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  • In addition to policymakers, have met with 50 external groups and organizations; some are peer organizations with whom we collaborate; some are “rival” organizations with whom we compete, and some are both: “competipeers with whom we engage in coopetition.” Note: in particular meetings with AAHC, UHC and AACOM; also role on Research! America board. [DGK: should we add ACP? And, should we “bold” ACP and AMA like we do Reearch!America, etc.]
  • Per final FY 08 budget, NIH gets $29.229 billion, an increase of $329 million, or 1.1 percent over FY 07 Note: November 2007 H/S conference agreement was $900 million, or 3.1 percent increase [insert FY 09 pres budget info] NEXT SLIDE: outline, The Work Ahead
  • The brutal facts, nevertheless, are daunting, and include a structural deficit -- $319 billion in fiscal year 2005 -- that even our nation’s chief accountant, David M. Walker, says is growing out of control. According to GAO [Government Accountability Office] simulations, balancing the budget by the year 2040 could mean having to cut total federal spending by 60 percent, or even raising taxes 2.5 [two and one half] times today’s level.
  • The “old world” is characterized by pathways of focused scholarship with disciplines, fairly predictable courses of advancement if one “follows the rules” (of a mentor from the same field usually) and “fits the mold” of background and academic path. Independence was not only a marker of success, but perceived as valuable to the institution (collaboration was “interesting,” but not essential). Diversity was seen as exceptional. The “new academic world” asks for individuals to align their goals with institutional needs and recognizes that adaptation is essential to maintain careers and organizational success. At a minimum, departments must cooperate, but collaboration and consensus allow more system diversity and creativity. Diversity is seen as adaptive and essential to social and scientific responsiveness. In order for individuals to meet responsibilities of work and avoid burnout, they must marry service and academic activities. This also increases creativity while supporting improvement in the work systems. [Note from Diane: Darrell– I know this is a bit wordy, but I figured you could pick and trim!]
  • The “old world” is characterized by pathways of focused scholarship with disciplines, fairly predictable courses of advancement if one “follows the rules” (of a mentor from the same field usually) and “fits the mold” of background and academic path. Independence was not only a marker of success, but perceived as valuable to the institution (collaboration was “interesting,” but not essential). Diversity was seen as exceptional. The “new academic world” asks for individuals to align their goals with institutional needs and recognizes that adaptation is essential to maintain careers and organizational success. At a minimum, departments must cooperate, but collaboration and consensus allow more system diversity and creativity. Diversity is seen as adaptive and essential to social and scientific responsiveness. In order for individuals to meet responsibilities of work and avoid burnout, they must marry service and academic activities. This also increases creativity while supporting improvement in the work systems. [Note from Diane: Darrell– I know this is a bit wordy, but I figured you could pick and trim!]
  • 34 A workgroup must be formed to identify each of the measures that will be used to judge and benchmark faculty performance. The workgroup must consistent of individuals who have worked within the school to study these measures for some time, and whom the faculty trusts to develop fair measures. If the group is not chosen fairly, then you will ultimately have problems getting the faculty to agree to the measures. At UFCOM, we ultimately had to go back to each department and give them a chance to give input on the measures. Each of these measures must be reasonable and there should be no more than a handful of measures in each category If there are too few measures, you will not get everyone to agree, and if there are too many measures, you will not be able to agree on the consensus of the measure.
  • The “old world” is characterized by pathways of focused scholarship with disciplines, fairly predictable courses of advancement if one “follows the rules” (of a mentor from the same field usually) and “fits the mold” of background and academic path. Independence was not only a marker of success, but perceived as valuable to the institution (collaboration was “interesting,” but not essential). Diversity was seen as exceptional. The “new academic world” asks for individuals to align their goals with institutional needs and recognizes that adaptation is essential to maintain careers and organizational success. At a minimum, departments must cooperate, but collaboration and consensus allow more system diversity and creativity. Diversity is seen as adaptive and essential to social and scientific responsiveness. In order for individuals to meet responsibilities of work and avoid burnout, they must marry service and academic activities. This also increases creativity while supporting improvement in the work systems. [Note from Diane: Darrell– I know this is a bit wordy, but I figured you could pick and trim!]

