Wednesday, March 9, 2016

Nataša Tomić - Reflections on the exchange experience in the Hubert Humphrey Program

March 7th, 2016.

Reflection on the exchange experience in the Hubert Humphrey Program

Nataša Tomić, M.D., 2015-16 Humphrey Fellow from Bosnia and Herzegovina

After seven months of the Hubert Humphrey Program at Virginia Commonwealth University (VCU) in Richmond, VA, I can state with confidence that the Program is worth the effort which all sides are investing in it.

For me, the Humphrey Program is a huge benefit, both professionally and personally, and, at the same time it is an asset for my organization, the Institute for Physical Medicine and Rehabilitation “Dr Miroslav Zotović”, Banjaluka in its efforts to serve the people and families in best way possible.

All parts of the Humphrey Program are well integrated, however, for clarity I have organized this reflection around three main components, how I see them.

The first component which is carried out through the series of Humphrey workshops, lectures and field visits is primarily oriented towards the leadership capacity building. All Fellows at VCU follow this part of the Program together. 
Dr. Randy Koch, Humphrey Program Coordinator at VCU and 2015-16 Humphrey Fellows cohort power posing in Washington D.C., October 2015.

This component has started with a battery of personality tests, which helped us to assess and gauge to what extent we know ourselves, our strengths, weaknesses, our preferred and authentic leadership style, our dispositional tendencies, e.g., for the work in teams or when exposed to stressful situation. All these are preconditions for any improvement in leadership skills. I certainly was not ignorant before the Program but still, I learnt a lot about myself, my preferences and most importantly, about my weak sides and areas needing the improvement.

Detail from a very intense and interactive Leadership Workshop

During many field visits in and outside of Richmond, we also had a chance to meet charismatic leaders who made difference in their communities and in lives of people.  These leaders were found in both public and private, non for profit organizations. Some of them are real inspiration, example to follow and consult with in future.

Global Leadership Forum where all Humphrey Fellows got together was an event with a special energy which I never felt before. So many accomplished people, from all around the world, so many opportunities for all kind of exchanges. I am proponent of the environment protection for quite some time and Forum gave me additional tools. It was also very good to learn more about the Humphrey Alumni Network as a good platform for exchange of ideas and projects.

Two other major events which I perceive as a great contribution to leadership development are Enhancement Workshops, so well organized by Institute for International Education.

I already completed the Strategic Negotiations Skills workshop which was mentally and emotionally exceptional experience. We, people in Balkans, surely could benefit from better negotiating skills in general, but then particularly in our political life.  Partly due to my active engagement prior and during the Workshop, and partly due to her own interest in the region, Ms. Shanta Nagendram, the Workshop Leader, offered to deliver a Workshop in Bosnia and Herzegovina pro bono in the near future. I hope to be able to find partners in B&H to make such a workshop to happen.

Also, I was really honored that participants at Negotiation Workshop from so many different countries proposed me to make closing remarks on our behalf. My closing remark was recorded and it is great memory and great learning resource for me. 

Participants to the Strategic Negotiations Skills   Workshop and Ms. S. Nagendram

In two weeks I will be attending the Global Development & Social Justice Workshop in Atlanta and when I look at the Agenda, the lecturers and site visits (Jimmy Carter Centre, Martin Luther King Centre, and CDC) and knowing that fellows with similar interest will be attending this Workshop, I really feel blessed once again with Humphrey Fellowship.

The Humphrey Workshops and lectures were also a vehicle to learn about various aspects of the American way of life, systems of education and health care, diversity policy, foreign policy etc. Again, we were also learning from visit to various organizations and discussions with their teams, from visits to historical and natural heritage sites and through participation in traditional American cultural and sports events (minor note:  no way to learn the baseball rules).

Time spent with my Host Family is marvelous. It makes me feel welcome in a special way. I had a chance to fully experience Thanksgiving, to go out to places known only to those living in Richmond and make friends for life who promised to come to the region in next few years.

My Host Family – Sasha and Jim Finch & guests during Thanksgiving Dinner 2015

As for the Virginia Commonwealth University, we feel part of this diverse community not only because of our IDs. We are well informed, we are welcome to all events and enjoy all benefits of studying at VCU.

The VCU truly lives its motto Make it Real. There are many examples but my favorite is: The research questions should be answering the issues and problems which communities face and science should strive to improve the quality of life of people.

