Dec 212015

My dear wife grew up in Southern California and has a taste for Mexican food. Unfortunately, I have a taste for food of any composition. Mexican food clearly fits the bill.

There is a selection called “Special Dinner” on many Mexican restaurant menus. It is fit for a sumo wrestler just off his diet. Years ago, I really seemed to be able to meet the gustatory challenge. Lately, however, I am beginning to see that consuming the “Special Dinner” all in one sitting is just impossible.

So following a recent attempt, when I was asked by the kind waiter about my desire for dessert, my answer was “¡Nada más!”

Literally translated, this means “no more!”

This is the season for giving, and plenty of receiving. It clearly has become a season for excusable excess.

We all enjoy enormous privilege that is envied by those who have not had the opportunities we customarily enjoy. This year has been, in balance, one of achievement and success. Yet we rarely take the time to – or enjoy the luxury of – counting all the positives. As a culture, we are blessed with the ability to bring hope and healing to our fellow citizens.

As we celebrate the bounty of the season, we should think about the joy we have in the life we live and in the opportunity to work with such a positive mission. We may be able to say “¡Nada más!” Who could ask for anything more?

Together, we have accomplished so much this year, and this should give us all a feeling of peace and contentment.

I wish you all a peaceful and safe holiday season. I hope you will spend it celebrating all the good that has been created and looking forward to the New Year with a sense of great excitement and anticipation for all that can – and will – be achieved. It will be good!

All the very best,


Nov 232015

Do we need meetings? I think that answer is “yes.” Are our meetings meeting our needs? I am thinking that answer is a qualified “yes.”

I have had the privilege of working here at the Brody School of Medicine, on and off, over the last 30 years or so. To a significant degree, that has made me a product of this environment. There is much to be proud of here, as evidence of our unique culture. I also believe that we must continue to examine ourselves – individually and collectively – and seek to improve our processes as a result of this review.

Without any doubt, there is a need for us to process more information in less time. Some have indicated that we need fewer or more efficient meetings so folks can focus on their “real work.”

I have had a wide range of experiences in meetings. Some flow easily, and even the most complex challenge is processed to action with little drama. Others are painfully difficult for the majority of the participants.

I’ve observed that certain characteristics are common to successful meetings – ones that run smoothly and accomplish the real work they were intended to accomplish:

  1. The agenda is thoughtfully prepared prior to the meeting. It may or may not need to be published prior to the meeting, depending on the context of the conversation that is imagined.
  2. The meeting is held in a comfortable space and environment.
  3. The meeting is led by a facilitator, sometimes called the chair, who ensures all attendees are meaningfully engaged and heard. This is a talent.
  4. Timelines are helpfully anticipated and respected.
  5. Attendees express respect for their colleagues through their body language, words and actions.
  6. Gratitude is expressed when staff bring items to the attention of the membership.
  7. Distractions are purposefully limited. This includes attempts to multi-task, particularly with phones and computers.
  8. When the work is completed, there is a sense of celebration for work well done and the meeting is called to an end.
  9. Folks look forward to seeing each other again!

With those things in mind, I humbly propose that some improvements could be made within Brody’s meeting culture. For example, prior to dense agenda items being brought before leadership, support staff should work as diligently as possible to present a mature work product, with the intention that leadership would then add value to the conversation – and the work would be accomplished with efficiency.

We should strive to avoid any behaviors that limit the orderly flow of discussion and deviate significantly from the aspirations embedded in the list above, including:

  1. Routine interrogations of professional staff when information is presented.
  2. Stereotypical “finding fault” with every agenda item at every meeting.
  3. Attempts to gerrymander the agenda by “know-it-all” individuals.
  4. Withholding opinions during a meeting, but de-constructively holding a separate meeting in the hallway.

You probably know of – or have experienced – additional traps.

As Dean, I have the duty and the authority to referee those meetings I am in control of. There is an essential additional functionality that is necessary and helpful to me. But we all share in the responsibility to help our peers. We all have blind spots.

Our challenge is to help each other understand our positive roles in facilitating our processes so that we can accomplish more. Meetings should be at least mildly pleasurable, even if the content is challenging.

