MISSIONS AND MANDATES

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• MISSIONS AND MANDATES
• CHALLENGES

• PLANNING FOR THE FUTURE

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TODAY WE WILL DISCUSS

• THE MISSIONS AND MANDATES OF THE ACADEMIC MEDICAL
  CENTER
• CHALLENGES THAT ACADEMIC MEDICAL CENTERS MUST
  ADDRESS
• THE ROLE OF UK HEALTHCARE IN THE KENTUCKY MEDICAL
  MARKETPLACE
• THE PLANNING PROCESSES THAT HAVE BEEN INITIATED
  AT THE UNIVERSITY OF KENTUCKY TO ADDRESS OUR
  SPECIFIC ISSUES.
• THEN, HOPEFULLY WE CAN DIALOGUE

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MISSIONS OF AND MANDATES TO ACADEMIC MEDICAL
CENTERS

• EDUCATION
• CLINICAL SERVICE
• RESEARCH

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A MEDICAL SCHOOL IS BORN

• MEDICINE IS A STUDY OF HUMAN GROWTH,
  DEVELOPMENT, AND ILLNESS THROUGHOUT THE LIFE
  SPAN. IT INCLUDES THE BIOLOGICAL, MENTAL,
  EMOTIONAL, SOCIAL, AND CULTURAL FACTORS THAT BEAR
  UPON NORMAL HUMAN DEVELOPMENT AND ITS
  ABERRATIONS. IT IMPLIES AN INTEGRATIVE APPROACH
  AND DENIES THE NECESSITY FOR ARTIFICIAL
  SEPARATION BETWEEN THE TRADITIONAL BASIC AND
  CLINICAL SCIENCES OR BETWEEN UNDERGRADUATE,
  PROFESSIONAL AND POSTGRADUATE EDUCATION. THUS,
  MEDICINE IS AS CONCERNED WITH HEALTH AND ITS
  PRESERVATION AS WITH DISEASE AND ITS DIAGNOSIS
  AND TREATMENT. William R. Willard, M.D.

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EDUCATION

• THE UNIVERSITY OF KENTUCKY MUST TRAIN THE
  SPECIALISTS AND SUB-SPECIALISTS SERVING KENTUCKY
  SINCE IT SETS THE STANDARD FOR CARE IN SPECIALTY
  MEDICINE IN KENTUCKY.

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CLINICAL SERVICE RESPONSIBILITIES

• PRIMARY CARE
• SECONDARY AND TERTIARY CARE
• QUATERNARY AND SPECIAL SERVICES

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PRIMARY CARE

• WE MUST DO ENOUGH PRIMARY CARE TO FULFILL OUR
  TEACHING MISSION
• WE MUST ADEQUATELY SERVE SPECIAL POPULATIONS
  THE UNIVERSITY FAMILY
• WE MUST DO OUR FAIR SHARE IN SERVING THE
  UNDERSERVED
• WE MUST STRESS THE ROLE OF PATIENT ADVOCACY AND
  THE VALUE AND REWARDS OF LONGITUDINAL CARE
• WE MUST EMPHASIZE EFFICIENCY AND SERVICE

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SECONDARY AND TERTIARY CARE

• MUST DO ENOUGH OF THIS TYPE OF CARE TO MAINTAIN
  ROBUST AND VIABLE CLINICAL PROGRAMS AND
  OUTSTANDING TRAINING PROGRAMS
• MUST SET THE STANDARD FOR APPROPRIATENESS,
  EFFICIENCY, QUALITY AND SAFETY

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QUATERNARY AND SPECIAL PROGRAMS

• PEDIATRIC SUB-SPECIALTIES
• LEVEL 1 TRAUMA CENTER
• TRANSPLANTATION
• INNOVATIVE SURGERY I.E. ROBOTICS
• ADVANCED NEUROSURGERY
• INNOVATIVE APPROACHES TO CANCER I.E. BONE
  MARROW TRANSPLANTATION
• ETC, ETC, ETC

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MY PERSONAL CLINICAL SERVICE GOAL

• ANY INDIVIDUAL RICH OR POOR CAN FEEL
  COMFORTABLE THAT SHOULD THEY BE DIAGNOSED WITH AN
  ILLNESS NO MATTER HOW COMPLEX THAT THEY CAN
  GET CARE AT UK HEALTHCARE AND NOT WORRY ABOUT
  WHETHER THEY SHOULD GO TO MAYO CLINIC, THE
  CLEVELAND CLINIC, OR BOSTON.

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• WE MUST REALIZE THAT OUR TRUE COMPETITORS ARE
  OTHER SUCCESSFUL ACADEMIC MEDICAL CENTERS, SUCH
  AS THE UNIVERSITY OF CINCINNATI, OHIO STATE,
  INDIANA UNIVERSITY, VANDERBILT, AND WASHINGTON
  UNIVERSITY IN ST. LOUIS, AND NOT LOCAL COMMUNITY
  PROVIDERS.