I am also involved in the cooperation with Reynolds Community College. Until now, r we had several very good events. In a few days I will moderate our joint Conference The Nutritional Landscape: Perspectives on the Global & Local.

For me, one of the surprises in USA was the extent of volunteerism, community engagement and individual donations for various causes, both local and non-local.

Students are encouraged to join various organizations and such engagement is very much valued. I see how such engagement help to develop their leadership’s skills and to increase the sensitivity for those less fortunate.

As the Red Cross is my first love,  I have joined the ARC and participated in a small scale humanitarian events. From our B&H news I realize that Red Cross in Banjaluka cannot find enough money to maintain soup kitchen and I would like to help with that when back home.

I did some community work with a Meetup group James River Hikers, like collecting garbage along the river bank, cutting ivy from trees and painting over graffiti.

Cleaning the surrounding of the James River North Bank area

Being in the group of international fellows is such a precious opportunity to learn about other countries. Formal and non-formal events where we get together, such as Country Dinner & Movie Night further strengthen ties in our Group. In April, the Fellow from Turkey and me will have joint Dinner & Movie Night. I am looking forward to present dishes, dance and a movie from Bosnia and Herzegovina. 

The African Dinner & Movie Night

Until now, I had four presentations about Bosnia & Herzegovina, about the Institute “Dr Miroslav Zotović”, Banjaluka where I work, about my reasons for applying to the Program and about my goals in the Humphrey Fellowship year and later on.

The presentations were for the Program partners & general audience, for students of the VCU Health Administration Department, for Reynolds Community College and Rotary Club Richmond. In April, I will have presentations in Kiwanis Club and presentation about my Final Project. 

Prior to presentation in Rotary Club of Richmond, with President Kenny Janes

I am proud and honored to be one of the faces of my Country. In my presentations and in informal talks about the Country and Balkan area in general, I prefer to focus on potentials, natural beauties, great places to visit  and hospitability of people, not only on our recent past. I like to say that every part of Bosnia and Herzegovina is safe for visitors and tourists, from all over the world, as it is the case.

American and other people are curious, like to hear about the Country and its life, from the political organization up to day-to-day life. It is a great feeling when people, after talking to me and hearing the first-hand information, express their wish to come to the region, as we need that change in the perception of others.

As I was home during winter holidays, I used the opportunity to present, and in a way, to “de-mystify” the Humphrey Program to my colleagues and other team members in my Institute. During three consecutive days I had 15 presentations for almost 300 attendees. I really enjoyed sharing with medical and non-medical teams the most important things I learnt and experienced as a Humphrey Fellow.

Presentation about the Humphrey Program at VCU in the Institute “Dr M. Zotović”
during the morning meeting of doctors; December 2015.

The second component of the Humphrey Program at VCU are the graduate courses. I attend courses at VCU Health Administration Department. The content of courses is very appropriate for me as my career will continue in field of health & organizational management. The Course in Organizational Behavior gave me a framework to reflect upon my experiences as a manager and leader, to get better theoretical base for phenomenon which I already lived through, to gain new skills for e.g., implementing the change in organization and to get hold of the excellent learning resources which remain with me. I was studying a lot and passed my final fall exam with 97, 37 %. In fall semester I was also partly following The USA Health Care System, joining the class for several field visits and lectures such as Quality in Health Care. In spring semester I attend course The Management of Health Care Organizations, with many case studies which are relevant for my work back home. Professors are very engaged, innovative and require interaction which is great.

Until now I was able to successfully complete all individual assignments and group projects, in quite a competitive environment. Despite the fact that financing of health care in the USA is very different form the European models, there are many things to learn even from that part, e.g., the payer’s requirements for detailed medical documentation, goals setting, use of outcome measures and follow up on the patient’s progress. Most of these are universally good tools for EBM clinical practice.

In most countries, the problem is not with the health care per se than with a management of health care services. I expect that in near future in B&H fewer medical doctors (unless they have proper additional education) will be health managers and that proper health administrator profession will emerge and advance.

 Presentation of the CapStone Project with a group of VCU HAD master students in the Course Organizational Behavior

I also took opportunity to attend non-credit courses:

Global Health and Social Media - enabled me to get an insight into the huge involvement and role of social media in public health and to do some comparisons with use of social medical for this purposes back home.
Medical Advertising course – which is very interesting and new filed for me. The Course is about the impact and implications of medical advertising on use of medication, on the relationship between health professionals and patients and other related phenomenon.

