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

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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

Existing + New Schools

Existing Schools

16,488


What Worries Americans About Health Care?

  • 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

  • “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 Care?

  • 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


The Expert


The Technology


Will technology remove all the barriers in medical education?


Discontinuity in the Medical Education Continuum

Premedical

MedicalSchool

Residency and Fellowships

Practice


The Decision Dilemma in Health Care

1000

100

Facts per Decision

10

Human Cognitive Capacity

1980

1990

2000

2010

2020

Adapted from: W. Stead, Vanderbilt University


Clinical and Translational Science Awards (CTSA) Research Network


The Decision Dilemma in Health Care

1000

100

Facts per Decision

10

Human Cognitive Capacity

1980

1990

2000

2010

2020

Adapted from: W. Stead, Vanderbilt University


Connected 24/7


The MCAT as the Gateway to a Career in Medicine


A Virtual World-Wide Faculty


Leaving the World of “See One, Do One, Teach One”

Source: Rhode Island Hospital Medical Simulation Center

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


DataRepository

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

Residency and Fellowships

Practice

Premedical

MedicalSchool


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.


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


Taking Physician Handwriting Out of the Equation

Photo courtesy of Evanston Northwestern Healthcare


Relegating the Medical Chartto the Museum


Real World ComparisonsAccessible to Patients


Patient Feedback Becomes a Reality


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

  • “Culture eats strategyfor lunch every day”

  • Andy Grove

  • Former Chairman of Intel


The Traditional Culture of Health Care

  • Individualistic

  • Autonomous

  • Scholarly

  • Expert-centered

  • Competitive

  • Focused

  • High-achieving

  • Hierarchical


Embracing an Emerging Culture for Health Care

  • Collaborative

  • Transparent

  • Outcomes-focused

  • Mutually accountable

  • Team-based

  • Service-oriented

  • Patient-centered


If we want shared collaborative environments, we need standards.


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.


What Does This Mean for Health Care Leaders?

  • If “culture eats strategyfor 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 Make values explicit, and

  • use them visibly in everyday decisions!


  • #2Align governance, leadership, and

  • management across organizational

  • and “corporate” divisions!


Hospitals and Clinics

University

Physician Practice

The Academic Health Center

Medical School


  • #3 Use the tools of mission-based management

  • to realign and maximize resources!


Program Assessment

High/High

High/Low

  • Mission

  • Contribution

Low/High

Low/Low

  • Financial Performance


  • #4 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

High-performingTeam

Real Team

Working Group

PERFORMANCE IMPACT

Potential Team

Pseudo-

Team

TEAM EFFECTIVENESS

Source: Katzenbach and Smith, 1993


  • #5 Focus leadership recruitment on

  • organizational fit, and do real succession

  • planning for long-term stability!


Embracing an Emerging Culture for Health Care

  • Collaborative

  • Transparent

  • Outcomes-focused

  • Mutually accountable

  • Team-based

  • Service-oriented

  • Patient-centered


Diffusion of Innovations

“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

Time to Adoption


Creating a Culture of Teamwork and Collaboration


Creating a Culture of Reliability and Quality in the Face of High Risk


Creating a Culture Based on “Evidence” Rather Than “Eminence”

Issacs and Fitzgerald, BMJ 319: 1618, 1999


Creating a Culture of Trust


Creating a Culture in Which All Teach and All Learn


An Integrated World of Education, Research, and Health Care – With the Patient at the Center

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