Title: MISSIONS AND MANDATES
1- MISSIONS AND MANDATES
- CHALLENGES
2TODAY WE WILL DISCUSS
- THE MISSIONS AND MANDATES OF THE ACADEMIC MEDICAL
CENTER - CHALLENGES THAT ACADEMIC MEDICAL CENTERS MUST
ADDRESS - THE ROLE OF UK HEALTHCARE IN THE KENTUCKY MEDICAL
MARKETPLACE - THE PLANNING PROCESSES THAT HAVE BEEN INITIATED
AT THE UNIVERSITY OF KENTUCKY TO ADDRESS OUR
SPECIFIC ISSUES. - THEN, HOPEFULLY WE CAN DIALOGUE
3MISSIONS OF AND MANDATES TO ACADEMIC MEDICAL
CENTERS
- EDUCATION
- CLINICAL SERVICE
- RESEARCH
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5A MEDICAL SCHOOL IS BORN
- MEDICINE IS A STUDY OF HUMAN GROWTH,
DEVELOPMENT, AND ILLNESS THROUGHOUT THE LIFE
SPAN. IT INCLUDES THE BIOLOGICAL, MENTAL,
EMOTIONAL, SOCIAL, AND CULTURAL FACTORS THAT BEAR
UPON NORMAL HUMAN DEVELOPMENT AND ITS
ABERRATIONS. IT IMPLIES AN INTEGRATIVE APPROACH
AND DENIES THE NECESSITY FOR ARTIFICIAL
SEPARATION BETWEEN THE TRADITIONAL BASIC AND
CLINICAL SCIENCES OR BETWEEN UNDERGRADUATE,
PROFESSIONAL AND POSTGRADUATE EDUCATION. THUS,
MEDICINE IS AS CONCERNED WITH HEALTH AND ITS
PRESERVATION AS WITH DISEASE AND ITS DIAGNOSIS
AND TREATMENT. William R. Willard, M.D.
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7EDUCATION
- THE UNIVERSITY OF KENTUCKY MUST TRAIN THE
SPECIALISTS AND SUB-SPECIALISTS SERVING KENTUCKY
SINCE IT SETS THE STANDARD FOR CARE IN SPECIALTY
MEDICINE IN KENTUCKY.
8CLINICAL SERVICE RESPONSIBILITIES
- PRIMARY CARE
- SECONDARY AND TERTIARY CARE
- QUATERNARY AND SPECIAL SERVICES
9PRIMARY CARE
- WE MUST DO ENOUGH PRIMARY CARE TO FULFILL OUR
TEACHING MISSION - WE MUST ADEQUATELY SERVE SPECIAL POPULATIONS
THE UNIVERSITY FAMILY - WE MUST DO OUR FAIR SHARE IN SERVING THE
UNDERSERVED - WE MUST STRESS THE ROLE OF PATIENT ADVOCACY AND
THE VALUE AND REWARDS OF LONGITUDINAL CARE - WE MUST EMPHASIZE EFFICIENCY AND SERVICE
10SECONDARY AND TERTIARY CARE
- MUST DO ENOUGH OF THIS TYPE OF CARE TO MAINTAIN
ROBUST AND VIABLE CLINICAL PROGRAMS AND
OUTSTANDING TRAINING PROGRAMS - MUST SET THE STANDARD FOR APPROPRIATENESS,
EFFICIENCY, QUALITY AND SAFETY
11QUATERNARY AND SPECIAL PROGRAMS
- PEDIATRIC SUB-SPECIALTIES
- LEVEL 1 TRAUMA CENTER
- TRANSPLANTATION
- INNOVATIVE SURGERY I.E. ROBOTICS
- ADVANCED NEUROSURGERY
- INNOVATIVE APPROACHES TO CANCER I.E. BONE
MARROW TRANSPLANTATION - ETC, ETC, ETC
12MY PERSONAL CLINICAL SERVICE GOAL
-
- ANY INDIVIDUAL RICH OR POOR CAN FEEL
COMFORTABLE THAT SHOULD THEY BE DIAGNOSED WITH AN
ILLNESS NO MATTER HOW COMPLEX THAT THEY CAN
GET CARE AT UK HEALTHCARE AND NOT WORRY ABOUT
WHETHER THEY SHOULD GO TO MAYO CLINIC, THE
CLEVELAND CLINIC, OR BOSTON.
13- WE MUST REALIZE THAT OUR TRUE COMPETITORS ARE
OTHER SUCCESSFUL ACADEMIC MEDICAL CENTERS, SUCH
AS THE UNIVERSITY OF CINCINNATI, OHIO STATE,
INDIANA UNIVERSITY, VANDERBILT, AND WASHINGTON
UNIVERSITY IN ST. LOUIS, AND NOT LOCAL COMMUNITY
PROVIDERS.
