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Strategic Planning Committee Presents an Integrated Plan for CUMCColumbia University Medical Center Strategic Plan
Strategic Plan for Patient Care
Academic Planning Reports Executive Summary: Research The committee recommended that major emphasis be placed on the following strategically important research topics:
In addition to the strong basic science programs in neuroscience, structural biology, and developmental biology, the committee identified several clinical research programs that represent a robust, coordinated research effort. These include research into diabetes and obesity, the biochemistry of lipids and their relationship to atherosclerosis, studies on the etiology of asthma, certain areas in the clinical neurosciences, and circulatory physiology (congestive heart failure), where major clinical trials are in progress. Cardiology was viewed as strong in many areas, as indicated by the fact that several junior faculty have successful research programs, and by the existence of a large NIH funded study for treatment of type II diabetes and macrovascular disease. Critical crosscutting issues that impact all research programs in all the schools must be addressed. The chronic and worsening shortage of space affects our research productivity, our ability to recruit and retain faculty and staff, and our professional and personal quality of life. We must provide the resources, work climate, and infrastructure to support high quality research with administration and management of equally high caliber. Priorities include strengthening the Office of Grants and Contracts and the Institutional Review Board and providing additional housing for research animals. We must design systems and incentives at Columbia University Medical Center that support the types of collaboration and interaction necessary in the modern environment of science, and promote additional fruitful collaborations with colleagues at the Morningside Heights campus. And the University and NewYork Presbyterian Hospital must continue their commitment to genuine partnership in addressing research questions and management decisions. Executive Summary: Education Because of the size and complexity of its task, the Strategic Planning Committee on Education limited its initial efforts to identifying issues of importance to all of the health sciences schools. Many school or program-specific issues emerged in the course of the committee's work, and these should be addressed by separate committees. The committee's discussions and a series of focus groups including all major constituencies identified four major needs to be addressed in advancing the educational programs. Tangible Rewards for Teaching. The committee identified a deeply felt need to address expectations and compensation for teaching and to recognize the efforts of teaching faculty. As a first step, the committee recommended that the four health professions schools and the graduate program establish committees to review this report in a timely manner and develop specific implementation plans responding to the recommendations. Space for Teaching, Learning, and Living. The committee recommended an immediate review of space utilization and needs and implementation of interim measures, including a proposed clinical assessment facility. Long-term planning should ensure that education needs are clearly articulated and addressed. Both long and short-term plans should address needs for space for study, dining, socializing, and housing. Support Mechanisms for Teaching, Assessment of Teaching, Assessment of Student Learning, and Innovation. Faculty and students would benefit from a system providing "one-stop shopping" for educational support, including mechanisms for coordination and priority setting, and from investing in development of a Center for Clinical Performance Assessment to be used for undergraduate and graduate health professions education and for continuing medical education. Removing Barriers and Creating Incentives for Interactions and Collaborations. The dean and others should continue leadership efforts to promote school, program, campus, and hospital partnerships to advance education. |TOP| Executive Summary: Patient Care The Patient Care Strategic Planning Committee developed a vision for patient care at Columbia intended to make this the best place to be a patient, to work as a member of the health care team, and to learn and model patient care skills. The vision statement for patient care, the five key elements believed necessary to achieve it, and a priority goal and first objective for each element are summarized below. Vision We, the healthcare team at Columbia University Medical Center, are dedicated to continuing our tradition of providing the highest quality medical care, focused on the needs of our patients and their families. We will realize our vision through responsible innovation to create tomorrow's medicine in a welcoming environment, supported by state-of-the-art technology and systems. We will be valued for, and defined by, our creativity, compassion, and commitment to ever-improving excellence in patient care. Highest Quality Medicine is defined as measurable expression of our desire and commitment to exercise leadership in academic medicine, including patient care, by defining standards, accurately measuring accomplishments, and inspiring improved performance. The priority goal is to track and analyze outcomes, beginning with development of a plan that facilitates each unit/service/ department having one externally vetted outcome measured and tracked. Culture of Caring is a work environment that actively promotes awareness of and responsiveness to the needs of the patient on the part of every member of the health care team and support staff. The priority goal is to develop a formal set of values and standards to orient and educate all staff. As a first objective the committee recommends development of a comprehensive orientation to culture, values, and expectations for new and current members of the Columbia Medical Center community. Best People includes finding and keeping the best people at every level of the organization: identification and recruitment of superior performers within and outside the organization, development of training and incentives to foster and reward excellent work, and creativity in designing career opportunities. The priority goal is commitment to employee satisfaction, beginning with an analysis of what each constituency of the workforce wants and requires in order to have a high quality of work life. Enabling Organization is a structure that actively facilitates the attainment of our patient care vision. The priority goal is to create and fill the position of Patient Care Dean, beginning with development of a position description and suggested search process. Supportive Infrastructure refers to the physical characteristics of the organization, including management and business systems, that influence and in some cases define the achievement of institutional goals. The priority goal is to evaluate utilization and distribution of existing space, focusing first on outpatient space. The committee recommended that the planning process proceed on several fronts, beginning with definition of the duties and authority of the Dean for Patient Care. Facilities and Space The most cursory examination of facilities and space at the Columbia University Medical Center reveals the need for upgrading, expansion, and beautification of the physical plant in order to meet the needs of patients, faculty, students, and the surrounding community. Partly in anticipation of proposed academic initiatives and partly in recognition of current inadequacies, the University and the Columbia University Medical Center initiated a comprehensive review of existing facilities and an assessment of available or potential sites for expansion. A multidisciplinary team of engineers, architects, urban planners, experts in medical center design and others, working closely with key University and Hospital officials, has prepared a comprehensive Campus Planning and Development Survey which appears in The Dean's First Response to Planning Recommendation. Highlights include:
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Columbia University Medical Center Strategic Plan for Research Introduction The Committee on Research was asked to consider the topics in the biomedical sciences and supporting disciplines and technologies that will be most important in the next two decades, to assess the strength of Columbia University Medical Center research efforts in those areas, and to recommend priority areas for development and strengthening. This report is intended to be strategic rather than comprehensive, and does not address every area of research. The topics discussed in the following pages reflect Dean Fischbach's presentation to the faculty in June 2001, the committee's early discussions, and issues arising in later discussions that the committee found particularly compelling. Process Overview of Research at Columbia University Medical Center The Columbia University Medical Center campus is a research-intensive environment. External support for 2000-2001 totaled $354,674,633, primarily in the form of grants and contracts from the National Institutes of Health (NIH). While the campus is well supported, funding trends in recent years suggest there is reason for concern about its future prospects. Still, Columbia University Medical Center is a formidable presence in American biomedical research. Faculty, fellows, and students represent major research strengths, along with our affiliated hospitals. We have both established and potential links with the Columbia University Morningside Heights campus, and it is the hope of the committee that those links may be strengthened and expanded. Areas of Excellence The strongest basic science programs are in neuroscience, structural biology, and developmental biology. These topics will be discussed in further detail in the section on Columbia's strengths. In addition, several clinical research programs represent a robust, coordinated research effort. These include research into diabetes and obesity, the biochemistry of lipids and their relationship to atherosclerosis, studies on the etiology of asthma, certain areas in the clinical neurosciences, and circulatory physiology (congestive heart failure), where major clinical trials are in progress. Cardiology has strengths, as indicated by the fact that several junior faculty have successful research programs, and by the existence of a large NIH funded study for treatment of type II diabetes and macrovascular disease. Areas of Opportunity Other areas of research have not been as strong, and compare less favorably with similar efforts in other first rate institutions. Cell biology, for example, has been severely depleted over the past decade. Immunology was once strong here, but the departure of senior leadership in the early 1990s was not compensated for by the development of a new and strong molecular immunology program. Our traditional strength in physiology has not kept pace with modern systems biology. In addition, the Columbia University Medical Center efforts in several more general core technologies need strengthening. These include chemical biology, the emerging disciplines of genomics and proteomics, and the allied field of bioinformatics. Recommendations for strengthening these priority areas appear in the following section on core research needs. Several clinical research programs need stronger, more coordinated research efforts. These include, but are not limited to, selected areas in cardiovascular and cancer research as well as transplantation biology, infectious diseases, autoimmune diseases, and allergy. A more complete discussion of these areas appears in the section on areas needing to be strengthened. The research areas discussed in the following sections are of greatest strategic importance to the future growth and development of the Columbia University Medical Center campus. Although the topics discussed are thought to be of particularly high priority, this list is not intended to exclude other research initiatives. For each of the priority research area discussed below, the strategic planning group recommends that a specific plan for future support and development should be prepared. These plans should include a detailed consideration of:
|TOP| Core Research Needs That Span Individual Research Disciplines Genomics/Proteomics. Over the next decade it will be important to improve the dialogue among Columbia scientists in regard to genomic research and its role in the future of biomedicine. The development of genome science is inevitably linked to both biology and technology. Genome science will develop through the contributions of multiple disciplines and will likely draw upon talent from academia and industry. Each of these groups place differing value upon various aspects of science versus technology and these "cultural differences" can hinder the progress. It is clear, however, that a robust program in genomics and proteomics is necessary to complement advances in genetics and to promote growth in related fields. Prediction of molecular pathways and protein networks will require teams of biologists working alongside computational scientists, mathematicians, and engineers with the goal of predicting, testing, and ultimately understanding how complex networks of proteins interact to regulate biological systems. This goal overlaps with "systems biology." In order to serve the Columbia community and promote research of common heritable disorders we must develop genomic technology as a cheap solution for large-scale genotyping. These advances must include nanotechnologies, whose prime targets would include single molecule assay, and protocols to "perturb" single cells or groups of cells in vivo using model organisms, followed by global assay of mRNA or protein changes. Whole genome analyses are certain to lead to a growing number of biological predictions, some of which may be testable en masse. They might include microfabrication of miniaturized, semi-automated "laboratories" to test predictions from computational, proteomic, microarray based data. The following critical issues need urgent consideration:
|TOP| Chemical Biology. Chemistry provides a crucial underpinning to medical research. The detailed visualization of molecular processes of the cell, particularly in relation to chemotherapeutic treatment and diagnosis of disease, has been the prime interface where chemistry, medicine and cell biology come together. To capitalize on the promise of molecular medicine, a modern biomedical research institution will require people to build and manipulate molecules. Further advances in understanding the molecular basis of human diseases will require interactions between chemists and clinical research teams. The strategic planning group feels that creation of a "chemical biology" institute will greatly facilitate interaction and recruitment of scientists working at the interface of biology and chemistry and foster translational research. The institute would have its own faculty, space, and graduate training program and should be administered independently from the Department of Chemistry. The institute should be part of a larger Program in Chemical Biology that encompasses affiliated researchers in a variety of departments including, but not limited to, Pharmacology and Medicine (Columbia University Medical Center) and Chemistry (Morningside). Bioinformatics/Informatics. Computational Biology encompasses computational structural biology (which has a strong chemical and biochemical component), DNA and amino acid sequence analysis (an area with a heavy computer science and statistical component), population genetics, evolutionary biology, systems biology (modeling cellular networks), microarray analysis (which has elements of all of the above), and computational neurobiology. The overall area is an essential component in the full exploitation of the masses of genomic and proteomic data currently becoming available. Columbia already has a significant number of faculty members who can be defined as computational biologists and who are doing high quality work, but there is no integrated program. Lacking a graduate program, seminar program, common computational infrastructure, and organized service component, we are not viewed as a major player in this field. A Computational Biology Center, with its own space and budget, could maintain and disseminate state of the art software tools, organize a university-wide graduate program, and possibly provide a service activity involving workshops and training programs in bioinformatics for university staff. The Center would coordinate and complement ongoing computational biology research at both Columbia campuses, including the Columbia Genome Center and the Departments of Medical Informatics, Biochemistry and Molecular Biophysics, and Pharmacology. Medical informatics deals with biomedical information, data and knowledge--their storage, retrieval, and optimal use for problem solving and decision making. Its emergence as a new discipline is due in large part to rapid advances in computing and communications technology, to an increasing awareness that the knowledge of biomedicine is essentially unmanageable by traditional paper-based methods, and to a growing conviction that the process of informed decision making is as important to modern biomedicine as is the collection of facts on which clinical decisions or research plans are made. Columbia has one of the few academic departments of medical informatics, although several medical schools are creating academic units in this area. Growth in the area of medical informatics will require additional space and accommodation to the tension between academic/research activities of the faculty and demands for service. We must meet the challenge of high quality, interdisciplinary education for scientists who pursue careers in any of the applied information disciplines. |TOP| Strong Research Programs in Need of Continued Support Neuroscience. The complexity of neural function and the burden of brain disease guarantee that neuroscience and the study of related clinical problems will remain a vibrant and vital field for the foreseeable future. A better understanding of how the brain gives rise to cognition and emotion is one of the great challenges of modern biomedical science. Equally important is the challenge of understanding disorders of the complex but vulnerable brain. The burden of diseases of the nervous system presents one of the greatest public health challenges of this time. Columbia's progressively stronger presence in basic neuroscience and our historically eminent position in the associated clinical fields of neurology, neurological surgery, and psychiatry will help to ensure a continued leadership role. However, we must take steps to maintain a broad and excellent cadre of research faculty, to foster more interaction between basic and clinical scientists and among disciplines, and to be certain that we understand and act on changing research directions. Issues requiring attention include:
Future studies of brain disorders will focus on early intervention (beginning in childhood, in many instances) and on revolutionary new technologies. For example, stem cells can now be used to replace or augment cells injured by disease. Studies of neural stem cells should be part of a larger effort in cell therapies, including the heart, the pancreas, and other tissues. |TOP| Biophysics and Structural Biology. An understanding of molecular structure at an atomic level is imperative not only for modern biochemistry but also in many aspects of cell and molecular biology. These structures are often the starting point for therapeutic designs. The time is ripe for structural biology to become fully integrated into the fabric of the medical school in a manner similar to the assimilation of molecular biology techniques 10-20 years ago. An appropriate way to foster this may be through appointments made jointly between clinical and basic science departments. The current strength of structural biology here places Columbia among the top institutions in this area. Further expansion with true excellence will be needed if our relative strength is to be maintained and enhanced. Although we already have considerable breadth in structural biology, there are some notable omissions:
Developmental Biology. Developmental biology has close links to cell biology, genetics, neuroscience, and medicine. A key factor in its rise over the past fifteen years has been the realization that core developmental programs are remarkably conserved during animal development. As a consequence, model genetic organisms, such as the fly and worm, are now widely regarded as valid systems for relevant and rapid analysis of the function of genes relevant to human biology. With the success of sequencing of the fly, worm and human genomes, key problems regarding the function of normal and altered proteins can now be addressed. Maintaining current strengths is obviously essential. The existing developmental biology effort could be strengthened in three main ways:
|TOP| Key Areas in Need of Strengthening Cancer. Cancer is a major clinical problem, and many of its central phenomena - malignant transformation, cellular proliferation, and apoptosis - represent scientific questions that are important in other fields as well. Cancer research at Columbia includes a Comprehensive Cancer Center (one of only two such centers in New York), the Institute of Cancer Genetics, the Institute for Cancer Research, and the Oncology Division of the Department of Medicine. The Mailman School of Public Health and the Morningside campus (for example, the Laboratory of Populations) share an interest in the environmental factors and trends in prevalence involved in many forms of cancer. The scope and complexity of cancer research make for difficulties of communication and coordination. These problems are not unique to Columbia, but need to be addressed. The sense of the committee was that we have good leadership and many investigators with complementary skills, but we lack an overall vision and effective mechanisms for coordination. The future of cancer research at Columbia warrants serious study, possibly with outside advice, and with attention to infrastructure needs. Cardiology. Columbia is recognized as a leader in several areas, notably cutting edge clinical trials in congestive heart failure and in arrhythmias, as well as important epidemiological studies. In collaboration with the Department of Surgery, Cardiology leads one of the busiest heart transplant programs in the country. There is excellence in a number of areas of basic and translational research including the study of cardiac ion channels and atherosclerosis. Columbia is considered one of the leading institutions in both of these areas. In contrast, despite a reasonably busy interventional program, clinical research related to coronary heart disease requires significant development. However, there are clear opportunities to develop stronger research, patient care, and teaching programs. Key areas for development include cardiovascular genetics/genomics, vascular biology, cardiac physiology, muscle biology, and coronary heart disease. One major goal should be to establish a Cardiovascular Institute that includes basic and translational research components. Additional dedicated research space in a new building or part of a new building would help develop the program and provide identity for investigators. Regardless of where additional research efforts are housed, there are significant opportunities for additional collaborations across the Columbia University Medical Center, given the significant interests of the schools of dentistry, nursing, and public health in the epidemiology, global disease burden, and disparities among populations in cardiovascular disease. |TOP| Cell Biology. The committee was not united in its assessment of the scope or quality of cell biology at Columbia. Some members believe there are significant gaps; others maintain that better coordination and exchange of information, possibly with recruitment in selected areas, will be sufficient. There was general agreement that Columbia is not preeminent in this field and that current and future efforts would be well suited to increased collaboration with the downtown campus. It may also be an appropriate topic for a major outside review. Given the scope and maturity of the field, it seems unlikely that Columbia can achieve expertise across the entire spectrum. Critical areas discussed include nuclear organization, stem cell biology, and the biophysics of molecular machines. Core resources such as microscopy and informatics are likewise important. Clinical Research. Advances in science have set the stage for a new golden age of clinical investigation. Although Columbia is strong in selected areas of clinical research, we have not in recent years been leaders in the design of clinical trials. There is great opportunity because the Office of Clinical Trials has established effective mechanisms for collaborating with industry and for coordinating the participation of faculty and the regional patient population. Columbia is well represented in a number of multi-site clinical trials funded by the NIH. There is also a need to train and mentor young clinician scientists. We need better ways to identify promising potential clinician scientists and to provide funding and protected time for them. The process of recruiting and mentoring clinical scientists should be comparable to that which is in place for basic scientists In order to involve more faculty in a wider range of trials, we need to develop skills in identifying clear, meaningful questions that can be answered by well-designed trials. A new NIH-funded K30 program will provide master's level training in biostatistics. Plans for the location of ambulatory care and research space adjacent to each other will also help to promote clinical investigation in general. Other factors that need to be considered in strengthening our clinical trials capability include:
|TOP| Geriatrics. Columbia has a distinguished record of research in diseases related to aging. However, Columbia currently has no significant organized research program in geriatrics. Clinical researchers here have not yet been able to put together a collaborative program that provides incentives for hospital participation. Our limited collaborations with local nursing homes could be expanded to include longitudinal studies and clinical trials. There are 30,000 people over the age of 65 living north of 155th Street, and they represent one of the most ethnically diverse aging populations in the country. Stronger liaison with the community is critical to future clinical research initiatives. Grants are available in fields related to aging. Columbia has a grant for a Research Center in Minority Aging Research, but more needs to be done, covering a broader spectrum of clinical research. Health Disparities. Although not identified initially as a topic for consideration, the persistent disparity in health status and outcomes among different socioeconomic groups, between the majority and minority populations in this country, and between populations in developed and emerging economies, came up repeatedly in the course of committee discussions. The Deans of the schools of dentistry, nursing, and public health expressed strong interest in underserved populations. Columbia should continue and expand its current efforts to understand and address the health care needs of the ethnically diverse communities of the Harlem and Washington Heights neighborhoods surrounding the medical center. Closely related to health disparities at home is the increasingly important issue of global health. The Mailman School of Public Health has become a leader in studies of HIV transmission and prevention in Africa and Asia. This work should be expanded and