Thank you for your thoughtful introduction.
It is my pleasure to be here in Philadelphia not only as a participant in the national meeting of the American Chemical Society, but also to witness my good friend and colleague receive the 2008 Paul J. Flory Educational Award by the Polymer Chemistry Division.
Indeed, Dr. Frank Kelley, who is Dean Emeritus of The University of Akron's College of Polymer Science and Polymer Engineering and Professor Emeritus of Polymer Science, epitomizes the requirements of this coveted award as a promoter of polymer education.
He was chief administrator for the largest academic polymer program in the United States. Since 2000, The University of Akron program has been ranked as #2 in the nation by U.S. News and World Report.
Dr. Kelley has been widely published and received even wider recognition for his academic work.
At the outset of my presentation, let me provide a bit of context. I will do this by sharing some perspectives on our innovation ecosystem and related data. This will give a set of reference points for the U.S., the funders and performers of R&D and the place of colleges and universities in this domain.
Then, I will turn to suggestions and examples that I hope you may find useful in your deliberations as all of us seek to "connect the dots . . ." of the innovation ecosystem.
Above all, I intend to be somewhat provocative, as we need to be candid about these issues and challenge ourselves to innovate on innovation.
I have three basic starting points for the major themes of my remarks:
Erich Bloch, a former director of the National Science Foundation, commented that those of us in academic science who are faced with these forces of change seem to be caught in a sort of scientific "midlife crisis" because 50 years of doing research one way has fostered the belief that it cannot be done another way.
Indeed, academics have not come to the opportunity of innovation easily nor quickly. As recently as the 1990s, the majority of university leaders did not think that the academy should even be involved in anything related to commercialization.
Universities did not accept or take responsibility for any aspect of economic development. Some even went so far as to consider any partnership with industry a sort of Faustian bargain, believing that such relationships forced universities and faculty to sell their souls and corrupt their noble purposes in exchange for worldly riches.
Other universities, if not to that extreme, simply were so conservative that they succumbed to analysis paralysis. It made them anxious just to think about engaging with industry.
In contrast to the conceptual models of old, and much to the chagrin of many of my academic colleagues, innovation does not happen in isolation, it happens within what many are calling an innovation ecosystem - that system of loosely inter-connected elements that has enabled our society to make new discoveries, capture their value in the marketplace, enhance productivity and increase our standard of living.
To be sure, the innovation ecosystem is a complex and interactive
one. It is shaped by the funds
available to support research activities, by capabilities of the scientists and
engineers who conduct research, and by the settings in which that research is
conducted - that is, its "infrastructure" - which is increasingly
global and devoid of boundaries.
The innovation ecosystem also is shaped by prevailing public attitudes about the importance and usefulness of research in the broader context of societal pressures and economic opportunity.
Quite simply, the work we do at colleges and universities and in industry is not conducted in splendid isolation - rather, it is impacted by complex regulatory and support environments which, in turn, interact with financial opportunities and challenges across the world in an ever-evolving model.
Indeed, a shortcoming in any piece of the ecosystem could be the debilitating disconnects that undermine our capacity for commercialization and economic growth.
It is our task to find ways to optimize the positive interactions, to minimize or eliminate the negative ones and to seek ways in which we can further enhance the process by whatever means we can.
One such disconnect is between industry and the academy. There is much to be gained by stopping the finger-pointing between industry and universities and learning each other's cultures better.
I want to focus on some data by which we can describe the size and distribution of the R&D marketplace. Globally, the R&D marketplace is now approaching a trillion dollars - which is a sizable industry by any standard.
Presently about 75% of global R&D is done by the 30 OECD countries, of which 83% is dominated by only 7 countries, including 45% (approximately $340 billion) by the U.S. alone.
However, I hasten to add that the U.S. share of the world's R&D has been declining, just as other dimensions of U.S. dominance in science and engineering:
Within the U.S., 62% of R&D expenditures ($224 billion) are derived from industry, 30% ($94 billion) from the federal government and 7% ($23 billion) from foundations, states and our own research universities.
In terms of traditional R&D terminology, the U.S. performs about $60 billion of basic research (18%), $75 billion of applied research (22%) and $204 billion of development (60%).
Colleges and universities perform nearly three-fourths of the country's basic research, but only a nominal percentage of development. Industry alone performs about $184 billion of the nation's $204 billion of development.
