Strategic Planning Leadership Retreat
Carmel Valley Ranch January 29-31,
2004
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Presentation Summaries
Medical Education
Julie Parsonnet, M.D., Senior Associate Dean for Medical Education, presented
"Medical Education -- Towards a Medical University"
Abstract
Dr. Parsonnet provided a brief review of major accomplishments in Medical Education in 2003, including the initiation of the new Stanford Curriculum, a Faculty Senate Committee on Performance Assessment and Advising, and a new funding mechanism for the Office of Continuing Medical Education. She also reported excellent results in our admissions yields and our residency matches.
She also presented an in-depth review of the Scholarly Concentrations, the structure of the new curriculum and the developing mechanisms for curriculum evaluation.
She concluded with a presentation of objectives for Medical Education in 2004, including the continued implementation of the new curriculum, improvements to student evaluations, incorporation of residents and fellows into the scholarly concentrations, developing mechanisms to facilitate and foster excellence in teaching, and developing a more robust CME program.
Discussions following the presentation addressed issues associated with the integration of our medical and biosciences graduate programs, the importance of ensuring that our admissions criteria reflect the types of students most appropriate to the new curriculum, and the importance of evaluating the "hidden curriculum" that represents what students are actually learning through all modalities.
Graduate Education and Postdoctoral Training
John Boothroyd, Ph.D., Senior Associate Dean for Research and Training, presented
"Flexible
Strength in Graduate Education"
and
"Postdoctoral Training: Building on Excellence"
Abstract
Dr. Boothroyd reported on the high levels of graduate student satisfaction with their decision to attend Stanford, but also laid-out an agenda for improvements in the areas of graduate student diversity, increased flexibility for 1st year students and increased strength in interdisciplinary training.
He also reported on a number of planned initiatives designed to make the postdoctoral scholar/scientist career and attractive choice, to promote increased diversity among postdoctoral scholars, and to foster successful career transitions from postdoctoral scholar to independent scientist.
He identified a continuing commitment to developing additional mechanisms to increase the exposure of graduate students and postdoctoral scholars to clinical medicine and translational research.
He concluded his presentation by soliciting discussion around the issues of increased graduate student and postdoctoral scholar diversity, increased exposure to clinical medicine and translational research, increased teaching opportunities for students and fellows and improved mentoring.
Discussions following the presentation ranged widely across these issues as well as issues of housing affordability for postdoctoral scholars, limitations on the duration of postdoctoral training, and opportunities for clinical exposure.
Graduate Medical Education and Postgraduate Medical Education
Harry Greenberg, M.D., Senior Associate Dean for Research and Training, presented
"Opportunities for Change in Graduate and Postgraduate Medical Education"
Abstract
Dr. Greenberg provided an overview of the student and trainee types within in the School's medical and graduate biosciences programs. He noted a surprising degree of symmetry among our programs, with medical students and biosciences graduate students being roughly equal in size and total pre-degree students being about 50% to size of total post-degree trainings. He reported a current total School of Medicine student and trainee population of approximately 2,820. He also summarized the complexity of the academic and administrative organizations currently involved in support of these students and trainees.
He summarized the charge and key findings of the Dean's task force on Residents and Fellows, including the need to strengthen the decanal role in these programs, the need to develop and "customer service" oriented administrative structure, the need to develop and oversee SUMC program standards, including elements of increased scholarship.
He concluded by delineating specific future goals for out GME/PGME programs, including addressing the specific Task Force recommendations, providing research opportunities similar to the scholarly concentrations, and developing a strategic plan for all our trainees.
Academic Affairs
David Stevenson, M.D., Senior Associate Dean for Academic Affairs, presented
"Academic Affairs: Our Changing Professoriate"
Ken Cox, M.D., Senior Associate Dean for Clinical Affairs (Pediatrics and Obstetrics), presented
"Clinician Educators: Critical Workforce For the Success of Stanford's Clinical Programs"
Abstract
As background, Dr. Stevenson summarized the history of the Medical Center Line and its recent refinements, the major additional revisions to the professoriate accomplished in 2003, and the current resultant structure and composition of the faculty (and related) positions at the School of Medicine. He also summarized the practical effects on the School of the new faculty billet cap and presented comparative data on faculty size and rank for Stanford and our peer research-intensive medical schools.
Dr. Stevenson also presented 3 key areas for new initiatives in 2004. These included a change in our faculty resource orientation from one of "billet control" to one of "position management", the continued transformation of the Office of Academic Affairs into a proactive and consultative service function, and the development and implementation of a new Faculty Leadership Development Program for all School of Medicine faculty.
