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Alicia D.H. Monroe, M.D. Sr. Dean of Education, Sr. VP Academic Affairs and Faculty Development Giving Life to Possible 3 rd Annual Educational Innovations Day

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Presentation Outline Are we optimally preparing our graduates? What new competencies do our faculty need to thrive in the changing environment? How can we use educational innovation to lead change?

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Health Care Delivery Model Growing needs for chronic illness management Reimbursement is decreasing FragmentedCostlyProvider-Centered Gaps in Health Care Quality and Safety Health information not consistently available Administrative demands are increasing

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Health Care Reform Mandates greater emphasis on quality care, prevention and chronic illness management Effective and Safe Care Communication and Care Coordination Patient/Family Care Experience Efficiency and Cost-reduction Payment/incentives to providers and hospitals linked to quality Kocher R, Emanuel EJ, Deparle NM. The ACA and the future of clinical medicine: the opportunities and challenges. Ann of Internal Medicine 2010:153:536-539. 4

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Health Care Reform Refocuses care around patient experience Engages providers, patients (and caregivers) in shared decision- making Requires team work to optimize preventive care and chronic illness management Millenson ML, Macri J. Urban Institute. Robert Wood Johnson Foundation. March 2012. http://www.rwjf.org/en/research-publications/find-rwjf-research/2012/03/will-the- affordable-care-act-move-patient-centeredness-to-center0.html 5

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Paradigm Shift in Professional Roles 20 th Century Autonomous Individually focused care or research Centralized leadership Delegates tasks to others 21 st Century Collaborative Works with team Facilitative leadership Demonstrates leadership and followership

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Drivers of Change in Healthcare 7 Patients culturally diverse; older; multiple diseases; information rich Employers $ Cost of care/goods Competitiveness Government $ Individuals $ Insurers $ Science and Technology Healthcare Delivery Providers Providers Systems & Processes Productivity Quality & Safety Supply chain Marketing Regulation Patient Outcomes Provider Outcomes System Outcomes

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Drivers of Change in Research 8 Research FundingDemands Exceed Supply Training pipeline producing more graduates Trainees supported by research grants contribute significantly to research 20% PhD Graduates in Academic Positions Hypercompetition Time Pressures Healthy Ecosystem of Science Writing and Revising Grant Applications Peer review Administrative responsibilities Regulation Scientists Spend Significant Effort Writing and Revising Grant Applications High Value Given to Publication in High Impact Journals NIH Funding Rates in low teens Alberts et al. Rescuing US biomedical research from its systemic flaws. www.pnas.org/cgi/doi/10.1073/pnas.1404402111

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Paradigm Driving Changes in Health Professions Education Changing Healthcare and Research Environment Required Competencies for 21 st Century Health Professionals Accreditation Changes (ARC-PA, LCME, ACGME, COA- NA, NCOPE, SACSCOC Educational Innovation To respond to changes 9

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Healthcare Reform Demands Change Patient- Centered Medical Homes Team-based care Value-based Healthcare Organizations Medical Education Medical Practice Quality and Safety Simulation Chronic Illness Care Payment Reform

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Recommendations for Change Increasing postdoctoral salaries Career internships Increase awards emphasizing originality & risk taking Science Education Biomedical Research Leadership training Science policy and writing Project Management Using staff scientists Alberts et al. Rescuing US biomedical research from its systemic flaws. www.pnas.org/cgi/doi/10.1073/pnas.1404402111

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A Hierarchy of Challenges Less difficult Changing discrete tasks More difficult Changing traditional roles and work identities Transforming work processes & established routines Most difficult Changing Culture Redesigning the education of health professionals and scientists Nutting et al. Health Affairs 2011;30(3):439

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Are We Optimally Preparing Our Graduates? 13

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Scientific advances in health care Research advances that guide clinical decisions (evidence-based medicine) Condition/disease specific best practices Integrative medicine approaches Evolving Knowledge Competencies 14

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Advanced communication skills to facilitate : Building partnerships Data gathering (values, beliefs, preferences) Patient activation and engagement in treatment decisions and self-care Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006. McKinley RK, Middleton JF. British Journal of General Practice. 1999; 49: 796-800. Committee on Quality of Health Care in America, Institute of Medicine. "Front Matter." Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press, 2001. Evolving Communication Competencies 15

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Evolving Clinical Competencies Advanced clinical skills to facilitate : Patient safety and medical error reduction Incorporation of public health and social and behavioral science research evidence into medical practice Population health and systems-based practice Committee on Quality of Health Care in America, Institute of Medicine. "Front Matter." Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press, 2001. 16

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17 Patient-Centered Care Competencies Cultural Background Personal Bias Recognition Patient Autonomy Health Literacy Cultural clinical skills Collaboration Patient - Family Collaboration - Teams Whole Patient Perspective Whole Provider Whole Healthcare Access, Outcomes Disparities, Care Continuum Social & Economic Milieu

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Health System Competencies 18 Operational Processes Outcomes by level Outcomes by metric -Quality -Service -Access -Safety Level of Healthcare Delivery - Individual Patient - Provider, aggregate provider - Delivery System - State and Federal - Global System and Process Engineering Organizational Structure Government and Regulatory Agencies Performance Improvement Clinical Resource Management Workforce Population & Public Health Individual Health Technology Finance

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Systematic measurement and review of program level outcomes is needed to assure continuous quality improvement. 19

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What new competencies do our faculty need to thrive in the changing environment? 20

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Sizing Up the Task of Reform After climbing a great hill, one only finds that there are many more hills to climb. Nelson Mandela Overwhelming Task Unrealistic Impossible Not what I signed up for Challenging but Necessary Creative Opportunity A chance to improve education to support quality care

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Embracing ChallengesPerspective Matters Patient- Centered Medical Home Health IT Meaningful Use Problems?Possibilities? Population-based Management Expanding portfolio of Innovative Masters Degree Programs Misalignment of Services and Providers High Quality, Cost- Efficient, Value- based care

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23 Leadership Competencies Emotional Intelligence Personal development Relationship optimization Teams Organization Stewardship Patient Team Organization Society Operations Change Needs Opportunities Implementation Individuals Populations Leadership Skills Society

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Emotional Intelligence Competencies Self awareness Understands personal moods and drives and their effect on others Self Management Controls disruptive moods, thinks before acting; strong drive to achieve, optimistic, resilient Social Awareness Understands emotions & responds appropriately, culturally sensitive Social SkillManages relationships, builds networks and teams, leads change Goleman D. What makes a leader? HBR January 2004

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Preparing Faculty for Adaptive Leadership Identify leadership challenges requiring changes in values, practices and relationships Frame key questions and issues Challenge current roles and clarify responsibilities Manage distress Manage conflict Challenge unproductive norms Heifetz RA, Laurie DL. The work of leadership. HBR December 2001

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How Can We Use Educational Innovation to Drive Change? 26

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The Road Ahead Challenges Shifting Roles Available Strategies/Tools

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Leading Transformation Change occurs from the inside out Requires commitment, focus and reinforcement Attitudes, mind-set, skills Cultivating an optimistic perspective Living your values Practicing forgiveness of yourself and others Being boldtaking calculated risks

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Summary Challenges bring opportunities When opportunity knocks, open the door All change is difficult and takes time Adaptive leadership can be cultivated and supports success Persistent pursuit of a vision can bring dreams into reality Together we can lead the necessary changes in health care and education

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