should involve the entire Columbia University Medical Center community. On an international and local level it is clear that cognitive and emotional disorders now have moved to the forefront of concern about the burden of disease. Columbia is in an excellent position to address these profound issues at both the local and international level. Human Genetics. Genetics is of fundamental significance in contemporary medical research and is the subject of much activity at Columbia. Genetics has moved beyond its initial focus on rare single gene disorders that follow Mendelian patterns of inheritance. The current effort, which represents an enormous challenge, lies in common complex diseases caused by the interplay of several genes and environmental factors. A separate committee convened last year to study the future of human genetics has already recommended that a trans-departmental Institute of Human Genetics be established. We have no role models in this area. Academic medical centers are still struggling with the shape of programs that will unite genomics, human genetics, and information sciences. Surely our plans will include approaches such as informatics, molecular and statistical analysis, high throughput genomic screening, genetic epidemiology, model organisms, gene/environment models, and ethics. |TOP| Immunology and Inflammatory Disorders. The development, function, and pathology of the immune system are areas of active research. Immunology is central to many aspects of medicine, underlying host responses to pathogens, autoimmune diseases, allergies, rejection of allograft transplants, and surveillance against tumors. Recent years have seen great progress in the elucidation of molecules, pathways, and regulatory cascades important for the immune system, as well as the creation of mouse models to study normal immune responses and immunological diseases. Although Columbia has faculty whose research focuses on the immune system, a critical mass is lacking. We need faculty with expertise in areas such as dendritic cell biology, tumor immunology, transplant immunology, and cellular immunology. Further, the immunology faculty lacks an organizational structure, and this hinders our ability to attract new faculty and graduate students. A previous committee recommended formation of a Department of Immunology. This committee discussed additional options including an interdepartmental center or institute. Immune and inflammatory disorders contribute significantly to disease burden and offer important research opportunities. Autoimmune disorders are a significant problem for which there is a great deal of funding currently available, and novel therapeutics are being rapidly developed. The School of Dental and Oral Surgery has identified oral inflammation and infection as a major priority, given their association with low birth-weight and systemic diseases such as cardiovascular and cerebrovascular disease and diabetes. In addition to the topics noted above, areas of the clinical program that require attention include:
Infectious Diseases. Columbia has outstanding basic and clinical scientists in this field. The clinical research program has focused primarily on HIV and has established prominent NIH funded programs including an AIDS Clinical Trials Unit and an HIV Vaccine Trials Unit as part of two major NIH-sponsored multi-site networks. These programs have also helped to foster important collaborative links within the Columbia University Medical Center including the Columbia-Rockefeller Center for AIDS Research and the Department of Epidemiology in the Mailman School of Public Health. International efforts include ongoing or planned projects with the University of Natal in Durban, South Africa. The School of Public Health, together with investigators in the Department of Medicine, is leading a global effort to provide treatment for HIV-infected women and their families in low-income countries, primarily but not exclusively in sub-Saharan Africa. As noted earlier, oral infection is a priority for the SDOS. The laboratory programs are focused on three important areas which all have high levels of peer-reviewed (including NIH) funding: viral neuropathogenesis and cell growth control; pathogenesis and molecular epidemiology of staphylococcal infections; and interactions of host cell proteins with HIV-1 gene products. In terms of future program growth, attention should be paid to the following:
|TOP| Critical Crosscutting Issues for Research at Columbia University Medical Center A number of topics that have great influence on the quality of research and campus life came up in the course of the committee's discussion. Neither time nor the charge to the committee permitted full exploration of these issues. We discuss them briefly here, with a recommendation that they be pursued further. Space Research Space. Current research space is decidedly inadequate in terms of amount, quality, and distribution. It is now the limiting factor that constrains recruitments, collaborations between scientists, the application of new technologies to current research problem, and the orderly growth of excellent programs. The quality and location of the space are as important as the amount, and critical adjacencies must be established. As fields such as neurobiology and biological chemistry engage collaborators from other disciplines, laboratories need to be designed to accommodate their joint efforts. The nearly universal calls for measures to promote translational research must be accompanied by building design that links basic scientists, clinicians, patients, and students. Research Animal Space. The power of genetic research and its application to clinical problems cannot be realized without adequate facilities to house the animal models needed to understand disease and evaluate potential therapeutics. The principal organism used to exploit modern genetics is the laboratory mouse, yet mouse facilities at Columbia are woefully inadequate - less than half the size of those at peer institutions. Facilities for care of research animals for all purposes and the organizational systems for supporting such care are in critically short supply, and planning is needed to determine the numbers of animals that may be required over the next several years. Interaction Space. The importance of what is inadequately described as "social space" cannot be overstated. Science is a highly evolved social activity that requires constant discussion and debate. Well-distributed space, whether for regularly planned meetings or chance encounters, is critical to the interactions that generate new ideas and collaborations. And the basic requirements for appealing and affordable meals - and spaces in which to enjoy them - are felt at all levels. Faculty, staff, students, patients and their families, and the broader community need, and deserve, a more welcoming environment than we now provide. Promoting Interactions Among Investigators Promoting and sustaining collaboration has proven to be one of the greatest challenges for Health Sciences. The committee noted the lack of significant interactions among investigators working on related or complementary topics, as well as the paucity of links among basic, clinical, and translational research. The roots of the problem appear to lie in organizational structure, geography, and behavior. Departments, centers, and institutes, while perhaps conceived with a view towards bringing like activities together, may outlive the realities of interdisciplinary research or may take on their own identities that discourage rather than facilitate interaction. It may be appropriate to review current structures of departments, centers, and institutes to be sure they are still accomplishing their objectives and not impeding the interdisciplinary and collaborative nature of contemporary science. The Deans of M-SPH, SDOS, and SON and their representatives on the committee identified several important areas for potential collaboration. Many of these topics are of interest to the College of Physicians and Surgeons and components of the Morningside campus as well. Biomedical engineering, global health and health disparities, and outcomes research are just a few examples of fields in which more joint efforts would be desirable. Research Administration The administrative, policy, and compliance infrastructure that supports research at Columbia University Medical Center needs to be strengthened. Committee members frequently mentioned the need for more proactive efforts to publicize grant opportunities and other programs such as loan forgiveness; the importance of cultivating an attitude of customer service among staff who support the research effort; and the need for better systems to collect required information, especially for large applications like training grants. The resources and systems available to support activities of the Office of Grants and Contracts and the Institutional Review Board should be examined. In addition to improving basic support for the research programs, we should be striving to foster a norm of constructive criticism in proposing and managing research projects. Columbia University Medical Center-Morningside Heights Interactions Just as the biomedical sciences are converging in many areas, scientists are beginning to appreciate the degree to which virtually all fields of scientific inquiry can