CPR course - I completed the ARC Course on CPR and America Hearth Association CPR Course for health care providers. The experience and materials will help my Organization in CPR education of our staff and interns.

In this section I will also mention my professional course of choice - the CARF Course which I attended in Seattle in February 2016 and which is about the Accreditation Standards for Medical Rehabilitation. Namely in 2015, few months before my departure to USA, the Institute “Dr. M. Zotović” has met the National Hospital Standards for the Service Quality and Patients Safety and I was coordinating that process. The next step may be international accreditation for some rehabilitation programs and my CARF course  is very valuable and instrumental.

If we ever embark on the journey of international accreditation, the journey will be more important than destination itself. The CARF standards serve as a good framework for stewardship, they also emphasize the WHO ICF model of disability & rehabilitation which means that rehab process should be informed not only by  impairment and limitation in function, than even more by the goals, activities and participation of person with disability in the family and community life.

In an attempt to make CARF standards for Medical Rehabilitation accessible for teams in the Institute and beyond, I will translate CARF standards in Serbian language in my free time. 

CARF training with C. MacDonell, Managing Director of CARF Medical Rehabilitation Services – session about the Children Rehab Services

The third component of the Program is the Professional Affiliation (PA), which is basically a form of 30 days internship in the organization of the Fellow’s interest.

My Interest was to learn more about organization and delivery of rehabilitation medicine services, in another words about various aspects of management, from management of a single case up to the continuing education of rehabilitation teams.

With support of my advisers, Dr. D. Clement and Dr. B. Balster I got in  contact with Dr David Cifu, Professor and Chair of the VCU Dept. for Physical Medicine and Rehabilitation.

In his capacity, Dr. Cifu has granted me access to VCU rehabilitation services (both children and adults) and generously helped me with contacts in other rehab facilities, such as rehabilitation departments dept. in nearby VA McGuire Hospital and  Children’s Hospital at VCU. 

With Dr. David Cifu During one of the Ground Rounds at VCU Dept. for PM & R

I benefited greatly from contacts with Ms. M. Sizemore, Chief of Rehabilitation Services at VCU PM&R Dept., and many other colleagues and team members who were very open for cooperation and helpful. I am impressed and took a lot from the VCU Star Service ProgramOur Caring Service Starts with Me. It is a Program for staff development and organizational culture change, designed together with the Disney Institute. The ultimate goal is to improve the patients & families experience in the health system. The STAR Service Conference which I attended played a lot of emphasis on the emotional intelligence and employees satisfaction.  

Among organizations visited until now, the Rehab Dept. of the very well-known Sheltering Arms Hospital is the most similar to our Institute back home. Doctors and therapists expressed their readiness to establish cooperation in near future, primarily in field of neurological rehabilitation.

During my professional affiliation, I was able to make a “comparison study” of what practices we could improve with almost no cost, just by changing the way we do it back home, in my Institute. It was also good to get confirmation that in many areas of physical rehabilitation, for adults and children the Institute in Banjaluka is keeping up, despite very limited resources. 

I am about the finish my local PA  - it was so useful to observe rehab services delivery, be part of team meetings, witness the communication with patients & families, observe the work in specialized clinics (such as feeding clinic or prosthetic clinic), ground rounds and other sessions of continuing education.

          With the team form the VA McGuire Hosital, during the Amputee & Prosthetic Clinic 

            With the team from the Children’s Hospital at VCU – meting before the Feeding Clinic

Right now, I am in the process or arranging the non-local professional affiliation which should take place in May and I hope to get to the Rehabilitation Institute of Chicago, the best rehabilitation facility in USA. 

During the Global Leadership  Forum in Washington I met with the B&H Embassy representative and learnt about the  previous cooperation between  the University of Maryland  and hospitals in Bosni and Herzegovina. I am trying to explore this option as the University of Maryland has the Institute for Rehabilitation and Orthopedic Surgery and may be a good long–term partner for our Institute

There are many other subcomponents of the Program and I will list only few, which are more related to my Final Project and my future work in the Institute.

  1. Thinking  strategically:
Two days’ workshop, adjacent field visits, training in CARF standards which require that any Organization applying for accreditation must have a strategic plan – all have laid ground  for formulation of my Final Project that I will carry out upon return from USA. It will be facilitation and coordination of the Strategic planning process in the Institute, resulting in the Strategic Plan.

