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“Developing Leaders at Duke Medicine” Feagin Leadership Forum 2014 May 16 th , 2014

“Developing Leaders at Duke Medicine” Feagin Leadership Forum 2014 May 16 th , 2014. Victor J Dzau, MD CEO, Duke University Health System Chancellor for Health Affairs, Duke University. What is Leadership?.

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“Developing Leaders at Duke Medicine” Feagin Leadership Forum 2014 May 16 th , 2014

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  1. “Developing Leaders at Duke Medicine”Feagin Leadership Forum 2014May 16th, 2014 Victor J Dzau, MD CEO, Duke University Health System Chancellor for Health Affairs, Duke University

  2. What is Leadership? A true leader “defines what the future should look like, aligns people with that vision, and inspires them to make it happen despite obstacles.” - J.P. Kotter “The job of a leader today is not to create followers. It’s to create more leaders” – Ralph Nader

  3. A Vision for Health Leadership • There is a growing demand for trained leaders with real-world experience and innovative approaches to healthcare leadership • Need to train current and future leaders across health care in four themes • Leadership, Management, Quantitative health sciences, and Innovation • Longer term goal to contribute to developing the workforce of the future • New roles across clinical and non-clinical care to enable task shifting, care teams, and coordination

  4. Leaders are needed for the challenges ahead • Health Care Environment • Affordable Care Act- The pace of change • Medicaid & uninsured • Financial challenges- pressure on reimbursement • Cost reduction • Strategic direction- scale, partnerships, population health, etc • Need for More Innovation • Academic • Declining research funding • Rising cost of education • Informatics, Big Data, Learning Health System • Diminishing Resources- “doing more with less” • Reduced clinical dollars & research funding • How to wade the challenges of clinical vs. academic

  5. What kind of Leadership in Healthcare? • “[Clinician]-executives may be the only ones capable of coping with the rapid and profound changes as well as the medical, financial, and ethical complexity that now beset the practice of medicine.” –JAMA 1987 • However, the current generation of leaders are “accidental administrators” • Must move from accidental to cultivated leadership • This process has begun with curriculum offerings such as MD/MBA, MD/MHA, etc.: • 1993- 6 formal MD/MBA programs nationally • 2001- 33 formal MD/MBA programs nationally • 2009- 51 formal MD/MBA programs nationally

  6. Leadership Development at Duke Medicine

  7. Feagin Leadership Program Vision- Create a unique opportunity for the exploration of moral and ethical leadership principles that resonate across five disciplines: medicine, military, research, athletics, and business. The Feagin scholars participate in a year-long leadership development curriculum that includes seminars, workshops, conferences, and mentorship opportunities led by the Feagin Program’s Community of Leaders.

  8. Feagin Forums- 5 years of excellence The Feagin Forums have continually been the place where academics, industry, and military can convene to push the leadership message. Feagin Forum 2009- Leadership in Sports and Sports Medicine: How Leaders Build Exceptionally Effective Teams Feagin Forum 2010- Cultivating an environment of shared learning to enhance individual and team leadership abilities Feagin Forum 2012- Relationships Matter; Establishing, Building, Maintaining Feagin Forum 2013- Ethical Leadership – It is about Character, Integrity and Courage Feagin Forum 2014- Balanced Leadership – Professional - Social - Emotional - Spiritual - Physical

  9. In order to develop leaders, healthcare organizations require: 1) A systemic mechanism to build and nurture a health leadership culture & ecosystem, and 2) A systemic mechanism to support the leadership process

