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Understanding and Navigating Constant
Change in the Academic Medicine
Landscape

Presenters: 
Michael Warden, Johmarx Patton, Kathleen Ludewig Omollo

Except where otherwise noted, this work is available under a Creative Commons Attribution 4.0 License 

(http://creativecommons.org/licenses/by/4.0/). Copyright 2014 The Regents of the University of Michigan.

MSIS Lunch and Learn - June 13, 2014


1
Introduction
Changes exist all around us… 
●  Job Requirements
●  Roles
●  Problems
●  Location
●  Major Projects
●  Structure
●  Leadership
●  Team Makeup
●  … where I put my lunch and get my water! 
2
1868-1891. Public domain image.
3
2012- Present. Image CC
BY NC University of
Michigan,
UMHS Media Bank.
How many EVPMA’s (interim and permanent) have we had
appointed from the University of Michigan Medical School?

A. 1
B. 2
C. 3
D. 4
E. 5
Change
4
How many EVPMA’s (interim and permanent) have we had
appointed from the University of Michigan Medical School?

A. 1
B. 2
C. 3
D. 4
E. 5
Change
Lazar Greenfield, M.D.
EVPMA 2002-2003
5
Constant Change
 Image CC BY P-A-T-R-I-C-K Flickr
6
Permanent White Water
Image CC BY Andy Arthur, Flickr
7
Permanent White Water
Image CC BY Pete Bellis, Flickr
8
Academic Health/Medical Centers (AHC/
AMC): 3 Communities
School of
Medicine
Teaching
Hospital
(Clinical)
Practice Plan
9
Academic Health/Medical Centers:
3 Communities
School of
Medicine
Teaching
Hospital
(Clinical)
Practice Plan
10
University
Academic Health/Medical Centers:
3 Communities
School of
Medicine
Teaching
Hospital
(Clinical)
Practice Plan
11
Academic Health/Medical Centers:
3 Communities
School of
Medicine
Teaching
Hospital
(Clinical)
Practice Plan
12
Academic Health/Medical Centers:
Different Models for Governance
School of
Medicine
Teaching
Hospital
(Clinical)
Practice Plan
School of
Medicine
Teaching
Hospital
(Clinical)
Practice Plan
Least integrated
Most integrated
School of
Medicine
Teaching
Hospital
(Clinical)
Practice
Plan
School of
Medicine
Teaching
Hospital
(Clinical)
Practice
Plan
School of
Medicine
Teaching
Hospital
(Clinical)
Practice
Plan
Reference: Levine JK. Considering
alternative organizational models for
academic medical centers. Acad
Clin Pract. 2002;14(2):2–5.
13
Academic Health/Medical Centers:
Different Models for Governance
School of
Medicine
Teaching
Hospital
(Clinical)
Practice Plan
School of
Medicine
Teaching
Hospital
(Clinical)
Practice Plan
Least integrated
Most integrated
School of
Medicine
Teaching
Hospital
(Clinical)
Practice
Plan
School of
Medicine
Teaching
Hospital
(Clinical)
Practice
Plan
Reference: Levine JK. Considering
alternative organizational models
for academic medical centers. Acad
Clin Pract. 2002;14(2):2–5.
Question:
Which one is U-M?
A
E
B C DSchool of
Medicine
Teaching
Hospital
(Clinical)
Practice
Plan
14
Academic Health/Medical Centers:
Different Models for Governance
School of
Medicine
Teaching
Hospital
(Clinical)
Practice Plan
School of
Medicine
Teaching
Hospital
(Clinical)
Practice Plan
Least integrated
Most integrated
School of
Medicine
Teaching
Hospital
(Clinical)
Practice
Plan
School of
Medicine
Teaching
Hospital
(Clinical)
Practice
Plan
Reference: Levine JK. Considering
alternative organizational models
for academic medical centers. Acad
Clin Pract. 2002;14(2):2–5.
Question:
Which one is U-M?
E
School of
Medicine
Teaching
Hospital
(Clinical)
Practice
Plan
15
AHC - 3D Mission
Each of these 3 missions,
touch each of the 3
communities, but to
varying extents
depending on the model
Clinical Research
Education
16
AHC - 3D Mission
Missions are
complementary yet
competitive
Clinical Research
Education
17
AHC - 3D Mission
Missions are
complementary yet
competitive
Clinical Research
Education
+ $
- $
- $
18
AHC - 4D Mission?
Clinical Research
Education
Community
Service
19
After the completion of high school, what is the typical
duration of education/training before becoming a licensed,
independently practicing physician in the US?
A. 6 years
B. 8 years
C. 12 years
D. 15 years
E. 19 years
Education
20
After the completion of high school, what is the typical
duration of education/training before becoming a licensed,
independently practicing physician in the US?
A. 6 years
B. 8 years
C. 12 years
D. 15 years
E. 19 years
Education
21
After the completion of high
school, what is the typical
duration of education/training
before becoming a licensed,
