It's great to be back and to see to what good use
this building has been put. It's wonderful to see it's being
used with all the different students in the various venues.
And it raised a question that I asked earlier to Gordon,
I said, well what did you do
How did the students before this building was built?
I guess that's something get taken care of?
But it's a pleasure to be here. I'm not here to talk at you.
I'm not here to give a lecture. I'm here to try to raise
some issues, which I hope you will find stimulating and
provoke some discussion,
the big picture as it affects athe nation's academicng
health centers in general,
in particular. and this academic health center
we can go on, and so forth. I'veA couple of years ago,that
I was very happy in my position as executive vice president
and Dean in San Antonio when I got a call asking me
to look at this position
Health Centers. aAnd I must say at the time,ic
that I was not familiar with
And it's possible that that organization.
with it as well as. manI had, of course, beeniar
very active and familiar
The person was very persuasive with the AAHC.
and looked at the position. And I realize there wast
a whole other world out there.
the of world medical schools A world that existed beyond
important role in the future. thaAnd that organization,ry
the Association of Academic Health Centers,
is not a discipline-specific
In other words we're not organization.
or physicians, representing medicine
we're not representing we're not representing nursing,
Specifically, we're representing everyone.
It's a non-disciplinary specific
umbrella organization for all the components
of academic health centers, which we define as an accredited
degree-granting institution of higher education that
consists of a medical school. That medical school can be
either allopathic or osteopathic.
And I must say I have learned a great deal in the last couple
of years about osteopathic
active members. mPlus, one or more otherry
health profession schools or graduate programs.
So for example, nursing,
dentistry, allied health, pharmacy,
public health, of course, vand graduate studies,
in the biological sciences. And that's one more "and"
to our definition, an owned or affiliate relationship
with a teaching hospital, health system or other
organized healthcare provider.
of what an academic That'shealth center is.nition
A fascinating creature. One that is undergoing
a great deal of evolution.
I was interviewing for this job that there was a wave out there
that was building,
An integration of academic a wave toward integration.
in a very substantive way. health centers
could be part of that wave And that this organization
some of the organizational and and help and facilitate
that are taking place amongst academic health centers.
And not only, by the way, in the United States, but I'm
learning in various places
So what I'd like to do around the world as well.
a little bit today. iSome of my views aboutu
these organizational issues.
very interesting to you at first, but it really is
interesting.
because you need to take It's kind of fascinating,
and look at the big picture. a step back
together for you. AndI'd like your reactionsces
to some of the things that I'm about to tell you.
So getting back to the AAHC,
of academic health centers, wewe have a mission statement,s
a vision, etc., I'm not going to bore you with that.
But let's first look at academic health centers
in the larger societal context. We're going to do a lot
of big picture stuff right now. We're all aware that there are
a lot of forces that are driving
health center complexes. change within our academic
and we can discuss them briefly. I can pick just three of them
demographic, socio-cultural Sand political trends;;
and the third would be
These three categories of forces just economics.
now the nation's academic are impahealth centers.matically
Let's look at them very briefly.
is something I don't need to dwell on for this audience,
but there clearly is exponential growth and
discovery in everything that's going on right now in
the basic mechanisms of disease,
information technology, new medical devices and tests.
You know, I had a very
I'm part of a group called interesting discussion.
together some very interesting the Blue Ridge Group, which puts
And they talked about knowledge management
and medical decision-making.
Vanderbilt, who is an expert We had somebody come in from
an average clinician can juggle about five facts simultaneously,
in making a patient decision, comfortably.
And actually, if you are
you can probably do up to ten-- a refive to ten facts.st,
Well right now, we suspect
the good clinician will need in the next five to ten years,
And that if this curve continues to juggle about 100 facts.
in 20, 30, 40, 50 years, of information development,
that surround a clinical there might be a 1,000 facts
the capabilities decision, which is beyond
far beyond the capabilities of the human mind.
What does that mean for healthcare delivery?
And what does that mean for medical decision-making?
You begin to get into these kinds of discussions,
and you realize the power of science and technology
to change drastically the way we do things and the way
things are going to happen. So that's a force that is very
powerful and is one that we're comfortable with,
because we know about science,
we don't know where its taking we know about technology.
leading us, but we understand uthe basic ethos of sciences
and technology. But when we get into the
second area, socio-cultural and political trends,
well you know, we get a little more uneasy.