14RESEARCH
- GENERATION OF NEW KNOWLEDGE - A FUNDAMENTAL
VALUE OF UNIVERSITIES
15 - MY PERSPECTIVE
- THE BEST WAY TO ASSURE THAT WE OFFER STATE OF
THE ART CARE IS BY PARTICIPATING IN IMPROVING
THE STANDARD OF CARE. THAT MEANS RESEARCH
BASIC TRANSLATIONAL CLINICAL AND HEALTH
SERVICES.
16UNILATERAL INTRAPUTAMENTAL GDNF IMPROVES
BILATERAL MOTOR FUNCTIONS IN PATIENTS WITH
PARKINSONS DISEASE
John T. Slevin2,5,6,, MD, Greg A Gerhardt,
1,2,5,, Ph.D., Charles D. Smith 2,5,, MD, Don
Gash 1,5, Ph.D., Richard Kryscio 3,5, Ph.D., and
A. Byron Young 4,5, MD
- Departments of Anatomy and Neurobiology1,
Neurology2, Statistics and Public Health3 and
Neurology4and the Morris K. Udall Parkinsons
Disease Research Center of Excellence5,
University of Kentucky, Chandler Medical Center,
800 Rose Street, Lexington, Kentucky, 40536 USA
Neurology Service, Department of Veterans Affairs
Medical Center, Lexington, KY6
17CHALLENGES FACING ACADEMIC MEDICAL CENTERS
- ECONOMIC
- EMPHASIS ON QUALITY
- EMPHASIS ON SAFETY
18ECONOMIC PRESSURES
- HEALTH CARE WILL CHANGE BECAUSE OF ECONOMIC AND
SOCIAL REASONS - I DO NOT KNOW HOW IT WILL CHANGE.
- I DO NOT KNOW WHEN IT WILL CHANGE.
- I DO KNOW THAT IT WILL CHANGE.
19 ECONOMIC PRESSURE FOR CHANGE
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22SOCIAL PRESSURE
Millions
23SOCIAL PRESSURE
24- PUNDITS SAY THAT THE ANSWER IS
CONSUMERISM
25- SHIFT OF RESPONSIBILITY FOR COST CONTAINMENT
-
- CONSUMERS
THROUGH ECONOMICS
INCENTIVES -
AND DISCENTIVES -
- PROVIDERS THROUGH MANAGED
- CARE APPROACHES
-
-
- INSURANCE COMPANIES
- THROUGH BENEFITS DESIGN
26- PREMISE IS THAT A WELL INFORMED CONSUMER
(PATIENT) ARMED WITH DATA AND INCENTED BY
FINANCIAL CONSIDERATIONS (LARGE CO-PAYS AND
DEDUCTIBLES) WILL MAKE WISE, EFFICIENT CHOICES. -
27MY CONCERNS WITH CONSUMERISM
- MAKE CRITICAL MEDICAL DECISIONS UNDER FINANCIAL
DURESS - INFORMATION INCOMPLETE AND DIFFICULT TO INTERPRET
- COSTS MAY INTERFERE WITH GOOD FOLLOW-UP AND
PREVENTIVE CARE - FRAGMENTED CARE BAD FOR QUALITY CARE
28IF CONSUMERISM IS NOT THE ANSWER SOMETHING ELSE
WILL BE TRIED
- EVENTUALLY ECONOMIC REALITY WINS OUT
29THEREFORE WE MUST ALWAYS MAINTAIN A FOCUS ON
COSTS
- STANDARDIZE SUPPLIES, MEDICINES
- DECREASE VARIANCE IN CARE
30THE LARGEST OPPORTUNITY FOR COST CONTAINMENT AT
MOST ACADEMIC HEALTH CENTERS IS IN MEDICAL
MANAGEMENT.
31 -
- STAYING COST EFFECTIVE
- WILL KEEP US IN THE GAME
- TO WIN WE MUST LEAD IN QUALITY, AND WE MUST BE
ABLE TO DEMONSTRATE OUR QUALITY QUANTITATIVELY
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35- WE WILL HAVE A CENTRAL FOCUS ON IMPROVING AND
DOCUMENTING OUR QUALITY AS QUANTITATIVELY AS
POSSIBLE. - TEAM SPORT
36TO ERR IS HUMANBuilding a Safer Health System
- PREVENTABLE ADVERSE EVENTS ARE A LEADING CAUSE
OF DEATH IN THE UNITED STATES. WHEN EXTRAPOLATED
TO THE OVER 33.6 MILLION ADMISSIONS TO U.S.
HOSPITALS IN 1997, THE RESULTS OF THESE TWO
STUDIES IMPLY THAT AT LEAST 44,000 AND PERHAPS AS
MANY AS 98,000 AMERICANS DIE IN HOSPITALS EACH
YEAR AS A RESULT MEDICAL ERRORS.