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RESEARCH

• GENERATION OF NEW KNOWLEDGE - A FUNDAMENTAL
  VALUE OF UNIVERSITIES

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• MY PERSPECTIVE
• THE BEST WAY TO ASSURE THAT WE OFFER STATE OF
  THE ART CARE IS BY PARTICIPATING IN IMPROVING
  THE STANDARD OF CARE. THAT MEANS RESEARCH
  BASIC TRANSLATIONAL CLINICAL AND HEALTH
  SERVICES.

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UNILATERAL INTRAPUTAMENTAL GDNF IMPROVES
BILATERAL MOTOR FUNCTIONS IN PATIENTS WITH
PARKINSONS DISEASE
John T. Slevin2,5,6,, MD, Greg A Gerhardt,
1,2,5,, Ph.D., Charles D. Smith 2,5,, MD, Don
Gash 1,5, Ph.D., Richard Kryscio 3,5, Ph.D., and
A. Byron Young 4,5, MD

• Departments of Anatomy and Neurobiology1,
  Neurology2, Statistics and Public Health3 and
  Neurology4and the Morris K. Udall Parkinsons
  Disease Research Center of Excellence5,
  University of Kentucky, Chandler Medical Center,
  800 Rose Street, Lexington, Kentucky, 40536 USA
  Neurology Service, Department of Veterans Affairs
  Medical Center, Lexington, KY6

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CHALLENGES FACING ACADEMIC MEDICAL CENTERS

• ECONOMIC
• EMPHASIS ON QUALITY
• EMPHASIS ON SAFETY

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ECONOMIC PRESSURES

• HEALTH CARE WILL CHANGE BECAUSE OF ECONOMIC AND
  SOCIAL REASONS
• I DO NOT KNOW HOW IT WILL CHANGE.
• I DO NOT KNOW WHEN IT WILL CHANGE.
• I DO KNOW THAT IT WILL CHANGE.

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ECONOMIC PRESSURE FOR CHANGE
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SOCIAL PRESSURE
Millions
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SOCIAL PRESSURE
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• PUNDITS SAY THAT THE ANSWER IS

CONSUMERISM
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• SHIFT OF RESPONSIBILITY FOR COST CONTAINMENT
• 
  
• CONSUMERS
  THROUGH ECONOMICS
  INCENTIVES
• 
  AND DISCENTIVES
• 
  
• PROVIDERS THROUGH MANAGED
• CARE APPROACHES
• INSURANCE COMPANIES
• THROUGH BENEFITS DESIGN

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• PREMISE IS THAT A WELL INFORMED CONSUMER
  (PATIENT) ARMED WITH DATA AND INCENTED BY
  FINANCIAL CONSIDERATIONS (LARGE CO-PAYS AND
  DEDUCTIBLES) WILL MAKE WISE, EFFICIENT CHOICES.

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MY CONCERNS WITH CONSUMERISM

• MAKE CRITICAL MEDICAL DECISIONS UNDER FINANCIAL
  DURESS
• INFORMATION INCOMPLETE AND DIFFICULT TO INTERPRET
• COSTS MAY INTERFERE WITH GOOD FOLLOW-UP AND
  PREVENTIVE CARE
• FRAGMENTED CARE BAD FOR QUALITY CARE

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IF CONSUMERISM IS NOT THE ANSWER SOMETHING ELSE
WILL BE TRIED

• EVENTUALLY ECONOMIC REALITY WINS OUT

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THEREFORE WE MUST ALWAYS MAINTAIN A FOCUS ON
COSTS

• STANDARDIZE SUPPLIES, MEDICINES
• DECREASE VARIANCE IN CARE

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THE LARGEST OPPORTUNITY FOR COST CONTAINMENT AT
MOST ACADEMIC HEALTH CENTERS IS IN MEDICAL
MANAGEMENT.

• TEAM SPORT

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• STAYING COST EFFECTIVE
• WILL KEEP US IN THE GAME
• TO WIN WE MUST LEAD IN QUALITY, AND WE MUST BE
  ABLE TO DEMONSTRATE OUR QUALITY QUANTITATIVELY

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• WE WILL HAVE A CENTRAL FOCUS ON IMPROVING AND
  DOCUMENTING OUR QUALITY AS QUANTITATIVELY AS
  POSSIBLE.
• TEAM SPORT

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TO ERR IS HUMANBuilding a Safer Health System

• PREVENTABLE ADVERSE EVENTS ARE A LEADING CAUSE
  OF DEATH IN THE UNITED STATES. WHEN EXTRAPOLATED
  TO THE OVER 33.6 MILLION ADMISSIONS TO U.S.
  HOSPITALS IN 1997, THE RESULTS OF THESE TWO
  STUDIES IMPLY THAT AT LEAST 44,000 AND PERHAPS AS
  MANY AS 98,000 AMERICANS DIE IN HOSPITALS EACH
  YEAR AS A RESULT MEDICAL ERRORS.

