Creative Teaching and Administration: Going from Half Empty to Half Full

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Creative Teaching and AdministrationGoing from
Half Empty to Half Full

• Central Group on Educational Affairs Plenary
  Session
• Omaha, Nebraska
• March 19, 2004
• Ruth-Marie E. Fincher, MD
• Medical College of Georgia School of Medicine
• Karen Marcdante, MD
• Medical College of Wisconsin

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Invitation from Gary BeckWe would like you to
speak about Shrinking to Greatness. . . . Doing
More with Less
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Did You Ever Get Enough. . .

• Money
• Time
• Space
• Energy
• Perceived autonomy?

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Orson, did you get enoughice cream?

• Never did. Never will.
• Orson Wells

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Call from Deb Klamen

• We are looking forward to your interesting,
  provocative, entertaining talk. . . .
• Two suggestions One Great
• Why dont you invite Karen Marcdante to join
  you?
• Supportive challenge

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Rhee could talk about whats in her closet. . .
.
Money? A change sorter!
Obviously not enough space
And not enough Time (energy??) to clean it up. . .
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Deans Reaction to Invitation

• Why did they think of you?
• I am not sure I want you
• to be known
• for doing more with less. . .

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Our Dream

• Education Centerpiece of mission, intersecting
  all others

Education
Research
Service
Patient Care
From Michael Wilkes, 2003
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Our PerceptionEducation Feels Squeezed
Research
Service
Education
Patient Care
Modified by R Fincher, 2004
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Real Life

• Faculty are asked to produce more
• Clinical income
• Research dollars and products
• Educational outcomes

How do we keep up?
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We Arent the Only OnesDoing More With Less
(DMWL)

• Google search 7,870,000 results
• First 200 results included
• Schools
• Government (city, state, federal)
• Information Technology
• Business
• Agriculture
• Cooking tips for the poor homeless

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Lots of Products

• White papers
• Articles
• Opinion statements
• Ads for services, books, software
• Powerpoint presentations
• Conference announcements
• Task force reports

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What Can We Do?

• As a System
• As Individuals

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Fact or Fiction?

• There are fewer clinical faculty in US medical
  schools than 10 years ago.

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Number of Students and Full-time Faculty in US
Medical Schools
Slide from R Watson
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Fact or Fiction?

• Medical schools receive too few dollars to
  support the education mission.

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Revenue and Education

• Annual cost of educating a medical student
  48,500-56,000
• Student revenues generated
• Tuition state support
• Private schools 47,000
• Public schools 105,000
• Source R Jones, AAMC, 2002
• Conclusions Education makes money!
• The revenue stream problem. . .

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The Bottom Line

• Less money to pay for the work
• Clinical revenues
• Faculty work harder/dollar earned
• Faculty work harder to earn the same/less
• State appropriations
• Cuts in 37 states since 2002
• Do not necessarily support education
• Source W Mallon, AAMC 2003

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The Crystal Ball

• Stagnant state dollars
• Increased competition for research dollars
• Increased reliance on endowment
• W Mallon, AAMC 2003

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Makes Us Feel Like. . . .
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Or this. . . .
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DMWL Issues for Academic Medical Centers

• Faculty have
• more clinical responsibilities
• less time for
• scholarly activity
• teaching
• Administrators (deans, chairs)
• have fewer to disperse
• Schools seem to place
• less emphasis on teaching
• more emphasis on grant clinical dollars

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More DMWL Issues

• Lost staff
• may not be replaced
• Resources are limited
• Equipment
• Supplies
• Travel funds
• Renovations

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Impacting the System

• Influence your sphere
• Dont get an ulcer over the rest of the universe

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Helping the System DMWL

• The president, dean, and chairs set the tone
• but we can all help
• We are part of the system. . . .