Transcript

  • 1. Darrell G. Kirch, M.D. President and CEO, AAMC February 8, 2008 The Chair of the Future: Crossing the Cultural Divide Association of Medical School Pharmacology Chairs
  • 2. An Historical Perspective
  • 3. The Academic Health Center Medical School University Physician Practice Hospitals and Clinics
  • 4. So How Do We All Feel About Academic Medicine 100 Years After Flexner?
  • 5. Connecting Outside the Beltway
  • 6. Accreditation Council for Continuing Medical Education Accreditation Council for Graduate Medical Education American Hospital Association American Medical Association Educational Commission for Foreign Medical Graduates Federation of American Societies for Experimental Biology Federation of State Medical Boards National Board of Medical Examiners American Association of Colleges of Pharmacy Association of Governing Boards of Universities and Colleges Association of American Universities American Council on Education National Association of State Universities and Land Grant Colleges Washington Higher Education Secretariat Institute of Medicine Alliance for Academic Internal Medicine American Association of Colleges of Nursing Connecting Professionally American Association for Retired Persons American Association of Directors of Psychiatric Residency Training American Psychiatric Association American College of Cardiology American Dental Education Association American Medical Student Association American Public Health Association American Surgical Association Association of American Physicians Association of American Veterinary Medical Colleges Association for Hospital Medical Education Association of Osteopathic Directors and Medical Educators Association of Schools of Public Health Blue Ridge Academic Health Group Council of Heads of Medical Schools Council of Medical Specialty Societies Howard Hughes Medical Institute Institute for Healthcare Improvement Joint Commission on Accreditation of Healthcare Organizations Learning Action Network Medical Group Management Association National Health Council National Health Museum National Medical Fellowships Association of Professors of Medicine Society of Medical Administrators Association of Medical School Pharmacology Chairs
  • 7. What is the source of our discontent?
      • Is it all just about money?
  • 8. Some Fiscal Realities NIH Funding, FY 1995-2009 [in billions] Constant (BRDPI) Current (Budget)
  • 9. Some Fiscal Realities Faculty Compensation vs. the CPI Source: AAMC Report on Medical School Faculty Salaries, 1990-1991 through 2004-2005
  • 10. Some Fiscal Realities Projected Loan Payments as a Percentage of Projected Physician After-Tax Income Source: “Medical Educational Costs and Student Debt,” AAMC, 2005
  • 11. The Ultimate Fiscal Reality – The Federal Deficit
    • “ GAO’s current long-term simulations continue to show ever-larger deficits resulting in a debt burden that ultimately spirals out of control.”
    • – David M. Walker
    • U.S. Comptroller General
  • 12. What is the source of our discontent?
      • Have we simply failed to find the right strategy?
  • 13. A Decade of Growth: Total Annual Medical School Revenues $ billions $32 billion $ 71 billion
  • 14. A Decade of Growth: Total Annual Federal Research Funding $ billions $ 5.8 billion $ 15 billion
  • 15. A Decade of Growth: Total Annual Support from Teaching Hospitals $ billions $ 4.8 billion $ 9.6 billion
  • 16. A Decade of Growth: Total Number of Full-Time Medical School Faculty In thousands 93,240 121,326
  • 17. A Decade of Growth: Pharmacology Department Total Expenditures In millions million million
  • 18. A Decade of Growth: Pharmacology Department Research Expenditures In millions million million
  • 19. A Decade of Growth: Total Number of Full-Time Pharmacology Faculty
  • 20. A Profession On the Rise
    • A record number of nearly 17,800 students began medical school this year.
    • A Gallup poll tells us that the American public continues to view medicine as the “most desirable” profession a young person could pursue.
  • 21. If the problem isn’t as simple as money and strategies to build revenues, where should we turn our attention?