The Institute has grown rapidly in last decade, many new services emerged. We have operational plans but not really a strategic one. During the winter break I discussed the necessity for strategic planning with my superiors and several colleagues back home. Despite our differences in opinion about future of the Institute, we all agree that it is a high time for us to sit down and discuss where we want to be in next three to five years. In this process the Institute may re-define its position in the health system, re-examine its purpose and priorities in near future, keeping in focus the best interest of population we serve.

Not only my knowledge about the strategic thinking, then also a knowledge about the organizational change, negotiation, project development, monitoring and evaluation  will all be applied in this process. Few days ago I applied for the American Management Association Workshop - Facilitation of the Strategic Planning Process, and it would be perfect is my application is granted.

I am additionally equipped with documents and the open source links (e.g., from the VA Strategic Planning Division). I am grateful that my Final Project was accepted by the Humphrey Program and that I enjoy the support of the consultants from Richmond. Discussions prior and during the strategic planning for the Institute will go far beyond walls of the Institute as we are leaders in rehabilitation, orthopedic surgery and barromedicine and as such, we have a strong influence on the health policy.

  1. Research and Project development
During my months in USA I got an insight into research and other kind of projects, mainly health and management related, from many different angles. I became aware that many teams are working full time on research / projects only (clinical and non-clinical). Back home, it is still a luxury which we cannot afford and our clinicians are struggling with competing tasks of clinical work & research. However, I think that there are many opportunities for our teams to get involved in joint projects with USA partners. I established good contacts with Centre for Rehabilitation Science and Engineering at VCU (CERSE) and there research themes which are of common interests. Also, the National Institute of Health (NIH) has grants which could enable such cooperation in research. 

Going one step down, there is a need to put more effort to keep up with a practice which is supported by the evidence form research. My Institute is affiliated to Banjaluka University and it is our obligation, as teaching and leading hospital. Along this line, Humphrey Seminars about analysis of scientific articles and ethical aspects of research with human subjects were very useful. Some novel approaches, such as transparency in research and shifting peer review upfront, in order to get feedback on study design early on in the research process, instead in moment when results are about to be published, were a real eye-opener for me. Also, I am glad I learnt more about the qualitative research as it is very resonant and appropriate type of research for the rehabilitation process.

The Institute “Dr M. Zotović” has a good reputation in general, but also as a  trustworthy partner in many small- and medium scale projects. Still, when compared with our capacities, our project portfolio is underdeveloped.

There are several reasons for it: as a governmental organization (despite being not for profit) we often cannot access the available international funds for projects so we try to cooperate with NGOs and get involved that way, second, we never made project development as one of our priorities, thus we are not intentional about that kind of expertise in the Institute.

My previous involvement with different projects helped our teams to develop and implement various projects, small and bigger ones, focusing either on education of rehab teams or research in field of disability. But it is a small number of projects.  With more protected time for project development, with new contacts & partners from the USA I hope we could realize some of the ideas which I have in mind right now:

1.    Visit of professors from the VCU Dept. for  Physical Medicine and Rehabilitation and VA Hospital  to Bosnia and Herzegovina coupled with lectures on the Rehab Conferences; exchange of residents and other team members (major expenses being  is their time and air ticket, the Institute can provide accommodation and local travel);

2.    Linked to 1. would be training in use of outcome measures in Rehabilitation Goal Setting Process and evidence based practice reviews; 

3.    Project with Sheltering Arms Rehab Dept. about the most functional and beneficial equipment in neurological rehabilitation – how to review the scientific literature and make good decisions for purchase.

4.    Feeding Clinic for Children who Fail to Thrive – introductory training by qualified instructor from the Pediatric Feeding Institute (we met at the Children’s Hospital at VCU)

5.    Research project with CERSE, together with organization of persons with disability about the need for education: How to approach to person with disability. Primary target group would be residents of various medical specialties

6.    Organization of the Strategic Negotiation Skills for various stakeholders in B&H

Personal experience of the Fellowship

It is difficult to separate the personal and professional parts of the Humphrey Fellowship as these are so closely interwoven.

What I know for sure is that I am very happy that I landed in Richmond, a big and yet very manageable and warm town. Nature is amazing, the entire Virginia is a state in the forest, I adore green and squirrels jumping on streets of Richmond downtown.

