understanding and navigating constant change in the academic medicine landscape presenters: michael...
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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
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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!
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1868-1891. Public domain image.
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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. 1B. 2C. 3D. 4E. 5
Change
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How many EVPMA’s (interim and permanent) have we had appointed from the University of Michigan
Medical School?
A. 1B. 2C. 3D. 4E. 5
Change
Lazar Greenfield, M.D.EVPMA 2002-2003
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Permanent White Water
Image CC BY Andy Arthur, Flickr
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Permanent White Water
Image CC BY Pete Bellis, Flickr
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Academic Health/Medical Centers (AHC/AMC): 3 Communities
School of Medicine
Teaching Hospital
(Clinical)Practice Plan
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Academic Health/Medical Centers:3 Communities
School of Medicine
Teaching Hospital
(Clinical)Practice Plan
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University
Academic Health/Medical Centers:3 Communities
School of Medicine
Teaching Hospital
(Clinical)Practice Plan
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Academic Health/Medical Centers:3 Communities
School of Medicine
Teaching Hospital
(Clinical)Practice Plan
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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.
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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
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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
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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
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AHC - 3D Mission
Missions are complementary yet competitive
Clinical Research
Education
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AHC - 3D Mission
Missions are complementary yet competitive
Clinical Research
Education
+ $
- $
- $
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AHC - 4D Mission?
Clinical Research
Education
Community Service
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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 yearsB. 8 yearsC. 12 yearsD. 15 yearsE. 19 years
Education
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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 yearsB. 8 yearsC. 12 yearsD. 15 yearsE. 19 years
Education
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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 yearsB. 8 yearsC. 12 yearsD. 15 yearsE. 19 years
Education
Chart adapted from: AAMC
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UndergraduateBachelors Degree
Years: 4
Medical School(MD)
Years: 4
ResidencyYears: 3-5+
SubspecialtyYears: 1-4
Board Certification
Recertification
Licensure
Independent Practice
Continuing Medical Education
SubspecialtyCertification
Education
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UndergraduateBachelors Degree
Years: 4
Undergraduate Medical Education (UME)Medical School (MD)
Years: 4
ResidencyYears: 3-5+
SubspecialtyYears: 1-4
Board Certification
Recertification
Licensure
Independent Practice
Continuing Medical Education
SubspecialtyCertification
Chart adapted from: AAMC
Education
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UndergraduateBachelors Degree
Years: 4
Medical School(MD)
Years: 4
Graduate Medical Education (GME)ResidencyYears: 3-5+
Graduate Medical
Education (GME)
SubspecialtyYears: 1-4
Board Certification
Recertification
Licensure
Independent Practice
Continuing Medical Education
SubspecialtyCertification
Chart adapted from: AAMC
Education
25Chart adapted from: AAMC
UndergraduateBachelors Degree
Years: 4
Medical School(MD)
Years: 4
ResidencyYears: 3-5+
SubspecialtyYears: 1-4
Board Certification
Recertification
Licensure
Independent Practice
Continuing Medical
Education (CME)
SubspecialtyCertification
Medical School FacultyTypes of Faculty:
● Research ● Instructional● Clinical● Adjunct
Education
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What are the credentials of primary care providers?
A. MDB. DOC. NPD. PAE. Any of the aboveF. None of the above
Clinical Care
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What are the credentials of primary care providers?
A. MDB. DOC. NPD. PAE. Any of the aboveF. None of the above
Clinical Care
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Gone are the days of having only 1 doctor...
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New Models
Clinical Care
30All 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 ResearchPatient-Oriented
Clinical Research
Improve health outcomes
Translation to clinical studies
Translation to health care practice
31Chart 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%
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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)?
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Research
Based on: National Science Foundation Survey, 2010, Top 125 Ranked Institutions with NSF Support
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ResearchBefore > 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.
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Discussion / Activity (15 minutes)
Tools and techniques that you can use to focus your efforts and create stability:● Not To Do Lists● Stakeholder Mapping
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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
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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.
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Stakeholder Mapping
Allies
Bedfellows
Und
ecid
eds
Fen
cesi
tter
s
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.
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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.
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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
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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
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