contribute to discovery and to technological progress. Biology and chemistry are the disciplines with which Health Sciences has had the greatest traditional commonality of interest. The committee included a member from the Department of Chemistry and an invited speaker from the Department of Biological Sciences. Computer science, engineering, physics, and earth science also represent emerging fields of common interest. University-Hospital Interactions The different and sometimes divergent missions of the university and the its affiliated hospitals come into play in research as in other aspects of the medical center's programs. The institutions are both collaborators and competitors, with the balance of those relationships constantly shifting. Nowhere is the challenge of the relationship more evident than in the assignment and utilization of space. At the same time, however, the university and hospital are united by a common commitment to research, education, and patient care engaging the efforts of faculty, students, and house staff, and they depend on each other for success. |TOP| Columbia University Medical Center Strategic Plan for Education Introduction In July 2001 Vice President and Dean Gerald Fischbach appointed the Strategic Planning Committee on Education ("Education Steering Committee") and charged it with examining educational issues at Columbia University Medical Center. The purpose of this review was to identify current needs and future directions for all Health Sciences degree-granting programs, including space, resources for teaching, management and evaluation of the educational programs, and curricular content of our degree-granting programs. From the outset, it was agreed that this self examination should be an iterative process extending over a period of 3 - 4 years, that the Steering Committee would first address questions viewed as of overarching concern to all schools and programs at the Columbia University Medical Center and to NewYork Presbyterian Hospital, and that once these overarching concerns were identified, then school, program, and hospital specific committees would examine questions relevant to their individual programs. The Columbia University Medical Center campus of Columbia University includes four professional schools as well as the biomedical science programs of the Graduate School of Arts and Sciences. The College of Physicians and Surgeons (P&S) is focused on the M.D. degree but also includes an M.D./Ph.D. program, a master's program in nutrition, and programs in occupational and physical therapy. The Mailman School of Public Health (M-SPH) offers the M.P.H., M.S., Ph.D., and Dr. P.H. degrees. The School of Dentistry and Oral Surgery (SDOS) offers a program leading to the D.D.S. degree as well as postdoctoral specialty programs. The School of Nursing (SON) trains nurses at several levels: entry to practice, advanced practice, and D.N.Sc., and plans to offer a Doctor of Nursing Practice program. About 2,500 students are enrolled in programs at the Columbia University Medical Center campus. This represents about 2,000 FTEs, as some programs, notably public health and nursing, include substantial numbers of part-time students. Process The Education Committee held preliminary meetings in July of last year and several additional meetings in the fall. These discussions revealed that Columbia's Health Sciences schools confront certain overarching educational issues that are relevant to all schools. Several issues relevant to post-graduate and continuing education programs involve the University and the NewYork Presbyterian Hospital. In addition to common concerns, the individual schools and programs have specific concerns that are best addressed at the local level. The committee decided to address Health Sciences-wide issues first, charging the schools to engage in their own strategic planning processes (using, when appropriate, data from the campus-wide planning process.) Representatives from the Hospital were invited to participate, with a view toward engaging the Hospital more actively in planning once the first step was completed. In order to ensure that issues of concern to all the health professions schools were identified and addressed, the committee decided to function as a Steering Committee and to form a smaller Oversight Committee composed of Steering Committee leadership and the academic deans and program leaders. To clarify which educational issues were common to all schools and programs and which were more limited or specific in scope, and to expand the number of faculty and students involved in the planning process, the Committtee convened a series of focus groups, conducted with the assistance of an outside facilitator, Sharon K. Krackov, Ed.D., Associate Dean for Educational Program Development at the New York University School of Medicine. Dr. Krackov worked with committee staff to prepare questions and a format that were approved by the Oversight and Steering Committees. A total of 26 focus groups met between January and April 2002. All schools and programs, and most major constituencies within them, were represented. Participants included members of curriculum committees, course and program directors, department chairs, and students. Residents and postdoctoral fellows, who play a key role in both the work force and the education program, participated, as did a group of education administrators. The groups were invited to provide a vision of what an ideal program would look like, and to identify impediments to achieving the vision. The groups also voted on their top priorities for change, contributing to the identification of issues to be addressed at the Health Sciences level. |TOP| Results of Education Focus Groups Strengths The focus groups identified major strengths of the health sciences educational programs that should be recognized and preserved. In each school, all constituents cited the high caliber of the students and the excellence of the faculty as the greatest assets of the educational programs. Students were described as innovative, mature, creative, and diverse, and the course directors as dedicated and committed to advancing the education programs. Excellent research on the part of the faculty informs and is integrated into the educational programs in all schools, and all agree that this contributes to the quality and rigor of each program. The potential for all schools to collaborate in synergistic ways in the educational programs was recognized as valuable, although not realized. Needs The focus groups identified four major needs that must be addressed in order to advance and develop the educational programs. These shortcomings undermine the faculty's efforts to develop innovative educational practice, or to keep pace with current advances in educational practice, and place Columbia behind the national curve and trends in health science education. They affect all schools, programs, and constituencies at the Health Sciences and reflect a remarkable degree of consensus among faculty, students, fellows, and administrators. They are:
A fifth topic, the creative use of information sciences and technology to achieve educational goals, was suggested as an important topic for future planning. All of these are important, and while they cannot all be resolved immediately, the committee's goal was to identify specific actions that can be taken in the near future and others requiring more detailed planning and additional resources. All constituents in all focus groups agreed that strategic planning for education must first and foremost address these issues if we hope to create a climate that will foster the development of creative educational programs. A wealth of school and program-specific issues emerged; these will serve as the basis for further study and planning by school and program - specific committees now being empanelled. It is important to note that valuing and rewarding teaching, and quantity and quality of facilities, are primarily structural in character; that is, they reflect conditions that most agree must change in order to enable effective teaching. The focus groups and committee discussions highlighted the urgency of a number of issues related to postdoctoral fellows. The committee is pleased to learn that many of these issues will be addressed by the Dean's office. In addition, the committee feels that the focus group process did not probe deeply enough into issues affecting the residency programs and recommends more detailed exploration from the perspectives of the university, the hospital, the residents, and their program directors. Vision and Priorities for Education at the Columbia University Medical Center Campus Of the four issues that emerged from the focus groups, the first three are closely related and of highest priority. Investment in one area without investment in the others will not result in the desired improvement in educational quality. The fourth, addressing the need to encourage and facilitate collaborations, includes several topics of varying degrees of urgency. Most focus group participants were primarily interested in promoting research collaborations and in facilitating joint teaching and cross-registration for schools. Many recognized the urgency of improved collaborations with the Hospital in all aspects of clinical education. Subsequent planning efforts in the schools of