Darrell g kirch m d president and ceo aamc may 14 2008
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Supporting a Culture of Collaboration Across Health Care MedBiquitous. Darrell G. Kirch, M.D. President and CEO, AAMC May 14, 2008. What Worries Americans About Health Care… …and What Role Can Technology Play in Eliminating Those Worries?. Will there be a doctor in the house when I need one?.

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Darrell g kirch m d president and ceo aamc may 14 2008

Supporting a Culture of Collaboration Across Health CareMedBiquitous

Darrell G. Kirch, M.D.President and CEO, AAMCMay 14, 2008


What Worries Americans About Health Care……and What Role Can Technology Play in Eliminating Those Worries?

  • Will there be a doctor in the house when I need one?


First year medical school enrollment projected to increase 21 by 2012
First-Year Medical School Enrollment Projected to Increase 21% by 2012

Existing + New Schools

Existing Schools

16,488


What worries americans about health care
What Worries Americans About Health Care? 21% by 2012

  • Will there be a doctor in the house when I need one?

  • Will I be able to pay the bill?


The fiscal reality hanging over america
The Fiscal Reality Hanging Over America 21% by 2012

  • “GAO’s current long-term simulations continue to show ever-larger deficits resulting in a debt burden that ultimately spirals out of control.”

  • –David M. Walker

  • U.S. Comptroller General


What worries americans about health care1
What Worries Americans About Health Care? 21% by 2012

  • Will there be a doctor in the house when I need one?

  • Will I be able to pay the bill?

  • Will the system and the people in it actually “care” for me?


The Patient 21% by 2012


The Expert 21% by 2012


The Technology 21% by 2012



Discontinuity in the medical education continuum
Discontinuity in the Medical Education Continuum education?

Premedical

MedicalSchool

Residency and Fellowships

Practice


The decision dilemma in health care
The Decision Dilemma in Health Care education?

1000

100

Facts per Decision

10

Human Cognitive Capacity

1980

1990

2000

2010

2020

Adapted from: W. Stead, Vanderbilt University



The decision dilemma in health care1
The Decision Dilemma in Health Care Network

1000

100

Facts per Decision

10

Human Cognitive Capacity

1980

1990

2000

2010

2020

Adapted from: W. Stead, Vanderbilt University





Leaving the world of see one do one teach one
Leaving the World of Network“See One, Do One, Teach One”

Source: Rhode Island Hospital Medical Simulation Center

www.lifespan.org/rih/services/simctr/training/


Building an e portfolio over a career

Data NetworkRepository

DataRepository

DataRepository

DataRepository

Building an E-portfolio Over a Career

DataCompilation

TrustedAgentHub

DataCompilation

Medical Professional

DataCompilation


Technology as a tool to create a true continuum of lifelong learning in medicine
Technology as a Tool to NetworkCreate a True Continuum of Lifelong Learning in Medicine

Residency and Fellowships

Practice

Premedical

MedicalSchool


Technology as a tool to enable individualized physician learning
Technology as a Tool to Enable Individualized Physician Learning

Residency and Fellowships

Practice

Premedical

MedicalSchool

Life-longLearning

Two-YearCollege

Residency and Fellowships

Premedical

MedicalSchool

Practice

Life-longLearning

Residency and Fellowships

Premedical

MedicalSchool

Life-longLearning

Practice

Non-Premed Degree

MedicalSchool

Life-longLearning

Practice

Residency and Fellowships

Re-training

Pre-medical

Practice


Will technology remove all the barriers in medical education?

No, but when used wisely, it can be a powerful enabling tool.



Taking physician handwriting out of the equation
Taking Physician Handwriting system?Out of the Equation

Photo courtesy of Evanston Northwestern Healthcare


Relegating the medical chart to the museum
Relegating the Medical Chart system?to the Museum


Real world comparisons accessible to patients
Real World Comparisons system?Accessible to Patients



Will technology solve all the problems in our health care system?

No, but when used wisely, it can be a powerful enabling tool.


If our solving our problems in educating health professionals and delivering health care isn’t as simple as strategically applying the latest technology, where should we turn our attention?


Embracing a new culture in health care
Embracing a New Culture in Health Care professionals and delivering health care isn’t as simple as strategically applying the latest technology, where should we turn our attention?

  • “Culture eats strategy for lunch every day”

  • Andy Grove

  • Former Chairman of Intel


The traditional culture of health care
The Traditional Culture of professionals and delivering health care isn’t as simple as strategically applying the latest technology, where should we turn our attention?Health Care

  • Individualistic

  • Autonomous

  • Scholarly

  • Expert-centered

  • Competitive

  • Focused

  • High-achieving

  • Hierarchical


Embracing an emerging culture for health care
Embracing an Emerging Culture for Health Care professionals and delivering health care isn’t as simple as strategically applying the latest technology, where should we turn our attention?

  • Collaborative

  • Transparent

  • Outcomes-focused

  • Mutually accountable

  • Team-based

  • Service-oriented

  • Patient-centered



Technology standards can ultimately facilitate collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.


Standards in the absence of trust will go nowhere. collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.


What does this mean for health care leaders
What Does This Mean for Health Care Leaders? collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.

  • If “culture eats strategy for lunch every day…”

  • And if a positive culture is a key source of future excellence…

  • How do we change the culture in our institutions?


  • #1 collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress. Make values explicit, and

  • use them visibly in everyday decisions!


  • #2 collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.Align governance, leadership, and

  • management across organizational

  • and “corporate” divisions!


The academic health center

Hospitals and Clinics collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.

University

Physician Practice

The Academic Health Center

Medical School


  • #3 collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress. Use the tools of mission-based management

  • to realign and maximize resources!


Program assessment
Program Assessment collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.

High/High

High/Low

  • Mission

  • Contribution

Low/High

Low/Low

  • Financial Performance


  • #4 collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress. Foster collaboration and accountability,

  • accepting nothing short of

  • high performance teams in all mission areas!


A new model for the organization creating high performance teams
A New Model for the Organization – collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.Creating High Performance Teams

High-performingTeam

Real Team

Working Group

PERFORMANCE IMPACT

Potential Team

Pseudo-

Team

TEAM EFFECTIVENESS

Source: Katzenbach and Smith, 1993


  • #5 collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress. Focus leadership recruitment on

  • organizational fit, and do real succession

  • planning for long-term stability!


Embracing an emerging culture for health care1
Embracing an Emerging Culture for Health Care collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.

  • Collaborative

  • Transparent

  • Outcomes-focused

  • Mutually accountable

  • Team-based

  • Service-oriented

  • Patient-centered


Diffusion of innovations
Diffusion of Innovations collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.

“Deliberate”Respond to Evidence

“Skeptical”Respond to Peer Pressure

“Suggestible”Respond to Change

“Traditional”Respond to Authority

“Venturesome”Respond to Innovations

Early Adopters(13.5%)

Early Majority(34%)

Late Majority(34%)

Innovators(2.5%)

Laggards(16%)

E.M. Rogers and C. Cassel


Culture change as the key to shifting the adoption curve
Culture Change as the Key to Shifting the Adoption Curve collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.

Culture Change

Time to Adoption


Creating a culture of teamwork and collaboration
Creating a Culture of Teamwork and Collaboration collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.



Creating a culture based on evidence rather than eminence
Creating a Culture Based on “Evidence” Rather Than “Eminence”

Issacs and Fitzgerald, BMJ 319: 1618, 1999




An integrated world of education research and health care with the patient at the center
An Integrated World of Education, Research, and Health Care – With the Patient at the Center

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