37- SAFETY, LIKE QUALITY AND COST CONTROL IS A
- TEAM SPORT
38- CAN YOU EMPHASIZE COST CONTROL AND QUALITY AT
THE SAME TIME, OR ARE THEY ANTITHETICAL GOALS?
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42 IMPROVEMENTS IN COSTS AND QUALITY
43PROCESS IMPROVEMENT PIGGY BACK TECHNIQUE
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45Need a system that --
- INTEGRATES CARE
- EMPHASIZES MAINTENANCE AND PREVENTION
- DEVELOPS APPROACHES THAT UTILIZE EVIDENCE-BASED
MEDICINE AND MEASURES SERVICE AND QUALITY - DEFINES WHAT IS OR IS NOT COVERED, AND IS
COMPREHENSIVE IN COVERAGE FOR MAJOR ILLNESSES
(STANDARDIZED BENEFIT PACKAGES) -
46- FUNDAMENTALLY, THE CHALLENGE FOR US IS TO MOVE
BEYOND INDIVIDUALITY OR A RELIANCE ON DEPARTMENTS
TO AN UNDERSTANDING OF ENTERPRISE AND
INTERDISCIPLINARY CARE.
47A CASE FOR CHANGE
48CAUSES OF DETERIORATION IN CLINICAL ACTIVITY
- NO COMMON VISION BETWEEN DIFFERENT ELEMENTS OF
THE CLINICAL ENTERPRISE - NO AGREEMENT ON GOALS
- INADEQUATE COMMUNICATION
- STALEMATED DECISION MAKING
- UNDER INVESTMENT IN FACILITIES AND PROGRAMS
AGING OF PHYSICAL PLANT - INABILITY TO RECRUIT
- LOSS OF KEY FACULTY
49THEREFORE IT BECAME CRITICAL TO
- DEFINE A VISION
- ESTABLISH GOALS FOR CLINICAL, ACADEMIC AND
FINANCIAL PERFORMANCE - ESTABLISH AND CLARIFY A DECISION-MAKING PROCESS
- COMMUNICATE EFFECTIVELY
- RETAIN CURRENT FACULTY AND RECRUIT NEW
INDIVIDUALS - DEFINE PROGRAMMATIC AND FACILITIES NEEDS AND
COMMIT TO THEM. - ESTABLISH FISCAL ACCOUNTABILITY RESPONSIBILITIES
AND STRICT DISCIPLINE
50- AS WE AGREE ON A VISION
- FOR AND
- PLAN TO IMPLEMENT WE
- MUST ENGAGE AND EMPOWER
- THE FACULTY.
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52STRATEGY
- GEOGRAPHIC APPROACH
- PROGRAMMATIC APPROACH
- AGE SPECIFIC
53MARKET DEFINITION
54COMPETITIVE RELATIONSHIPS
55PROGRAMMATIC
- CARDIOVASCULAR
- CANCER
- NEUROSCIENCE
- PEDIATRICS
- ETC.
- MUST PLAN IN DETAIL
56AGE SPECIFIC
57FACILITIES
- WE MUST.
- UNDERSTAND THAT WE MUST DEVELOP A HEALTH CARE
DELIVERY SYSTEM NOT MERELY REPLACE SOME ELEMENTS
OF THE HOSPITAL - DEVELOP A LONG-TERM VISION FOR INPATIENT AND
OUTPATIENT SPACE NEEDS. - UNDERSTAND NECESSARY IMMEDIATE FIXES
- SITE BED TOWER
58ACADEMIC
- IMMEDIATE, INTERMEDIATE AND LONG-TERM NEEDS FOR
SPACE TO SUPPORT RESEARCH AND TEACHING - ALL THE COLLEGES OF THE ACADEMIC HEALTH CENTER
- MUST BE INCLUDED IN PLANNING PROCESS
59FINANCIAL PLAN
60COMMITTEES
61COMMUNICATION
- WEBPAGE
- EMAIL NEWSLETTERS
- VISITS TO DEPARTMENTS
- BREAKFASTS WITH THE EVPHA
- WHATEVER IT TAKES
62- OUR SUCCESS IS DEPENDENT ON OUR ABILITY TO
RECRUIT AND RETAIN OUTSTANDING FACULTY AND
STUDENTS AND HAVE THEM WORK TOGETHER IN A
COHERENT CO-ORDINATED FASHION TO SERVE ALL THE
MANDATES OF AN ACADEMIC MEDICAL CENTER
63- WE NEED TO
- SURVIVE TOGETHER IN ORDER TO THRIVE TOGETHER
64UK HEALTHCARE MUST SERVE ALL KENTUCKIANS BETTER
AND BETTER