Dr. Cox then reported on the work findings and recommendations of the Clinician Educator (CE) Task Force, which he chaired. He began by summarizing the current status of clinician educators and the objectives of the Task Force. These included clarification of CE compensation and benefits relative to their peers (both academic and non-academic) and identification of existing barriers to the full utilization of these appointments.
Dr. Cox presented data on the numbers and distribution of CE by rank and by duration of appointments, by the % FTE of their appointments, and by their distribution among departments.
He summarized the current state of the issues, and their potential resolution, for the key areas of concern to the CE: creating a valued position, providing opportunities for a competitive salary, and providing a fair and competitive benefits plan that includes housing and professional/sabbatical leave provisions.
The discussions that followed these two presentations addressed issues relating to the key roles of CE as educators and clinicians, the role of "Instructor" as a transitional appointment for future faculty, the potential role of the VA as a model for non-faculty academic roles, and the key role of CE in the success of the hospitals.
Finance and Administration
Mike Hindery, Senior Associate Dean for Finance and Administration, presented
"Finance and Administration: NOT Lost in Translation"
Abstract
Mr. Hindery’s presentation included a summary of significant 2003 accomplishments, a description of the rationale and structure of a proposed new management model for academic units, and a summary of key initiatives planned for 2004.
Most notable among the reported accomplishments in Finance and Administration were the development and implementation of new formulas for school general funds allocations and for the allocation of University shared expenses (allocated costs) including the assessment of a “citizenship tax,” continued implementation of university administrative information systems, development of an SUMC facilities master plan, and continued improvements to employee retention and respectful workplace programs.
Mr. Hindery summarized the most significant internal and external factors that are affecting the administrative work of the Medical School. These include the proliferation of departmental and non-departmental academic units, the workload burdens of new information systems and compliance obligations, our efforts toward increased interdisciplinary activities, and the desire to invest in the strategic plan and its initiatives. He outlined a proposed administrative model that allows for a more flexible and efficient response to these challenges while preserving the critical roles of departmental administration in support of the faculty’s programs.
Plans for 2004 include further discussions of the administrative model and additional pilot programs, a comprehensive review of the school’s operating, consolidated and capital budgeting processes, continued administrative systems implementation, continued refinement of funds flow formulae with SHC and LPCH, and increased efforts to create and promote programs contributing to an appropriate work-life balance.
Mr. Hindery presented the proposed administrative model. The model is intended to be flexible enough to accommodate different needs within the School and involves clustering and sharing management and administrative roles and responsibilities among department and non-department units. The proposed model is premised on enhanced service to faculty and students and the provision of service at the local level, increased career development and job satisfaction for staff, satisfying compliance requirements, and an appropriate response to systems changes and associated work-flow requirements.
Dinner Speaker
Jordan Cohen, M.D., President, Association of American Medical Colleges, spoke on
"Contemporary Challenges For Academic Medical Centers"
Abstract
Dr. Cohen introduced the key challenges confronting the primary missions academic medicine, delineating the factors behind these challenges and their likely implications on medical schools. He commended the efforts underway at Stanford, suggesting that they represent thoughtful and appropriate responses to many of these challenges.
Information Resources and Technology
Henry Lowe, M.D., Senior Associate Dean for Information Resources and Technology, presented
"Transforming
the IT Environment"
Abstract
Dr. Lowe reviewed the primary goals of IRT and the IRT development model, as articulated last year, and steps taken during 2003 toward achieving those goals. He then present the key plans for 2004 in each of IRT's functional areas (IT Security, Desktop Support, Website applications, Wireless computing, Knowledge Management, Learning Technologies, translational research data systems, and clinical informatics).
Key IRT initiatives featured by Dr. Lowe included the implementation of a "trusted network" model to enhance medical school security, the development of a "hub and spoke" IT support model for desktop support, continued implementation of the new School of Medicine web architecture and supporting systems, development of an integrated and centrally managed School wireless network, the development of a Knowledge Management strategic plan, the continued development of a translation research data repository and the development of plans for a medical school Center for Clinical Informatics.
The subsequent discussions expressed support for IRT's efforts to collaborate with SHC and LPCH. Support was also expressed for the planned data repository and the development of a desktop support service.
Government, Public Affairs and Communications
Ryan Adesnik, Director of Government Relations, and Paul Costello, Executive Director of Communications and Public Affairs, presented
"2004 -- Collision Course? Defending Science from Politics"
Abstract
Mr. Adesnik and Mr. Costello described the current national climate as it relates to public policy and support for science. They provided a number of specific examples of recent efforts to politicize the traditionally impartial deliberations over funding priorities and individual grant applications. They presented an inventory of key initiatives likely to come before Congress in 2004 that could have significant consequences on the nation's scientific priorities. These included the FY05 NIH funding authorization, a potential comprehensive NIH reauthorization, and additional efforts to secure legislations banning human reproductive and therapeutic cloning.