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Investing in Facultys Future

• Early investment costs
• Recruitment and start up packages
• Early years learning curve
• Subsequent returns. . . or losses. . . .
• Faculty may
• Stay and become increasingly valuable
• Leave because of frustration
• Leave for growth position
• Conclusion
• Loss of faculty costs money

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Faculty Development

• Is a great investment
• Saves money
• Fosters doing more with less

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Faculty Development Centers

• Numerous wonderful examples
• Key principle Growing educators
• If you want 1 year of prosperity, grow grain
• if you want 10 years of prosperity, grow trees
• if you want 100 years of prosperity, grow
  people.
• Chinese Proverb
• Key challenge Ensuring the system values the
  nurturing

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Create Systems that Value People

• Positive, happy professional environments
• Reward good work
• Appreciate colleagues
• Peers
• Those who work for us

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Align Dollars with Missions

• Identify education dollars align them with key
  education activities
• Teaching
• Curriculum development and innovation
• Educational administration
• Course/clerkship director
• Curriculum committee chair
• Negotiate line item budgets for education

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Collaborate and Manage

• Centralize curriculum oversight and management
• Reward interdisciplinary curriculum
• Reward collaboration/team work
• Reduce reinventing the wheel
• Reward thinking out of the box

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(No Transcript)
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Maximize TalentsOne Size Doesnt Fit All

• Establish core teaching faculty
• Identify the right people
• Create a vision and set them loose
• Maximize 2-for-l
• Reward contributions
• Recognize service teachers
• Expected for promotion?
• Component of academic citizenship?

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PT as Rewards

• Ensure PT guidelines reflect changing
  expectations of clinical faculty
• Clinician/educator tracks
• Career pathway or career dead-end?
• Money earners or academic physicians?
• Reward all forms of legitimate scholarship
• Two-fers Find scholarship in daily work
• Document the evidence to demonstrate value
• Educators portfolios (Consult Deb Simpson!)

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Ensure a System that Values Proactive Career
Development

• Chair faculty collaboration
• Practice the art of negotiation
• Support dept while ensuring own progression
• Set goals, objectives, anticipated outcomes
• Assess outcomes and reset goals
• Your chair will be sure you meet the departments
  needs
• No one cares more about yours than you. . . .

Negotiate talk with your chair
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Promote anInfrastructure to Value Teaching and
Scholarship

• Faculty development centers
• Career development
• Teaching/educational research skills
• Societies or Academies
• Recognize accomplishments based on selection
  criteria

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Characteristics of Societies and Academies

• Mission
• Support educators
• Promote curriculum development
• Advance educational scholarship
• Members
• Distinguished educators
• Selected by peer review
• Organizational structure
• School-wide
• Designated leadership
• Resources to fund initiatives
• Irby D, et al. Acad Med (In press)

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Resources How Much?

• Funding of academies/societies
• MCW 10K/yr (deans office)
• UCSF 6M endowment
• U Fla 40K/yr (deans office)
• Baylor 50K/yr (college/endowment)
• Harvard 1M/yr for 6 yrs (president and
  school)
• Mt. Sinai 1M endowment
• Irby, et al. Acad Med (In press)

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We Cant Do Everything But We Can Do Something

• Taking time is a thiefs trade making time is a
  strategists. An effective manager must be both
  strategist and thief, stealing time from less
  compelling or more leisurely pursuits to get the
  job done.
• Lewis Kelly
• (Thanks to Peggy Wagner)

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• DMWL Might Be More Difficult than Moving a
  Graveyard. . . .

Slide thanks to Malcolm Cox
Swanson G. In Tosteson et al. New Pathways to
Medical Education. Cambridge MA, Harvard
University Press, 1994
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What Will You Do When You Go Home?

• Consider the culture at your institution
• E.g., politics, specific resource issues, faculty
  environment
• Based on presentation, list 2 ideas or changes
  you should advocate when you get home.
• How will you make the issues recognized as urgent
  (or at least important)?
• E.g., data needed, coalitions that will support
  idea

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DMWL in Your Life
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Top 5 ways to DMWL

• Buy ear plugs and Kevlar the noise and attacks
  only slow you down
• Be nasty no one will approach you for a new
  task
• Be on the right track, but go slower- youll get
  run over
• Volunteer someone else
• Become less competent theyll ask you to do
  less and less

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Oh No! CGEA is Tomorrow

• What did I get accepted? Where is that
  abstract? Arghh the budget is due (and my boss
  just told me he needs more justification even
  though he hasnt read what I gave him). I
  promised to meet my junior colleague to help on
  her CGEA presentation . And
• Ive got study section next week, and a
  student is at my door, the RRC/LCME is HIPPA
  IRB Oh no! my boss is back and they want me to
  serve on that committee even after I said NO!!!