To realize that our enterprises are vastly impacted
by socio-cultural and political trends.
You could pick, just simply,
population growth, the aging of the population,
end of life management, and a host of socio-cultural
issues and political issues that are beyond our control.
We like to be in control
And these are way beyond of things.
Yet all of these factors our control.
how we do our business, how we get our work done,
how we are employed,
how we run our lives. hAnd that's a huge factor.,
We're undergoing tremendous demographic changes
in the United States, and around the world.
These will impact what we do. In politics, you know,
who knows?
and I'll talk about this Except that healthcare,
other than the war in Iraq a little bit later, is emerging
And I want to get into a as a lead issue in Washington.
So, socio-cultural and discussion with you about that.
Then finally, brute economics, political stuff, very important.
our bills, don't we? you know we have to pay
And we want to grow We wanin development.xpand.
I got a quick look at some of the buildings going up
on the campus.
okay, how are they paid for? And my reaction was,
How will you keep these buildings open, the electricity
going, fully populated
Especially in an era where NIH and flourishing?
purchasing power. An NIH dollar is not worth
very much compared to what it used to be worth.
I met with Dr. Zerhouni recently, a couple of weeks ago.
We meet on a regular basis. And he said tell your folks to
be prepared for 2-3% increases
which you know, doesn't even for the foreseeable future,
So, I look at these buildings and I think okay, how does
this great university and this
going to keep the lights on, great academic health center
and everything else happening. the researchers flourishing
happened in the last 30 years to There are three things that
of academic health centers. draThe one is the BiDole Act.ics
Is everybody familiar with the BiDole Act?
Is anybody familiar with that?
I think it was around 1980. I don't need to go into that.
It was really very seminal
other entities that receive ifederal funding to harnessd
the intellectual property that they produced.
And has spawned a revolution
the nation's universities and academic health centers.
It had a very profound impact.
licensing and commercialization It othat are indeeds for
very, very powerful.
constrained NIH funding, it will And I predict, in an era of
as we work in the area become even more important,
and intellectual property, of tech transfer
and things of this sort. intellectual property bundling,
1980, we're only just beginning to see the full impact of that.
Then there's something
When was the last time called the anti-tax movement.
who proposed tax increases? a Can anybody tell me?ed
Does anybody have a memory
There had to be somebody, or maybe that person
wasn't elected. But can you think of anyone
who was elected on a platform of tax increases?
This is one of the most interesting sociological
phenomena in the United States. For the past 30 or so years,
we've had an anti-tax movement
indeed profound. in this country that has been
aspects of our public lives, And it has affected so many
infrastructure that we have: in terms of the basic
social services, funding Police, fire protection,
It goes on and on and on. But we've adopted a very, very
powerful anti-tax mentality.
some people would say draconian, And that has had dramatic, and
but they've had dramatic impacts I'm not necessarily saying that,
and how we look for money oand resources for things
that don't necessarily
We don't look for a fire department
or a police department
And then finally, I think perhaps the most significant
economic force has been the rapid growth of the market
in healthcare.
so dramatically. You know, the times have changed
to patients by drug companies is a fairly new phenomenon.g
Yet, we can't escape it on television today.
In the early 1970s, under Richard Nixon, there was
an opportunity
Nixon believed in HMOs. forHe saw an opportunity.m.
This was opposed by organized medicine, socialized medicine.
And a very hard fought campaign was successful in not letting
that move forward.
was a very short-sighted I think what happened is that
Because instead of having socialized medicine,
a far stronger force
And that is the force has of the free marketre.
and the free market economy.
in the last 30 years. And tExtremely dramatic.matic
And as a result,
in the health sector, enin the trillions of dollars.ed
And I'm not talking wealth
and specialists. in the hands of rich physicians
the hands of insurance companies I'm talking about wealth in
and spin-offs, and medical device companies,
the health market. and all the things that surround
When you think about how Enormous wealth.
you know, somebody's got changing the healthcare system,
take some of that money away, toa very, very difficult thingd
to do.
has been that the market, Even more as efficientbout this
and effective as it is, is a very blunt instrument.
It seeks profit.
of healthcare delivery And there are many aspects
Certainly not in the short-term. that are simply not profitable.
in those directions. And the market tends not to move
in other directions where profit can be had.