They concluded with a call to action by the school's faculty and offered a faculty program of media training and media appearances, editorial board briefings, Op/Ed pieces, high profile speaking engagements and participation on campus tours and in policy forums. They highlighted some key successes in 2003 resulting from efforts such as these.
The discussion that followed reinforced the seriousness to the threats and the importance of action by the entire community, including faculty, leaders and students.
Stanford Hospital and Clinics and Lucile Packard Children's Hospital
Martha Marsh, President and CEO of SHC, presented
"Stanford Hospital and Clinics and Stanford University School of Medicine: Partners in Translational Medicine" (Presentation Copy Not Available)
Norm Rizk, M.D., Senior Associate Dean for Clinical Affairs (Adult), presented
"Clinical Programs Strategic Planning"
Chris Dawes, President and CEO of LPCH, and Ken Cox, Senior Associate Dean for Clinical Affairs (Pediatrics and Obstetrics), presented
"Lucile Packard Children's Hospital Update"
Abstract
Ms. Marsh provided a status update on the programmatic and financial health of SHC, including a summary of key efforts undertaken since 2002 leading to a much-improved situation. She expressed caution, however, about the significant challenges still ahead. Most notable among these are continued pressures on the costs of care, the importance of quality of care, increasing barriers to access to care at Stanford, and local competitive threats.
She outlined an SHC success strategy that would unite the joint interests of SHC and the School in translational research and medicine in the development of clinical centers of excellence with close ties to the school's planned institutes. With concurrent SHC management efforts in quality and service initiatives, joint investments in new markets and a renewed capital investment program, Ms. Marsh felt confident that these efforts would lead to the continued strengthening of SHC.
Dr. Rizk provided a summary of the recent financial and program activities of the faculty's outpatient services. He also reviewed the options that were discussed a year ago for maintaining our patient base and changes that have occurred that directly effect (and reduce) the options available to us. He presented the proposition that, to succeed, we must position ourselves as the quality and value leader in healthcare -- that SHC must become the "must have" provider for local employers' health plans because patients demand access to SHC.
Dr. Rizk outlined the key institutional initiatives that are required in order for this strategy to succeed. These included recognizing and promoting the unique talents of our faculty, developing more functional business relationships between and within the School and SHC, eliminating current barriers between clinical departments through the creation of clinical centers and other interdisciplinary ventures, and making a reality of the promise of translational research and medicine.
Mr. Dawes described the transformation that has occurred at LPCH during the past 5 years reflecting concerted efforts to achieve their long-term goals of Preeminence and Sustainability. He noted, in particular, the role of the Children's Health Initiative in supporting coordinated investments in LPCH Information Systems, Core Programs, Centers of Excellence, Regional Programs of Excellence, and Critical Programs and Services. He also stressed the value of the alignment between the LPCH Centers of Excellence and the School's Institutes.
Dr. Cox provided an update on the successful development and implementation of faculty practice organization for Pediatrics and Obstetrics faculty at LPCH. He outlined the underlying rationale for the FPO and its key organizational features and put forward the major objectives for the FPO in 2004. These include a series of programs to improve patient access, patient satisfaction, clinical facilities, and billing and contracting.
Mr. Dawes then concluded with a summary of the LPCH priorities for the next 5 years. These include building and maintaining programmatic momentum in key clinical areas and undertaking the systematic implementation of a multi-year, multi-phased facilities renewal program to ensure the continued availability of children's services in the community.
During the discussion period questions were raised about the competitive challenges from Sutter, Kaiser and UCSF and the relative priorities of primary/secondary care and tertiary/quaternary care for preserving our patient bases. There was also an extended discussion of the roles that the School's CME programs could play in securing physician alliances. The essential role of an adult FPO was reinforced by a number of individuals.
Enabling Translation (Panel)
Phil Pizzo, M.D., Dean, presented
"The Faculty Interests Survey -- 2003"
Irv Weissman, M.D., Ph.D., Director, Cancer/Stem Cell Institute, presented
"The Institute for Cancer/Stem Cell Biology and Medicine"
Karl Blume, M.D., Associate Director, Cancer/Stem Cell Institute, presented,
"NCI-Designation of Stanford University as a Comprehensive Cancer Center"
Bill Mobley, M.D., Director, Neurosciences Institute at Stanford, presented
"Neurosciences Institute at Stanford (NIS)"
Judy Swain, M.D., Chair, Department of Medicine, presented,
"Stanford Cardiovascular Institute"
Ann Arvin, M.D., Associate Dean for Research, presented,
"Stanford Immunology, Transplantation and Infection Institute"
Paul Yock, M.D., co-Chair, Department of Bioengineering, presented
Abstract
Dr. Pizzo briefly summarized selected findings from the 2003 survey of medical school faculty. He noted that the survey had a very high (64%) overall response rate. From the survey, he showed that faculty, on average, indicated an affinity for 9 of the 20 affinities areas indicated. The 4 planned institutes encompassed the medium-to-high interests of 84% of the faculty. Including programs in Bioengineering, and Genetics/Genomics and increased this number to 90% of the school's faculty. He concluded that the school's plans for interdisciplinary initiatives were appropriately targeted to be inclusive of the faculty's interests.
