Jul 172014

Hello Brody Pirates,

As I write this, there are a whole variety of activities and happenings that are influencing my thoughts.

Recently, we all experienced the Fourth of July annual celebration. This national holiday accents the real significance of one of the most profound developments in the history of our country. During these festivities, there are those of our colleagues who were “on call” and otherwise serving the citizens of eastern North Carolina. Even then, there was time to reflect on all of our relationships, including those close to us. I would include our personal families as well as the members of our professional teams. What are the unmet personal goals and ambitions that are only possible based on the culture and country that we live in? In what ways does all of this thoughtfulness bring meaning to the Brody School of Medicine as we support our mission?

It is easy to find a simple answer. In real terms, all that is necessary is that we work hard and serve well. Of course, the challenge is to apply this approach to every day experience, with all practical detail. Achieving clarity in our real world context demands much in the way of careful thought and implementation.

About two months ago, I received an email unexpectedly. It came from one of my patients who had a kidney transplant about 28 years ago. The patient and her kidney are in really great condition.

My patient and her dog, UsherThis remarkable grandmother has given me permission to post her picture here, and is in remarkably good health. She admitted that the secret to her success lay in the regular consumption of cherry pie, washed down with a popular fermented beverage. One has to eat the whole pie to assure success, she admitted!

You may share my skepticism that this is not the whole answer to her success. For certain, she has a vibrant sense of humor. Maybe it is the fact that she continues to work and engage life in the most positive manner that has contributed to her success.

For certain, there are more biologically complex and profound answers to this survival experience that we have not yet discovered.

There are similarities with a complex set of conversations that we are having within the School. As an example, the leadership team of both Vidant and the Brody School of Medicine met recently for an hour to engage in a discussion of two complex and challenging clinical cases.

The group attempted to resolve and explain some unexpected outcomes and came up with many plausible answers for the issues that were presented. The conversation was emblematic of the complexity of many of our processes. When faced with these complexities, we typically apply basic principles and then venture well beyond. There are many other applicable dimensions to consider, including human factors and behaviors, interdependent medical processes and extrapolated assumptions based on biological diversity.  The best minds use all of this information in creating opinions and the necessary solutions. Even then, this is sometimes just the beginning of an even more complex process.

Unavoidably however, it is human nature to look for the simplest of answers. It takes real world experience and professional discipline to find the very best explanations.

Our tripartite mission here at “the Brody” simply defines the priorities. It takes constant attention to the contemporary dynamics of medicine for our mission to refresh and remain relevant.

Best regards,


Jun 182014


This will be a part of an ongoing conversation that I will be having with you. Yesterday, the Chancellor distributed a memorandum to the Brody faculty and staff. I most certainly echo all that he has said. I also wanted to let you know a bit about how we are working to sustain our missions of education and service to the region.

First thing – we must continue to recognize that we have been very successful in creating primary care doctors for North Carolina and supporting a mission of service over the years.

We contribute mightily to the research efforts of the university. We provide quality health services to an increasing number of patients who do not have the ability to pay for their health care, and are recognized as a transformational force in the region.

These facts have been heralded by others at local, regional and national levels.

At the same time, we are all aware that health care is undergoing a transformation and, as a result, we must also change.

In recent years, we have been significantly challenged to continue to provide excellence in education and clinical service to all people of our region.

In the last five years, Brody has absorbed a cumulative, permanent state budget cut of $9.2 million, or nearly 19 percent of our state funding. These cuts mean we have had to teach our students and take care of our patients with fewer resources.   Losses in funding for support staff and operations has made it more difficult and costly to hire and retain qualified employees, to keep essential basic functions operating smoothly, and to keep needed medical equipment up-to-date.

Much of the shortfall resulting from these legislative cuts was able to be “back-filled” with money from the ECU Physicians practice.  More recently, our ability to continue to backfill through our faculty practice has been further compromised seriously by legislative actions, which have effectively eliminated millions of dollars from our previous and future practice revenue.

We are working very diligently on efforts to convince policymakers and payers to alter actions they have already taken, and to change or abandon consideration of additional actions that are harmful to Brody’s financial sustainability. Proactively, and on a daily basis, we are informing and educating key leaders about the impacts of their decisions on Brody. Although that work will continue very aggressively, we must concentrate most of our efforts on those things we can impact directly – the Brody School of Medicine and ECU Physicians practice.

Realizing that this compounding series of factors were coming together to fundamentally alter the historical environment in which Brody has operated, I and members of my senior leadership team have been working with department chairs and external consultants to conduct a comprehensive analysis of the school’s operations and funding sources, and those of the ECU Physicians practice. Our goal was to develop a detailed understanding of our current situation and the factors that contributed to today’s reality, as well as a very clear vision of where we need to go as an institution in order to secure a bright future for the school while becoming more self-reliant in the process.