Within the U.S., academic performers garnered about $47 billion, or 14% of the $340-billion U.S. total, in 2006. Of special concern is the fact that industry-supported university research has dropped to below 5% of all university research.
Although, in 1995, 875 of 4314 degree-granting institutions participated in the U.S. research economy, the top 100 captured 80% of all available funds. In general, universities are largely disconnected from industry support and this explains why we remain so far apart on many issues.
This discussion of innovation economies leads naturally to some general comments on globalization and the emergence of open innovation. The speed of globalization and the sourcing of new technology from any person anywhere in the world are rapidly transforming science and technology.
The Wall Street Journal put it this way: "Open market innovation works for the same reason that free trade works: It enables the laws of comparative advantage to govern the allocation of R&D resources. In essence, a company gets lower cost, higher quality ideas from the best sources in the world, allowing it to refocus its own innovation resources where it has clear competitive advantages. With the right people in place to recognize beneficial trade-offs, the company is able to ‘export' ideas that other businesses could put to better use."
(Darrel Rigby and Christopher Zook, Manager's Column, The Wall Street Journal, December 3, 2002, p. B-2)
Another manifestation of the impact of globalization on science and technology is the growing number of cross-country alliances, which have increased dramatically in the last two decades.
In the United States, about 800 formal research joint ventures were formally registered between 1985 and 1999. They involved about 4,200 organizations, nearly 90% of them industrial firms. Thirty percent were foreign-owned participants, indicating a broad interest in this form of activity. Universities were important partners in many of these research joint ventures. Between 1985 and 1999, they participated in 16%of them.
(Ibid, pp. O-14-15)
I think that the U.S. can learn from what many other countries are doing, and I also believe that some U.S. states hold lessons for other countries and for the U.S. itself.
For example, although the U.S. federal government has a large and diverse framework for considering R&D policy and funding, most states lack a framework for considering R&D activities, or for integrating R&D at the state level with programs at the federal level.
Notably, a 1995 report of the State-Federal Technology Partnership Task Force chaired by the Governors of Ohio and Pennsylvania (the Celeste-Thornburg Report, as it has come to be known) called attention to this disjunction and offered policy recommendation to remedy it.
PCAST has wanted to
address this gap in the U.S. innovation ecosystem and focused its 2004
Cleveland meeting on topics related to what different states are doing to
better deploy its R&D resources.
I think it is important for us to note that other countries are effectively solving policy disjunctions within their national boundaries and that even the new European Union is going beyond the U.S. in integrating its science and technology policies and strategies across its individual "states."
What is more, the traditional benchmarking of one state against another is no longer sufficient. Regional clusters of innovation, as studied by the Council on Competitiveness, must today be benchmarked not against other states, but also against other world regions that support similar competitive industries.Having thus provided a context and background, let me now turn to a series of specific topics . . . elements and pieces of the innovation ecosystem that need to be connected, enhanced or optimized. The biggest challenge we face is ourselves - our human partiality and the habits we have cultivated over many generations.
I will begin with the challenge of the two cultures, business and industry and ask (at the risk of mixing metaphors) "where is Copernicus when you need him?"
Human partiality notwithstanding, the first thing that the concept of an innovation ecosystem tells us is that neither industry nor academia is exclusively central to innovation.
We need a "Copernicus" to tell us that the innovation economy's "sun" does not revolve around either one of us or even both of us uniquely. Rather, and to return to the ecosystem metaphor, globalization and the new economy are increasingly demanding that we move towards one another - and the sooner we realize this, cease the finger-pointing and stop fighting the inevitable, the sooner we will see much needed convergent evolution.
Indeed, ad hominem attacks and less than well-informed suspicions or accusations only serve to distance and antagonize. For example, I know of no evidence to support notions that industry is any better than universities at technology transfer.
Although many universities are still new to it, some such as MIT, Purdue and Wisconsin are highly effective and seasoned veterans. Others, such as Akron, have been nationally recognized as exemplars and are pioneering in new, innovative directions.
Many companies, on the other hand, have large stockpiles of patents which they have accumulated for various reasons - perhaps defensively, perhaps because they simply didn't know what do with them or because they represented non-core technologies in which they had neither the experience nor inclination to commercialize.
