Sutter Health

Department Chair

Site Lead and Psychiatrist

Self-Management of Depression

Depression is a complex illness, which presents in a myriad of ways and almost 60-70% people treated with antidepressants fail to achieve a symptom-free state when first treated with these medications. The treatment of depression cannot be pigeon-holed into one or two kinds of treatment modalities. Self-management is increasingly becoming the standard of care in people with long-standing medical conditions. Self-management puts one in the driver’s seat with regards to making choices regarding one’s health. However, treatment of depression has lagged behind in incorporating the concept of self-management with the most popular self-help paradigm on depression focusing mostly on cognitive-behavioral approaches. Self-management goes beyond the narrow perspective of self-help and addresses life style changes, social relationships, communication, problem-solving, and also includes elements of wellness and recovery.

Author and Blogger

Kaiser Permanente

Senior Physician

County of Humboldt

Medical Director

ProMedica

UPMC

Resident Physician

Central Institute of Psychiatry

Mahatma Gandhi Institute of Medical Sciences

House Officer

Harpreet S. Duggal, MD, FAPA, is a board-certified psychiatrist and an international expert on self-management of depression. He has practiced psychotherapy and psychopharmacology for over 20 years and has authored over one hundred articles in scientific journals. He is also a bestselling author of books on depression. Check out his blog on evidence-based strategies for self-management of depression and lifestyle psychiatry. The content on this platform or other social media sites should not be construed as treatment advice or a substitute for it.

Harpreet Duggal, MD, FAPA

Indian Health Service

I have been a nurse consultant-improvement advisor for the Improving Patient Care (IPC), Division of Improvement and Innovation, Office of Quality since its inception in December 2018. I previously worked with the Office of Clinical and Preventive Services (OCPS). I have been with the IHS since 2014. I collaborate with Office of Quality team members in analyzing and evaluating clinical and administrative processes that improve the overall effectiveness of the IHS. I also serve as a mentor, coaching clinical staff and none clinical team members on improvement tools and methodologies for improving patient outcomes.

Nurse Consultant-Improvement Advisor MBA/MHSA

779th Medical Group

Lead three other Disease Managers.  Planned and managed 10 different programs to care for over 12K beneficiary. Lead planner; coordinated with Patient Center Medical Home teams educated over 3,000 patients on Lifestyle Modifications and managed to save $200,000 dollars on recaptured appointments.  Followed up with over 500 patients diagnosed with Diabetes mellitus Type II and over 300 with either patients diagnosed with hypertension, dyslipidemia and/or a combination of co-morbid conditions.  Healthcare Effectiveness Data and Information Set (HEDIS) metrics improved over 10%.  As clinic practice guideline subject matter expert developed the annual training plan for the medical facility. Identified over 250 diabetic patients delinquent on the HEDIS control metrics maximized evidence based care; raised metrics by 30%. Subject Matter Expert (SME) on (HEDIS) and National Committee for Quality Assurance (NCQA). 

Job Description: Key Duties, Tasks and Responsibilities:

- Planned and managed programs covering over 12K chronically ill patients conducts and coordinates 5.3K outpatient encounters 
- Utilized Military Healthcare Systems Population Health Portal and other databases to identify disease management patients
- Planned, directed and executed population health-based initiatives to achieve Air Force's goal of building healthy communities
- Served as clinical practice guidelines SME and resource for the Family Practice Clinic and all other hospital staff.
- Develop and implement individual and group disease management strategy and activities

Additional Duties:
Interim Health Care Integrator, Alternate Director of Medical Management Team, Program Manager of the Diabetes Self Management American Diabetes Education Recognition Program for the medical facility and Medical Management Team Cost Center Manager

- "Maximized evidence based care, improved metrics by 30%, facilities compliance with standards propelled 12%; providing $197,000 in savings for the facility"

Disease Manager

Responsibilities

- Planned, directed and provided specialized anti-couagulaion therapy for over 190 patients
- Independently implemented protocols for high risk patients; forecasted access needs and provided patients and family education
- Directly supervised medical technicians. Oversaw training requirements for four nurses and paraprofessional personnel 

- "Ace manager and coordinated care for 190 patients, 800 annual appointments and managed to save over 2,000 physicians/providers over equating to $500,000 in yearly workload cost. 
- "Transitioned 25 patients to home monitoring program. Increased appointments availability by 12% saved $5,000".
- " Spearheaded integration of pharmacy staff into the clinic, improving access to care 25% and adding $125.00 of care value"

Job Description: Key Duties, Tasks and Responsibilities:

- Planned, directed and provided specialized anticoagulation therapy in a nurse-managed clinic for over 190 patients

Nurse Manager-Anti-Coagulation Clinic

USCENTCOM COMMAND SURGEON'S OFFICE

Job Description: Key Duties, Tasks and Responsibilities:
Senior Medical staff advisor to command surgeon.  Lead the CENTCOM Health Engagement Program. Planned, directed, and oversaw joint/combined contingency health support for over 260K US Coalition Forces in 27 nations to include the Horn of Africa, Southwest and Central Asia. Synchronized and de-conflicted medical support by integrating coalition, DoD Health Affairs, Joint Staff and service components actions and achieving unity of effort and operational synergy. Advise the Command Surgeon on the Area of Operation political, economic, cultural and medical environment.  
-Additional Duty:
Managed the Joint Theater Trauma System (JTTS) program for the Command. 

- Streamed line process for JTTS; staffing and training improved by 40% and readiness 30% 
- First tier officer, unbeatable combination of initiative and management set the standard for health engagement in CENTCOM.  Expanded boundaries of engagements and produced results.  
- Shaped DoD/DoS bioengagement program for Afghanistan & Pakistan; synchronized CTR, BEP & CENTCOM interests
- Developed 1st Command Health engagement website, improved synchronization
- Created 1st Command health engagement strategy for Central Asia, garnered and managed  the execution of $2.5M in support of 15 activities.    
- Strategist behind Pakistan health engagement, developed first responder and nurse nursing program
- Developed and executed the 1st senior level visit with Uzbekistan in 3+ years, lead open dialog and opportunity for partnership 
- Identified opportunity and lead plan for the development and construction of health facility in for Kyrgyzstan ministry of defense medical service

International Health Specialist

United States Air Force

Job Description: Key Duties, Tasks and Responsibilities:

- Directed clinical support of gastroenterology and hematology operations for the second largest Air Force Medical Center
- Directly supervised two gastroenterology nurses and six technicians and oversaw the scheduling of over 2,700 procedures.
- Oversaw all patient and family education.
- Collaborate with Element (section) chief to establish unit policies.
- Managed $250 thousand dollars annual supply budget and $1 million dollars in medical equipment.
- Provided one-on-one monitoring and intravenous sedation. 

ADDITIONAL DUTIES:

- Team member-Delayed team of the Contingency Response Team  
- Infection Control Monitor

- "Process owner for gastroenterolgy clinic; accepted as the "best Practice" at the Air Force-wide clearinghouse!"
- "Restructured clinic's layout and booking scheduling increasing productivity by 30% and averting $2,700 dollars on referral cost"
- "Lead the merger of adult and pediatrics gastroenterolgy clinics increased clinic's productivity by 30%" 
- "Instrumental in organizing colon cancer group teaching visits for 576 new patients; saved $38 thousands in out of the medical facility referral and avoided $60 thousands in procedures cost" 
- "Hand picked as Advanced Cardiac Life Support Instructor; instructed over 150 staff members and saved $22,000 thousands dollars "
- "Lead the clinic in preparation for Joint Commission on Accreditation of Healthcare Organization 's inspection witch directly contributed to the medical center's accreditation" 
- "Great and enthusiastic Nurse Manager; focused team leader, nursing and leadership skills set him apart; accolades from peers and senior staff"
- "Epitome of of professionalism and admirable leader" 
- "Selected as Chief Nurse at Expeditionary Medical Support Training Support training exercise, praised by by senior cadre in charge"
- "Participated in the International Health Specialists Program and translated for four clinics"

Nurse Manager-Gastroenterology Clinic

Job Description: Key Duties, Tasks and Responsibilities: 

- 17 bed Medical, Surgical, Cardiothoracic Vascular, Coronary and Pediatric Intensive Care Unit.
- Coordinated with healthcare providers, nursing units, ancillary and outside (civilian) agencies to ensure safe, effective and individualized patient care.
- Provided emotional and educational support to patients and their families.
- Operated life support and monitoring equipment worth $2 million dollars.
- Participated on flight (nursing units) risk management, staff orientation and staff development, quality improvement and medical readiness (contingency response) activities.

ADDITIONAL DUTIES:

- Member of Emergency Response Team and Contingency Response Team


- "Enthusiastic and excellent officer and clinician; complex problem solver; ready for Nurse manager position and a must for intermediate military education"

- "Self starter; amazing transition to critical care..quickly assumed leadership role in new nursing specialty"

- "Essential to Joint Commission on Accreditation of Healthcare Organization 's inspection-- Clarified and enforced national guidelines; performed weekly oversight and surveillance and resolve all problems areas"

- " Distinguished specialist; the only Critical Care Nurse with a medical-surgical nurse national certification; led the way!"