I am reminded also that we benefit from the richness of our conversations. Our differences enhance the quality of our interactions and the product that is created. It is attractive to me that our leaders have different qualities, because the combination of their various tendencies is what facilitates resolution of the most complex issues.

Some of our colleagues are more analytical and like tangibles such as numbers. Some are more imaginative and really enjoy change. Some might be defined as “touchy feely” because they follow their gut instincts with abandon, while others are wired to be cautious, painstakingly organized and extremely precise in planning for the future. It’s all of these qualities respectfully expressed together that add essential value to the outcomes we create.

I implore each of you to consider how you might better appreciate these differences and adhere to a core value system we can all support. How can we respect honesty and clarity without being brutal? How can we champion generosity of thought, appreciation and respect for others? How can we model trustworthiness? How can we diminish fear, as it is sometimes mistakenly thought to be a motivator?

This is a time to move beyond words. We can only change through personal commitment and the embracing of a value system that is demonstrated through action.

Please consider what I have said here, and let us have a meaningful conversation. Let us commit to changing our meeting culture for the better. We need more meetings that meet our needs.

Thanks for all you do for the citizens of eastern North Carolina, and Happy Thanksgiving!


Jul 082015

It has been quite some time since I last posted to this blog. Contributing to my sluggishness in completing my assignment has been the hot, humid – some would say lazy – days of June? It seems everything in the world is changing, even the climate. But some of it bodes well (though perhaps not the weather).

A lot has happened at Brody since I last shared my thoughts with you. All of it is good, thanks to the extraordinary humans that make up the Brody School of Medicine family. It is your dedication, commitment and effort that is transforming Brody into a model for other medical schools to emulate.

I would be remiss if I did not comment on the success we are enjoying from work we have done in the recent past. We have begun to turn the financial tide against which we were struggling. Although there is still much work to do, our redoubled efforts are resulting in ECU Physicians anticipating a modest financial positive margin by the end of the fiscal year. The Governor and the Legislature are supporting this turnaround. While a final state budget is still weeks, if not months, from being finalized, I am very pleased that all three budget proposals – the Governor’s, the House’s and the Senate’s – each contain $8 million in new funding for Brody. With the strong support of university friends, trustees and others, our very effective advocacy for Brody in Raleigh will not abate.

In order to continue this turnaround, key hires have been made. Organizational structures have been better defined, revamped or added to. A new compensation plan has been put in place and continues to be refined. To learn more about the new roles and to understand the composition and inter-relationship of the boards, committees, teams and groups that are guiding our course, please spend a few minutes looking at materials in the ‘Recent Updates’ section of the Preserving the Mission webpage.

Now, let’s turn our attention to work we must do to secure our future.

For several months we have been engaged in meaningful conversations with Vidant leaders. Both organizations have come to a clear understanding that we are each stronger and better positioned to deliver on our respective missions. Vidant Health’s new CEO, Dr. Mike Waldrum, and Brian Floyd, president of Vidant Medical Center, both entirely share that view. The shared vision we have for meaningful alignment has led ECU and Vidant to jointly engage Huron Healthcare to gather, review and analyze information provided by both Vidant and ECU to develop options and recommendations about how our two organizations might more closely align our medical services, educational activities and research.

Huron has begun this work and will continue their limited engagement with us for approximately 12 weeks, with an anticipated report toward the end of September. To efficiently sift through information, Huron has requested four specific committees be created to help gather information, provide advice and context, and suggest direction for their project. Both Vidant and ECU will have equal representation on these committees. From ECU, the committee representatives will include a mix of faculty and administrative leaders. If you’re interested to know who serves on these committees, that information is also available on the Preserving the Mission web page under ‘Recent Updates.’

I expect the result of Huron’s work to be a report with options or recommendations on how the two organizations might consider pursuing enhanced alignment and how that might be accomplished. In all meaningful ways, whatever set of options and recommendations are presented will mark the beginning of a process of consideration, decision and implementation that will take substantial study and time to reach conclusion and will involve all of us, including the Chancellor, ECU Board of Trustees and the UNC Board of Governors.

