Center for Transcranial

Magnetic Stimulation
Clinic (CFTMS)
Cejamil S. Calderon

Hahn School of Nursing and Health Sciences, University of San Diego

HCIN 556- Health Care Leadership, Values, and Social Justice

Professor Josh Wymer

 Transcranial Magnetic Stimulation(TMS)

(YouTube, 2019, December 4)

 TMS Needs/problems to be addressed
• The CFTMS Clinic is greatly needed to people that suffer from major depression, Neuropathic Pain (NP),
Acute Pain, Primary Headache Disorders, and Posttraumatic Brain Injury Related Headaches (PTBI-HA).
• According to the Center for Disease (CDC) Chronic pain is one of the most common reasons adults seek
medical care, has been linked to anxiety and depression, and poor perceived health or reduced quality of
life.
• Approximately 50 million U.S. adults have chronic pain
• Target population that would veteran population in San Diego County.
• According to the VHA among veterans who died by suicide in 2017, 58.7% had a diagnosed mental health
or substance use disorder in 2017
• Veteran suicide does not just impact the victim but their family members, friends and acquittances.
• The conditions of chronic pain and depression have been separately addressed in countless scholarly
research and, it is clinically documented that there are significant neurobiological correlations between
chronic pain and major depressive disorder
• There is an overall need for TMS to be included to the veterans’ treatment plan that would meet those
mental health and pain criteria.
 Goals/Objectives for the CFTMS Clinic

Three major goals and objectives for the CFTMS clinic would be the following:

1. Utilize Transcranial Magnetic Stimulation (TMS) as a treatment to reduce

depression, anxiety, chronic/acute pain, and head disorders among the veteran

community.

2. Utilize TMS as a treatment to reduce suicide rates within the veteran community

3. Implement a CFTMS clinic VA San Diego

CFTMS Clinic Procedures/Scope of Implementation
 CFTMS Clinic Work flow Diagram
Cejamil Calderon

TMS Tech
Patient checks into TMS Tech brings TMS Tech TMS Tech Apply
applies TMS Coil
TMS Clinic with front patient into Instructs patient Standard TMS
over patients
desk administrator procedure room into exam table Tracker to patient
scalp

CFTMS
Workflow TMS detaches
standard TMS
TMS Tech turns
Patient undergoes
TMS treatment
Pain
Anesthesiologist
Pain
Anesthesiologist
Conducts a
off machine and from anywhere to activates TMS timeout and

Analysis for Tracker and coil

5-15 minutes machine verifies patient
information

Technician

Pain
Patient checks out of User Group:
Anesthesiaologist TMS Tech brings
address any concerns patient back to front
TMS Clinic with front • Pain Anesthesiologist
or questions from desk
desk • TMS Technician
then patient
Administrator • Administrator/
Scheduler
 Leadership
Traits Examples
• Took a democratic leadership
approach to all task.
• I had delegated the pamphlet design
to my colleague since he had a strong
background in digital marketing.
• I had delegated the submission of the
mass production to the reproduction
department to my other team
member because she was familiar
with the submission process and had
built a rapport with the reproduction
department staff.
• Preemptively knew the strengths and
weaknesses of my team .
• Used the knowledge to execute the
task.
 CFTMS Team Climate

• Taking a democratic leadership style also showed a caring and purposeful

work culture to achieve the CFTMS pamphlet task.
• The CFTMS Clinic staff had built cohesiveness by having consistent
communication.
• Daily Morning meetings to discuss daily tasks and goals
• Monthly Staff meetings to discuss about progress of the clinic

• Giving constructive feedback to my teammates daily to give my them

reassurance
• Addressing any issues with coordination with the Health Administration
Services