Early in 2013, we hired Hunter Partners, a consulting group specializing in the issues we face, to help us conduct an extensive evaluation of the ECU practice plan and make recommendations for how we might best position ourselves to continue our success.

We have some outstanding and extraordinarily productive faculty. That productivity is in clinical practice, in education and in research. I intend to publicly recognize and celebrate these most vital individuals.  What we have also found is that these super-performers are often not just under-appreciated, but they are also under-compensated for what they do. Once firmly underway, the transformation and restructuring of Brody and ECUP will allow us to include appropriate increases in compensation to reflect the disproportionate contribution these high-achievers make.  To these high-performers, I ask that you continue your great work and actively engage your colleagues to encourage them to emulate you.

We also have found that the majority of people are solid performers who consistently contribute to the Brody mission.  To you, I say thank you!  You are the sturdy backbone of our school and practice plan. Please continue your good work.  I appreciate everything you do. Additionally, I ask you to identify ways – big and small; personally or systemically – that will help improve what we do and how we do it. If your insights can help us find ways to mentor and inspire one more student, care for one more patient in a day, seek another opportunity to secure a research grant, or implement myriad other enhancements, you will be helping to meet the challenge we all face.

There are also a small number of under productive faculty, and these will need to be coached, and monitored. Compensation will be adjusted accordingly.

Change for Brody provides an opportunity for all of us – faculty and staff, as well as our extended university family and the community – to imagine and build our future together.

The Brody School of Medicine is neither alone nor the first medical school to undergo transformational change. Emory University School of Medicine, Wake Forest Baptist Medical Center and a peer community-based medical school, University of South Carolina School of Medicine, have all begun significant restructuring in order to position themselves for the changes affecting all of us.  Mergers, acquisitions, integration of clinical practices, “right-sizing” and new management arrangements are everywhere one turns.

Four decades ago, when the ECU School of Medicine was created, a tripartite mission was clearly established and has become deeply rooted within our values and our daily work.

Today, in the midst of tectonic shifts in health care and medical education, and increasing pressure on state funding and practice revenue, our vision remains clear and our mission remains constant.  Brody is and will remain dedicated to training our doctors and treating our citizens.

While we remain dedicated to our mission, we must adjust how we are organized and how we operate to accommodate today’s realities.

It is important to know that in every way possible, the decision to take an action is objective – based on analysis of our own data, as well as review of the evidence and peer-based benchmarks. I ask your full support to implement them.

We will continue working very hard to educate leaders in Raleigh about the value and critical nature of retaining the Medicaid Upper Payment Limit, or UPL, and SODCA, for ECUP’s financial stability.

Concurrently, chairs and senior leaders in my office are working to determine how best to operate ECUP practices to improve patient access to care, effectiveness and efficiency, patient satisfaction, and revenue optimization, along with anything else within our control.

We are carefully reviewing positions funded by the practice plan, and considering where this funding is appropriate, and in some cases, looking for other funding arrangements or opportunities to right size our clinical enterprise.

This work is being done thoughtfully, and with attention to medical school and residency accreditation requirements, the most prevalent medical conditions in our region, and the historical profitability of the unit.  We have established principles that help us define what is core to the function of our school.

Our clinical operations must become more efficient and consistent.  So, we have brought in Ms. Deb Brown to serve as Interim Clinical Operations Director.  Ms. Brown has experience in working with academic practice plans all over the country to successfully make the same kinds of changes and improvements she is beginning to implement here.

The changes and actions we are implementing are designed to improve patient satisfaction and health outcomes. We believe that the changes, when implemented, will lead to increased productivity and enhanced revenues that are important to support the missions of our school.  We also are focusing on measures that are aimed at assuring a high level of faculty and staff vitality and satisfaction.

More information is available by visiting “Preserving the Mission” on the Brody Web page. If you have questions or comments – either specific to your personal situation or more general in nature – you will have an opportunity to privately submit your question or comment to be addressed.

My colleagues and friends, there is no way to be less than fully transparent about the challenges we face and the concerted actions we must take. We do these things to prepare for the future of health care in eastern North Carolina. The Brody School of Medicine will remain the leader for improving the health of our population and for increasing access to care for our fellow eastern North Carolinians.

I ask you to join me in shaping an exciting future for our school and practice, so we can continue to serve the citizens of this state through excellence in education and clinical care!

Thank you.

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 http://www.ecu.edu/cs-dhs/bwfc/about.cfm 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.