independently practicing
physician in the US?
A. 6 years
B. 8 years
C. 12 years
D. 15 years
E. 19 years
Education
Chart adapted from: AAMC
22
Undergraduate
Bachelors Degree
Years: 4
Medical School
(MD)
Years: 4
Residency
Years: 3-5+
Subspecialty
Years: 1-4
Board Certification
Recertification
Licensure
Independent
Practice
Continuing Medical
Education
Subspecialty
Certification
Education
23
Undergraduate
Bachelors Degree
Years: 4
Undergraduate Medical Education (UME)
Medical School (MD)
Years: 4
Residency
Years: 3-5+
Subspecialty
Years: 1-4
Board Certification
Recertification
Licensure
Independent
Practice
Continuing Medical
Education
Subspecialty
Certification
Chart adapted from: AAMC
Education
24
Undergraduate
Bachelors Degree
Years: 4
Medical School
(MD)
Years: 4
Graduate Medical Education (GME)
Residency
Years: 3-5+
Graduate
Medical
Education
(GME)
Subspecialty
Years: 1-4
Board Certification
Recertification
Licensure
Independent
Practice
Continuing Medical
Education
Subspecialty
Certification
Chart adapted from: AAMC
Education
25
Chart adapted from: AAMC
Undergraduate
Bachelors Degree
Years: 4
Medical School
(MD)
Years: 4
Residency
Years: 3-5+
Subspecialty
Years: 1-4
Board Certification
Recertification
Licensure
Independent
Practice
Continuing
Medical
Education (CME)
Subspecialty
Certification
Medical School Faculty
Types of Faculty:
●  Research
●  Instructional
●  Clinical
●  Adjunct
Education
26
What are the credentials of primary care providers?
A. MD
B. DO
C. NP
D. PA
E. Any of the above
F. None of the above
Clinical Care
27
What are the credentials of primary care providers?
A. MD
B. DO
C. NP
D. PA
E. Any of the above
F. None of the above
Clinical Care
28
Gone are the days of having only 1 doctor...
29
New Models
Clinical Care
30
All images from The Noun Project. See references at end for attributions.
Research
contributions to new knowledge
“bench to bedside”
“disciplinary guilds” - for reviews of proposals for funding
and for verifying results
Basic Research
Patient-Oriented
Clinical
Research
Improve health
outcomes
Translation
to clinical
studies
Translation to
health care
practice
31
Chart adapted from: http://ncrr.nih.gov/
Research
On average, what percentage of research costs are
covered by external grants (e.g. government,
foundations)?
A. Over 90%
B. 60 - 80%
C. 30 - 70%
D. Less than 30%
32
Research
A. Over 90%
B. 60 - 80%
C. 30 - 70%
D. Less than 30%
On average, what percentage of research costs are
covered by external grants (e.g. government,
foundations)?
33
Research
Based on: National Science Foundation Survey, 2010, Top 125 Ranked Institutions with NSF Support
34
Research
Before > Now > Future
Scope (Data and Team):
Small > Big > Massive
Approach:
Observation > Analysis and Reduction > Synthesis and
Integration
Job Security:
Salary Secure > Tenure Uncertain > No Tenure for Research
Control:
Investigator > Principal Investigator, Institution, Funder >
Program Director
Reference: A. Rees Midgley, 1980. Biological Science Research: Yesteryear, Today, and Tomorrow.
35
Discussion / Activity (15 minutes)
Tools and techniques that you can use to focus
your efforts and create stability:
●  Not To Do Lists
●  Stakeholder Mapping
36
Not To Do Lists
To Do: NOT To Do:
USO Program
Transition to Operations
Process
Project Management KPIs
Staff Development
Knowledgebase Alignment
Product Owner training
Project Management training
classes
Legacy Documentation
Cleanup
Expanded Onboarding
“What could I make a good case
for doing?”
Time?
Important?
Focus Waste
Bombs Ignore
Y N
Y
N
37
Matrix adapted from: Gregory P. Shea, Leading
Change in Medicine and Business: Bridging the Gap,
e.d. Sheldon Rovin, Aspen, 2001.
Stakeholder Mapping
Influence
Appreciate
Control Those who can ‘control’ the outcome - make the change
happen or not happen
Those who can ‘influence’ the outcome - make the change
harder or easier
Those who can ‘appreciate’ that the change is occurring, but
have little power in affecting the course
Reference: Gregory P. Shea, Leading Change in Medicine and Business: Bridging the Gap, e.d. Sheldon
Rovin, Aspen, 2001.
38
Stakeholder Mapping
Allies
Bedfellows
UndecidedsFencesitters
Opponents
Adversaries
Yes No
Yes
No
“Does the Stakeholder Agree with you?”
“Do you trust the
Stakeholder?” Focus time and effort here.
Reference: Gregory P. Shea, Leading Change in Medicine and Business: Bridging the Gap, e.d. Sheldon
Rovin, Aspen, 2001.
39
Closing Remarks