  10. Academic Health Systems & Innovation Dzau VJ, Ackerly DC, Sutton-Wallace P, Merson MH, Williams RS, Krishnan KR, Taber RC, Califf RM. The Role of Academic Health Science Systems in the Transformation of Medicine. Lancet 2010 Ackerly DC, Sangvai DG, Udayakumar K, Shah BR, Kalman NS, Cho AH, Schulman KA, Fulkerson WJ Jr, Dzau VJ. Training the Next Generation of Physician-Executives: An Innovative Residency Pathway in Management and Leadership. Academic Medicine. 2011 Ackerly DC, Udayakumar K, Taber R, Merson MH, Dzau VJ. Perspective: global medicine: opportunities and challenges for academic health science systems. Acad Med. 2011 Dzau VJ, Yoediono Z, Cho A: Fostering Innovation in Medicine and Healthcare: What Must Academic Health Centers Do? Acad Med 2012 Andolsek K, Cuffe M, Dzau VJ, Murphy G, Nagler A, SchlueterJ,Moore P, Weinerth J: Fostering Creativity: Duke Medicine Quasi-Endowment Encourages Graduation Medical Education Innovation Academic Medicine 2013. Dzau VJ, Cho A, Ellaissi W, Yoediono Z, Sangvai D, Shah B, Zaas D, Udayakumar K Transforming Academic Health Centers for an Uncertain Future; NEJM 2013

  11. Academic Health Systems:Creating the health leadership culture & ecosystem Environment significantly influences leadership abilities There must be structures and clear incentives for faculty to pursue new ideas Environment significantly influences innovative abilities There must be structures and clear incentives for faculty to pursue new ideas Supporting leadership requires dedicated resources (money, time, infrastructure) Dzau VJ, Yoediono Z, ElLaissi W, Cho A: Fostering Innovation in Medicine and Healthcare: What Must Academic Health Centers Do? Acad Med 2013

  12. Genesis of Leadership Development at Duke Medicine DMIHI Affinity Group Duke Endowment Grant DIHI Faculty Workshop Inaugural MLPR Class 2007 7/1/2009 DIHI Scientific Symposium/Launch Implementation Seminar Series 10/3/2012 7/1/2010 September 2013 2011 City of Medicine Academy opens at DRH LEAD Program Inaugural class 2011 August 2013 2012 2009 2008 2013 2011 2010 Implementation Science Retreat Duke Medicine Health Leadership Summit 9/27/2010 Launch of C-CHAMP Innovation Workshops Establishment of IPIHD 2/2013 1/1/2010 5/2013 7/2011

  13. DIHI domains of innovation DIHI Duke Institute for Health Innovation • Implementation and • Health Delivery Science • Catalyze multidisciplinary teamwork; Duke Medicine & University; National & Int’l leaders • Structured interface to DUHS • A living laboratory to incubate, refine, validate and scale new ideas • Health Technology Innovation • Incubator for health technology innovation • Develop enabling infrastructure and policies • Interdisciplinary collaboration • Applied Health Policy • Analysis of policy from national and global perspectives • Application of policy into health care reform efforts • Health Leadership & Workforce Development • Goal to train current and future leaders across health care in • Leadership • Management • Innovation • Quantitative health sciences

  14. Duke Institute for Health Innovation: Mission: To promote transformative innovation in health and healthcare through high-impact research, leadership development and workforce training and cultivation of a community of entrepreneurship

  15. Health Leadership Development: Learning Continuum We are defining a Health Leadership Development core curriculum, from which we can create multiple learning experiences from customized training to degree programs with an initial focus on clinician leaders Competencies The Learning Continuum Executives MBA, MHSA (future) Faculty CCHAMP, MMCi, LEADER Residents & Fellows MLPR, Master Clin Leader,HVCC, LHS Medical & Nursing Students PCLT, Feagin, LEAD, MD/MBA, DNP, GNE Undergraduates Global health High School Students City of Medicine Academy, Made In Durham 15

  16. Overview of select DIHI Affiliated Leadership Programs • Management & Leadership Pathway for Residents (MLPR) • Chancellor’s Clinical Leadership in Academic Medicine Program (CCHAMP) • Master of Management in Clinical Informatics (MMCi) • City of Medicine Academy; Made In Durham

  17. Creation of Leadership and Management Programs • Management and Leadership Pathway for Residents (MLPR) • 15-18 months of project driven management rotations/modules combined with clinical training. Rotations aligned with clinical requirements, trainee interests, and institutional priorities where trainees are teamed with DUHS senior leadership • Chancellor’s Clinical Leadership in Academic Medicine Program (C-CHAMP) • Provides a management toolkit for mid-career clinicians, that allows them to lead and grow their departments and divisions with increased efficacy. • The Master of Management in Clinical Informatics (MMCi) • MMCi represents an innovative curriculum that develops the workforce of the future to address the needs of people who are fluent in the use of data to drive strategic decision making.