So you see for example, more and more activity
in cosmetic surgery.
and I'm probably going There's an interesting study,
I don't remember exactly to misquote it, because
in a dermatology journal the facts and figures,
in which they looked at time within the last month or so,
with a dermatologist. And I can't remember what state
it was in or what kind of national sample or local sample
it was, but they had two things.
that you were concerned about, If you had a mole
you wanted to get it evaluated, it the average wait timeor,
to an appointment was 28 days or so.
But, if you wanted to get a wrinkle taken care of,
it was much less, maybe 10, 12, 14 days.
I think there's a message there.
the market in healthcare There's a message about
And to me that is a substantial thing we have to consider
as we look at the landscape of healthcare reform
and the forces that are impacting on our nation's
academic health centers.
socio-cultural and political, the BiDole act, economic forces
and so forth, science and technology,
and there's probably a host of other things that
I haven't mentioned.
a fundamental remolding of what we call the academic
health center enterprise. And the remolding, in the
broadest terms, that's taking place is from an ivory tower to
a complex business enterprise.
Complex business enterprise. Ivory tower.
Big change. All in aBig change., or so.
We just need to be aware of it. But unlike business
enterprises, academic health centers have missions
that must go on regardless of profitability.
We can't tell your dean that we have a little shortfall
in the budget next year,
third-year medical students. I guess we won't educate
"That's a no-go folks." We have missions
we just can't discard.
business enterprises So the complexity of our
by the fact that we can't truly run them as businesses.
I had the honor of giving a talk at the business school
at the university of Texas at Austin to some MBA candidates.
And I to convince them
that running an academic health center was more difficult
than any other corporation
And of course, they laughed a little bit when I started
with that, but they all agreed with me at the end.
Where else can you not cut
that are not profitable? product lines
things like tenure? WheWhere else do you haveth
the comprehensive regulatory
in almost everything that we do. web that engulfs us
to a very complex business We are in a transition
be run strictly as a business. enterprise that can't
any comments or things Anybody want to make
more specific level of stuff? bAnybody have any reactionst
to things that I'm saying?
or is some of it resonating, Am I off base,
I'm sure this is not or comments of any kind?
( inaudible ) That's a really great question.
I've evolved so much
I've gone through so many permutations..
And I think it's a great, great question.
What is it going to take
First of all, I don't think to mthat the health systemge?
is dysfunctional. I don't think that the
health system is unsustainable. I think people who tell you that
are missing the boat. Because I come from
the school of thought that says every system is perfectly
designed for the results
Our system is perfectly designed that it gets.
Bad outcomes, expensive, etc. for the reBeautiful. it gets.
It works fine for that. I've come around to
a philosophical point on this,
It kind of dawned on me my pwhen I was up in Canada.is.
And that was before I saw the Michael Moore film, Sicko.
And I don't know if anybody's had a chance to see it.
I was up in Canada, and I was attending a meeting of the
organization that's kind of the companion organization
to ours up there. There was something going on
in Quebec at the time,
health insurance, or whatever. some bill for more private
over this. And they were having a debate
speaker came up to the podium and said we can't have this
bill because it violates the
of solidarity. fundamental Canadian principle
solidarity. We care about each other.,
We want to have a safety net
That really made an impression that's meaningful and real.
Then I saw the movie Sicko, which I agree with the critics.
He takes small examples and generalizes to whole
health system in France,
the thing in Cuba or whatever. or wherever, you know, and does
which is that, you know, But he makes the same point,
going to start to care when are the American people
So I've come to the conclusion about each other.
reform in this country that substantive healthcare
a change in the American psyche. is only possible when there's
individualists, who, you know, A change from being rugged
straps and get the job done. pull yourself up by the boot
kind of thing, to a change And if you can't do it, tough,
Whether that's even possible. whereBecause I think to gether.
substantive change requires a change in the psyche.
And I've written a little piece where I say change the psyche
before we change the system.
I have no idea. But there's where I'm evolved to
at this point in time.
( inaudible ) You're getting into a lot
of important issues here. Thank you for raising
that point. First of all, there's the whole
patent law situation. There was just a patent bill
that was passed recently
I think yesterday or today. thaWe do have a dysfunctionalt,
patent system, which impacts
of intellectual property. But the future in intellectual
property for universities,
what we call IP bundling, intellectual property bundling,
because it turns out
and particularly on the road to commercialization,
there are many, many points along the way where things
have to be joined and put together.
