HJNO Jan/Feb 2025

HEALTHCARE JOURNAL OF NEW ORLEANS I  JAN / FEB 2025 29 striving to help them achieve their optimal state of health and will wisely deploy limited resourc- es efficiently and effectively toward that goal. To that end, I have written extensively in prior articles how I am thrilled to be a part of a “sys- tem that delivers health” rather than a tradi- tional health system. As the world of healthcare continues to lurch forward — and sometimes backward — in this tumultuous journey that we call value-based care, size and scale become incredibly important. Health systems need to reach a certain size to be able to most effec- tively leverage scale that delivers clinical excel- lence not only at the tertiary or quaternary level, but across disparate geographies as well. And so, in this article, I would like to continue the theme of highlighting exceptional coaching in the world of IBD. Shamita Shah, MD, would be equally well represented in an article entitled the heroes of healthcare. She is a phenomenal “coach” who leads a centralized Crohn’s and Colitis center of excellence in the New Orleans region and collaborates closely with a team of diverse resources on how to scale the same level of care delivered from a centralized hub of clinical excellence across different regions. Shah is a native of New Orleans who com- pleted medical school, internal medicine resi- dency, and a chief resident year at LSU Health Sciences Center in New Orleans. She then completed gastroenterology training at Och- sner Health, followed by a dedicated one-year IBD fellowship at the University of Chicago. After completing her training in 2008, she was recruited to be the clinical director of IBD at Stanford University. She stayed on faculty there until 2015, at which time she returned to Och- sner Health as the medical director of IBD. She exemplifies the Bill Gates quote, “Most people overestimate what they can do in one year but underestimate what they can do in ten years.” Few have accomplished as much in her 9 years at Ochsner as Shah. Under her leadership, she helped to create what Michael Porter, PhD, MBA, and Elizabeth Teisberg, PhD, would call an “integrated practice unit,” originally de- themselves are often embarrassing, anxiety provoking, and subject to significant stigmati- zation. Imagine having to contend with all the daily stressors of life at both a personal level and within the workplace, but add to that fre- quent diarrhea, abdominal pain, bloody stools, fever, joint pain, rashes, malaise, immunosup- pression, and a host of other problems. Lack of appropriate treatment will lead to ongoing inflammatory damage as a patient’s dysregu- lated immune system attacks previously normal tissue. Without the ability to block that inflam- matory damage, dangerous complications ensue. These complications include fistulas, infection, abscesses, and others that will often require repeated surgical resections, especially in the absence of effective treatment. Prevent- ing those complications requires both excep- tional coaching and teamwork. Teams may vary in the composition of resources and knowl- edge domain skill sets but typically include IBD specialists, colorectal surgeons, pharma- cists, therapists, advanced practice providers, dietitians, and, most importantly, the patient. These coaches and teams then work together to help the patient make progress despite the litany of challenges impeding their progress. For IBD, it is not just the physical manifesta- tions that require great coaching expertise, but rather it is the emotional and mental manifes- tations of the disease that require coaching as well. The world of sports abounds with numer- ous examples of players who struggle under one coach, only to have a resurgence in their athletic career when they come under the tute- lage of an outstanding coach. The same holds true for patients in the management of their IBD as they may experience complication after complication under the care of a lesser coach. The “coach” (i.e., physician) might write them off, thinking that they have done everything they can to help them, blaming noncompliance or some other factor intrinsic to their charac- ter for lack of success. But the genuinely great coaches/physicians never blame their patients and never give up on them. They are constantly Much of this series has focused on cardio- metabolic conditions, even introducing the new framework of cardiovascular-kidney- metabolic syndrome — rightly so since car- diovascular disease and its risk factors like obesity and chronic kidney disease still ac- count for the leading causes of morbidity and mortality in this country. But inflammatory bowel disease (IBD) is an important enough condition to devote more time to this topic. And as a chronic condition, it serves to high- light the importance of team-based care and the role of great coaching in its management. As I am authoring this continued story of IBD, including Crohn’s disease and ulcerative coli- tis, and acknowledging the challenges of us- ing football as an analogy given the incidence and prevalence of chronic traumatic encepha- lopathy, the sport nevertheless provides a use- ful construct for how to make goal-oriented progress against chronic disease. In football, like most sports, even talented players cannot overcome bad coaching, thus highlighting the importance of great coaching and requiring a coordinated team effort for success. It takes a great offense to overcome the many would- be “tacklers” that impede forward progress in chronic condition management. As a refresher to the analogy of it taking a great offense to help patients make progress toward their health-re- lated goals, please remember the array of bar- riers that can obstruct their forward progress. They include adverse childhood traumatic ex- periences, impaired mental health, detrimen- tal socioeconomic factors, low health literacy, poor self-efficacy, maladaptive coping mecha- nisms, and payment mechanisms that reward more care rather than better care. In this sce- nario, the patient has the ball and might have tremendous difficulty making forward progress if not surrounded by a highly coordinated team of resources helping them to overcome these many obstacles. How those resources are utilized and deployed becomes a function of effective coaching to help them overcome those barriers. For IBD, even the symptoms “Great coaches lie awake at night thinking about how to make you better. They relish creating an environment where you get more out of yourself. Coaches are like great artists, getting a stroke exactly right on a painting, except they are painting relationships. Most people don’t spend a great deal of time thinking about how they are going to make someone else better, but that’s what great coaches do.” – Ronnie Lott, NFL Hall of Fame Defensive Back