May 222014

This time I am not talking about the Black River in Jamaica. It’s the one in Watertown, Upstate New York. Google them; they are completely different. Guess which one freezes in the winter?

Have you ever been white water rafting? I’ve been twice – once on the Nantahala near Bryson City in western North Carolina and the other time on the Black River in Watertown. I don’t think that I am going to repeat any of these experiences anytime soon. Falling out of the raft is not a good thing and working the rapids is for much less “mature” folks!

Dr. Cunningham and his wife, Sydney, on a whitewater rafting trip in upstate New York.

See the picture. My dear wife Sydney is at the prow of the raft, loving every minute. Where is her oar? Is it anywhere near the water? There am I amidships. Please look at the facial expression. Where is the oar? Digging deep in the water?

The helmsman was an Air Force pilot who did this job in the summer. Foolishly, to my judgment, he seemed to relish taking a group of complete strangers down a river that we would soon find out presented some seriously treacherous technical stretches. There was this place downstream where an old dam used to exist. All that was left was a submerged slab of concrete to the left bank of the river and a precipitous fall-off to the right. Across the chasm, as we could clearly see, was a cave in the wall of rock that turned the river sharply, to then plunge into a canyon beyond. Just as we arrived at the dam, we were told that the eddy current within the cave was strong enough to hold a raft in its grip indefinitely. Casually, our guide admitted that some had died there.

The helmsman barked sharp instructions: “Dig when I say so!” We maneuvered to the left bank of the river and awaited our turn. The raft ahead of us spun helplessly, it seemed, and sluiced over the slab of concrete, going backwards over the falls. All of us gasped in horror, and those in the doomed craft screamed and vanished!

Miraculously, we soon recognized that they were not sucked into the cave.

We were next.

I am here to tell the story, so, clearly, we all survived. Sydney had a wonderful time. I could barely walk when we finally pulled out for lunch; I was so physically and mentally exhausted.

I learned many lessons that day. Trust your helmsman, especially if he has done some of the same work before. It is even more compelling if he is the only helmsman that you have. It is okay to rely on perfect strangers. And make sure that you listen to precise instructions and DIG!

Some of these lessons are allegorical and related to life in general. The river flows irresistibly in one direction only. We are in the forward-moving current of life.  We will experience smooth sailing some days, and then there are both the expected and unexpected challenges that crop up. It’s all an unavoidable part of the experience.

Where there is a will and there is the skill, there is a way. Some will enjoy the ride. But for some occasions, the job is all about digging deep, all oars in the water, and being sure to avoid the eddy currents.

Take care, and that reminds me – wear sunscreen y’all!


Mar 312014

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.

blog3This picture is representative of the “Redesigning Education to Accelerate Change in Healthcare” (REACH) Initiative. It includes the Teachers of Quality Academy, a group of 38 faculty members across the health sciences who are spending a year learning how to improve health systems and developing curriculum for our students. The REACH project team just hosted a team of American Medical Association leaders on campus. From all reports, a very rich and productive conversation developed.
blog2This picture represents some of the faculty and staff who attended a March 26 program that was supported by the Brody Women Faculty Committee, “Effecting Diversity and Gender Changes in Academic Medicine.” The Brody Women Faculty Committee hosted two leaders, Edna Chun, associate vice chancellor for human resources at the University of North Carolina at Greensboro, and Dr. Rosalind Fuse-Hall, president of Bennett College, who brought a powerful message of how diversity and inclusion can amplify business success in our enterprise.
blog1This picture represents some of those who engaged in Real-Time Strategy work several weeks ago. This has served as a backdrop to discussions that are critical to our success as a medical school. Real Time Strategy is a cross-section of faculty and staff who spent time imagining the future we envision for the Brody School of Medicine

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.


Mar 122014

This blog series is about medical matters isn’t it? So I can mention this new word that I made up without expecting too many “bless your hearts.”

The point is that, as you know, my blogs are typically prompted by current events, and, of course, my own personal perspectives. I publish them on an “as needed” p.r.n. basis.

I have talked about heroes in the past. My great privilege is to work with all of you. Embedded within our culture is an indefatigable adherence to the mission of the school, and I am incredibly encouraged by the faithful commitment that I see and experience every day. Thank you so much!

I just met a whole roomful of similar heroes this morning. Our Office of Health Access facilitated a conversation with all of the health department directors from “down east.” We asked them to come here because we wanted to know how we could best continue our many collaborations and informal interactions with them.

My clear recognition is that, spiritually, you heroes at Brody are not alone in this part of the state. These health directors appear to be the most committed and dedicated leaders you could ever meet – all personally working to benefit the citizens of our region.

One could become jealous, because you could say the health directors have co-opted our mission. I am not jealous even for a moment – this is the very best thing that could happen to us. We must invite more folks to co-opt our mission!

I have long recognized that the work of improving the health of all of the citizens in eastern North Carolina is one that cannot be accomplished through the hard work, even with the lifetime work, of us here at “the Brody.” We need partners, and the folks that I met today seem to understand the need to work together.

Over the four decades of our existence, we have developed intimate relationships with all of the various agencies, businesses and practices that serve the health of our citizens. It is our intention to continue this work together.

Yes, these folks I met today, like many of you, are representative of the “different type of heroes” that I have described before. These individuals have no issue with holding the fort and minding the store. Some days, we all are satisfied to just make things better.

By the way, all of the other health sciences deans attended the meeting as well – Dean Sylvia Brown, Dean Greg Chadwick and Dean Stephen Thomas. They are my heroes, too!

Keep up the good work.

Until next time,