It's not one thing, often,
It's this in conjunction with this,
which puts this,
to work with that, whatever. and this device is made
deal with issue of IP bundling. We think that will be a powerful
change agent for academic health
amongst each other in new ways centers to work together, or
which will help to commercializationone,
and which will put forward, I think, a much more doable
kind of structure for reaping some of the economic rewards.
But really what we're after is just good commercialization
of our products.
I'm not an IP lawyer. I've talked to a lot of them.
We need reform
But you think we need to have this idea of working together,
bundling our intellectual property, as a way to have
a substantive change
in tech transfer. inRight now, many officesow
are doing the best they can,
It's almost like hoping to get a hit.
You have a lot of things playing a roulette.
and maybe something will happen and maybe something won't.
Sometimes, the incentives for the faculty aren't
well aligned with tech transfer.
but the lab, the department, You know, not just the inventor,
all should benefit. The university should benefit.
And they're waiting for a hit to come through.
We think that by bundling things
we may have a better chance together, of havingtilization,
a more robust operation.
of activity in this right now. But yes, there's a lot
( inaudible ) Unless a miracle happens.
Unless you have a "Gatorade," or the equivalent.
( inaudible ) I would argue that
it's necessary for us to do this, just the way that I would
argue that the necessary for us to do clinical trials.
If you look at the clinical trials operation at this
university, I would venture that it's small potatoes
in terms of revenue,
research budget. compared to your overall
a small fraction of that. The risks are very high.
It's a very high risk area. It's a very complicated area.
Yet, I would argue
health centers need to do that. thaWe need to be a magnetic
for clinical trials.
We need to be developing We need to be conducting them.
from it. the new knowledge that comes
with tech transfer. I think these need to be
profitable areas for us so
not necessarily make that we can sustain them,
( inaudible ) a forAbsolutely. them.
( inaudible ) And we're also very weak
in the area of legal help,
If you come up with something, in this regard.
for infringement of somebody that you're going to be sued
You need really deep pockets else's--
So you're right about that. to sustain soYes?ing through.
( inaudible ) I actually have--
It's in here. Can I save that for a little bit
later, because I've got some
It's a very important trend. very strong feelings about that.
( inaudible ) Correct.
( inaudible ) I think we've made a lot
of progress.
the AAHC for doing great work I reallyin this area.ratulate
You know, it's only as good as the disclosure
in the first place, as you know.
disclosure has proven Gto be a challenge in manyte
of the academic health centers
Is it the faculty chose not to around the country.
they should disclose, they're not disclosing properly,
that's one thing. Then getting it into a database
or a meaningful format
by somebody is another thing, and then having a process
in place to actually gauge
conflict of interest or not. whether this is a significant
manage that conflict And then if it is, how to
and requires a lot of resources. is an enormous issue
to industry, which we will do Asbecause of the changinger
financial economics,
we need to figure out athe best ways to manage those,,
and it has to begin with the idea of integrity.
And it's got to start right at the top and go right through
the entire organization.
It's got to be clear that Ththis is a fundamental thingt.
that we're going to do
But it's a big, big issue. at every level.
( inaudible ) Yes I do.
I mean, don't misinterpret me,
some great things in healthcare I think tright now.is doing
And you want each sector
I think we're out of balance to do what it does best.
( inaudible ) rightAbsolutely.s all.
Yes?
Well, what I see happening ( inaudible )
with the university. is changing relationships
This is my mother's doctor And development--
Nope? Good. That's the only call I take
during lectures.
to deal with that. She's turning 90, so I've got
Jefferson Medical College She's a in Philadelphia.ient at
I've written about it,
But anyway, yes, I do. it's an amazing story.
like this one, I think for universities
and meaningful ties iwith new departments,ew
and other departments, that have not had good relationships
with the academic health center in the past.
Departments of Sociology, Departments of Psychology,
Departments of Humanities.
can be blended in. All these other things that
toward doing that. There's a clear trend
( inaudible ) Well, I've learned a lot about
nursing in the last two years,
As I have about pharmacy, and veterinary medicine,
and dentistry, and so forth.
that I'm just learning about. TheAnd we're just completingere
a major Macy's sponsored
we're looking at work force wshortages, particularly inh
the academic sector,
I'm going to be reporting buton that in October.ell.
And it's clear that no one
of a short in "X" has reahealth profession,impact
impact on somebody else's health profession.