What is more, a telling reversal of fortunes is underway as some universities like Akron are now assisting industry in commercializing their shelved, non-core technology patents. Imagine that!
We can learn from each other. Schooling ourselves, as universities, in the language of business would be a good start. Understanding the full dimensions of Bayh-Dole, which many universities and industries misinterpret, is a necessity.
Adapting our university structures to more closely address applied and business issues, as Arizona State University and The University of Akron are doing, will also help bridge the divide.
And I am encouraged by the fact that the University Industry Demonstration Partnership has been formed by a consortium of companies and universities to identify solutions and models that will improve our mutual appreciation and support the essential partnerships that are being formed.
Recognizing that the growth of federal R&D investments has slowed and may be declining as a percentage of GDP, and that industry has reduced the number and size of its R&D activities, the President's Council of Advisors on Science and Technology (PCAST) has undertaken a study of how the federal government can facilitate and promote successful innovation strategies.
Not surprisingly, my PCAST colleagues agree that engagement between industry and universities is increasingly important for innovation and that additional government funding and personnel should now be put in place to support emerging networks of collaboration and reward those who find solutions to regional problems.
Of course CRADA's, SBIR's, STTR's and a host of other collaborative programs and tax credits that support R&D and technology transfer have, in the experience of nearly all PCAST members, done much to promote innovation by building an appropriate infrastructure, but new tools are needed.
Of course, part of the reason that universities and industry have not come together easily derives from the fact that in many disciplines the time between discovery and innovation was previously often measured in decades - with notable exceptions to this disconnect in the fields of agriculture and engineering, both of which (thanks to the Land Grant Act of 1862 and the Hatch Act) had experiment and extension stations in each state.
These experiment and extension stations actively interacted with industry to solve problems in agriculture and industry, increasing efficiency for farmers and industry through the process of innovation.
Other disciplines witnessed a major paradigm change with the information technology and biotech revolutions when almost any new discovery or improvement was seen by corporate sectors as an opportunity to translate to the asset ledger in an intellectual property form or better yet monetized or otherwise turned into a revenue stream.
Today, as business clamors for innovation in all fields, we neglect to implement collaborative models, similar to those used by the experiment stations, with proven value.
As we discussed before, universities perform the lion's share of the nation's basic research, but very little applied or development work. We also saw how little university research, less than 5%, is supported by industry.
Clearly, if universities account for only a fractional percentage of development and industry is responsible for 90% of development, the two naturally must work together for university-developed technology to be commercialized.
Conversely, with governmental organizations, which perform less than 10% of development (and most of that is on military technology), providing 63% of the funds going to support university research, government is in an excellent position to serve as matchmaker by structuring appropriate incentives for both parties. I think there is a lot that we can do in this space.
Universities, however, are not the only group in need of logical innovation partners. IBM, Bell Laboratories and Xerox all have significantly reduced the size of their core research facilities.
Others, like Intel, have established
research centers at Carnegie Mellon, University of California Berkeley and
University of Seattle Washington.
This clearly points to an increased demand for external research capabilities, but I believe that in future years universities will again face increasing competition to fill that void, both from within and outside of their ranks.
Not only do universities
and industry seem to need each other's support, but also their work together
creates connections that streamline the technology transfer process and help us
to keep up with the rapid pace of development. That is why, Don Alstead, the
former Chairman of the Lord Corporation, kept an office or made regular visits
to many universities - so he could be the first to benefit from the linkages.
Among my industrial colleagues, an important practice for optimizing innovation is that of linking technical needs to discovery and innovation in real time. Thus, in order to optimize our national innovation ecosystem, real-time connections between universities and industry seems a logical way to improve the speed with which we create, assess, apply and distribute new technology.
Proctor & Gamble, Nike, Innocentive and the X-Prize, among others, have created a new reward-based innovation model - Open Innovation - that has been getting a lot of attention.
Open Innovation reaches inventors globally and challenges to solve specific problems with the promise of large cash rewards for those who are successful. For the funder of Open Innovation, the risk is minimal in that payment is made only for successful results. Moreover, the X-Prize Foundation has found that often those who aspire to earn the prize leverage resources far in excess of the prize money.
Quite simply, the process of Open Innovation, a model for which The University of Akron Research Foundation hosts semi-annual events, tells us that universities, major industry and small entrepreneurial companies often must look outside their own organizations to find solutions to problems.
