kirch-2-8-08 amspc.ppt
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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
© 2008 AAMC. May not be reproduced without permission.
An Historical Perspective
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The Academic Health Center
Medical School
University
Physician Practice
Hospitals and Clinics
© 2008 AAMC. May not be reproduced without permission.
So How Do We All Feel About Academic Medicine 100 Years After
Flexner?
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Connecting Outside the Beltway
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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 CollegesWashington 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 EducationAssociation 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
© 2008 AAMC. May not be reproduced without permission.
What is the source of our discontent?
Is it all just about money?
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Some Fiscal Realities NIH Funding, FY 1995-2009 [in billions]NIH Funding, FY 1995-2009 [in billions]
$0
$5
$10
$15
$20
$25
$30
$35
1995 1997 1999 2001 2003 2005 2007 2009
Constant (BRDPI)
Current
(Budget)
© 2008 AAMC. May not be reproduced without permission.
Some Fiscal RealitiesFaculty Compensation vs. the CPI
4.7%5.2%
2.9%
4.1%
2.4%
5.0%
3.6%
3.5%
2.2%
2.9%2.9%2.9%
2.1%
7.1%7.3%
4.8%4.2%
2.7%
4.3%
2.5%
3.3%
2.1%
1.1%
3.2%
3.7%
2.3%
2.2%
2.9%2.6%
2.9%
2.8%3.1%
3.8%
5.6%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
9.0%
10.0%
90-91 91-92 92-93 93-94 94-95 95-96 96-97 97-98 98-99 99-00 00-01 01-02 02-03 03-04 04-05 05-06 06-07
Compensation % increase
CPI % Increase
Source: AAMC Report on Medical School Faculty Salaries, 1990-1991 through 2004-2005
© 2008 AAMC. May not be reproduced without permission.
Some Fiscal RealitiesProjected Loan Payments as a Percentage of Projected Physician After-Tax Income
Source: “Medical Educational Costs and Student Debt,” AAMC, 2005
© 2008 AAMC. May not be reproduced without permission.
The Ultimate Fiscal Reality – The Federal Deficit
“GAO’s current long-term simulations continue to show ever-larger deficits resulting in a debt burden that ultimately spirals out of control.”
– David M. Walker
U.S. Comptroller General
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What is the source of our discontent?
Have we simply failed to find the right strategy?
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A Decade of Growth: Total Annual Medical School Revenues
0
10
20
30
40
50
60
70
80
1996 2006$ billions
$32 billion
$ 71 billion
© 2008 AAMC. May not be reproduced without permission.
A Decade of Growth: Total Annual Federal Research Funding
0
2
4
6
8
10
12
14
16
1996 2006$ billions
$ 5.8 billion
$ 15 billion
© 2008 AAMC. May not be reproduced without permission.
A Decade of Growth: Total AnnualSupport from Teaching Hospitals
0
2
4
6
8
10
12
1996 2006$ billions
$ 4.8 billion
$ 9.6 billion
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A Decade of Growth: Total Number of Full-Time Medical School Faculty
0
20
40
60
80
100
120
140
1996 2006In thousands
93,240
121,326
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A Decade of Growth: Pharmacology Department Total Expenditures
$756
$371
$
$100
$200
$300
$400
$500
$600
$700
$800
1995 2005
In millions
million
million
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A Decade of Growth: Pharmacology Department Research Expenditures
$188
$456
$
$100
$200
$300
$400
$500
1995 2005
In millions
million
million
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A Decade of Growth: Total Number of Full-Time Pharmacology Faculty
1797 1958
0
1000
2000
3000
4000
5000
1996 2006
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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.
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If the problem isn’t as simple as money and strategies to build
revenues, where should we turn our attention?
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Embracing a New Culture in Academic Medicine
“Culture eats strategyfor lunch every day”
Andy Grove
Former Chairman of Intel
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© 2008 AAMC. May not be reproduced without permission.