So what does a shortage of nursing really mean?
What does a shortage
of radiology techs really mean?
for everybody else? We're trying to big picturen
this and to work
It's very exciting. But it's one that I think
also influenced greatly by
of health workers globaliaround the world.gration
Let me jump back. This has been great, by the way.
Let me just jump back a little bit here.
What's happening
You have basically with organizational models?
or organizational models two prototypical
You have the fully integrated of academicmodel.h centers.
And that's a fully integrated model where there's a single
board of some kind, under which is somebody with a title,
whatever it might be, chancellor, CEO, who knows,
whatever that title is. And that person,
everybody reports to, who reports to a single board.
Hospital, clinical, health system, research, deans
everybody, comes up through this one person,
a fully integrated model. Vanderbilt would be
a good example
Penn State is one of that's thinking about,el.
is pretty well integrated.
integrated the medical school Univand the health system, has
but not the other health profession schools,
so there's a prototypical model.
or split model, where you have The other is a splintered
reporting to somebody, the dean, for example,
directly to not a provost, the Dean of Medicine reporting
of the university. but to the president
reporting to a provost, And ythe other deans ofdeans
the health profession schools.
permutations of this particular And splintered modelmany
around the country. If you ask, well why do
you have the particular model that you have, you've got to
look at your history, economics and politics.
And that will explain why things are the way they are.
Now, what is happening
to address the challenges that I mentioned earlier?
It is clear to me, and I visited
health centers recently-- A trend toward what I would call
corporate management. And I don't mean corporate
in a pejorative sense,
What are we seeing but in a management sense.
We're seeing expanded roles for existing physicians, such
as a VP for health affairs. That may be a single person
called the VP for health affairs, or it may be
the VP for health affairs and the dean title, or whatever.
What people are telling me
the VP role is getting and what I'm seeing is that
So much so, that in many cases bigger and bigger all the time.
vice dean or something like that there's an executive dean, or
VPs for research with tsystem wide responsibilities,.
not just for running
or grants management or however, the compliance office
the brain power, collaboration that is done, but
Creating liaisons where there weren't before.
Creations of new roles in this
in compliance, and so forth. corporate management structure
around the country and I'm seeing a lot of this happen
along what I would a lot of reorganization
So the creation of centers, and institutes and other venues
for cross fertilization of disciplines,
breaking down the silos.
to relate to stakeholders. Markedly increased efforts
from public affairs I knowand development.e here
That is a big push right now. Why?
Because people need the money,
It makes good sense. and also because it makes sense.
are very broadly defined, including the public,
and grateful patients and community leaders.
But the stakeholders
Accelerating the transition of research into practice.
That is a big push. The CTSA that you've gotten,
congratulations.
for this institution, has been an example of that.
Trying to move the continuum
and clinical research. more towards translational
our knowledge, and what we're actually putting into practice
is getting larger and larger. It's getting increasingly
intolerable.
to close that gap. And we need to try
in the translational So there's a lot of effort now
Not isolated, but linked in the continuum.
Globally minded.
globalization, thank you. I've written a piece called,
"The Multinational Academic Health Center."
I am convinced that,
multinational organizations, if we're not today, we will be
I've been working closely inwith a group from Singapore,d.
which is a very interesting island state, an island nation.
Duke is starting
Some very famous researchers a medical school there.
California have relocated there. from the University of
an academic health center, They want to build
I just met with them in New York an integrated model.
And I'm going to see them in November.
It highlights this globalized phenomenon that's taking place
in clinical care, in research and in education.
And every place that I've been to has something going on
in the international arena, although it may not be
totally well organized, it might be decentralized, etc.
But, you know, I have a vision
in this together globally, that we're all going to be
can play a role in bringing this together.
Academic health centers are,
apolitical organizations. They just want to do good.
We want to improve the public's health and well-being,
whether it's the United States
Why can't we work together or around the world.
centers around the world with our friends who operate
Mutual programs that seek to improve the public good,
whether it's in discussing
migration of medical personnel the dicey issues of the
from country to country; from around the world,
health, which are very dramatic whetand important; whetherlic
it's issues of research and education.
I mean, there's so many things
in a multinational sense. I think that your point is
so well taken, that we will see our evolution into multinational
academic health centers in the very near term.