• Expecting excellence from my teammates

• Providing the structures and the mission of the CFTMS
• Reminding them we do this for the Veterans Well-being
 Diversity Awareness and Inclusion
• Team consists of multicultural and diverse background
• Filipino, Irish, and Korean
• Male and Female
• Under 30 and over 40
• Each member of my team contributed their valuable knowledge and
experience to executing the implementation of the CFTMS Clinic
• We made sure that we kept each other safe, involved, engaged, respected,
valued, influential, authentic and sincere.
 Conflict Management and Resolution
Conflict Resolution
• Communication with HAS and looking deep into
• Appointment template issues and not being the conflict:
designed and implemented in a timely manner
• Technical Error
• 2 months from the initial request for the
appointment templets • No individual to blame (separate the problem from
the person)
• The HAS supervisor was apologetic and
compromised with our team to get the
appointment templates rushed and activated
(Mutual gains)
 Ethics, Values and Social Justice Principles
• As a leader I exhibited the six pillars of character amongst my core team,
external and internal personnel.
• Trustworthiness
• Respect
• Responsibility
• Fairness
• Caring
• Citizenship
 Ethics, Values and Social Justice Principles

• https://www.youtube.com/watch?v=2zXvWqc4vAE

(10newsvideos, The local VA has a new way to combat chronic headaches 2017)
 Self-Reflection
• Grown my professional and leadership skills
• Being a leader and overall being a person that your peers can look up to has put a
different outlook on my professional life.
• Being a leader is not an easy position
• You must create anon toxic work culture,
• Having a constructive climate amongst your staff
• Have amazing conflict resolution skills
• Overall be a competent individual that knows the current work environment and
knowing your organization inside and out. Be Sincere!
• For me to improve as a leader I must take on my projects in my work environment,
even though it is uncomfortable and unfamiliar.
• I must expose myself to these situations in order to improve my skills, ethics and
values.
• I look forward to my journey to hopefully become a hospital executive and lead my
peers that I sincerely care about.
 Lessons Learned
• From a leadership perspective I have learned that leaders must
have a democratic approach to any issues and have a lot of
patience when coordinating with external entities (HAS, Vendors,
other departments).
• As a leader one thing that I can improve upon is my internal
patience for things to be done.
• I have the mentality of getting the job done as quickly and as
accurately as possible, but there will always be issues or slight
hiccups.
• Overall, it’s been an insightful experience and this project has
helped me grow as a future healthcare leader.
 References
• 10newsvideos. (2017, December 13). The local VA has a new way to combat chronic headaches. YouTube.
https://www.youtube.com/watch?v=2zXvWqc4vAE&list=PLO2LCF1O7jOM-WSq2iV4jV3_Vei4JXm54.
• Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., Kerns, R., Von Korff, M., Porter, L., Helmick, C. (2019, September
16). Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults - United States, 2016. Centers for Disease Control and
Prevention. https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm
• Leung, A., Shirvalkar, P., Chen, R., Kuluva, J., Vaninetti, M., Bermudes, R., Poree, L., Wassermann, E., Kopell, B., Levy, R. (2020).
Transcranial Magnetic Stimulation for Pain, Headache, and Comorbid Depression: INS‐NANS Expert Consensus Panel Review and
Recommendation. Neuromodulation: Technology at the Neural Interface, 23(3), 267–290. https://doi.org/10.1111/ner.13094
• Northouse, P. G. (2019). Introduction to Leadership (5th Edition). SAGE Publications, Inc. (US).
https://bookshelf.vitalsource.com/books/9781544351629
• Rizvi, S., & Khan, A. M. (2019, May 23). Use of Transcranial Magnetic Stimulation for Depression.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6649915/
• U.S. Department of Veterans Affairs. (2019). (rep.). 2019 National Veteran Suicide Prevention Annual Report. Retrieved from
https://www.mentalhealth.va.gov/suicide_prevention/index.asp
• U.S. Department of Veterans Affairs. (2019, August 20). VA’s Implementation of the Veterans Information Systems and Technology
Architecture Scheduling Enhancement Project Near Completion. U.S DEPARTMENT OF VETERANS AFFAIRS.
https://www.va.gov/oig/pubs/VAOIG-16-03597-171.pdf.
• World Health Organization. (2020, January). Depression. World Health Organization. https://www.who.int/news-room/fact-
sheets/detail/depression
• YouTube. (2019, December 4). Transcranial magnetic stimulation (tms) overview. YouTube.
https://www.youtube.com/watch?v=_ttfgMYU96k.