ICU nurse

- Assessed , planned, evaluated and implemented nursing care activities for over 1,000 patients annually on a 6 bed inpatient, 6-bed ambulatory procedure unit (APU) which serviced 14 medical specialties from infants to pediatrics.

- ADDITIONAL DUTY: Hospital Nursing Workload Management Monitor/Report. ACLS & TNCC Instructor. 

- "Selected to become Pediatric Advance Cardiac Life Support Instructor due to consummated nursing ability. 

-"A rising star that outshines peers; positive and eager, seizes new opportunity, outperforms colleagues"

Medical-Surgical Clinical Nurse

Job Description: Key Duties, Tasks and Responsibilities:

- Provided nursing care for medical, surgical pediatric and geriatric patients averaging 50 patients a month.

- Augmented emergency room nursing care during crisis situations. 

- Supervised seven medical technicians 

- ADDITIONAL DUITES:
     - Quality Monitor and Unit Scheduler   

- "Spearheaded education improvements; training records 100 % reviewed and up to date, personnel 100% competent"

- "Review and up date unit instructions- during Joint Commission on Accreditation of Healthcare Organizations survey the group awarded "Accreditation with Commendation"!

-"Dedicated nurse manager; primed for nurse manager at larger facility".

Unit Mission Description:


Job Description: Key Duties, Tasks and Responsibilities: 

- Direct care giver to cardiology, pediatric, dental, hematology,/oncology, nephrology, and orthopedic patients on a 28- Bed outpatient observation unit.
- Assesses and prioritize patient's needs based upon severity of illness or injury.
- Monitors cardiac rhythms, oxygenation and vascular status of adults and pediatric patients undergoing diagnostic procedures.
- Administers medications and intravenous fluids. 
- Operates life-sustaining equipment and performs life saving measures. 
- Coordinates patient care with physicians and ancillary healthcare personnel.
- Provides health education to patients and families. 
- Supervises two-five medical technicians. 

Additional duties:  Infection Control Officer.  ACLS Instructor 

Hospital PICC Team member--Part of selected group of nurse strained to insert and troubleshoot central catheters for the medical center 

- "Completed Advanced Cardiac Life Support, Pediatric Advanced Life Support and Pediatric Emergency Response quickly--developed as one of our  cardiology specialist "

- "Strong Leader; great role model; talented educator; helped develop practice guide lines for care of post-operative patients"

23 Hour Observation--Medical - Surgical Clinical Nurse

Job Description/Key Duties, Tasks and Responsibilities: 

- Assess, plans and executes nursing care for 47 patients who have undergone complex surgical procedures. 
- Implements diagnostics and therapeutic orders prescribed by a health care provider. Administers medications and operates life sustaining equipment.
- Documents care, reports patient progress and maintains patient records.  
- Participates in medical technician training and in unit management; assigns and supervises three medical technicians.
- Shift leader on weekends and night shifts.  

Additional Duties: Infection Control Officer

Clinical Nurse-Medical-Surgical

I have been a nurse consultant/improvement advisor for the Improving Patient Care (IPC), Division of Improvement and Innovation, Office of Quality since its inception in December 2018. I previously worked with the Office of Clinical and Preventive Services (OCPS). I have been with the IHS since 2014. I collaborate with Office of Quality team members in analyzing and evaluating clinical and administrative processes that improve the overall effectiveness of the IHS. I also serve as a mentor, coaching clinical staff and none clinical team members on improvement tools and methodologies for improving patient outcomes.

I have completed multiple trainings in the area of Safety & Quality to including Institute for Healthcare Improvement(IHI) Improvement Coach, IHI Breakthrough Series College, TeamSTEPPS Master Training Course, Core Strengths Facilitator Certification, Improvement Advisor, PKP Inc. and the Institute for Health Improvement (IHI) Improvement Advisor (IA) Training. 

I served 20 years as an Air Force Nurse Corps officer. In addition to being a staff officer for US Central Command, I serviced has a clinical nurse focus on medical, surgical, ER, ICU and primary care. I also have been a nurse manager in gastroenterology and anticoagulation clinics and is a specialist in international health. Throughout my years as a nurse, I played key roles on numerous process-improvement projects. I retired from active duty service at Joint Base Andrews in Prince George's County, MD, where he served in the medical director's office as lead disease manager/populations’ health.

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The Battle

Harpreet Duggal, MD, FAPA

Benjamin Feliciano

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