And Asia is going to be a place that we need to pay
a great deal of attention to. If the 19th century was the
European century, or whatever.
was the American century, everybody's saying that
the 21st century is going to be the Asian century,
You've got to pay attention.
on and be part of it. So those are some of the thingsg
that I see happening, and this trend toward running it
more like a business. Remember I said the evolution
from the ivory tower to a complex business enterprise.
Very, very important. It means that the faculty
and the staff have to change
the way they view their jobs. And not necessarily
in a negative way.
that is so important to many people in academia,
needs to be understood
doing something productive, and doing something productive
that advances the strategic plan of the academic
health center that everybody's labored on.
Basically, we're in this
And we all have to be moving in the same direction.
It doesn't mean we can't have new ideas, we can't go out
on promising on paths of research and investigation.
But at the end of the day everybody's got to be working
together toward the same ends.
that I like to make, which is that we're getting to a point
in our evolution where
of internal dissidence we cannot tolerate the degree
in many academic health centers, that we've had traditionally
between the medical school internal dissidence, friction
friction between departments, anfriction between thisal,
and friction between that,
That's a problem for us now, and whatever.
time, a lot of emotional energy, because it consumes a lot of
and you don't get anything done. and eats up a lot of resources,
those places that minimize And I'm convinced that
through reorganization and internal dissidence
other good things, integration, are going to be the places
that clearly advance
Those that fall prey to the quagmire of internal dissidence
in whatever way it develops,
staying where they are today. They're not going to be able
to maintain even the status quo.
when I talk about that. I thiSo we're going to seeI mean
a continuing horizontalization
enterprise throughout all its mission and management areas.
We're going to see a process
This is good, because I think the process of accelerated
change enables you to make
That will facilitate the tough decisions quickly.
If you're stymied by a rigid resource allocation.
you're going to figure out structure, as many places are,
So I've been working with a a couple of places that havet.
intolerable situations
their school, or their schools. It's tough because the hospital
has a separate board, maybe not unlike here,
and you need legislation
so they're coming up with ideas, to get around it, etc.,
they're working together. Creative solutions, maybee
a bridge board can be developed.
created that will oversee Maysome of these things. be
People are trying to do what
structures that are preventing they can to get around rigid
from moving ahead. progress and presenting people
( inaudible ) Great point.
I saw this yesterday in Chicago.
institutions I was visiting, I won't tell you which
You know, it brings to point-- but I visited a whole bunch.
all these relationships between Ththe academic health centerin
and the university
You've got structure, and you've got personality.
Structure and personality.
Is the structure in such a way Okay?
to get things done? And if it is, you've got to
change that structure somehow,
But even more importantly, and be creative to do it.
that the job cannot be done? are the personalities such
in leadership positions who don't have the personality
that's integrative
in seeing the big picture. and collaborative
structure is, it doesn't matter what the org chart shows, you've
got to have the personalities that work together.
In every hire that comes up,
or a search committee, if I were sitting on a board
somebody in an important or whatever, looking for
the main thing I would look for, leadership position,
right word, but I would look for maybe personality isn't the
of working with other people, sand is not totally focused
on advancing their own career,
the big picture for the organization as a whole
and willing to work with people and to develop new relationships
and that float new ideas, and to bask in the reflected glow
of other people around them,
Do you see what I mean? rSo yes, this is a big issue.
The thing that causes almost the maximum amount
of casualties in leadership positions that I've been in,
I've noticed in the last couple of years,
has been friction between-- personality clashes,
essentially.
and the leader Friction between a leader here
it's a university president right aor somebody else, whether
whoever that might be.
is absolutely crucial for getting the job done.
Now some places have put
president that puts into place, into a structural formatrsity
that protects the president from problems that might occur
in a health center, because it's such a high risk,
high profile, high economic driver.
And therefore, will delegate
not to a provost-- a good amount of authority,
from the humanities. A provost generally comes
around the country in history Aand whatever, but they don'ts
know much about how to run
what it means, an academic health center,
So they will delegate that what it's all about.
who has that responsibility. to another person
the title of vice chancellor And that person could have
Some university presidents for health affairs, or whatever.
they don't like having don't want to do that, because
And they think they're taking something away from the provost
and doing something bad with the university.
But in my experience, I was involved on a blue ribbon panel,
in a very high profile
involving a failure of a major transplant program at
an institution in the country.
that just went belly up with a lot of bad publicity.
And all kinds of bad things happened.
We went out to investigate it.
anybody was doing a bad job, or criminal, or anything like that.
