Written by Marybeth Kotrodimos, University Health Partners of Hawaii
Leah Taylor photo by Vina Cristobal
As Business Director of UHP’s Family Medicine Clinic, you know that even in the best of times, though ever-cheerful and friendly, Leah Taylor, MBA, has got to be one busy person.
Among her many duties, she handles contracts and large purchases for the clinic, budget agreements with vendors, HR, credentialing for faculty; she’s on the COA [Council of Administrators], as well as JABSOM committees.
“Of course now, I’m working on the move,” she tells us, referring to Family Medicine’s relocation from their facility in Mililani to their new clinic next to Pali Momi Medical Center. “Planning with architects and the Department Chair on developing the architectural plan, working with an interior designer, working with the contractor, getting supplies moved over . . .” and you sense that the list goes on.
This would be a big move even without dealing with the concerns and constraints of a world pandemic, but in the time of COVID-19, it had to be extra challenging. How did the coronavirus affect Family Medicine’s operations?
“We have lots of meetings now,” Leah says. “When the COVID first started, – there was an internal department COVID group of us: Desiree Navarro (Clinic Manager), Dr. Allen Hixon (Dept Chair), Dr. Chien-Wen Tseng (Senior Researcher), Dr. Komal Soin (Director of Women’s Health), Dr. Robert Carlisle (Clinic Medical Director), Dr. Lydia Rolita (Residency Program Director), Heidi Kubo (Residency Program Administrator), and myself – in mid-March for about six weeks every morning at 7:00 and every afternoon at 4:00, we’d have a zoom meeting to discuss how COVID affects our clinic, residents and patient care. We now have update meetings only twice a week. Before we were changing operations & work flows on almost a daily basis. If it wasn’t for those who were on these recurring calls, telemedicine would never have gotten off the ground. I simply bought IT equipment, but the others in the meetings were the integral ones in developing and implementing telemedicine for our department.”
At this point, they were already in the middle of moving the entire clinic to another location. Although planning for the physical relocation was a lot of work, Leah says she “couldn’t have survived without the guidance of the Department Chair, Dr. Allen (Chip) Hixon and the clinical expertise of the Clinic Operations Manager, Desiree Navarro.”
Has telemedicine helped them through the crisis? “It definitely has,” Leah says. “It took us a while to get into the groove of it. I think the big challenge, initially, was we’re not just a faculty clinic, we’re a residency clinic, so what they have to do is have the residents on zoom, the attending faculty on zoom, and the patients on video via doxy.me.” There are some extra steps needed for them to coordinate a telemedicine visit with a patient, but, she said, it’s been totally worth it.
As with all healthcare practices, during the pandemic, Family Medicine has, of course, had to limit the number of people who can be seen at once in the clinic, so telemedicine has helped greatly in that it has enabled them to see patients who might have otherwise had to wait much longer for an appointment. In fact, she says, when they go back to being able to see patients as they did before COVID, they want to continue incorporating telemedicine into their practice.
“We are limited to five residents seeing patients at a time in the clinic,” Leah explains, “but if they are doing telehealth, they can see more patients and not be constrained by the number of rooms the clinic has available.”
In their new location in the Pali Momi Outpatient Center, Family Medicine had its first telehealth visit on June 12, saw it’s first in-person patient on June 13, and officially opened on June 15.
By all accounts, the move went amazingly well, owing in no small part to Leah, according to Family Medicine Department Chair, Dr. Allen (Chip) Hixon: “I think Leah Taylor deserves a lot of credit for being involved in every step of the operational planning timelines and coordinating all the pieces. And you know, it’s a big deal.”
So what is the reason for the move anyway? “About four years ago,” Leah says, the Department of Family Medicine and Community Health, started looking for new location for the Family Medicine clinic, so this move marks the end of long journey home for them.
