Contemporary Challenges for Academic Medical Centers

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Contemporary Challenges for Academic Medical
Centers

• Stanford School of Medicine
• Strategic Planning Leadership Retreat
• Carmel Valley Ranch
• January 29, 2004

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Challenge

• A test of ones ability or resources in a
  demanding but stimulating undertaking

-- American Heritage Dictionary
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Todays demanding tests are both external and
internal
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Grappling with External Realities

• Unrelenting financial pressures
• Constraints on health care spending
• Flattening of the NIH budget
• Push back on tuition increases
• Increased demand for accountability
• Value for money
• Quality of care measures
• Time and effort reporting
• Conflicts of interest and commitment

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Grappling with Internal Realities

• Academic culture resistant to change
• Departmental prerogatives v. institutional
  strategic goals
• Academic freedom v. calls for accountability
• Entitlement mentality v. need for compliance
• Marginalization of education
• Clinical and research demands on faculty time
• Lack of explicit budget / diminishing cross
  subsidies
• Insufficient reward / incentive for teaching

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Challenge

• A test of ones ability or resources in a
  demanding but stimulating undertaking

-- American Heritage Dictionary
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Todays stimulating challenges offer enormous
opportunities for all three of our missions

• Education
• Research
• Clinical Care

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Education

• Establish a firm grounding in basic science
• Prepare students for life-long learning
• Create appropriate (esp. non-hospital) learning
  environments for acquiring enduring clinical
  skills
• Communication skills
• Cultural sensitivity
• Team work

• Information management
• Quality improvement techniques
• Systems thinking

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Education

• Inculcate professionalism

• Balance admissions criteria (intelligent
  idealists)
• Emphasize throughout all 4 years of the
  curriculum the critical importance of
  professional standards
• Monitor and burnish the informal curriculum
• Sustain the joy of medicine!

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• The key to restoring a sense of contentment to
  the medical profession may lie in the hands of
  educators who encourage students to have more
  accurate expectations of a medical career than
  did the generations trained during the
  tumultuous past 50 years.
• - Abigail Zuger, M.D. Dissatisfaction
  with Medical Practice NEJM Jan 1, 2004

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Research

• Reap the promise of the post-genomic era
• Create the scientific infrastructure for
  prospective medicine
• Translate basic discoveries into useful and
  affordable clinical tools
• Collaborate, collaborate, collaborate!

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Clinical Care

• Refashion Americas outmoded system for the
  delivery of health care
• Embrace other health professionals
• Reduce unwanted variation
• Systematize routine care
• Focus on improving quality care
• Patient-centered
• Effective
• Efficient

• Safe
• Timely
• Equitable

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• This is our purpose we dont mean to predict
  the future, we mean to create the future of
  Academic Medicine.
• - Philip Pizzo