The variations we experience in the daily weather resulting from global climate change can sometimes make us uncomfortable or even nervous. Similarly, the possibility of change at Brody, particularly in the midst of an industry-wide upheaval, can be unnerving and anxiety-producing. I advise you to take great comfort from the knowledge that at the conclusion of this effort, Brody faculty and staff will continue to do on a daily basis what we have been doing for over 40 years. We will teach students, we will train residents, we will care for patients, we will conduct important research and we will continue to improve the lives and health of eastern North Carolinians. In short, Brody will preserve the mission we have so successfully championed.

Stay cool, y’all!

Mar 062015

The sort of weather we’ve experienced lately prompts contemplation. I thought we were in the warm South until last week. What is all this “polar vortex” stuff about?

Since I can’t seem to figure out the weather, I have been thinking about the work that is being done to implement our new faculty compensation plan. The objective for this work is to fairly measure clinical and educational efforts with logical parameters, then link compensation with value.

We have been through one cycle of this with the faculty. I am forecasting it will take several cycles for us to become completely familiar with all of the nuances.

To facilitate that process, I have appointed a Compensation Advisory Committee chaired by Senior Associate Dean for Academic Affairs Dr. Elizabeth Baxley. The team is broadly constituted to bring a variety of perspectives to the work. Despite all the support and thought that went into creating the compensation plan, implementation still has been a significant challenge.

A compensation plan is not just a data-driven exercise. “Culture” also comes into play. Compensation is clearly linked to money and pay, but that is not all.

When I was in Syracuse, I helped develop and implement a physician compensation plan. It was a culture-changing exercise.

Physician Compensation PlansThe picture illustrates the relatively thick book titled, “Physician Compensation Plans – State-of-the-Art Strategies,” by Bruce A. Johnson, JD, MPA, and Deborah Walker Keegan, PhD, FACMPE. It is published by the Medical Group Management Association.

I bought this book in Syracuse, and even though it is a few years old, it is still relevant. The book describes all the dynamics and complexities likely to occur with any rationally-conceived compensation plan.

To quote a couple of sentences from the introduction:

“Why would medical directors or practice executives decide to champion a new compensation plan for their medical practice? Just the mere thought of tackling the complex, emotionally laden, legal minefield of physician compensation puts fear in the hearts and minds of otherwise rational beings. It is fully recognized that the process of changing a physician compensation plan may not be top on the list of career-enhancing events.”

Now that is encouraging!

But having a well understood and implemented compensation plan is essential in the orderly execution of our mission. It goes well beyond the satisfaction of individuals. This is a hugely important cultural transformation for us all.

Most of us speak about transformation in the third person. The reality is that the landscape we’ve become accustomed to is changing all around us, and we must individually accept this in order to prepare ourselves for our shared future.

We must personally adapt.

Which leads me to the concepts of Authority, Autonomy and Accountability.

Each of us “wears a hat” in the organizational structure. It is the authority vested in us by the organization. Similarly, as professionals we wield a significant amount of autonomy in our practices. Likewise and inevitably, each of us is accountable. We may point defensively to someone else, but in reality, in reflection, who is that someone?

This is where individual and personal introspection in these last (hopefully) dark days of winter may bear fruit.

We have full authority to support our mission, individually and collectively. We have autonomy that is evidenced by the faithful execution of our medical profession. We are accountable for the financial viability of our school. We are fully accountable for our individual actions.

Because excellence is our only acceptable standard, we are accountable for activities across the whole spectrum of work – not just the clinical activities. We champion graduate medical education and the advancement of science itself. All of this, of course, is intimately linked with our own personal desires for achievement and success.

Obviously, most of us balance these three principles in very practical and acceptable ways. The exciting challenge is when we all commit to converge our energies and actions for the most superlative implementation of winning strategies. That is how we can remain competitive in a volatile and complex medical world!

The weather has clearly complicated all of our lives, but it is nothing compared to the hugely transformative changes we have purposefully implemented. I also realize that “change happens at the speed of trust.”

As spring arrives, I am confident we will enjoy a renewed sense of commitment and all of the courage necessary to embrace a bright future of opportunity.

I hope to see you soon. Stay warm! And dry!