Even the venerable Encyclopedia Britannica, perhaps succumbing to the pressures of Wikipedia, has begun to openly invite corrections and contributions to its entries.
Although the Encyclopedia's editors retain the prerogative to accept or reject any of suggested changes, this indicates an important shift in that corporation's cultural mores. An entity that began in the 1700s has embraced a form of "open innovation," what the computer generation refers to as Web 2.0. Such change is surely reason to wonder if academia is willing to embrace similar behavior. Are U.S. universities bold enough to create a 2.0 campus culture of innovation, centered on externally focused research and open collaboration, and grounded in the needs of our consumers and constituents?
I think that any person or entity that professes to have and distribute knowledge will need to embrace a form of open innovation to remain credible and current.
This is an interesting reality for many in higher education, who value "academic freedom" and the free and open sharing of information (including peer review), yet who in many ways are themselves not adept at seeking or accepting input, regardless of the source, or of making appropriate adjustments in a timely manner.
Likewise, open innovation also will pressure industry innovators, who will need to look outside of their own organizations to keep pace with the speed of discovery and progress.
I will be among the first to openly admit that, thus far, our nation's universities have not redefined and restructured themselves to sufficiently facilitate discovery to innovation in today's economic, technologic, and social environment. There are, of course, fine examples of innovations within universities (MIT's Media Lab comes to mind).
If a 300-year-old compiler of knowledge, Britannica, can embrace an emerging model of collaboration based on public faith, surely innovative higher education research institutions can as well.
appropriate first step would be the creation of an open Wiki for specific human
and world conditions with the elite scholars, scientists and engineers from
both industry and academia participating as well as anyone who can provide
Intellectual Property and Technology Transfer
I would suggest that many in industry, and some of us in academe, need to revise our perspectives and positions, as well as expectations on technology transfer and innovation for our economic community to flourish.
In an effective innovation ecosystem, any company and any university should be able to participate in strategic partnerships that are mutually beneficial through the exchange of comparable value.
The key is comparable value. By comparable value, I do not mean only money, but also the exchange of personnel, technology, research commitments and other reciprocal agreements that can bring comparable value to both parties. Strategic partnerships, in which mutual interests are satisfied, hold great promise.
Yet, some in industry
have begun a disconcerting campaign to gain the maximum access to university
work for less than comparable value.
Their efforts and sweeping statements often leave you false impressions and have led to confusion as well as Congressional hearings.
The complaints leveled
by industry tend to focus on three things:
1. The slowness of negotiating agreements and on two particularly contentious issues,
2. Access to and ownership of intellectual property rights (including the IRS private benefit to industry problems, wherein some public universities are avoiding agreements with private industry to avoid jeopardizing tax exempt financing of buildings) and
3. Third party access to the research information that has been supported by a company.
The slowness of negotiating agreements is a concern for industry and increasingly for universities.
More and more universities are putting in place university-related research foundations with decision-making authority and the ability to make immediate decisions. And some of us have seen significant delays as deals are vetted through corporate legal offices. All parties can improve in timely responsiveness.
Regarding the IP rights, the apparent limits resulting from the IRS private benefit rules need to be resolved by legislation. However, the IP issues are much deeper than the IRS matter which impacts only a relatively small portion of the higher education community.
The more problematic issue is that of accepting the premise that there should be a fair or comparable value exchange in the relationship (and I would submit in any relationship for it to flourish).
Recently, some companies are telling us and Congress that international universities are much easier to work with.
They also suggest that foreign institutions are willing to grant university IP rights to the company sponsor without license commitments and that many international universities are willing to limit third party access to research.
Some companies allege that U.S. universities insist on these things because of provisions in Bayh-Dole.
In a similar vein, a business executive recently advocated that "a university and its faculty should not own IP".
The argument is made that in the private sector, IP is developed by the enterprise that makes the investment. "That (sponsor) enterprise, therefore, owns the IP exclusively and thus has the right to exploit that IP at its own discretion..."
Our colleague further said "...it is (his) opinion that a university and therefore faculty have a ‘duty and obligation' to consider the public as an investor and stakeholder in any IP developed with public funds."
We find the conclusion that the investor owns the complete research results, regardless of relative contribution, and fair market value considerations to be erroneous.
If the sponsor pays the fair market value of the research, including a component for its commercial potential, then we would agree that the sponsor should have the benefit of the commercialization potential.