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And the problem is?

• Whats important?
• To you
• To your boss
• What has priority?
• Why did I ever say yes?

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A review of literature in search of answers

• Business literature
• Productivity
• Engagement
• Motivation
• Time management
• Career development

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Concordance across literature

• Setting priorities
• Collaboration
• Delegation
• Time Saving Activities
• Recovery and Refreshment
• Engagement

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1. Setting priorities

• First, ask yourself
• Is your work worthwhile?
• Do others you work with (support staff, etc)
  believe their work is worthwhile?

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Worthwhile Work

• Understood as Important
• Leads to a well understood/shared goal
• Guided by values

Blanchard K, Bowles S. Gung Ho! 1998.
Blanchard Family Partnership Ode to Joy Limited.
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It starts with a Purpose

• What is your purpose?
• Take a minute, write it down.
• What makes work worthwhile?
• What are you passionate about?

You have a purpose, so now what?
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Alignment

• How does your purpose fit with that of your
• Boss
• Department
• School

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Values

• Values should guide your behavior
• Often determined by leaders, but require
  agreement of others
• Values become real only when you demonstrate
  them in the way you act and you insist others
  behave.
• Blanchard Bowles. Gung Ho!

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An example from MCW

• The Office of Medical Education (Peds)
• Purpose To develop excellent physicians
• Values
• Ensure Safety
• Excellence in Patient Care
• Exude Professionalism
• Engaged Learning
• Enhance Individual Growth

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Other examples of Values

• Authenticity
• Commitment
• Concern for others
• Creativity
• Fairness
• Generosity
• Harmony

• Humor
• Integrity
• Knowledge
• Loyalty
• Perseverance
• Respect
• Security
• Service to others

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What values do you live by?

• List 3-5 values that you use to determine your
• Plans
• Decisions
• Actions

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List tasks you need to accomplish

• Which will help achieve your purpose?
• Will values determine your plans/actions?
• Do they align with others priorities?

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What if priorities dont match?

• Find a way to reframe them
• Reflect on your options
• Work on their priorities
• Work on your priorities
• Does it mean you leave?

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2. Collaboration

• Collaboration occurs when (individuals) work
  together as equals, with mutual respect,
  exchanging thoughts and ideas for the purpose of
  generating new information, options and
  solutions. They share a belief that each of
  them has had relevant experiences, holds
  important knowledge and perspectives and brings
  essential expertise that is needed to achieve the
  purpose.

Handbook of Leadership Development. 2nd Ed.
McCauly CD Van Velsor E (eds). 2004. John
Wiley Sons
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Collaboration Audit

• Presented in Kouzes and Posner The Leadership
  Challenge
• Tool to assess how collaborative for
• Organizations
• Individuals

Kouzes JM Posner BZ. The Leadership Challenge.
1995. Jossey-Bass Publishers. San Francisco
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Features you look for

• Someone who has
• Different skills
• A record of execution
• An open mind
• A critical voice regarding my work
• A history of sharing credit
• And who is fun to work with

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Chose one of your tasks

• Identify 1-2 possible collaborators
• Rate them on criteria
• Different skills that will help
• Record of execution
• An open mind
• A critical voice regarding my work
• A history of sharing credit
• And who is fun to work with

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3. Delegation

• Raise your hand when your definition of
  delegation appears.
• You are delegating a task to someone else. You
  have asked them to

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• Assemble the facts and give them to me. I will
  make the decision and take action
• Assemble and study the facts. Recommend an
  action for my approval.
• Assemble and study the facts and take action
  after checking with me.
• Assemble and study the facts and take action
  notify me so I can intervene if I want to.
• Assemble and study the facts and take action.
  Report to me afterwards.
• Assemble and study the facts and take action. No
  need to report to me.

H. Lane C. Wayser. Make Every Minute Count.
2000 Marlowe Co. NY
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Delegation and Time

• The more autonomy you support, the less time it
  takes you
• Know the person, his/her qualifications, the task
  and the penalty if not done right
• Provide explicit boundaries and clear guidelines
• Recognize that the product wont look exactly the
  way it would if you did it

• Celebrate you have time to do other things!