  18. MLPR Background (2010) Increasing need across healthcare for physician executives Desired career choice of many graduates (>90 MD-MBA programs) No formal pathway or career trajectory to become physician executive Little opportunity to use management skills during residency training Success often described as ad hoc, serendipitous, accidental

  19. Need for MLPR 2010

  20. MLPR Pathway Overview • 15-18 months of project driven management rotations/modules combined with clinical training • Depending on flexibility of primary program, most trainees will add up to 12 months of training to ACGME clinical residency • Rotations include core and selective opportunities designed to give breadth of experience as well as depth in areas in which trainee has particular interest • Rotations aligned with clinical requirements, trainee interests, and institutional priorities

  21. MLPR Benefits Develop clinical and management skill sets in coordinated program Access personal mentoring by senior leaders across Duke Medicine Experience the full breadth and depth of a health system beyond a given specialty, hospital, or training program Gain in-depth understanding of how the clinical, research, and educational enterprises of an academic health system function within a framework of financial, managerial, regulatory, and entrepreneurial forces Acquire expanded knowledge of the administrative, financial, and organizational issues related to the management of health at individual, system, community, and population levels Career fast-track

  22. C-CHAMP Overview (2010- ) Chancellor’s Clinical Leadership in Academic Medicine Program (C-CHAMP) The purpose of C-CHAMP is to: • Increase the successes of program participants and strengthen the pipeline for Duke Medicine’s next round of clinical leaders. • Provide faculty participants with a management toolkit that allows them to lead and grow their groups with increased efficacy. • Strengthen the institution through engagement and innovation and to eventually improve its culture.

  23. 2010 2011 • 2013 Kickoff 1.31.2013! • 27 Participants • 25 physicians • 1 Nurse Practitioner • 1 Physician’s Assistant • 52% female; 48% Male • 22% URMM 2012

  24. MMCi Program Objectives (2012-) • The goal of the program is to improve quality and reduce cost of health care. • This high level objective is carried out by equipping graduates with the ability to view health care challenges and possible technology solutions, through the lens of business principles and processes. • The program addresses health informatics skills and career interests of a variety of types of candidates • Clinicians, IT professionals, Researchers, Health Care Administrators, Business Managers, Entrepreneurs and Consultants. • This knowledge applies to people who work in a variety of roles in clinical, research, vendor and accountable care and payer organizations

  25. MMCi Market Need Government and Industry drive for Meaningful Use EHR systems Explosion of data and challenge to turn data into knowledge to improve quality and reduce cost of health care

  26. MMCi Curriculum Informatics Courses • Health IT Business Solutions • Clinical Informatics Strategy • Data, Information and Knowledge Representation and Modeling • Secondary Data Use • Practicum • Ethics Seminar Management Courses • Strategy • Marketing Analysis • Decision Models • Supply Chain Management • Managerial / Cost Accounting • Corporate Finance • Organizational Design and Innovation

  27. Educating and Training Clinicians for a Transformed Delivery System October 18th 2012 Moderators Victor J Dzau MD, DSc Nancy Nielson MD, PhD