However, industry does
not seem to want a fair-market pricing and prefers to use the historical cost
reimbursable basis pricing model.
If the innovations are turned over to the general public, not a private company, there would be a loss of proprietary position and thus the loss of incentive to invest in development and commercialization. Such would reduce innovation rather than support innovation.
If we agree with our friend that industry sponsors do own the IP, then we have these additional questions:
1. How then should research be priced?
2. If it is priced as cost plus as most university research is priced, then there is unequal exchange of value distorting the value proposition.
3. How do we select who has the opportunity to sponsor?
4. How do we fairly invite potential sponsors? Is it a bid process?
Also, university faculty members are entitled to revenue sharing and if the IP is handed over to the sponsor, then there is no additional reward from the university to the inventor for his or her genius.
The federal Bayh-Dole law states that inventions developed by a university using federal funding belong to the university, not the federal investor. Some in industry may wish differently, but fairness and the law suggest otherwise.
We invite those in industry who are decreasing their U.S. university collaborations, to reconsider and help develop models that are consistent with a highly interactive innovation ecosystem and are based on a fair exchange of value.
I would note that a 2003 PCAST report on technology transfer had important recommendations to advance the understanding of Bayh-Dole and the practice of technology transfer.
Also, the Kauffman foundation is suggesting that the boundaries of universities and industry need to become more porous.
They suggest that universities should push up the volume of technology, rather than seek the individual economic home run and we are seeing examples of this emerge. For example, Carnegie Mellon University has adopted a "Five percent and go" policy in an attempt to reduce delays and lower transactions costs.
At the very heart of IP law and the functioning of the USPTO is the premise that even while protecting IP, we should facilitate further discovery and innovation.
This is worth examining fully in the National Academies and Council on Competitiveness reports on IP.
It is not that the premises are wrong in law; it is that the practice of IP law has now been subverted by two things: the inability of the USPTO to appropriately examine patents and the degree to which some lawyers go to obfuscate the very thing they should be clarifying. Much more is to be gained by advancing basic understanding of the issues than by trying to defend the core mission of the academy.
Perhaps, the intellectual property system itself could benefit from open innovation. The constitutional basis for intellectual property recognizes the need to encourage disclosure of new inventions and creations.
The quid pro quo of the patent system is that in exchange for making the invention public, the inventor shall be provided exclusive rights for a limited period of time.
However, there are significant delays in making the inventions public with our current system. So why not consider a patent system, at least for selected technologies, that truly leads to immediate public disclosure.
Recently, a University of Akron intellectual property management class discussed the possibility of major changes to the patent system that would include disclosing all inventions publically on the Internet.
The concept is that public online disclosure would clearly meet the constitutional objective of promoting the progress of science and useful arts, and could help determine inventorship, encourage increased discussion on prior art, improve the quality of patents, and eliminate some research and development redundancy as one could consider in near real-time what other experts were thinking and doing, and then build upon it. It would truly accelerate innovation.
Undoubtedly, some will object to sharing any IP until inventions are verified, protected and derivative inventions are considered.
However, this open innovation model may be appropriate in selected technology areas. The public good of early disclosure and its impact on innovation, may out-weigh the costs associated with loss of proprietary position in some circumstances.
A final element in our technology transfer discussion lies in our failure to tackle the optimization of our education system.
Indeed, if the often quoted suggestion that 95% of all technology transfer takes place as people move from college into the workplace or from one company to another is true, then why do we seldom include this in our technology transfer discussions?
Thus, I suggest that close relationships between business and universities are the first step in a talent supply chain optimization.
Our methods of education have developed at an extremely slow pace when compared with virtually all other value-producing endeavors.
Indeed, despite the fact that the first responsibility of every university is that of educator - teaching and training members of society in a way that will make them productive, proactive and innovative - we devote precious little attention to research designed to demonstrate what works educationally.
Do we hear anyone
clamoring for evidence-based education?
It is the responsibility of universities to develop a serious academic approach to the concept of talent supply chain management.
Recent reports such as
the Academy's "Rising Above the Gathering Storm," The Council on
Competitiveness' "Innovate America" and the Department of Energy's "Science and
Mathematics Education Task Force," which I chaired, point to future, significant
workforce development challenges in science and engineering.