Dr. Weissman described the recent scientific and organizational history of Cancer/Stem Cell activities at Stanford and offered a number of examples of on-going areas of Discovery leading to Translation and on to Therapy. He concluded with a presentation of emerging active collaborations in cancer/stem cell related areas.
Dr. Blume provided an update on efforts to achieve NCI designation as a comprehensive cancer center. He also detailed some of the programmatic and core resources areas encompassed within the NCI proposal.
Dr. Mobley presented the vision for the NIS and elaborated on its relationships to existing neurosciences activities at Stanford. He also described the unique role of NIS in facilitating translational activities among existing and future neuroscientists and outlined how the operating principles embraced by NIS will make this possible.
Dr. Swain described the mission, focus and organization of the SCVI. She put forward the SCVI "Grand Challenge" and discussed how the SCVI model would provide unique opportunities to meet this, and subsequent, challenges.
Dr. Arvin described the principles of the SIITI and its unique orientation scope among the planned institutes. She elaborated on each of the four centers planned within the institute and described their potentials for discovery and unique impacts on science and clinical care. She concluded with a discussion of the predicators of success for the institute.
Dr. Yock provided an overview of the unique organization and initiatives undertaken through the Biodesign Program, focusing on innovation and effective models for technology transfer. He also described program's innovative training opportunities.
During the discussion period, Rick Myers (Chair, Department of Genetics) described recent efforts among the faculty to define an interdisciplinary initiative in Human Genetics. He indicated a great deal of interest among the faculty and significant opportunities for training and translational research.
A number of observations were made about the need for programmatic flexibility and responsive by the institutes in order to enable them to succeed in filing the ever changing gaps between the more static departmental structures.
The innovative approaches to training and translation sponsored by the Biodesign Program were noted as models for similar efforts within the institutes.
SEMC and Development
Phil Pizzo, M.D., Dean, presented
"Translating Our Vision and Goals into Reality: Capital and Programmatic Planning"
SMILE
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Abstract
Dr. Pizzo reviewed the state of SUMC facilities planning a year ago and outlined what has changed (and what has not changed) during the intervening period. He then described the major goals of the current School of Medicine Master Facilities Plan and how they are reflected in the near-term in the SEMC projects and how they will be played out in the years following the SEMC. He described in more detail the work completed to-date on the SMILE project and the plans underdevelopment by LPCH for facilities renewal and development in Palo Alto. He concluded the facilities portion of his presentation by reintroducing the question of a second campus -- to be discussed further during the breakout sessions.
Dr. Pizzo also presented an overview of the development efforts that have been undertaken since the last retreat. He used, as an example of integrated planning, development efforts around the Cancer/Stem Cell Institute and the SHC Clinical Cancer Center. He concluded by laying out the challenges for a successful effort to raise funds for the school's key strategic goals.
Breakout Sessions
The retreat participants were divided into 7 breakout groups. Each were assigned 2 discussion areas from the following list:
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- Extending our Education Mission
Education1.jpg - Extending our Patient Care Mission
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Patient_Care2.jpg - Extending our Research Mission
Research1.jpg - Extending our Faculty and Roles
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Faculty2.jpg - Extending our Campus
Campus2b.jpg - Translating our Vision and Goals into Reality: The Importance of
Philanthropic Support.
Translating1.jpg
Translating2.jpg
Translating3.jpg
Summary1.jpg
Summary2.jpg
Summary3.jpg
Each group was facilitated by a Senior Associate Dean and supported by a staff member to record the group's discussion.
Working off a list of exemplary questions for each assigned discussion area, the groups were asked to develop Brainstorming Ideas, identify significant challenges and supporting factors, and develop up to 5 specific recommendations for action.
Spokespersons for each discussion area then summarized the group's discussion and key action ideas. These presentations were transcribed by a "graphic facilitator" onto a very large template comprehensive. Throughout an extended "town hall"-type discussion period, these action ideas were further elaborated and diagramed. At the conclusion of the retreat, participants were each a strip of colored dots and asked to place them on those action items they felt they would be willing to commit to personally supporting -- through their own time and energy.
The results of these presentations and indications of interest and support are currently in the process of being tabulated.