Uma Kotagal: A catalyst for change
On January 22 – her 70th birthday – Uma Kotagal, MBBS, MSc, became the first woman to receive the William Cooper Procter Medallion – the highest honor the Cincinnati Children’s Board of Trustees confers. She was feted by family, friends and colleagues at the Queen City Club downtown.
Kotagal, who is senior executive leader of Population and Community Health, is no stranger to winning prestigious awards. She received the Daniel Drake Award from the University of Cincinnati College of Medicine, was recognized as one of Ohio’s Most Powerful and Influential Women, as well as a YWCA Career Woman of Achievement, and she has won numerous honors for teaching. She also was elected to the Institute of Medicine – one of the highest honors in the fields of health and medicine.
With so many accolades to her name, Kotagal could easily step back and bask in her success. But that isn’t her nature. There is so much work still to do.
The early years
Kotagal was born in Bombay, India, the youngest of four girls. Her father, grandfather and sister were surgeons. But she was drawn to neonatology.
“As a young medical student, I was awestruck by the transition a fetus makes as it becomes a newborn child – the circuits, the systems all changing at the moment of birth,” she explains. “This also started my fascination with systems and transformation.”
After earning her medical degree from the University of Bombay’s Grant Medical College, Kotagal did her internship at Detroit General Hospital and her pediatric residency at Children’s Hospital of Michigan. She completed her first year of fellowship in neonatology there, but transferred to Cincinnati Children’s in 1975 for additional postdoctoral training in neonatal physiology and to be with her husband, Shashi Kant, a nephrologist.
Kotagal initially worked in a research lab studying vascular systems, but she became increasingly interested in clinical care systems. “I was always struck by the gap between the enthusiasm for discovery and the enthusiasm for application of that discovery. We’d find something, and it was like a big, shiny object that was so exciting. But then we’d put it on the shelf, saying, ‘Okay, that’s done’ and move on to the next shiny thing. We didn’t make sure the knowledge was applied or hand it off to someone who could do that.”
Reggie Tsang, MD, director of Neonatology, gave her the opportunity to explore her theories when he appointed her director of the University Hospital nurseries. “Creating reliable systems to close the gap and deliver better outcomes, safer care and better patient experience at a lower cost became my work for the next 25 years,” she says.
Help from colleagues
Kotagal is quick to acknowledge the role her colleagues and mentors played in supporting her journey. Bill Schubert, MD, president and CEO from 1983 to 1996, sent her to Harvard to complete the program for clinical chiefs, where she learned about business methods, finance and health systems. Her fellow physicians – Paul Perlstein, Bill Keenan and Ed Donovan – were great partners in neonatology, linking financial and clinical data to study and describe provider variation and care.
At a time when female faculty members were few, Janet Strife, Bea Lampkin, Jennifer Loggie, Helen Berry and Virginia Donaldson provided a critical sounding board for her advocacy efforts. Together, they began the Women’s Faculty Association.
She returned to the Harvard School of Public Health for her master’s degree in health services research, which she completed in 1996. She then came back to Cincinnati Children’s as director of Health Policy and Clinical Effectiveness. She found great collaborators in Tom DeWitt, MD, director, General and Community Pediatrics, and Maria Britto, MD, MPH, a health services researcher in Adolescent Medicine.
Board Chair Lee Carter, President and CEO Jim Anderson, and Trustee Geoff Place invited Kotagal to join them in developing the 2001 strategic plan. Kotagal says, “We put delivering outstanding clinical care at the forefront. It marked the first time the institution explicitly stated that we valued clinical care as much as research.”
Under Kotagal’s direction, Cincinnati Children’s applied for and won a Pursuing Perfection grant from the Robert Wood Johnson Foundation that funded quality improvements for acute and chronic conditions. The grants were a response to the Institute of Medicine’s recently published landmark reports – To Err Is Human and Crossing the Quality Chasm, which called out the poor (and dangerous) design of healthcare systems in hospitals nationwide. The revolution had begun.
Spread and transformation
Kotagal remembers those early days. “We were learning a lot,” she says. “We were partnering with people in Sweden, Minnesota and California, working together in our attempts to transform care. It was an unbelievably difficult task. You have to go at a faster pace than the pace of resistance, because there are always people trying to slow you down, saying why change isn’t such a good idea or that things aren’t really that bad.”
At the end of the first year, there was still some money left in the Pursuing Perfection grant. Kotagal’s teacher, Tom Nolan, PhD, from Associates in Process Improvement, asked if Cincinnati Children’s was interested in learning improvement science. So Kotagal and her team used the funds to send a small group of faculty (MDs) and clinical director Susie Allen, MSN, to the Intermountain Healthcare Delivery Institute to train with course director, Brent James, MD. They came back inspired and excited about the impact they could have. More groups from Cincinnati Children’s attended subsequent courses, building deep bench strength in improvement capability.
“Learning how to improve was so important that we began teaching our own course, I2S2,” says Kotagal. “We recruited Carole Lannon and Peter Margolis, which gave us a huge capacity to advance improvement and, through Learning Networks, an opportunity to change the lives of kids at scale. We also added a national course called ‘Advanced Improvement Methods,’ which embeds research design in the improvement effort. People come from children’s hospitals across the country to participate.”
In 2010, Kotagal became the first executive director of the James M. Anderson Center for Health Systems Excellence, which was established to expand Cincinnati Children’s work in transformational improvement. More recently, she stepped down from that role to lead the community pillar of the 2020 Strategic Plan. Her efforts have led to the creation of Impact U in partnership with Cincinnati Public Schools’ Strive program, to build improvement capability in the community.
Kotagal appropriately cites William Cooper Procter, who said, “Things don’t just happen. You make them happen.”
Kotagal has been making things happen since she started her career at Cincinnati Children’s over 40 years ago. “When I see 120 hospitals taking part in Solutions for Patient Safety, when I see Carole Lannon’s work on reducing late preterm births, when I see the academic track of research improvers advancing and the number of people we’ve trained in other places, it’s hard not to feel like you’ve changed an industry,” she says. “But my work is unfinished when it comes to the children in the community, so I’m not satisfied. I’m hoping I can continue to build capacity for others to do this work and advance the health of our poorest children.”