  28. A Learning Health System Curriculum at Duke (2013-) Level 1 Level 2 Level 3 Who: Strategy group What: planning Maestro integration; choosing health system priorities; commercialization How: Planning group integrated w/ IDEAs, DIHI Deliverables: Project options for Level 2; Maestro-based tools; development strategy Leads: Cho/Kaminiski Who: 5-8 GME trainees (resident and fellow) What: Learning Health Care curriculum, with test cases drawn from DUHS- prioritized HVCC concepts How: Ongoing group project work Deliverables: LHC curriculum; two demonstration projects Leads: Abernethy/Zaas Who: All GME trainees Begin with IM, Peds, ED, Radiology What: ACP-HVCC or adapted interactive curriculum How: Group discussion format; digital formats Deliverables: Curriculum, with post testing; field evidence of impact Leads: S. Woods/C. Avery

  29. Duke and CMA As of Fall 2011, the CMA is strategically located on the campus of Duke Regional Hospital With students from the City of Medicine Academy. Photo courtesy of DPS.

  30. City of Medicine Academy (2006-) • City of Medicine Academy is giving students with an interest in pursuing careers in healthcare direct experience in the real world of medicine • most opportunities happening at Duke Regional Hospital • School has expanded from 220 to 330 students in the last four years. • Over the last four years, the average graduation rate for each class has been 95%. This year it was 100% • Graduates have included nurses, social workers, and certified nurse assistants at Duke, as well as, a Senior Pharmacologist for the USFDA.

  31. Made in Durham Taskforce Members • J. Howell: Manager, Merck • B. Ingram: President, DTTC • B. Ingram: General Partner, Hatteras Venture Partners • E. Paradise: Site Exec., Cisco • I. Kohar Parra: Lead Organizer, Durham CAN • M. Ruffin: County Manager, Durham County • M. Sanders: VP, Biogen Idec • D. Saunders-White: Chancellor, NCCU • H. Scherich: President, Measurement Incorporated • C. Steinbacher:CEO, Durham Chamber of Commerce • A. Seimens: CEO, FHI 360 • S. Williams: Manager, Sensus • B. Wilson: CEO, Blue Cross/Blue Shield of NC • L. Winner: Executive Director, Z Smith Reynolds Foundation Taskforce • V. J. Dzau: Chancellor, Duke Medicine (chair) • A. Brown-Graham: Director, Institute for Emerging Issues (co-chair) • J. Bailey: Senior VP, GSK • E. Becoats/ H Osteen: Superintendent, DPS • T. Bonfield: City Manager,City of Durham • B. Brinegar: CEO, McKinney • E. Bushfan: Superior Court Judge, State of NC • M. Eakes: CEO, Self-Help Credit Union • M. Goodmon: VP, Capitol Broadcasting Co. • K. Hammond: Pastor, Union Baptist Church • A. Harris: President, N.C. Institute for Minority Econ. Dev. • Staff • David Dodson: MDC • Cay Stratton: MDC • Julie Mooney: MDC • Max Rose: MDC • MaryAnn Black: Duke Medicine

  32. Health Leadership Development We are defining a Health Leadership Development core curriculum, from which we can create multiple learning experiences from customized training to degree programs with an initial focus on clinician leaders Competencies The Training Continuum Executives MBA, MHSA (future) Faculty CCHAMP, MMCi, LEADER Residents & Fellows MLPR, Master Clin Leader,HVCC, LHS Medical & Nursing Students PCLT, Feagin, LEAD, MD/MBA, DNP, GNE Undergraduates Global health High School Students City of Medicine Academy, Made In Durham 32

  33. The Future of Medicine The future of healthcare will require a shift in focus towards population health and a consciousness of costs. Are we training the next leaders in medicine to lead in these areas? How can the many at Duke come together to ensure that we have a home base that ensures that the leaders in medicine and academic medicine come from Duke University—DIHI can be that platform. Proprietary & Confidential

  34. Thank you Feagin team Thank you, Dean Taylor! Your leadership in this area is very much appreciated. Thank you Joe Doty, thank you Maureen LaBoeuf! Thank you Feagin Scholars for your tireless efforts this year!

  35. Thank you John A. Feagin Jr., MD! Thank you for your service to our country and your commitment to foster leadership to the field of medicine

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