1.  Whitewater needs to be managed to have happy,
healthy, engaged staff.

2.  Change is constant, especially in medicine.

3.  Mapping stakeholders and maintaining to do and
not to do lists are example techniques to create
stability and provide direction amidst that change.
40
References
Gregory P. Shea, “Leading Change” in Medicine and
Business: Bridging the Gap, e.d. Sheldon Rovin,
Aspen, 2001. 

Association of American Medical Colleges, Group on
Information Resources - http://aamc.org/gir 
41
Image attributions for New Models of Clinical
Care on slide 30 
All images from TheNounProject.com
●  Nurse - CC BY Scott Lewis from the Noun Project
●  Doctor - Public domain
●  Person - CC BY Alex Berkowitz from the Noun Project
●  Brain - Public domain
●  Pulse CC BY TNS
●  Coordinate Patient Care - Public domain
●  Mhealth - CC BY Edward Boatman
●  iPhone - Public domain
●  Radiography - CC BY Wojciech Zasina
●  Cardiograph - CC BY Wojciech Zasina
●  Surgery - Public domain
●  Blood Glucose Meter - CC BY Danilo Casagrande de Almeida
●  Laptop - CC BY Edward Boatman
42

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Understanding and Navigating Constant Change in the Academic Medicine Landscape - June 2014

