“DEVELOPING LEADERS AT DUKE MEDICINE”FEAGIN LEADERSHIP FORUM 2014

MAY 16TH, 2014

Victor J Dzau, MDCEO, Duke University Health System

Chancellor for Health Affairs, Duke University

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

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

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Leaders are needed for the challenges ahead

• Health Care Environmento Affordable Care Act- The pace of changeo Medicaid & uninsuredo Financial challenges- pressure on reimbursemento Cost reduction o Strategic direction- scale, partnerships, population health, etc

• Need for More Innovation• Academic

o Declining research fundingo Rising cost of educationo Informatics, Big Data, Learning Health System

• Diminishing Resources- “doing more with less”o Reduced clinical dollars & research fundingo How to wade the challenges of clinical vs. academic

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

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Leadership Development at Duke Medicine

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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.

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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

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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

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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, Schlueter J,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

 

 

Academic Health Systems:Creating the health leadership culture & ecosystem

Teach itCreate space

for and support it

Implement it

Dzau VJ, Yoediono Z, ElLaissi W, Cho A: Fostering Innovation in Medicine and Healthcare: What Must Academic Health Centers Do? Acad Med 2013

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)

Environment significantly influences leadership abilities

There must be structures and clear incentives for faculty to pursue new ideas

Genesis of Leadership Development at Duke Medicine

2009 2010 2011 20122008

Launch of C-CHAMP

7/1/2009

Duke Endowment Grant

1/1/2010

Inaugural MLPR Class

7/1/2010

DIHI Faculty Workshop

10/3/2012

2013

Implementation Science Retreat

9/27/2010

DIHI Scientific Symposium/Launch

September 2013

Innovation Workshops

5/2013

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Implementation Seminar Series

2011

2007

DMIHI Affinity Group

Establishment of IPIHD

7/2011

Duke Medicine Health

Leadership Summit

2/2013

LEAD Program Inaugural class

August 2013

City of Medicine Academy opens at

DRH2011

DIHI domains of innovation

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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

Health Leadership &

Workforce Development

Goal to train current and future leaders across health care in

• Leadership• Management• Innovation• Quantitative health

sciences

DIHIDuke Institute for Health Innovation

Applied Health Policy

• Analysis of policy from national and global perspectives

• Application of policy into health care reform efforts

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

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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

Strategy Leadership

Financial Decision Making

Finance

Healthcare Ethics

Customer Relationship

ManagementMarketing Service

Operations

Negotiation

Managing Human

Resources

Effective Decision Making

Healthcare Law

Healthcare System

OverviewInnovation

Quality and Safety

Management

IT for Healthcare

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High School StudentsCity of Medicine Academy, Made In Durham

ExecutivesMBA, MHSA (future)

FacultyCCHAMP, MMCi, LEADER

Residents & FellowsMLPR, Master Clin Leader,HVCC, LHS

Medical & Nursing StudentsPCLT, Feagin, LEAD, MD/MBA, DNP, GNE

UndergraduatesGlobal health

The Learning Continuum Competencies

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

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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.

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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

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Need for MLPR 2010

Dual degree

graduate

Clinical Residency

MBA Employment

Physician Executive

Physician Executive

MLPR

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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

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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

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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.

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2010 2011

2012

2013 Kickoff 1.31.2013!• 27 Participants

• 25 physicians• 1 Nurse Practitioner• 1 Physician’s

Assistant• 52% female; 48% Male• 22% URMM

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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

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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

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Management Courses

• Strategy

• Marketing Analysis

• Decision Models

• Supply Chain Management

• Managerial / Cost Accounting

• Corporate Finance

• Organizational Design and Innovation

Informatics Courses

• Health IT Business Solutions

• Clinical Informatics Strategy

• Data, Information and Knowledge Representation and Modeling

• Secondary Data Use

• Practicum

• Ethics Seminar

MMCi Curriculum

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Educating and Training Clinicians for a Transformed Delivery System

October 18th 2012

Moderators

Victor J Dzau MD, DSc

Nancy Nielson MD, PhD

A Learning Health System Curriculum at Duke (2013-)

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Level 1 Level 2 Level 3

Who: All GME traineesBegin 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

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 projectsLeads: Abernethy/Zaas

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

Duke and CMA

With students from the City of Medicine Academy. Photo courtesy of DPS.

As of Fall 2011, the CMA is strategically located on the campus of Duke

Regional Hospital

• 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.

City of Medicine Academy (2006-)

Made in Durham Taskforce 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

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

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

Strategy Leadership

Financial Decision Making

Finance

Healthcare Ethics

Customer Relationship

ManagementMarketing Service

Operations

Negotiation

Managing Human

Resources

Effective Decision Making

Healthcare Law

Healthcare System

OverviewInnovation

Quality and Safety

Management

IT for Healthcare

3232

High School StudentsCity of Medicine Academy, Made In Durham

ExecutivesMBA, MHSA (future)

FacultyCCHAMP, MMCi, LEADER

Residents & FellowsMLPR, Master Clin Leader,HVCC, LHS

Medical & Nursing StudentsPCLT, Feagin, LEAD, MD/MBA, DNP, GNE

UndergraduatesGlobal health

The Training Continuum Competencies

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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

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!

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Thank you John A. Feagin Jr., MD!

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Thank you for your service to our country and your commitment to foster leadership to the field of medicine