Darrell G. Kirch, M.D. President and CEO, AAMC May 14, 2008

1. Supporting a Culture of Collaboration Across Health CareMedBiquitous Darrell G. Kirch, M.D.President and CEO, AAMCMay 14, 2008

2. 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?

3. First-Year Medical School Enrollment Projected to Increase 21% by 2012 Existing + New Schools Existing Schools 16,488

4. 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?

6. 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

7. 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?

8. The Patient

9. The Expert

10. The Technology

11. Will technology remove all the barriers in medical education?

12. Discontinuity in the Medical Education Continuum Premedical MedicalSchool Residency and Fellowships Practice

13. The Decision Dilemma in Health Care 1000 100 Facts per Decision 10 Human Cognitive Capacity 1980 1990 2000 2010 2020 Adapted from: W. Stead, Vanderbilt University

14. Clinical and Translational Science Awards (CTSA) Research Network

15. The Decision Dilemma in Health Care 1000 100 Facts per Decision 10 Human Cognitive Capacity 1980 1990 2000 2010 2020 Adapted from: W. Stead, Vanderbilt University

16. Connected 24/7

17. The MCAT as the Gateway to a Career in Medicine

18. A Virtual World-Wide Faculty

19. Leaving the World of “See One, Do One, Teach One” Source: Rhode Island Hospital Medical Simulation Center www.lifespan.org/rih/services/simctr/training/

20. DataRepository DataRepository DataRepository DataRepository Building an E-portfolio Over a Career DataCompilation TrustedAgentHub DataCompilation Medical Professional DataCompilation

21. Technology as a Tool to Create a True Continuum of Lifelong Learning in Medicine Residency and Fellowships Practice Premedical MedicalSchool

22. Technology as a Tool to Enable Individualized Physician Learning Residency and Fellowships Practice Premedical MedicalSchool Life-longLearning Two-YearCollege Residency and Fellowships Premedical MedicalSchool Practice Life-longLearning Residency and Fellowships Premedical MedicalSchool Life-longLearning Practice Non-Premed Degree MedicalSchool Life-longLearning Practice Residency and Fellowships Re-training Pre-medical Practice

23. Will technology remove all the barriers in medical education? No, but when used wisely, it can be a powerful enabling tool.

24. Will technology solve all the problems in our health care system?

25. Taking Physician Handwriting Out of the Equation Photo courtesy of Evanston Northwestern Healthcare

26. Relegating the Medical Chartto the Museum

27. Real World ComparisonsAccessible to Patients

28. Patient Feedback Becomes a Reality

29. Will technology solve all the problems in our health care system? No, but when used wisely, it can be a powerful enabling tool.

30. 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?

31. Embracing a New Culture in Health Care • “Culture eats strategy for lunch every day” • Andy Grove • Former Chairman of Intel

33. The Traditional Culture of Health Care • Individualistic • Autonomous • Scholarly • Expert-centered • Competitive • Focused • High-achieving • Hierarchical

34. Embracing an Emerging Culture for Health Care • Collaborative • Transparent • Outcomes-focused • Mutually accountable • Team-based • Service-oriented • Patient-centered

35. If we want shared collaborative environments, we need standards.

36. Technology standards can ultimately facilitate collaboration, but the pursuit of perfect standards and universal agreement is likely to slow progress.

37. Standards in the absence of trust will go nowhere.

38. What Does This Mean for Health Care Leaders? • If “culture eats strategy for lunch every day…” • And if a positive culture is a key source of future excellence… • How do we change the culture in our institutions?

39. #1 Make values explicit, and • use them visibly in everyday decisions!

40. #2Align governance, leadership, and • management across organizational • and “corporate” divisions!

41. Hospitals and Clinics University Physician Practice The Academic Health Center Medical School

42. #3 Use the tools of mission-based management • to realign and maximize resources!

43. Program Assessment High/High High/Low • Mission • Contribution Low/High Low/Low • Financial Performance

44. #4 Foster collaboration and accountability, • accepting nothing short of • high performance teams in all mission areas!

45. A New Model for the Organization – Creating High Performance Teams High-performingTeam Real Team Working Group PERFORMANCE IMPACT Potential Team Pseudo- Team TEAM EFFECTIVENESS Source: Katzenbach and Smith, 1993

46. #5 Focus leadership recruitment on • organizational fit, and do real succession • planning for long-term stability!

48. Embracing an Emerging Culture for Health Care • Collaborative • Transparent • Outcomes-focused • Mutually accountable • Team-based • Service-oriented • Patient-centered

49. Diffusion of Innovations “Deliberate”Respond to Evidence “Skeptical”Respond to Peer Pressure “Suggestible”Respond to Change “Traditional”Respond to Authority “Venturesome”Respond to Innovations Early Adopters(13.5%) Early Majority(34%) Late Majority(34%) Innovators(2.5%) Laggards(16%) E.M. Rogers and C. Cassel

50. Culture Change as the Key to Shifting the Adoption Curve Culture Change Time to Adoption