  • 1. Understanding and Navigating Constant Change in the Academic Medicine Landscape Presenters: Michael Warden, Johmarx Patton, Kathleen Ludewig Omollo Except where otherwise noted, this work is available under a Creative Commons Attribution 4.0 License 
 (http://creativecommons.org/licenses/by/4.0/). Copyright 2014 The Regents of the University of Michigan. MSIS Lunch and Learn - June 13, 2014 1
  • 2. Introduction Changes exist all around us… ●  Job Requirements ●  Roles ●  Problems ●  Location ●  Major Projects ●  Structure ●  Leadership ●  Team Makeup ●  … where I put my lunch and get my water! 2
  • 3. 1868-1891. Public domain image. 3 2012- Present. Image CC BY NC University of Michigan, UMHS Media Bank.
  • 4. How many EVPMA’s (interim and permanent) have we had appointed from the University of Michigan Medical School? A. 1 B. 2 C. 3 D. 4 E. 5 Change 4
  • 5. How many EVPMA’s (interim and permanent) have we had appointed from the University of Michigan Medical School? A. 1 B. 2 C. 3 D. 4 E. 5 Change Lazar Greenfield, M.D. EVPMA 2002-2003 5
  • 6. Constant Change Image CC BY P-A-T-R-I-C-K Flickr 6
  • 7. Permanent White Water Image CC BY Andy Arthur, Flickr 7
  • 8. Permanent White Water Image CC BY Pete Bellis, Flickr 8
  • 9. Academic Health/Medical Centers (AHC/ AMC): 3 Communities School of Medicine Teaching Hospital (Clinical) Practice Plan 9
  • 10. Academic Health/Medical Centers: 3 Communities School of Medicine Teaching Hospital (Clinical) Practice Plan 10 University
  • 11. Academic Health/Medical Centers: 3 Communities School of Medicine Teaching Hospital (Clinical) Practice Plan 11
  • 12. Academic Health/Medical Centers: 3 Communities School of Medicine Teaching Hospital (Clinical) Practice Plan 12
  • 13. Academic Health/Medical Centers: Different Models for Governance School of Medicine Teaching Hospital (Clinical) Practice Plan School of Medicine Teaching Hospital (Clinical) Practice Plan Least integrated Most integrated School of Medicine Teaching Hospital (Clinical) Practice Plan School of Medicine Teaching Hospital (Clinical) Practice Plan School of Medicine Teaching Hospital (Clinical) Practice Plan Reference: Levine JK. Considering alternative organizational models for academic medical centers. Acad Clin Pract. 2002;14(2):2–5. 13
  • 14. Academic Health/Medical Centers: Different Models for Governance School of Medicine Teaching Hospital (Clinical) Practice Plan School of Medicine Teaching Hospital (Clinical) Practice Plan Least integrated Most integrated School of Medicine Teaching Hospital (Clinical) Practice Plan School of Medicine Teaching Hospital (Clinical) Practice Plan Reference: Levine JK. Considering alternative organizational models for academic medical centers. Acad Clin Pract. 2002;14(2):2–5. Question: Which one is U-M? A E B C DSchool of Medicine Teaching Hospital (Clinical) Practice Plan 14
  • 15. Academic Health/Medical Centers: Different Models for Governance School of Medicine Teaching Hospital (Clinical) Practice Plan School of Medicine Teaching Hospital (Clinical) Practice Plan Least integrated Most integrated School of Medicine Teaching Hospital (Clinical) Practice Plan School of Medicine Teaching Hospital (Clinical) Practice Plan Reference: Levine JK. Considering alternative organizational models for academic medical centers. Acad Clin Pract. 2002;14(2):2–5. Question: Which one is U-M? E School of Medicine Teaching Hospital (Clinical) Practice Plan 15
  • 16. AHC - 3D Mission Each of these 3 missions, touch each of the 3 communities, but to varying extents depending on the model Clinical Research Education 16
  • 17. AHC - 3D Mission Missions are complementary yet competitive Clinical Research Education 17
  • 18. AHC - 3D Mission Missions are complementary yet competitive Clinical Research Education + $ - $ - $ 18
  • 19. AHC - 4D Mission? Clinical Research Education Community Service 19
  • 20. After the completion of high school, what is the typical duration of education/training before becoming a licensed, independently practicing physician in the US? A. 6 years B. 8 years C. 12 years D. 15 years E. 19 years Education 20
  • 21. After the completion of high school, what is the typical duration of education/training before becoming a licensed, independently practicing physician in the US? A. 6 years B. 8 years C. 12 years D. 15 years E. 19 years Education 21
  • 22. After the completion of high school, what is the typical duration of education/training before becoming a licensed, independently practicing physician in the US? A. 6 years B. 8 years C. 12 years D. 15 years E. 19 years Education Chart adapted from: AAMC 22 Undergraduate Bachelors Degree Years: 4 Medical School (MD) Years: 4 Residency Years: 3-5+ Subspecialty Years: 1-4 Board Certification Recertification Licensure Independent Practice Continuing Medical Education Subspecialty Certification
  • 23. Education 23 Undergraduate Bachelors Degree Years: 4 Undergraduate Medical Education (UME) Medical School (MD) Years: 4 Residency Years: 3-5+ Subspecialty Years: 1-4 Board Certification Recertification Licensure Independent Practice Continuing Medical Education Subspecialty Certification Chart adapted from: AAMC