What was happening was that everybody in their own
narrow sphere was trying to do
that if you gave them another couple weeks or months,
they could fix the problem. So whether it was
transplant director,
it didn't really matter. the hospital director, the dean,
to do their job. They all were trying
was nobody between the president What was missing was that there
to point that out to anybody. aAnd the president certainlyer
didn't have the time
to be able to do that. and the inclination
in that particular position. We recommended putting somebody
of empowerment at the university So I'm a big advocate
the complex enterprise level of someone to oversee
in a sophisticated way of the academic health center
what goes on and in a way that harmonizes
That's not a message that everybody likes to hear.
There are many people who feel
because it's not good tfor the university, etc.
That's my position right now. But you're right about that
being an important point
There are many, many examples of of that.e.
But I think your point
Thank you. is exceedingly well taken.
that those institutions that are So in the end, I would posit
or more effectively able more effective in integration,
will be the ones to integrate their components,
Those that are unable to do so that will be successful.
rigid bureaucratic structures, are stymied by either
or whatever, or personality things,
to maintain the status quo. There will be an increasing gap
between the two kinds of institutions.
I was going to conclude with
healthcare reform and what's coming up on the horizon
in Washington, and maybe
about the association, a little bit
I've gone on too long. but I get the sense maybe
Before I move on to that, if you have the time
and patience, would anyone like to comment
about some of the thoughts up to this point, about
organization and management and things of that sort?
Yes?
Correct. ( inaudible )
That's a very insightful ( inaudible )
Could everyone hear what he had to say?
That was extremely insightful.
I think it's a leadership issue. I thank you for bringing it up.
that is emulated I think it's a leadership issue
I think it has to do from the very top.
and transparency with transparency of management,
and sharing of information. One thing I've learned about
academics throughout my career
information, is that if you give academics
And if you give them feedback they they will understando it.
that feedback.
you made a decision, whether If you tell them why
and were willing to tell them, they agreed with it or not,
That's transparency. that's good.
of change, cultural change, So I thinit's a changethis kind
that starts at the top
and the sharing of information with transparency at all levels
But it's a long row to hoe. ( inaudible ).
Yes.
Tenure, you mention that word and you get a room
full of people very quickly.
perspective on tenure, It's an interesting historical
I believe it started with the church many centuries ago.
And I mean, it's a whole
Basically, there is a cultural interesting thing.
an academic health center dand being part of a universityf
in say the department of English or Psychology,
or one of the other departments.
The fundamental difference There is a difference.
and what the expectations are. is in how the economics works
is very, very difficult. Bridging that
posit that discussions with the leadership of the Senate would
be a very worthwhile thing
some level of understanding. to have, to try to achieve
especially universities view the administration,
as the dark side. You've crossed over the line.
You're the enemy. You're the evil, or whatever,
because they have a lot of false
about what it is ideas and misunderstandings
what their responsibilities are, that administration does, and
their jobs are. and hTrying to demystifyicult
academic administration for the Senate
and for the faculty in general
to try to do. One thing I always would have
liked to have seen
and academic health centers, is for universities
to develop leadership programs, where they train the next cadre
of academic leaders through whatever kind of program they
might set up and put together.
something in that regard, to demystify this whole thing,
because academic administration is exceedingly important.
It's not the evil part
It's something that can make of the university.
happen for the better. things happen and make things
And I think communicating that But it's a very difficult job.
on a regular basis is important and then engaging them to come
over and try it a little bit
It would be a good idea. and see what it's like.
The answer is yes. ( inaudible )
I'm saviIs that okay?omorrow.
( laughter )
Let me refine that a little bit. ( inaudible )
in healthcare is it responds What the market does really well
and can pay for. to what people want
As opposed to what people need. That'You know, there's does.
a big difference
Market driven responds to want. You want to get something
and you have the money
you're going to get it. But you need a whole bunch
of other things that you may not want
or can't afford.
the market falls down. In that case, that's where
is very important. So that dichotomy
have a role to play in an overall healthcare system.
I think the want
the need is more important. How are we doing time wise?
( inaudible ) Okay.