Family Medicine’s residency program, Leah tells us, began in 1994 with Wahiawa General Hospital as their sponsoring hospital. In 2015, the Mililani clinic became a part of UHP.
“So now that UHP owned the clinic, Family Medicine still needed a sponsoring hospital. HPH/Pali Momi raised their hand and said that they would sponsor our residency program. So now a lot of our residents do their rotations at Pali Momi,” she explains. “They do their rotations there in the morning, then need to eat lunch and drive to Mililani so they can start seeing patients at 1:30 [p.m.]. That doesn’t leave time much time for eating and commuting.”
So she and Dr. Hixon started meeting with Pali Momi’s vice-president of real estate. They looked at “about five different locations” before they found the one that would meet all their needs and be close enough to Pali Momi Medical Center so that their residents would not be in such a time crunch during the course of their day.
The new Family Medicine clinic is a four-minute walk to Pali Momi Medical Center. (“I know! I timed it!” Leah says.) “So now what happens is our residents finish their rotations about 12:30 p.m. or so, they get to eat their lunch, and then walk over to our clinic.”
Also, she adds, there are a lot of meetings, trainings, and workshops given at the hospital which their residents and faculty couldn’t attend previously because they needed to drive to Mililani. Now they can benefit from participating in these educational events.
Though this is undoubtedly a good move for Family Medicine, “It’s been kind of hard too,” she says, “because we had a lot of patients from Mililani and Wahiawa that may have difficulty to keep coming to us because of the commute. You know, we’ve been around for about 25 years, so it will be hard if we lose them as patients. The new site, however, will allow the provision of many coordinated health services for our patients and a better clinical learning environment for the residents and faculty.”
“We were supposed to have a big grand opening,” Leah tells us, but because of COVID-19, they were unable to do that. However, on June 5, they had two kahu to bless the clinic. Only ten people could attend, she tells us, referring to regulations to prevent the spread of COVID. It was important that they “clear the room spiritually,” following Hawaiian tradition, Leah says. “But we talked to the kahu about having another blessing when things calm down so that all the people within our department, our partners, and our supporters can attend that.”
Included in that event, she says, will be UHP leadership, JABSOM leadership, Pali Momi hospital leadership, HPH leadership, Queen’s leadership, and members of the legislature who have supported them.
Leah first began working in Family Medicine in 2006, as a Research Corporation of the University of Hawaii (RCUH) student intern in UH’s Department of Family Medicine Research Division with principal investigators Dr. Lee Buenconsejo-Lum and Dr. Neal Palafox. She’s had other jobs since her internship but returned to the Department in 2014. Most of her employment with the Department had been “on the research administration side” she says. The clinical side is “completely new” to her, which is why coordinating with Dr. Hixon and Desiree was so instrumental in the success of the clinic relocation.
Healthcare can be “a difficult industry to be in” she said, but “every industry has its issues.” Overall, it has been an interesting and educational journey for her. However, her feelings for the work of family medicine are clearly unambiguous.
“We go by ‘Family Medicine’ for our UHP clinic, but our JABSOM department is really ‘Family Medicine and Community Health,’” Leah explains. “The goal is that we see all ages at all stages, which is really kind of our tag line. We see babies all the way to geriatric patients. Family medicine is not just about looking at the physical health of the patient. It is also incorporating all the social determinants of health. How’s the family life? How’s their economic situation? Do they have housing? Because you know someone who doesn’t have housing or doesn’t have a stable family life, it’s a lot more difficult for them to make healthy decisions.
“A mom that has three kids and working two jobs, it’s much more difficult for her to make a healthy meal than to just grab a McDonald’s meal and give it to her kids. It’s not because she doesn’t care or doesn’t want to. She just doesn’t have the time to do it.
“It’s not just how do you treat their diseases, but how can you be preventative? How can you provide social services? How can you get them in touch with the food banks? The job fairs? Things like that. The basic needs. So that’s family medicine – [we] look at the whole, not just the ‘why’.”