Cost and benefit calculations: metamorphosis
In 30 years of association with the Brody School of Medicine at ECU, I have never seen a time in which there was more thoughtful engagement by so many people. It is clear that we are all working to redefine what our school will need to thrive in the future. We have realized that we are in an environment that demands that we change and adapt to the future. Across the whole school, folks are taking this “metamorphosis” very seriously. This focus includes faculty, staff and students.
The diversity and the richness of the conversations that have been occurring are incredibly inspiring. It is impossible not to appreciate the true vitality of our faculty and staff as they engage in a wide variety of useful work. As I observe what is happening across the school, it is already possible to draw some conclusions.
Sincere attempts are being made to balance cost and benefit. Questions are being asked as to what needs to remain as essential and what is now redundant. The clear demand is that we manage and support our core missions of education, patient care and research in the most efficient and effective way. Some components must be retained while others need modification. Some traditions are now more sacred cows than critical to our future, and these need to be recognized and left behind. We will need to invest in new things, too. Preparing for a bright future for our school means finding the right balance between increasing efficiency or cost containment and appropriate investment in those things that will position us well in a new world of health care. In doing so, we must accept that we will not be able to serve all purposes – be all things to all people.
I’ll use a few pictures and some narrative to illustrate what we are observing. These are in no chronological sequence or priority.
The richness of these conversations is inspirational and compelling. They are breaking out at the very best time in our evolution, or as we have been saying, the “metamorphosis” of our medical school.
I’ll reassure that we are not the only ones who are facing similar challenges. This is a country-wide phenomenon at every academic institution.
Reassuring to me is that what I am reading from these conversations is that our precious school has all of the competencies to come out ahead of the curve! Our aggregate local knowledge and advantage are huge competencies themselves.
Read these overheard quotes and come to your own conclusions:
“Many things are going well between the medical school and education right now. But at the same time we need to continue to improve, as this is a time of metamorphosis, and we are a work in progress.”
“We have a great collection of diverse people who put patients first and see the future as quite bright. They have big hearts and maybe a chip on their shoulders. And that’s a good thing, as it keeps them striving for something better. Most people are on board, but there remain some who are tied to the past and some who have confusion, as we have three different missions.”
“Internally, the school doesn’t work as well as it could, and some people are in compartments looking and moving in their own directions. There continues to be a division between clinical and educational aspects, and the attitude is “That’s not my job.” Some faculty members are not as productive as they could be, and they stop others from being productive. We seem to be improving on moving these people out of the way. Others see research as a drain, but if managed appropriately research could play a leading role as we transition and lead. “
“At times we are impacted by negative outside factors. When times do get tough, the entire organization pulls together, powered by self-reliant determination. The staff, teachers and students are great providers that impact the wider community and state in a positive way.”
“The patient recognizes the Brody Medical School as a beacon in the community and enters expecting high quality and great services. The facilities are excellent and so is the quality of care offering same-day access. The patient wants and expects a one-stop shopping experience. We want to provide that experience as we see it leads to happy patients who return and an increase to revenues keeping things moving forward.”
“Unfortunately, the providers don’t always have all the tools they need. And so at times the patient has to leave and may need to come back multiple times or go to other service providers in different locations. Providers become great firefighters as they have multiple day-to-day problems they need to solve. They are good short-term problem solvers, but sometimes fixes backfire and lead to new problems, creating a cycle of fighting fires and wasting resources. Often internal and external communication breaks down creating new issues. And patients don’t always show up for appointments; technology is not being used at its highest level, so resources can be wasted.”
Some have commented about our “vision:”
“We have (need) a vision that we can all buy into, a vision that gives us energy and helps us with alignment. With an internal system working at full capacity, we have feedback loops that allow us to solve problems faster and better, leading us to new innovations, or better mousetraps. We are the “house of yes,” where happy patients keep coming back as we have a one-stop shopping care system that produces revenue so we can keep building our excellent system of care. Brody is filled with amazing, diverse people who have the tools and technology they need to do their jobs well. Research helps us to drive this bus. Our researchers and clinicians are engaged and collaborate together to understand what is needed. This culture of collaboration attracts new faculty who want to work in this type of environment. We will open our floodgates of knowledge as we all come together with one common mission and purpose that links us with Vidant. This is a time of metamorphosis, as the citizens in eastern North Carolina are transitioning toward good preventive health. And that’s our ultimate goal.”
Some are proposing early wins:
“We recognize that we do have some tools that could be used, like ‘My Chart,’ which could begin to help with patient communication and lead to better use of resources so appointment times are filled.”
“Perhaps we can create a shared vision for Brody, ECU and Vidant. The mission might be different in each area, but if a shared vision could be created, it might help people understand the interconnections of their work, leading to more opportunities for collaboration. “
“We should continue to foster a culture of collaboration. We should look for ways to bring young faculty, from clinical and basic sciences, together now so that they understand each other’s work. Find out what clinical faculty need from researchers so they see the power of working together.”
We will balance the intangibles and measure the objective outcomes. My colleagues, I am proud to say that you are all demonstrating what is essential in bring us to the very bright future that I predict is possible.
Carry on, and let me know how you are engaged in this metamorphosis. I’d like to hear from you.