( inaudible ) I think that when you
think about it, as economics
budget is level or declining, it gets more and more attractive
to take money from industry.
that money never comes My view is that
There's something attached. It may be nearly invisible, but
it comes with strings attached. It doesn't mean in my view
that you should never take it,
understand those strings, butand what they mean,need
and whether they fit in with
university and the academic the overhealth center. of the
I think you need to have--
for each place to decide It's a cultural thing
with those kinds what level of comfort they have
And, more importantly, of relationships.
those relationships. how do you manage
of managing those relationships? Do you have a clear plan
It means that there are guidelines that people have to
follow in regards to these
whatever you want to call it. And they have to be based,
on some intellectualizing of some kind, so that
there's a rational for it.
some places said, you know, we can't come up with
an intellectual rationalization for this,
and we're not going to do it. And I respect that.
I think other places can say
a rationalization, we can come up with
and we can change it and this is what it is,
But we're going to put this into place and follow it.
But inevitably, we're going to drift closer and closer
to industry, because of,
to demand it, but the world notof science and technologyoing
is going to demand it.
you're going to need to have And to get certain things done,
So I think you need to decide where this place culturallys
wants to fit on that continuum, and then to figure out a program
that successfully can manage
But I don't think there's thoa black or white answer.s.
I respect places
But every place has to have their own comfort zone for that,
but it's got to be clear
( inaudible ) Yeah, well that's a big issue.
We cannot be separated
in which we're embedded. from the community
be separated from it. Community can be defined
as a very narrow radius around
or it can be a huge region, an acador whatever.center,
Whatever it happens to be.
And we never should be separated But we cannot be separated.
that we're embedded. from the community
driver of the community's We arhealth and well-being.tant
Not only are we an essential
of the community, a vital economic engine
to this community,
look at the payroll, look at the jobs,
that spins off from that. But in terms of the health
and well-being of the community,
and well-being, the education of the next generation
of health providers,
and so forth, and so on. the generation of new ideas
of some kind or another. It's all for our community
we lose the public's trust, And we go down the tubes.
So we cannot be separated from our communities,
however you define them.
on a plane of public trust. AnAnd that public trustate
can only be gotten through
and acknowledging that working with our communities
of what we are they're an important part
Never, ever separate ourselves and what we want to become.
( inaudible ) I mean, there's a lot of debate
about that point. First of all, a lot
of academic health centers
different tracks for tenure. took the lead in developing
a different tenure track system here, but there's been a
lot of experimentation in that. The real debate in tenure,
as I understand it--
Is the relationship Ibetween tenure and salary,
more so than criteria for getting tenure, is what is
the nature of the link between
And that's a highly complicated, tenure and salary.
phenomenon from place to place. aI don't want to get into
that discussion.
where it's really important, But that seems to me the level
Maybe it would be a good time to concluded with a few remarks.
You've been great.
a few things. I waI think we all agreeion
that healthcare will have a much higher profile in 2008,
as we go into 2008. And there will be a lot
of debates over the uninsured and the future of
employer-based health insurance.
of pay for performance, and things like that.
I'm glad I'm not talking about
I've got some views on that. pay for performance today.
health worker shortages Tare going to become very,ed
very prominent. There will be a lot of debates
over what we mean by a nation,
in the production of our healthcare work force,
a lot to say about that issue.
about the role of the market We talked a little bit
I have an opinion about the growing role of the states
in healthcare reform. As you know, a number of states
have taken some highly visible
their health system. steps to change
Massachusetts, California, I think they're all commendable.
But you know, I don't see great things happening
on a state-by-state solution. I think you need a national
solution for this.
these state by state experiments And maybe we'll learn from
But in the end, it's got to be of what works and what doesn't.
I think we've got to be very a national solution.
not to lose the basic principle carof insurance, which is,rm,
cover the many
I was very concerned when the administration last year,
or a couple of years ago, was pushing a very boutique
kind of health insurance. You know, if you're under 25,
you can get it real cheap,
And it would be attractive and whatever.
I think you need to cover the many for the needs of the few
however you design the system.
we don't lose sight of that. And I want to be sure that
to the faculty and your staff that things are changing
is very important.
that it's not business as usual Ganymore is fundamental.nd
And taking the high road on all decisions is so important.
Sometimes, you need to sacrifice
bigger in the long run. It doesn't help people's careers
necessarily, because
for that to happen. But taking the high road
every time
is just extremely important, you have the opportunity to,
that's what you're doing. Anyway, why don't I break here
and thank you all for being such a great group
and dialoguing with me so much. I really appreciate it.
Thanks very much. ( applause )