we didn’t think earlier that we could afford to do.
ICOSA: How did you develop the strategy?
Dr. Kassebaum: We thought there are models out there that we want to replicate. Or are we creating new things that people will eventually replicate? When you do best practices, I suspect it’s like in the construction industry, there are people who are doing things and you say that looks like a best practice- let’s adopt that. It’s the thing I referred to earlier; looking around you always want to be engaged in the community that you are a component of which is the American Dental U.S. System.
At the Anschutz Medical Campus you have all these innovative and creative programs. The excitement was about what we would do if we had more space! What kind of innovative and unusual thing would we like to put in that third floor area? Now we’re working with two different private donors. Dr. Wilson: The reality is we pick up an economy of scale by doing this. With more space we can invite more students which also allows us to bring more professors with more diverse skill sets and so forth. In a sense we had a choice to contract, try to cut our way out of a problem. We’re trying to expand our way into a problem. I’m much happier to be expanding because I can lecture to 30 students and I can lecture to 60 students; it’s the same scale.
ICOSA: Working with the associations, did you find they were helpful, or did you find roadblocks? Is information open as far as from school to school and their strategic plans?
Dr. Kassebaum: Absolutely! When we talk about best practices, we talk about efficiencies. The strategies you develop are really on your own. So with the best practices, I can think of more specific things – how does their clinic really achieve their specific goals? Strategically thinking, do we want this kind of operation on this particular floor with this number of students? Those are your own strategies. But looking at how other dental schools do things has been fun. They look at us often because if you look at this building, we are one of the newest dental schools. We host people to come in and see how we did our clinic. The beautiful light in the clinic is brighter than any other light in any other dental school that we have visited, and so we like the idea that people come to visit, and it gives us a chance to interact.
ICOSA: What services does the school offer?
Dr. Kassebaum: We have an advanced dental education where dentists become specialists. We have programs for orthodontics, periodontics and advanced general dentistry. And then you look at dental schools and a very large component of what they do is created educational opportunities for people to earn the doctorate of dental surgery degree. We have two very significant programs that end in the awarding of the D.B.S degree. Those are an essential component offered in the dental school.
ICOSA: And you offer services to the community?
Dr. Kassebaum: We offer a complete range from implants to orthodontics and all the general comprehensive dentistry, and in-between we do preventive things. We have a wide age range. Our oldest patient may be in their 90’s. Our collaboration with the Children’s Hospital allows us to make sure that if we have patients who come in with small children, then our dental students actually participate with a clinic over at the Children’s Hospital. We are dedicated to serving the entire span of the age ranges from infant to elderly.
Dr. Wilson: We have about 30 sites all over the state that are not owned by the university, but our students rotate out to public health facilities. It’s part of their education. It’s been kind of a unique part of this school for a long time. That would be one of the practices that other schools have copied a great deal. We were one of the firsts.
Dr. Kassebaum: We were one of the firsts to put them out at those sites, and it’s very fun because those sites have very few providers in their area, so the dental students are a significant component of getting more care to the patients in rural areas. It could just be a medically underserved area. Our dental students have been out for extended periods of their training historically, and we’re really proud of that. Other dental schools have tried to replicate getting students out across the state because that’s what all of us value now. Not only for the experiences they gain, but they get something different if you’re out in a rural area than they gain in our metropolitan area. It’s also treating more patients than the providers out there could do alone. It’s a win-win. We have about 65,000 patient visits that we perform annually in this building. And we have 25,000 more patients when you talk about those external sites. And then we have a big mobile dental clinic that’s very cute and huge. It’s like a big RV and has some children painted on the side. And we go out to underserved areas. The front porch of it jets out and you have this operatory. And the students travel with a facility member who supervises all the activities. They have been out there 4 or 5 weeks, and we extended it by one more week because Gunnison wanted more service, so we decided to let the van stay one more week.
ICOSA: Do you do dental research?
Dr. Kassebaum: There are wonderful research opportunities here. If you look at the campus, I think one of the exciting things about Anschutz is this inter-professionalism permeates in all that we do. That means dental researchers are in the same building as medical researchers and many other of the health professions, so our researchers have a focus in cancer biology, dental materials and innovative materials that we can use in the oral cavity and in other parts of the body. The other thing we do is a lot of salivary gland and facial development research that we do on zebra fish which are a model we can use to learn more about the processes of a human.
I think collaboration is the existing word on the campus. It’s a national model for collaboration because this building, for example, doesn’t have classrooms. We have shared classrooms buildings with advanced educational spaces where we’re expecting pharmacy, medicine, college of nursing - all campus schools to use the same spaces with us. There are academic communities where clusters of students can meet and get together and share ideas. And then we participate in educational programming where there are actually students in the same classes and doing the same activities. So it’s a very special way to train people to work in teams, later and it’s called inter-professional education. It’s oddly enough fairly new. Dental schools have been siloes and existed on their own. Medical schools are separate and PT, Nursing. There is this effort to have collaboration and to have interaction at student level, at facility level.
We really are a national model for this. The whole campus is an amazing demonstration of how professions can work together and research patient care and education. It was intentional in the design of the campus, and it’s carried out by the way the buildings facilitate that, so it’s really a special environment.
The expansion of the dental school sets the bar for other educational institutions. Its success is no coincidence. In building infrastructure, having funding was not the main reason to build. Too many times initiatives are put forth with enthusiasm and good intentions, but without concrete strategy and analysis of data, they go nowhere. Due diligence is key in any practice of collaboration and infrastructure.