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

From June 2014 presentation by Michael Warden, Johmarx Patton, and Kathleen Ludewig Omollo of University of Michigan Medical School Information Services to their colleagues in the department.

Drawing upon the concept of "permanent white water," the presenters explore the constant change and churn that affects academic medical centers such as UMMS and tactics for how to thrive in such an environment. The presenters highlight trends and models within the education, research, and clinical domains.

Downloadable versions in PPTX and PDF are available at http://open.umich.edu/node/9706/.

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

  1. 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. 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. 3. 1868-1891. Public domain image. 3 2012- Present. Image CC BY NC University of Michigan, UMHS Media Bank.
  4. 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. 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. 6. Constant Change Image CC BY P-A-T-R-I-C-K Flickr 6
  7. 7. Permanent White Water Image CC BY Andy Arthur, Flickr 7
  8. 8. Permanent White Water Image CC BY Pete Bellis, Flickr 8
  9. 9. Academic Health/Medical Centers (AHC/ AMC): 3 Communities School of Medicine Teaching Hospital (Clinical) Practice Plan 9
  10. 10. Academic Health/Medical Centers: 3 Communities School of Medicine Teaching Hospital (Clinical) Practice Plan 10 University
  11. 11. Academic Health/Medical Centers: 3 Communities School of Medicine Teaching Hospital (Clinical) Practice Plan 11
  12. 12. Academic Health/Medical Centers: 3 Communities School of Medicine Teaching Hospital (Clinical) Practice Plan 12
  13. 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. 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. 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. 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. 17. AHC - 3D Mission Missions are complementary yet competitive Clinical Research Education 17
  18. 18. AHC - 3D Mission Missions are complementary yet competitive Clinical Research Education + $ - $ - $ 18
  19. 19. AHC - 4D Mission? Clinical Research Education Community Service 19
  20. 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. 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. 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. 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. 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. 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. 26. Medical School Faculty Types of Faculty: ●  Research ●  Instructional ●  Clinical ●  Adjunct Education 26
  27. 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. 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. 29. Gone are the days of having only 1 doctor... 29
  30. 30. New Models Clinical Care 30 All images from The Noun Project. See references at end for attributions.
  31. 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. 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. 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. 34. Research Based on: National Science Foundation Survey, 2010, Top 125 Ranked Institutions with NSF Support 34
  35. 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. 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. 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. 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. 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. 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. 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. 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

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