In April, WHI Communications Committee Co-Chair, Liz Conlin, spoke with Jack Billi, Professor of Internal Medicine at Michigan Medicine and Steering Committee member of the WHI, to discuss his early interest in becoming a doctor, the biggest health challenges we face, and some of his proudest accomplishments over a long and storied career in the medicine, quality improvement, and community-based work.
Q. What originally inspired your passion for health care?
Billi. My mother worked for a Manhattan physician for most of her career. She would bring me into her office when I was a little kid. Back then, she did everything in the office – EKGs, blood drawing, x-rays. I was fascinated by the office practice, the smell of the chemicals, the microscope. That was quite an indoctrination for me.
I can also remember my father talking about how good it would be if I became a physician. He was an accountant and had nothing to do with healthcare. But I think he watched my mother’s life working with physicians and thought that would be a good career for me.
My whole life, I never actually wanted to be anything else but a physician. And I think it ended up combining many of my interests. I was really interested in sciences, problem solving, and always enjoyed talking to people.
Q. What health challenges or gaps keep you up at night?
Billi. First and foremost, the biggest challenge now is the surge in COVID-19 cases in Michigan. It has spiked because of the U.K. variant being so widespread in the state; the understandable desire to get children back into schools so we don’t disadvantage their learning or safety further; and, because of challenges around vaccine hesitancy and reluctance.
I am confident that the vaccine is going to win in the end. But how soon and how long will it be? And how can we get more people vaccinated and practicing safe habits until then?
My second concern, which is related, is the issue of health equity. We deal with this a lot in the Washtenaw Health Initiative (WHI).
Health outcomes are so dramatically different by race, by gender. We have issues with housing and food insecurity, mental health and substance use disorder access, and finding employment for those in need. We also have an unstable housing problem within one of the wealthiest counties in the state.
The WHI is such a great venue for us to address some of those issues, because they’re not just medical. The health care system has their contribution, but so do all of the other community support systems. The WHI brings us all together to work on these issues
Q. What are your proudest professional accomplishments?
Billi. I think there’s no question that my proudest accomplishment is 44 years taking care of a group of patients in the same clinic I started in 1977. Before Taubman was built in the mid-1980s, I worked in this clinic and I used to direct it.
Some of my patients have been with me for 40 years. And some of them for multiple generations. I’m very proud of delivering their care for all those years. Some of them were my friends and became my patients; the rest of them were patients and became my friends. That’s been a long journey.
The second thing I’m proudest of is bringing lean thinking and scientific problem solving to workers at Michigan Medicine – to help them find and fix root causes of problems every day. Over my career, I transitioned from being a doctor of individual patients to being a doctor of “sick” health systems.
There’s nothing but problems in the way healthcare is delivered – frustrated workers, patients who are delayed or don’t know what to do, the wrong forms or incorrect information obtained multiple times – things like that. Healthcare is full of brilliant, compassionate people, but broken processes and mediocre results.
And, so, I decided that maybe I could spend my time teaching people to fix all those broken processes. The last 15 years or so, that’s what I’ve done – trying to help frontline healthcare workers, who know the problems and what their causes are, become empowered and take the initiative to solve them. We’re still in our infancy, but I’m proud of moving that model forward at Michigan Medicine.
Q. Why did you join the Washtenaw Health Initiative, and how has it been helpful?
Billi. All of those problems [previously mentioned] are part of why I’m committed to the Washtenaw Health Initiative. To try to make the connections between the healthcare system and the social service organizations who are taking on those really intractable problems in our community.
We’ve realized the limitations of the medical model for solving holistic problems. For example, if someone says “this person doesn’t have to stay in the hospital, they can get home IV antibiotics.” Well, if they are living under the Broadway Bridge, that isn’t going to work.
I know from experience, coalition work is messy. It’s not neat and tidy. Sometimes people can’t make the meetings. You realize you don’t have an important stakeholder at the table and you have to go and find them. They’re busy solving their organization’s problems. But I’m flexible for that. I have a high tolerance for messiness.
We’ve been fortunate to have such good people and organizations in this county, like our health department. But they can’t do it alone. They don’t have enough resources. They need partnerships with the healthcare providers and the social service agencies. The Washtenaw Health Initiative is one of the few places where we all come together.
I’m proud to contribute whatever I can to help make those connections between the medical care, public health and social determinant systems of care. I brought my trainees to State Innovation Model (SIM) meetings, Corner Health Center board meetings, and the Washtenaw Health Initiative, so that they see that there is more to life than being in the operating room or a clinic. They have to learn about all of these partners in the community in order to solve problems that only the community can solve.
Q. Who or what inspires you to continue working for improved health in our county?
Billi. I was the Board Chair for the Corner Health Center for the past two years and I’ll stay on their board for the next few years. Their work is similar to the WHI, but for those aged 12-25 and their children. They’re combining medical services, mental health, substance use, gender-related services, reproductive health, food insecurity, as well as teaching youth leadership skills.
A homeless kid with a backpack in need of a pair of boots will show up at Corner Health. And they’ll wrap around them and try to figure out how to get them stabilized and connected with other community agencies.
I’ll keep working on that because that inspires me every day – the clinicians who work with that population, the people who are doing that direct, frontline work, and the clients.
Jack is in the process of retiring from Michigan Medicine but plans to continue serving on the Corner Health Center Board of Directors, the WHI Steering Committee and other organizations he has been involved with.