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• SAFETY, LIKE QUALITY AND COST CONTROL IS A
• TEAM SPORT

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• CAN YOU EMPHASIZE COST CONTROL AND QUALITY AT
  THE SAME TIME, OR ARE THEY ANTITHETICAL GOALS?

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IMPROVEMENTS IN COSTS AND QUALITY
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PROCESS IMPROVEMENT PIGGY BACK TECHNIQUE
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Need a system that --

• INTEGRATES CARE
• EMPHASIZES MAINTENANCE AND PREVENTION
• DEVELOPS APPROACHES THAT UTILIZE EVIDENCE-BASED
  MEDICINE AND MEASURES SERVICE AND QUALITY
• DEFINES WHAT IS OR IS NOT COVERED, AND IS
  COMPREHENSIVE IN COVERAGE FOR MAJOR ILLNESSES
  (STANDARDIZED BENEFIT PACKAGES)

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• FUNDAMENTALLY, THE CHALLENGE FOR US IS TO MOVE
  BEYOND INDIVIDUALITY OR A RELIANCE ON DEPARTMENTS
  TO AN UNDERSTANDING OF ENTERPRISE AND
  INTERDISCIPLINARY CARE.

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A CASE FOR CHANGE
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CAUSES OF DETERIORATION IN CLINICAL ACTIVITY

• NO COMMON VISION BETWEEN DIFFERENT ELEMENTS OF
  THE CLINICAL ENTERPRISE
• NO AGREEMENT ON GOALS
• INADEQUATE COMMUNICATION
• STALEMATED DECISION MAKING
• UNDER INVESTMENT IN FACILITIES AND PROGRAMS
  AGING OF PHYSICAL PLANT
• INABILITY TO RECRUIT
• LOSS OF KEY FACULTY

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THEREFORE IT BECAME CRITICAL TO

• DEFINE A VISION
• ESTABLISH GOALS FOR CLINICAL, ACADEMIC AND
  FINANCIAL PERFORMANCE
• ESTABLISH AND CLARIFY A DECISION-MAKING PROCESS
• COMMUNICATE EFFECTIVELY
• RETAIN CURRENT FACULTY AND RECRUIT NEW
  INDIVIDUALS
• DEFINE PROGRAMMATIC AND FACILITIES NEEDS AND
  COMMIT TO THEM.
• ESTABLISH FISCAL ACCOUNTABILITY RESPONSIBILITIES
  AND STRICT DISCIPLINE

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• AS WE AGREE ON A VISION
• FOR AND
• PLAN TO IMPLEMENT WE
• MUST ENGAGE AND EMPOWER
• THE FACULTY.

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STRATEGY

• GEOGRAPHIC APPROACH
• PROGRAMMATIC APPROACH
• AGE SPECIFIC

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MARKET DEFINITION
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COMPETITIVE RELATIONSHIPS
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PROGRAMMATIC

• CARDIOVASCULAR
• CANCER
• NEUROSCIENCE
• PEDIATRICS
• ETC.
• MUST PLAN IN DETAIL

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AGE SPECIFIC

• PEDIATRICS
• MEDICARE

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FACILITIES

• WE MUST.
• UNDERSTAND THAT WE MUST DEVELOP A HEALTH CARE
  DELIVERY SYSTEM NOT MERELY REPLACE SOME ELEMENTS
  OF THE HOSPITAL
• DEVELOP A LONG-TERM VISION FOR INPATIENT AND
  OUTPATIENT SPACE NEEDS.
• UNDERSTAND NECESSARY IMMEDIATE FIXES
• SITE BED TOWER

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ACADEMIC

• IMMEDIATE, INTERMEDIATE AND LONG-TERM NEEDS FOR
  SPACE TO SUPPORT RESEARCH AND TEACHING
• ALL THE COLLEGES OF THE ACADEMIC HEALTH CENTER
• MUST BE INCLUDED IN PLANNING PROCESS

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FINANCIAL PLAN
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COMMITTEES
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COMMUNICATION

• WEBPAGE
• EMAIL NEWSLETTERS
• VISITS TO DEPARTMENTS
• BREAKFASTS WITH THE EVPHA
• WHATEVER IT TAKES

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• OUR SUCCESS IS DEPENDENT ON OUR ABILITY TO
  RECRUIT AND RETAIN OUTSTANDING FACULTY AND
  STUDENTS AND HAVE THEM WORK TOGETHER IN A
  COHERENT CO-ORDINATED FASHION TO SERVE ALL THE
  MANDATES OF AN ACADEMIC MEDICAL CENTER

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• WE NEED TO
• SURVIVE TOGETHER IN ORDER TO THRIVE TOGETHER

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UK HEALTHCARE MUST SERVE ALL KENTUCKIANS BETTER
AND BETTER