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Kirch-2-8-08 AMSPC.ppt

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Kirch-2-8-08 AMSPC.ppt

  1. 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. 2. An Historical Perspective
  3. 3. The Academic Health Center Medical School University Physician Practice Hospitals and Clinics
  4. 4. So How Do We All Feel About Academic Medicine 100 Years After Flexner?
  5. 5. Connecting Outside the Beltway
  6. 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. 7. What is the source of our discontent? <ul><ul><li>Is it all just about money? </li></ul></ul>
  8. 8. Some Fiscal Realities NIH Funding, FY 1995-2009 [in billions] Constant (BRDPI) Current (Budget)
  9. 9. Some Fiscal Realities Faculty Compensation vs. the CPI Source: AAMC Report on Medical School Faculty Salaries, 1990-1991 through 2004-2005
  10. 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. 11. The Ultimate Fiscal Reality – The Federal Deficit <ul><li>“ GAO’s current long-term simulations continue to show ever-larger deficits resulting in a debt burden that ultimately spirals out of control.” </li></ul><ul><li>– David M. Walker </li></ul><ul><li>U.S. Comptroller General </li></ul>
  12. 12. What is the source of our discontent? <ul><ul><li>Have we simply failed to find the right strategy? </li></ul></ul>
  13. 13. A Decade of Growth: Total Annual Medical School Revenues $ billions $32 billion $ 71 billion
  14. 14. A Decade of Growth: Total Annual Federal Research Funding $ billions $ 5.8 billion $ 15 billion
  15. 15. A Decade of Growth: Total Annual Support from Teaching Hospitals $ billions $ 4.8 billion $ 9.6 billion
  16. 16. A Decade of Growth: Total Number of Full-Time Medical School Faculty In thousands 93,240 121,326
  17. 17. A Decade of Growth: Pharmacology Department Total Expenditures In millions million million
  18. 18. A Decade of Growth: Pharmacology Department Research Expenditures In millions million million
  19. 19. A Decade of Growth: Total Number of Full-Time Pharmacology Faculty
  20. 20. A Profession On the Rise <ul><li>A record number of nearly 17,800 students began medical school this year. </li></ul><ul><li>A Gallup poll tells us that the American public continues to view medicine as the “most desirable” profession a young person could pursue. </li></ul>
  21. 21. If the problem isn’t as simple as money and strategies to build revenues, where should we turn our attention?
  22. 22. Embracing a New Culture in Academic Medicine <ul><li>“ Culture eats strategy for lunch every day” </li></ul><ul><li>Andy Grove </li></ul><ul><li>Former Chairman of Intel </li></ul>
  23. 24. The Traditional Culture of Academic Medicine <ul><li>Individualistic </li></ul><ul><li>Autonomous </li></ul><ul><li>Scholarly </li></ul><ul><li>Expert-centered </li></ul><ul><li>Competitive </li></ul><ul><li>Focused </li></ul><ul><li>High-achieving </li></ul><ul><li>Hierarchical </li></ul>
  24. 25. Embracing an Emerging Academic for Academic Medicine <ul><li>Collaborative </li></ul><ul><li>Transparent </li></ul><ul><li>Outcomes-focused </li></ul><ul><li>Mutually accountable </li></ul><ul><li>Team-based </li></ul><ul><li>Service-oriented </li></ul><ul><li>Patient-centered </li></ul>
  25. 26. What Does This Mean for Medical School Leaders? <ul><li>If “culture eats strategy for lunch every day…” </li></ul><ul><li>And if a positive culture is a key source of future excellence… </li></ul><ul><li>How do we change the culture in our institutions? </li></ul>
  26. 27. <ul><li>#1 Make values explicit, and </li></ul><ul><li>use them visibly in everyday decisions! </li></ul>
  27. 28. Academic Medicine; June 1996
  28. 29. Are Stated Values Consistently Aligned with Actions?
  29. 30. <ul><li>#2 Align governance, leadership, and </li></ul><ul><li>management across organizational </li></ul><ul><li>and “corporate” divisions! </li></ul>
  30. 31. The Academic Health Center Medical School University Physician Practice Hospitals and Clinics
  31. 32. <ul><li>#3 Use the tools of mission-based management </li></ul><ul><li>to realign and maximize resources! </li></ul>
  32. 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
  33. 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.
  34. 35. Program Assessment Mission Contribution Financial Performance High/Low Low/Low High/High Low/High
  35. 36. <ul><li>#4 Foster collaboration and accountability, </li></ul><ul><li>accepting nothing short of </li></ul><ul><li>high performance teams in all mission areas! </li></ul>
  36. 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
  37. 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
  38. 39. <ul><li>#5 Focus leadership recruitment on </li></ul><ul><li>organizational fit, and do real succession </li></ul><ul><li>planning for long-term stability! </li></ul>
  39. 42. <ul><li>#6 Rethink our approach to education! </li></ul>
  40. 43. Discontinuity in the Medical Education Continuum Premedical Medical School Residency and Fellowships Practice
  41. 44. In Search of Transformation – New Models of Continuity for the Process Premedical Medical School Residency and Fellowships Practice
  42. 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
  43. 46. Embracing an Emerging Academic for Academic Medicine <ul><li>Collaborative </li></ul><ul><li>Transparent </li></ul><ul><li>Outcomes-focused </li></ul><ul><li>Mutually accountable </li></ul><ul><li>Team-based </li></ul><ul><li>Service-oriented </li></ul><ul><li>Patient-centered </li></ul>
  44. 47. Creating a Culture of Teamwork and Collaboration
  45. 48. Creating a Culture of Reliability and Quality in the Face of High Risk
  46. 49. Creating a Culture Based on “Evidence” Rather Than “Eminence” Issacs and Fitzgerald, BMJ 319: 1618, 1999
  47. 50. Creating a Culture of Trust
  48. 51. Creating a Culture in Which All Teach and All Learn

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