Let me conclude with one last concept, that of Innovating on Innovation.
Gary Markovitz, founder and CEO of Innovation Business Partners, has shown a true recognition of the wide variety of sources from which solutions can come in his work with industry and with the U.S. Navy.
Gary developed software that improves the hit rate of patent database searches, allowing his clients a more effective snapshot of the research landscape in which they are working.
However, his work goes far beyond mapping existing technologies. Gary encourages clients to look at all possible solutions to their problem, often leading them to combine multiple technologies in widely disparate fields to create an entirely new product.
In a benchmarking
study with the Office of Naval Research, Gary's firm demonstrated the ability
to increase the rate of invention of Navy researchers by 50- to 100-fold and
shave years off the R&D cycle-time while reducing costs by millions of
I need not tell you that there are myriad university models for economic development: research parks, venture funds, urban redevelopment programs, small business development centers, industry collaborations and research consortia to name just a few. And surely you know that some universities are far more successful than others in creating and supporting strong and vibrant economies.
In our case, The University of Akron has become particularly successful in providing added value to industry by linking resources and by developing and commercially exploiting technology. In fact, an NSF-supported study released just a few months ago identifies The University of Akron and nine other smaller- and medium-sized research institutions as exemplars for technology transfer, commercialization and industry partnerships.
At The University of
Akron, we are innovating on innovation.
We have initiated a significant commercialization engine: The University
of Akron Research Foundation - consisting of our own technology transfer
personnel coupled with our programs in intellectual property law, science,
engineering and business.
The non-profit University of Akron Research Foundation is a model for working flexibly with industry and establishing long-term relationships that lead to future opportunities. It has achieved success through the efforts of an impressive team of professionals. Please feel free to come to Ohio and spend time with us; we'll learn much from each other, I am sure.
Here are examples of the interesting things that this is enabling us to do:
First, as industries adjust their talent and space utilization needs, we are managing their vacant space to accommodate incubator needs of new start-up companies and expanding research programs.
Likewise, we are consolidating industrial research equipment within our own facilities. We are assembling technical libraries, allowing us to expand our holdings as well as to manage the holdings of industrial partners.
We also are managing industrial talent and providing industry with the equivalent of academic research and teaching assistants--namely, industrial assistants.
Finally, we are exploring strategic partnerships that tie our research activities more closely with those of industry as well as partnerships that enable bundled intellectual property portfolios to create new enterprises that benefit industry and the university.
And we have started and angel investment network, ARCHangels, and an entrepreneurial Guerilla Ventures enterprise group.
Ladies and Gentlemen, the task before us is not easy. The innovation ecosystem is a complex and interactive one that grows larger and more intricate with every day. We must be committed to innovate on innovation...to focus our entire society on innovation.
Perhaps, as we do in most aspects of human affairs, we simply must be committed to muddling through, so . . .
Be cheerful, and plunge ahead!
A number of factors can limit or skew an individual's perspective on the world. Dr. Proenza offers examples and advice on how to seek additional perspectives.
While idealism fuels our dreams and ambitions, unrealistic ideals can be counter productive to effective work. Dr. Proenza discusses some of the pitfalls of unrealistic ideals and how to counter them.
Dr. Proenza urges graduates to live their lives with strategic intent and to be guided by their dreams.
Northeast Ohio has improved its talent dividend of citizens who hold college degrees. Dr. Proenza emphasized the importance of an educated populace and discussed methods to further improve the region's results.
In his last State of The University address as president of The University of Akron, Dr. Luis Proenza reviews the progress and returns on investments made over the past 15 years, and outlines necessary steps during this academic year to maintain this momentum .
Drawing upon his own experiences, Dr. Proenza encourages graduates to continue to seek the magic of learning throughout their careers.
Dr. Proenza advises graduates to no longer identify solely with their majors, but to also regard themselves as critical thinkers, communicators and problem solvers. Doing so, he said, will make the job market a more welcoming place.
In a lighthearted nod to J.K. Rowling's novels, Dr. Proenza offers graduates a final lesson of "A Defense Against the Dark Arts of Derision, Disrespect and Insult!"
If inventor and futurist Ray Kurzweil is correct in his predictions for the near future, "a lifetime of learning" has new meaning for today's graduates.
Dr. Proenza offers graduates in the College of Health Professions a more expansive view of the effects of their work with patients and clients