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Delegation and you

• List 3 things you could delegate
• Identify the level of delegation that you think
  you will use
• Could you push it one more level?
• For at least one item, write down the values and
  boundaries you will relay and when to contact
  with you

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• Assemble the facts and
• Give them to me. I will make the decision and
  take action
• Study and Recommend an action for my approval.
• Study and take action after checking with me.
• Study and take action notify me so I can
  intervene if I want to.
• Study and take action. Report to me afterwards.
• Study and take action. No need to report to me.

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4 Time Saving Techniques

• How many times in a day do you
• Arrive late?
• Check and answer your e-mail ?
• Wait for someone?
• Take advantage of small amounts of time?
• Spend time trouble shooting?
• Have a back up plan?

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Taking Control of Your Time

• Become more conscious of how you use your time
  (and that of others)
• Plan ahead
• Take work to places you are likely to wait
• Use small bursts of time
• Have a back up plan for tasks
• Be explicit with time requirements/deadlines
• Ask for help

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Time Savers Dont Do, Buy

• How many of you still
• Type most of your own correspondence?
• Gather your own data?
• Try to figure out computer programs?
• Clean your own house, mow your own lawns?

• What do you think your time is worth?

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The value of your time

• 7/hour for every 10,000 of your salary

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Why we dont buy it

• You are toooo cheap Deb guilt
• It seems faster to do it yourself

• Havent thought of it .
• No money to hire help.
• Havent developed the argument

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Time Savers Avoid Interruptions

• 1 hour of uninterrupted work X hours of usual
  work

3
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Tolerating Interruptions

• Leave the door open
• Desks facing traffic patterns
• Being nice
• Using interruptions to procrastinate
• Not providing explicit instructions to AA on who
  should be put through

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How can you stop them?

• Close the door
• Hang a sign
• Provide explicit instructions
• Turn things off
• Phone ringer
• E-mail notification

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Do NOT
Disturb
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6 Recover and Refresh

• Energy, not time, is the fundamental currency of
  high performance.

J. Loehr T. Schwartz. The Power of Full
Engagement. 2003. Free Press. NY
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What does this describe?

• Extremely long hours that interfere with rest
• Night work
• Working without holidays or breaks
• High pressure work without breaks
• Extremely demanding physical labor or
  continuously stressful work

Karoshi death from overwork
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The Rhythm of the Day

• Ultradian rhythms
• 90-120 minute cycles
• Account for waxing and waning of energy
  throughout day
• Physiologic changes highest alertness in first
  part of cycle
• After 90-120 minutes, body craves REST

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Take a Break

• People who maintain a scheduled break
• Are more productive
• Are more creative
• Are happier with their jobs
• How much time do you need?

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Practice

• 60 seconds just to sit.
• Now sit still, dont thumb through the program ..
  Just sit and let your mind be blank.

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How to Think Like Leonardo da VinciM. Gelb

• Posed question Where are you when you get your
  best ideas?
• In the shower
• Resting in bed
• Walking in nature
• Listening to music
• Almost no one answered at work

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Take a Walk

• Physical activity refreshes the mind

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DMWL Resources

• What do you do when the money is shrinking?

The answer is not always find more money!
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Doing More Engagement

• Engagement is being
• Physically energized
• Emotionally connected
• Mentally focused
• Spiritually aligned
• What percent of US employees are engaged
  in their work?

Loehr and Schwartz
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Engagement

• Gallup Organization 2001
• 27 are fully engaged
• 56 are not engaged
• 17 are actively disengaged
• What about in the health care industry?

lt 25 are fully engaged!
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How can we increase engagement?

• Attend to physical, emotional, mental and
  spiritual needs
• Balance stress and recovery
• Share purpose/values work toward them
• Recognize performance, empathize
• Provide realistic optimism

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Roadblocks to engagement

• Rewarding the wrong behavior
• Balancing short term gains and long term goals
• Forgetting that customers are real people

T Rieger, GMJ de Konig, Gallup Magazine. Dec 2003
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Money Issues?

• Seek more cost effective solutions
• free help
• Medical students, graduate students
• Volunteers
• Avoid the technology trap
• Keep eyes open for other sources - but dont
  count on them

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DMWL What You Can Do

• Establish purpose, values and goals
• Find collaborators
• Learn to delegate
• Utilize time-saving strategies
• Recover and refresh
• Find ways to engage others