The Traditional Culture of Academic Medicine
• Individualistic
• Autonomous
• Scholarly
• Expert-centered
• Competitive
• Focused
• High-achieving
• Hierarchical
© 2008 AAMC. May not be reproduced without permission.
Embracing an Emerging Academic for Academic Medicine
• Collaborative
• Transparent
• Outcomes-focused
• Mutually accountable
• Team-based
• Service-oriented
• Patient-centered
© 2008 AAMC. May not be reproduced without permission.
What Does This Mean for Medical School Leaders?
If “culture eats strategyfor lunch every day…”
And if a positive culture is a key source of future excellence…
How do we change the culture in our institutions?
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#1 Make values explicit, and
use them visibly in everyday decisions!
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Academic Medicine; June 1996
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Are Stated Values Consistently Aligned with Actions?
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#2 Align governance, leadership, and
management across organizational
and “corporate” divisions!
© 2008 AAMC. May not be reproduced without permission.
The Academic Health Center
Medical School
University
Physician Practice
Hospitals and Clinics
© 2008 AAMC. May not be reproduced without permission.
#3 Use the tools of mission-based management
to realign and maximize resources!
© 2008 AAMC. May not be reproduced without permission.
DiscretionaryFund
The Cauldron
Tuition andAppropriations
Grants andContracts
Clinical Care
Research
Education
Physician andHospital Revenues
A New Model for the Organization – Aligning Revenues with Effort
Source: D. Hefner
© 2008 AAMC. May not be reproduced without permission.
Mission-Based Funds Flow:The Interdependence of Our Missions
+ 25.7m
Hospital
Clinical Enterprise
($16.7m) ($8.4m) +$2.1m ($14.3m)
AdminPhysiciansEducationResearch
Overall Conclusion: At this college of medicine, the hospital and (to a lesser degree) the physician practice, cover negative margins in all other missions.
© 2008 AAMC. May not be reproduced without permission.
Program Assessment
Mission
Contribution
Financial Performance
High/LowHigh/Low
Low/Low
High/HighHigh/High
Low/HighLow/High
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#4 Foster collaboration and accountability,
accepting nothing short of
high performance teams in all mission areas!
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A New Model for the Organization – Creating High Performance Teams
Source: Katzenbach and Smith, 1993
PE
RF
OR
MA
NC
E I
MP
AC
T
TEAM EFFECTIVENESS
Pseudo-Team
Working Group
Real Team
Potential Team
High-performing Team
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The Teams Approach
Mission-Based Teams
Relationship-Based Teams
Resource Teams
Research
Academic
Clinical
IRT
Strategic Relations(including communication and marketing, and development)
Human Resources
Finance
Physical Resources
Teams Council
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#5 Focus leadership recruitment on
organizational fit, and do real succession
planning for long-term stability!
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© 2008 AAMC. May not be reproduced without permission.
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#6 Rethink our approach to education!
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Discontinuity in the Medical Education Continuum
Premedical Medical School
Residency and Fellowships
Practice
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In Search of Transformation – New Models of Continuity for the Process
Premedical Medical School
Residency and Fellowships
Practice
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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-longLearning
Two-YearCollege
Premedical Medical School
Residency and Fellowships
Practice Life-longLearning
Pre-medical
Medical School
Residency and Fellowships
Practice Life-longLearning
Non-Premed Degree
PracticeRe-training
Life-longLearning
© 2008 AAMC. May not be reproduced without permission.
Embracing an Emerging Academic for Academic Medicine
• Collaborative
• Transparent
• Outcomes-focused
• Mutually accountable
• Team-based
• Service-oriented
• Patient-centered
© 2008 AAMC. May not be reproduced without permission.
Creating a Culture of Teamwork and Collaboration
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Creating a Culture of Reliability and Quality in the Face of High Risk
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Creating a Culture Based on “Evidence” Rather Than “Eminence”
Issacs and Fitzgerald, BMJ 319: 1618, 1999
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Creating a Culture of Trust
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Creating a Culture in Which All Teach and All Learn