Darrell G. Kirch, M.D. President and CEO, AAMC May 14, 2008
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Transcript of 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, AAMCMay 14, 2008
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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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First-Year Medical School Enrollment Projected to Increase 21% by 2012
15,000
16,000
17,000
18,000
19,000
20,000
21,000
22,000
2002 2004 2006 2008 2010 2012 2014 2016
Existing + New Schools
Existing Schools
16,488
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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?
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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
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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?
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The Patient
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The Expert
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The Technology
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Will technology remove all the barriers in medical education?
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Discontinuity in the Medical Education Continuum
Premedical Medical School
Residency and Fellowships
Practice
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The Decision Dilemma in Health Care
10
100
1000
1980 1990 2000 2010 2020Adapted from: W. Stead, Vanderbilt University
Human Cognitive Capacity
Fac
ts p
er D
ecis
ion
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Clinical and Translational Science Awards (CTSA) Research Network
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The Decision Dilemma in Health Care
10
100
1000
1980 1990 2000 2010 2020Adapted from: W. Stead, Vanderbilt University
Human Cognitive Capacity
Fac
ts p
er D
ecis
ion
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Connected 24/7
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The MCAT as the Gateway to a Career in Medicine
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A Virtual World-Wide Faculty
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Leaving the World of “See One, Do One, Teach One”
Source: Rhode Island Hospital Medical Simulation Centerwww.lifespan.org/rih/services/simctr/training/
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Building an E-portfolio Over a Career
Medical Professional
TrustedAgentHub
DataCompilation
DataCompilation
DataCompilation
DataRepository
DataRepository
DataRepository
DataRepository
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Technology as a Tool to Create a True Continuum of Lifelong Learning in Medicine
Premedical Medical School
Residency and Fellowships
Practice
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Technology as a Tool to Enable Individualized Physician Learning
Premedical Medical School
Residency and Fellowships
Practice
Premedical Medical School
Residency and Fellowships
Practice Life-longLearning
Two-YearCollege
Premedical Medical School
Residency and Fellowships
Practice Life-longLearning
Pre-medical
Medical School
Residency and Fellowships
Practice Life-longLearning
Non-Premed Degree
PracticeRe-training
Life-longLearning
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Will technology remove all the barriers in medical education?
No, but when used wisely, it can be a powerful enabling tool.
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Will technology solve all the problems in our health care system?
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Taking Physician Handwriting Out of the Equation
Photo courtesy of Evanston Northwestern Healthcare
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Relegating the Medical Chartto the Museum
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Real World ComparisonsAccessible to Patients
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Patient Feedback Becomes a Reality
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Will technology solve all the problems in our health care system?
No, but when used wisely, it can be a powerful enabling tool.
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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?
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Embracing a New Culture in Health Care
“Culture eats strategyfor lunch every day”
Andy Grove
Former Chairman of Intel
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The Traditional Culture of Health Care
• Individualistic
• Autonomous
• Scholarly
• Expert-centered
• Competitive
• Focused
• High-achieving
• Hierarchical
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Embracing an Emerging Culture for Health Care
• Collaborative
• Transparent
• Outcomes-focused
• Mutually accountable
• Team-based
• Service-oriented
• Patient-centered
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If we want shared collaborative environments, we need standards.
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Technology standards can ultimately facilitate collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.
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Standards in the absence of trust will go nowhere.
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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?
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#1 Make values explicit, and
use them visibly in everyday decisions!
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#2 Align governance, leadership, and
management across organizational
and “corporate” divisions!
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The Academic Health Center
Medical School
University
Physician Practice
Hospitals and Clinics
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#3 Use the tools of mission-based management
to realign and maximize resources!
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Program Assessment
Mission
Contribution
Financial Performance
High/LowHigh/Low
Low/Low
High/HighHigh/High
Low/HighLow/High
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#4 Foster collaboration and accountability,
accepting nothing short of
high performance teams in all mission areas!
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A New Model for the Organization – Creating High Performance Teams
Source: Katzenbach and Smith, 1993
PE
RF
OR
MA
NC
E I
MP
AC
T
TEAM EFFECTIVENESS
Pseudo-Team
Working Group
Real Team
Potential Team
High-performing Team
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#5 Focus leadership recruitment on
organizational fit, and do real succession
planning for long-term stability!
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Embracing an Emerging Culture for Health Care
• Collaborative
• Transparent
• Outcomes-focused
• Mutually accountable
• Team-based
• Service-oriented
• Patient-centered
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Diffusion of Innovations
Innovators(2.5%)
Early Adopters(13.5%)
Early Majority
(34%)
Late Majority
(34%)Laggards
(16%)
“Venturesome”Respond to Innovations
“Suggestible”Respond to Change
“Deliberate”Respond to Evidence “Skeptical”
Respond to Peer Pressure
“Traditional”Respond to Authority
E.M. Rogers and C. Cassel
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Culture Change as the Key to Shifting the Adoption Curve
Culture Change
Time to Adoption
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Creating a Culture of Teamwork and Collaboration
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Creating a Culture of Reliability and Quality in the Face of High Risk
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Creating a Culture Based on “Evidence” Rather Than “Eminence”
Issacs and Fitzgerald, BMJ 319: 1618, 1999
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Creating a Culture of Trust
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Creating a Culture in Which All Teach and All Learn
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An Integrated World of Education, Research, and Health Care – With the Patient at the Center
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