  • 22. Embracing a New Culture in Academic Medicine
    • “ Culture eats strategy for lunch every day”
    • Andy Grove
    • Former Chairman of Intel
  • 23.  
  • 24. The Traditional Culture of Academic Medicine
    • Individualistic
    • Autonomous
    • Scholarly
    • Expert-centered
    • Competitive
    • Focused
    • High-achieving
    • Hierarchical
  • 25. Embracing an Emerging Academic for Academic Medicine
    • Collaborative
    • Transparent
    • Outcomes-focused
    • Mutually accountable
    • Team-based
    • Service-oriented
    • Patient-centered
  • 26. What Does This Mean for Medical School Leaders?
    • If “culture eats strategy for lunch every day…”
    • And if a positive culture is a key source of future excellence…
    • How do we change the culture in our institutions?
  • 27.
    • #1 Make values explicit, and
    • use them visibly in everyday decisions!
  • 28. Academic Medicine; June 1996
  • 29. Are Stated Values Consistently Aligned with Actions?
  • 30.
    • #2 Align governance, leadership, and
    • management across organizational
    • and “corporate” divisions!
  • 31. The Academic Health Center Medical School University Physician Practice Hospitals and Clinics
  • 32.
    • #3 Use the tools of mission-based management
    • to realign and maximize resources!
  • 33. Discretionary Fund The Cauldron Tuition and Appropriations Grants and Contracts Clinical Care Research Education Physician and Hospital Revenues A New Model for the Organization – Aligning Revenues with Effort Source: D. Hefner
  • 34. Mission-Based Funds Flow: The Interdependence of Our Missions + 25.7m Hospital Clinical Enterprise ($16.7m) ($8.4m) +$2.1m ($14.3m) Admin Physicians Education Research Overall Conclusion: At this college of medicine, the hospital and (to a lesser degree) the physician practice, cover negative margins in all other missions.
  • 35. Program Assessment Mission Contribution Financial Performance High/Low Low/Low High/High Low/High
  • 36.
    • #4 Foster collaboration and accountability,
    • accepting nothing short of
    • high performance teams in all mission areas!
  • 37. A New Model for the Organization – Creating High Performance Teams Source: Katzenbach and Smith, 1993 PERFORMANCE IMPACT TEAM EFFECTIVENESS Pseudo- Team Working Group Real Team Potential Team High-performing Team
  • 38. The Teams Approach Research Academic Clinical IRT Strategic Relations ( including communication and marketing, and development) Human Resources Finance Physical Resources Teams Council Mission-Based Teams Relationship-Based Teams Resource Teams
  • 39.
    • #5 Focus leadership recruitment on
    • organizational fit, and do real succession
    • planning for long-term stability!
  • 40.  
  • 41.  
  • 42.
    • #6 Rethink our approach to education!
  • 43. Discontinuity in the Medical Education Continuum Premedical Medical School Residency and Fellowships Practice
  • 44. In Search of Transformation – New Models of Continuity for the Process Premedical Medical School Residency and Fellowships Practice
  • 45. In Search of Transformation – New Models of Continuity for the People Premedical Medical School Residency and Fellowships Practice Premedical Medical School Residency and Fellowships Practice Life-long Learning Two-Year College Premedical Medical School Residency and Fellowships Practice Life-long Learning Pre-medical Medical School Residency and Fellowships Practice Life-long Learning Non-Premed Degree Practice Re-training Life-long Learning
  • 46. Embracing an Emerging Academic for Academic Medicine
    • Collaborative
    • Transparent
    • Outcomes-focused
    • Mutually accountable
    • Team-based
    • Service-oriented
    • Patient-centered
  • 47. Creating a Culture of Teamwork and Collaboration
  • 48. Creating a Culture of Reliability and Quality in the Face of High Risk
  • 49. Creating a Culture Based on “Evidence” Rather Than “Eminence” Issacs and Fitzgerald, BMJ 319: 1618, 1999
  • 50. Creating a Culture of Trust
  • 51. Creating a Culture in Which All Teach and All Learn
  • 52.