Within the framework of the Individual Professional Plan which we revise quarterly, we outlined our personal goals also. Some of my were to keep healthy and in a good shape which I managed to do, primarily thanks to our good accommodation in Dorm, with a fully equipped kitchen and full access to the excellent programs in the Carry Street Gym.

Also, the quality of my life in Richmond was so much better because early on I became a member of the Meetup group James River Hikers (JRH).  Dennis Bussey, the JRH leader is a very valuable partner of the Humphrey Program at VCU and hope it will remain so in the future as many fellows enjoyed various events organized by the JRH. 

Welcome party for the VCU Humphrey Fellows at Dennis’ place

I got to know Richmond surroundings and enjoy so much in hiking along the James River. With a JRH I also learnt about the history and life in different parts of USA. I have been in theaters, cinema and dinners. 

With James River Hikers in the Pocahontas State Park

Early  morning hike, with sun rising above Richmond

I became the Cookie Master and even made it to the Richmond newspaper  

But most important is that in Richmond I met people whom I believe will remain my friends for a lifetime. I think all of us feel privileged with opportunity to socialize with families of our coordinators, to enjoy having their children around with us and feel so accepted and trusted. Again, I hope to have a chance to host some of them during their visits to Bosnia and Herzegovina.

In Richmond I met with several people and families from different parts of Bosnia and Herzegovina. Professor at VCU, restaurant owner, truck driver, real estate owner – and I was really proud and pleased that all of them made it and have good lives here. They like both Richmond and Virginia. Socializing with them offered me another flavor of life in Richmond and USA. With them I enjoyed in many things which cultural life in Richmond offers and I am really glad they live life to fullest here.

Virginia History is amazing, with glorious and less glorious periods and I love to learn about it.  At many occasions (e.g., lectures in the Virginia Historical Society, VCU Office for Community Engagement) I heard about and witnessed the conscious efforts to bring the heavy burden of the past times out in the open and deal with it.

These efforts on reconciliations and development of mechanisms which will ensure equity and diversity on different levels are very interesting for me. I find them pretty universal and, to some degree, they could translate and be used to improve the situation in Balkans. Also, it is always good to know that others have problems too and that we are nit “unique”.  

It is also interesting this experience made me less fearful. If somebody told me a year ago that I would walk the streets of Chine town in Brooklyn at 10:30 p.m., with a girlfriend only and feel safe, I would not believe. The same is with finding my way out in a big city (e.g., Seattle).

I like meeting and getting to know people from different cultures. Now I understand even more that it takes lots of time and patience for us to understand each other but it is worth the effort. On the flip side, we often have the same values and wishes: health, supportive family, peace, prosperity, integrity and chance for everybody to educate and develop throughout the lifetime.  
This year all of us lived “artificial lives” as we were looked after so well and did not worry about daily necessities. So I am aware that I may have a “pink glasses view” of the life in USA. In discussion with my friends from Richmond I tried to point out some of aspects of American life style that are not so good, like too much salt and sugar in food, sometimes too big houses  and cars, waste of energy on air conditions etc., but they are quite defensive of all these things which they are used to. Everything is so smaller in Europe so that may be a major difference in our perception. 

Final remarks

During my Fellowship I articulated the biggest challenge for me: To get the task done, to get it done right while preserving the relationships in the team. It is even more difficult in international setting so there were many situations to master my skills. 

The Strategic Negotiation Skills Workshop:
with colleagues from Morocco, Mozambique and China.

This year was also an opportunity to step back from my everyday professional life and to and reflect: what was it that I was doing right and what was not so right or good. I got a chance to learn through so many channels, to interact with people I would never meet otherwise, to improve my intercultural competence, my tolerance, communication and hopefully leadership skills.

At one of the VCU workshops I heard the sentence: The biggest value I have are the people I know. I totally agree with it. Though Humphrey Program I met so many brilliant professionals and unique people that my value has multiplied few times.

We were (and still are) working a lot, but still I feel re-energized and ready to pure this energy back into the life of my Institute, to serve clinical teams and, indirectly, all our patients and wider community.

My family and friends are missing me. However, they have been supportive and are happy for me being so content with my Humphrey Year, a once in a life opportunity.

As soon as I am back home I will actively promote the Humphrey and other Fulbright programs and help young professionals to apply. Not everybody can be accepted but everybody can take advantage of going through the process and become more aware of one’s own wishes, strengths and weaknesses. In other words, to use it as a developmental opportunity. 

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