dentistry, medicine, and nursing should address the needs for better collaboration with the hospital. The fifth topic, creative use of information sciences and technology to achieve educational goals, requires further discussion. |TOP| Tangible Rewards for Teaching The 1995 self-study report of the College of Physicians and Surgeons to the Liaison Committee on Medical Education (LCME) stated: The changing health care environment and the increasingly competitive environment surrounding research awards are causing growing concerns about the ability of faculty, both clinical and basic, to devote time to teaching without compensation. This stress is felt in almost every department…Teaching…remains largely uncompensated…The College is most fortunate to have a large cadre of faculty who still consider teaching a privilege and a pleasure. It will be necessary to rely on that spirit heavily as the institution experiences the noted pressures of change."Columbia College of Physicians and Surgeons Self-Study Report to the Liaison Committee on Medical Education, 1995" The situation has not changed, it is not limited to P&S, and many would argue that it has become more urgent. While some faculty - in the School of Nursing, for example - are compensated for teaching, almost every constituency, including students, agrees that there are few tangible rewards for the faculty's investments in teaching. They urge better alignment of our values and reward systems by implementing more effective systems for documenting, compensating and providing credit for promotion and tenure for scholarly contributions to the educational programs. This will undoubtedly require additional financial resources. It can be argued that education is "job one" at all health sciences schools, yet teaching is seen as a low priority that is not valued or adequately recognized. Faculty believe teaching is expected, and information on teaching activity is required for ad hoc tenure reviews. But there are no Health Sciences-wide policies to guide faculty in establishing the level of their teaching commitments, or in defining their expectations of monetary or non-monetary support (including time). There are faculty who are dedicated to education in each school, and who are deeply committed to developing high quality educational programs, but they are limited in the time and energy that they can realistically devote to developing and improving the quality of the education programs. Teaching detracts from time that could be devoted to research or patient care, both of which generate critically needed salary support. The current promotion systems do not adequately compensate for teaching, provide time for it, or reward faculty for significant scholarly contributions to the education programs. Columbia is not alone in this regard; most educators at academic medical centers feel undervalued. "Training Tomorrow's Doctors, Task Force on Academic Health Centers, The Commonwealth Fund, April, 2002." Columbia has an opportunity to learn from institutions that have successfully addressed this problem, such as Stanford, the University of Pittsburgh, and the University of Florida. Most faculty and students showed little enthusiasm for a separate track for teaching faculty. The integration of teaching, research, and clinical practice is highly valued at Columbia, reflecting a belief that these activities complement and strengthen each other. There is a need for more transparency and accountability in how education is financed at Columbia Unversity Medical Center. A budget is a measure of one's priorities. The total degree-seeking student body generates tuition income on the order of $50 million per year a small fraction of income compared almost $355 million in external research funding (not including funding for the New York State Psychiatric Institute) and approximately $330 million in faculty practice income in 2000-2001. Still, an education budget would help to clarify and establish priorities for maintenance and upgrading of teaching facilities, for educational support systems and administration, and for teaching. The matter of compensating for teaching is a complex issue. Individual schools and programs have different traditions and revenue streams that may influence the options available. The committee recommends that several steps that can lead to a reasonable policy and plan of action:
Efforts to provide compensation for teaching should be undertaken with a clear understanding of their possible ramifications. First, it is almost certain that additional funds will have to be raised to support such an effort. Second, the commitment to value teaching through compensation has implications for how teaching is regarded in decisions affecting tenure and promotion. Even to examine the issue challenges traditional views of what it means to be a faculty member in an institution such as Columbia. |TOP| Space for Teaching, Learning, and Living There was resounding consensus across schools and constituents that the space and infrastructure for education are unacceptable. We need to develop state-of-the art educational space for teaching, study, socializing and living. There is insufficient teaching space of every type including: lecture halls, small group rooms, conference rooms, and laboratories appropriate for present-day teaching requirements. These inadequacies create immense competition and inconsistencies in scheduling, class locations and meeting times. There are perceived inequities in scheduling priorities across schools. The inefficient traffic flow within the campus adds to the frustration of students and faculty. Immediate short-term solutions are needed to improve the quality of the current teaching spaces, to provide further centralization and coordination of scheduling, and address actual and perceived inequities in the allocation of space. A review of currently available space should be undertaken immediately. It should address centrally scheduled teaching space, department-based and other unscheduled space that might be available to augment space now available or serve as swing space during renovations or construction. Increased emphasis on ambulatory care has changed the way medical students encounter patients. It is a major challenge to ensure that the student or resident experiences the full range of clinical decision-making, immediate care, and follow-up. This requires, among other things, additional rooms so that medical and nursing students and their instructors can see patients alone initially to formulate their assessment of the patient's problems and management. The examining rooms should also be large enough to allow a team of three (student, post-graduate, and senior instructor) to interact with the patient. The space should be set up to allow subsequent presentation to faculty supervisors and discussion of treatment options. This requires a mix of examining rooms and small conference space. The outpatient facility planned for 165th Street takes these needs into account, as do other recently completed renovations and plans. The following section includes a recommendation for a clinical performance assessment facility. Both short and long-term planning should address this need, including the relative merits of a centralized or dispersed location. The committee supports the concept of a unified education facility in a single central location (dedicated building or contiguous space) with sufficient capacity to accommodate the multifaceted classroom needs for all schools, and to provide educational services and support to faculty, students, and the library. It is essential to eliminate or significantly reduce the competition for rooms of every type - small group, large lecture, medium lecture, conferences, and clinical. Classrooms that can be easily and quickly modified to accommodate different size groups would be highly desirable. The facility should have state-of-the art information technology in every classroom and study space, comprehensive audiovisual equipment and dedicated support, effective climate control, and ample computer connections. The facility should be easily accessible, central, and foster interaction, communication, and social exchange among all health science constituents, schools, and disciplines. It should include a state-of-the-art library with adequate study and social space, taking into account existing recommendations for renovation of the present library. Also needed are cafeterias and lounges whose placement and capacity both allow and encourage spontaneous and planned intellectual interactions. Planning for educational space must address the issue of social space and housing for students, house staff, and junior faculty. For virtually every program and school, the housing was cited as inadequate. In particular, dormitories in Bard Hall are inappropriate for adult students. Social space must include adequate facilities for eating, socializing, and studying. The committee recommends that the Academic Deans or their designees be represented on all space planning for research, patient care, housing, and social space to ensure that the educational programs are not compromised and that educational needs are considered. | TOP | Support for Teaching, Assessment, and Innovation Teaching at Columbia should be informed by contemporary concepts of learning, best practices in pedagogy, appropriate technological support, and constant evaluation of content, teaching, and performance. Most teaching faculty have no training in educational methods, and it is extremely difficult for them to develop and improve teaching methods, materials and resources. Many expressed the desire for an entity that would provide "one stop shopping" to help with the development and evaluation of course materials. The committee believes this can best be done through a an entity that would provide:
As a first step, the committee recommends that the Dean appoint a working group to identify options for consolidating, improving, and making more accessible and efficient the educational resources now available to the faculty. High priority should be given to creating an infrastructure that would enable state-of-the art excellence in assessment and evaluation of student performance, including a Clinical Performance Assessment facility. Such a facility could be used to evaluate performance from the very beginning of clinical training through graduate and continuing medical education. It would be of immediate use for the schools of medicine, dentistry, and nursing, and the hospital. The ability to assess interviewing skills could be helpful for public health as well. Such a facility could also provide innovative ways of teaching students. Because of the importance of competency assessment in graduate medical education, and its imminent introduction into undergraduate assessment, it is important that this be undertaken as a joint University-Hospital initiative. | TOP | Incentives for Interactions and Collaborations In order to fully reap the benefits of being part of a great university, we must create systems that facilitate inter-school, campus and departmental interactions and collaborations. In general, faculty and students greatly value the opportunities for interactions between uptown and downtown, and cross-fertilization among schools. The opportunities for cross-registration, joint degree programs, and inter-disciplinary collaborations are impressive, but there are limitations and impediments to collaboration at many levels. For example, different calendars across health science schools inhibit collaborative educational opportunities. Regulations prevent students from enrolling in classes until drop-add periods. And while the focus of this report is on education, some faculty, especially from the School of Nursing, feel that more equal and reciprocal partnerships in research would ultimately enhance the quality of education. The committee recommends continued efforts to increase and improve communication between schools, between uptown and downtown, and between university and hospital. Also needed are opportunities, systems, and incentives that will foster collaboration among schools, programs, and hospital to enhance the quality, cross-fertilization, and synergy of the educational programs. Next Steps The committee has identified an ambitious agenda for change, and its task is not yet complete. This report outlines the needs that must be addressed if the Health Sciences schools are to maintain excellence and be in a position to develop integrated, innovative approaches to health professions education. As a first step, the committee recommends that the four health professions schools and the graduate program establish committees to review this report and comment on the recommendations. Such committees might be the same groups charged with school and program-specific strategic planning envisioned in the overall education planning process, or the deans may opt for specific task forces focusing on issues of expectations and compensation for teaching. The schools and programs should be charged with a specific timetable so that the Columbia Unversity Medical Center administration can compare their recommendations and identify common concerns. | TOP | Columbia Unversity Medical Center Strategic Plan for Patient Care Introduction Columbia has an opportunity to set new standards and an agenda for providing outstanding patient care in the face of exploding knowledge and new ways of organizing and financing health care. We must do this in an era of tension between the capacity to deliver care and the means to pay for it. Our vision for patient care, while it will require investment on our part, will ultimately make us more competitive in attracting staff and patients and in negotiating reimbursements based on outcomes data. Provision of the highest quality patient care is our highest goal. Quality must be measurable, continuously improving, and relevant to the needs of our patients. We want to make this medical center the best place to be a patient, to work as a member of the health care team, and to learn and model patient care skills. And we are committed to the concept of responsible innovation, in keeping with our stature as a leading research university. Process In July 2001 Dean Gerald Fischbach convened a Patient Care Strategic Planning committee as part of a broader strategic planning effort for the Columbia University Medical Center campus. Our committee, which included a large and broadly representative sample of clinical leadership, was charged with developing a strategy for the pursuit of our clinical mission over the next five years. We sought to generate a meaningful, understandable, motivating, and achievable blueprint to guide us through a time of opportunity and challenge. Because the process we chose required in-depth work sessions with continuity of participation, we agreed to proceed with an executive subcommittee of 12 who would complete the initial work, report to the full committee, and incorporate the full committee's feedback into an action plan. Dr. Klara Szutinski of the Millennium Consulting Group assisted with the design and conduct of the subcommittee's meetings. The subcommittee engaged in a five-phase, highly interactive strategic planning process that allowed the incorporation of a broad range of viewpoints and expertise. We agreed that the choice of vision elements and goals would not necessarily reflect the unanimous view of every member of our committee. Instead, we operated by consensus, defined as willingness to adopt and work towards the proposed outcome. | TOP | Recommendations Vision for Patient Care The first and most labor-intensive task was to develop a vision statement that would describe the environment we seek to create, point the way toward strategies for rapidly achieving priority goals, and build a foundation for future progress. Agreement on a vision, stated below, allowed the committee to identify a set of initial priority goals that are feasible and have the potential to make a real difference for everyone involved in patient care at Columbia. Vision We, the healthcare team at Columbia University Medical Center, are dedicated to continuing our tradition of providing the highest quality medical care, focused on the needs of our patients and their families. We will realize our vision through responsible innovation to create tomorrow's medicine in a welcoming environment, supported by state-of-the-art technology and systems. We will be valued for, and defined by, our creativity, compassion, and commitment to ever-improving excellence in patient care. We can achieve this vision only if certain key characteristics or elements can be fostered in the patient care environment. In short, we must transform our institution. The following key elements must be present in order to achieve the vision: Highest Quality Medicine: Measurable expression of our desire and commitment to exercise leadership in academic medicine, including patient care, defining standards, accurately measuring accomplishments, and inspiring improved performance. Culture of Caring: Creating a work environment that actively promotes awareness of and responsiveness to the needs of the patient on the part of every member of the health care team and support staff. Best People: Finding and keeping the best people at every level of the organization: identification and recruitment of superior performers within and outside the organization, development of training and incentives to foster and reward excellent work, and creativity in designing career opportunities. Enabling Organization: Creating an organizational structure that enables and actively facilitates the attainment of our patient care vision. Supportive Infrastructure: Physical characteristics of the organization, including management and business systems, that influence and in some cases define the achievement of institutional goals. This element encompasses space, systems, and communication. Critical Goals and Priorities, Feedback, and Action Planning For each element, a working group of three to four subcommittee members formulated critical goals and selected one or two priority goals that should be addressed first. The working groups' recommendations were discussed with the subcommittee, and in some cases modified. The full committee was highly receptive and enthusiastic about the subcommittee's recommendations. Their feedback helped to clarify existing supports or enablers that will help to facilitate each of these first priority goals; identify significant challenges or obstacles; and provide implementation suggestions for each goal and a specific objective to begin implementation. Based on discussions with the full committee, the subcommittee identified a "first objective" for each goal to serve as the basis for project planning and implementation. This section describes the goals and priorities, summarizes the feedback from the full committee, and the first objectives associated with that need to be accomplished within each element of the vision. | TOP | Highest Quality Medicine Columbia aspires to and rightly claims a position of leadership in academic medicine, including patient care. We must define standards for ourselves and accurately measure our accomplishments in order to motivate better performance, recognize success, and correct shortcomings. If we are to practice the highest quality medicine we must be able to name it, do it, measure it, and teach it, as stated in the following critical goals:
Priority Goal: Track and analyze outcomes. Our priority goal focuses on outcomes measurement as the prerequisite for success in providing the highest quality medicine. It addresses the desire of health professionals to provide excellent care for patients. It calls for us to track performance over time and in comparison with other institutions, and to set the standard for how outcomes research should be done. Outcomes reports will prove useful in marketing and in negotiating with regulators and insurance providers. It links to all the vision elements, and provides a framework for measuring and celebrating success. Recognizing that each unit may have a different starting point, the committee recommends that each begin by selecting one outcome to measure, and that it be vetted by an outside group, preferably a "client department." In order to succeed, the process will need to have a senior person in each unit responsible for it and should build on existing quality assurance measures. First Objective: Develop a plan that facilitates each unit/service/ department having one externally vetted outcome measured and tracked. | TOP | Culture of Caring A strong commitment to the values of caring and healing inspires many to become health professionals, but this commitment is tested daily in the patient care environment. Patients and their families also have a vision of the medical center as an environment in which they will be cared for, and are frequently disappointed when their expectations are not met. The establishment of a "culture of caring" as an essential element of our vision encompasses the following critical goals:
Priority Goal: Develop a formal set of values and standards to orient and educate all staff. Our mission is to educate - which includes modeling desired behavior - and we have a history and tradition of delivering excellent care. Both the NewYork Presbyterian Hospital and the Faculty Practice Organization have shown leadership in developing improved customer service initiatives. Customer service resonates with a majority of staff who want to deliver excellent patient care and contribute to Columbia's recognition as an outstanding medical center. The process should involve staff from all levels of the organization, define a measurable reward and recognition program, and make use of varied evaluation systems, including colleague evaluation. We should model and leverage what is already being done, with attention to the internal and external public relations value of what has been and will be accomplished. All constituents, including departments, should contribute to the cost of implementing this goal. First Objective: Develop a comprehensive orientation to culture, values, and expectations for new and current members of the Columbia Medical Center community. | TOP | Best People Finding and keeping the best people at every level of the organization involves the identification and recruitment of superior performers within and outside the organization, the development of training and incentives to foster and reward excellent work, and creativity in designing career opportunities. It includes the following critical goals:
Priority Goal: Employee satisfaction - commit to the ongoing development of an environment that provides a satisfying quality of work life to all members of the healthcare team. This goal focuses on people and reinforces the desire of most employees to create the best possible working environment. The NYPH leadership is already committed to the goal of having the "best people," and the New York City workforce is one of the best available. The reputation and resources of the University and the Hospital make this an attractive place to work. A focus on developing tools for assessing employee satisfaction will provide a means of measuring progress. Attainment of this goal will require a clear plan and efforts to incorporate and achieve buy-in from all major groups. Like the previous goal, this one requires the development of standards and values. Also needed is the collection of data, for example, analysis of attrition to determine the balance between negative and positive trends. Resources will be important to measure and monitor satisfaction, to publicize success, and to deal with chronic "dissatisfiers," including staff shortages. First Objective: Analyze what each constituency of the workforce wants and requires in order to have a high quality of work life. | TOP | Enabling Organization Members of the committee felt strongly that the time is ripe for creating an organization that facilitates the mission and inspires the confidence and cooperation of staff. This will require the achievement of administrative competence, accountability, and transparency at all levels and the development of a strong school and hospital partnership. Critical goals include:
Most urgently, it requires a senior leader who will be responsible for advancing and improving patient care at the medical center, for representing the entire clinical faculty, for partnering with the Dean for Research to identify and follow through on opportunities for improving clinical research, and for serving as liaison with the NYPH and other affiliated hospitals. Priority Goal: Create and fill the position of Patient Care Dean. This proposal has broad support from the committee and is viewed as important for achieving progress in many areas. It will fill an important gap and give practicing faculty and clinical departments someone to work with on issues and concerns. Similar positions exist at many medical schools. We should look at models elsewhere and define the boundaries of authority. The new Dean should have sufficient resources and focus on culture change, not just small issues. The consensus is that the position should be filled within months with an internal candidate. First Objective: Finish position description and design search process for the Patient Care Dean. Supportive Infrastructure Just as the human factors in an institution have the power to promote or impede progress, the physical infrastructure, defined broadly to include management and business systems, influences and in some cases defines the achievement of institutional goals. Deficiencies in the amount and quality of space and the lack of a welcoming environment for patients, staff and students are obvious. We must also address the use and distribution of current space, the impact of new centers and institutes, the acute need for new and enhanced ambulatory care space, and inefficient or redundant systems for information and communication. Critical goals for establishing a supportive infrastructure include:
Priority Goal: Develop a short-term plan to evaluate space usage and redistribute as necessary. The ambitious plans for long-term space development and acquisition underscore the commitment of the university and the hospital, but they also highlight the fact that difficult decisions that must be made now. The committee recommends an immediate, comprehensive review of space utilization, beginning with outpatient space. The urgency of this goal lends a great deal of momentum and support. The Hospital and the University have already made a commitment to address long-term space issues and have developed an ambitious plan. Assessment of current utilization and needs must be a joint university-hospital undertaking with specific priorities to guide decisions and creative approaches to solving space allocation problems. First Objective: Conduct an immediate, comprehensive review of space utilization, beginning with outpatient space. Next Steps The committee recommends that the planning process proceed on several fronts. Most urgent is the definition of the duties and authority of the Dean for Patient Care. That leader will play a key role in refining and forwarding the first priority goals that have been identified, and will provide leadership as we move on to address the remaining goals. This report includes our vision of what our patient care efforts must be and a more detailed description of the elements of that vision. Achievement of any single goal, while desirable, would not represent the cultural transformation we believe is so desirable. The aggregate achievement of these goals would help us to achieve a higher level of performance in our campaign to conquer human illness. We are fortunate to have a critical mass of leaders committed to working for excellence and constructive change. By building on our achievements, we believe that we can succeed in realizing our vision. Also of interest: Letter from Dean Fischbach Last updated |
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