  • 24. Education 24 Undergraduate Bachelors Degree Years: 4 Medical School (MD) Years: 4 Graduate Medical Education (GME) Residency Years: 3-5+ Graduate Medical Education (GME) Subspecialty Years: 1-4 Board Certification Recertification Licensure Independent Practice Continuing Medical Education Subspecialty Certification Chart adapted from: AAMC
  • 25. Education 25 Chart adapted from: AAMC Undergraduate Bachelors Degree Years: 4 Medical School (MD) Years: 4 Residency Years: 3-5+ Subspecialty Years: 1-4 Board Certification Recertification Licensure Independent Practice Continuing Medical Education (CME) Subspecialty Certification
  • 26. Medical School Faculty Types of Faculty: ●  Research ●  Instructional ●  Clinical ●  Adjunct Education 26
  • 27. What are the credentials of primary care providers? A. MD B. DO C. NP D. PA E. Any of the above F. None of the above Clinical Care 27
  • 28. What are the credentials of primary care providers? A. MD B. DO C. NP D. PA E. Any of the above F. None of the above Clinical Care 28
  • 29. Gone are the days of having only 1 doctor... 29
  • 30. New Models Clinical Care 30 All images from The Noun Project. See references at end for attributions.
  • 31. Research contributions to new knowledge “bench to bedside” “disciplinary guilds” - for reviews of proposals for funding and for verifying results Basic Research Patient-Oriented Clinical Research Improve health outcomes Translation to clinical studies Translation to health care practice 31 Chart adapted from: http://ncrr.nih.gov/
  • 32. Research On average, what percentage of research costs are covered by external grants (e.g. government, foundations)? A. Over 90% B. 60 - 80% C. 30 - 70% D. Less than 30% 32
  • 33. Research A. Over 90% B. 60 - 80% C. 30 - 70% D. Less than 30% On average, what percentage of research costs are covered by external grants (e.g. government, foundations)? 33
  • 34. Research Based on: National Science Foundation Survey, 2010, Top 125 Ranked Institutions with NSF Support 34
  • 35. Research Before > Now > Future Scope (Data and Team): Small > Big > Massive Approach: Observation > Analysis and Reduction > Synthesis and Integration Job Security: Salary Secure > Tenure Uncertain > No Tenure for Research Control: Investigator > Principal Investigator, Institution, Funder > Program Director Reference: A. Rees Midgley, 1980. Biological Science Research: Yesteryear, Today, and Tomorrow. 35
  • 36. Discussion / Activity (15 minutes) Tools and techniques that you can use to focus your efforts and create stability: ●  Not To Do Lists ●  Stakeholder Mapping 36
  • 37. Not To Do Lists To Do: NOT To Do: USO Program Transition to Operations Process Project Management KPIs Staff Development Knowledgebase Alignment Product Owner training Project Management training classes Legacy Documentation Cleanup Expanded Onboarding “What could I make a good case for doing?” Time? Important? Focus Waste Bombs Ignore Y N Y N 37 Matrix adapted from: Gregory P. Shea, Leading Change in Medicine and Business: Bridging the Gap, e.d. Sheldon Rovin, Aspen, 2001.
  • 38. Stakeholder Mapping Influence Appreciate Control Those who can ‘control’ the outcome - make the change happen or not happen Those who can ‘influence’ the outcome - make the change harder or easier Those who can ‘appreciate’ that the change is occurring, but have little power in affecting the course Reference: Gregory P. Shea, Leading Change in Medicine and Business: Bridging the Gap, e.d. Sheldon Rovin, Aspen, 2001. 38
  • 39. Stakeholder Mapping Allies Bedfellows UndecidedsFencesitters Opponents Adversaries Yes No Yes No “Does the Stakeholder Agree with you?” “Do you trust the Stakeholder?” Focus time and effort here. Reference: Gregory P. Shea, Leading Change in Medicine and Business: Bridging the Gap, e.d. Sheldon Rovin, Aspen, 2001. 39
  • 40. Closing Remarks 1.  Whitewater needs to be managed to have happy, healthy, engaged staff. 2.  Change is constant, especially in medicine. 3.  Mapping stakeholders and maintaining to do and not to do lists are example techniques to create stability and provide direction amidst that change. 40
  • 41. References Gregory P. Shea, “Leading Change” in Medicine and Business: Bridging the Gap, e.d. Sheldon Rovin, Aspen, 2001. Association of American Medical Colleges, Group on Information Resources - http://aamc.org/gir 41
  • 42. Image attributions for New Models of Clinical Care on slide 30 All images from TheNounProject.com ●  Nurse - CC BY Scott Lewis from the Noun Project ●  Doctor - Public domain ●  Person - CC BY Alex Berkowitz from the Noun Project ●  Brain - Public domain ●  Pulse CC BY TNS ●  Coordinate Patient Care - Public domain ●  Mhealth - CC BY Edward Boatman ●  iPhone - Public domain ●  Radiography - CC BY Wojciech Zasina ●  Cardiograph - CC BY Wojciech Zasina ●  Surgery - Public domain ●  Blood Glucose Meter - CC BY Danilo Casagrande de Almeida ●  Laptop - CC BY Edward Boatman 42