dom strategic plan 2012

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Strategic PlanDepartment of MedicineEmory UniversityPresented to the Executive Committee May 2012

2012

Dept of MedicineEmory University

1/1/2012


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TABLE OF

CONTENTS

I. ABOUT THE CHAIRII. THE DEPARTMENT

OF MEDICINE AND ITS DIVISIONS

III. MISSION AND VISIONIV. CORE VALUESV. OVERVIEW OF THE STRATEGIC PLANVI. CLINICAL CAREVII. RESEARCH IMPACTVIII.TRAINING &EDUCATIONIX. PEOPLEX. FINANCE,INFRASTRUCTURE AND PARTNERSHIPSXI. INFRASTRUCTURE &CONCLUSIONXII. APPENDIX

CONTENTS


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BOUT THE

CHAIRMAN

R. Wayne Alexander, M.D., Ph.D. isthe R. Bruce Logue Professor andChair of the Department of Medicineat Emory University School ofMedicine. Dr. Alexander receivedhis Ph.D. in Physiology from EmoryUniversity and his M.D. from DukeUniversity. His residency and

cardiology fellowship training werealso at Duke University. He was astaff associate at the National Heart and Lung Institute from 1971 to 1973. He wasAssociate Professor of Medicine at Harvard and the Brigham and Womens Hospitalwhen he left in 1988 to become R. Bruce Logue Professor of Medicine and Director,Division of Cardiology at Emory. He became Chair of the Department of Medicine atEmory in 1999. He has been Vice President of Research and on the Board of Directorsof the American Heart Association. He is a Senior Editor of the Cardiology Textbook,Hursts The Heart and has been on the editorial boards of numerous publications.His major research interests are in the biology of blood vessels and in the treatmentand prevention of cardiovascular diseases. He has broad interests in healthmaintenance and preventive medicine. Many of the 30-plus trainees from Dr.Alexanders laboratory are now leaders of academic medicine in the United States andworldwide.


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MESSAGE FROM THE CHAIRMAN

I am pleased to introduce the FY2012-FY2017 Department of Medicine Strategic plan.This plan provides the essential elements for an evolving and progressive modern

Department of Medicine: mission and vision for the future, committees and action itemsfor direction, and benchmarks for measurement of success.

Emory Universitys Department of Medicine excels in the areas of education, clinicalcare and research. Our distinction in these areas is exemplified through our residency and

fellowship rankings; regional, national and international academic recognitions; clinicalreputation and research standing. The unparalleled caliber of our exceptional facultymakes all of this possible.

Nevertheless, we must not rest on our laurels but must strive to continue to scrutinizeall of our programs to ensure unremitting excellence. We must continue to improve thequality of our clinical care, increase the number of awarded research grants, create newand innovative faculty programs, optimize our administrative and resource managementand create sustainable business models for all of our divisions. This strategic plan outlineshow we intend to reach these goals in the coming years.

The departments executive committee led this initiative in order to ensure that all ofour missions are represented and that our leadership shares and supports the priorities,goals and initiatives set forth here. Numerous faculty and staff from across thedepartment dedicated much of their time to make this plan a reality. I thank each and

every one of you for your efforts to make the Department of Medicine the best it can be. Ilook forward to the outstanding department that we will become because of yourdedication and passion.

Sincerely,

R. Wayne Alexander

Tomaintain our leadingposition in research, and build

on the strengths in our current

programs, our strategic plan

illustrates a future focusedrowth


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ABOUT THE DEPARTMENT OF MEDICINE

he Department of Medicine (DOM) is steeped in a rich tradition of excellence, built on thelegacies of medical leaders such as Eugene Stead, Paul Beeson, and more recently, Willis

Hurst and Juha Kokko. Through the work of its nine divisions and one center, the DOMhas pioneered discoveries in medicine, education, scientific and clinical investigation, andclinical care. Our program offers students and residents the latest knowledge in treatmentpractices, scientific theories, research, and patient care. Located in one of the country's

leading research institutions, Emory University, the DOM offers a stimulating atmosphere ofscholarship that leads to success across many medical disciplines.

The clear strength of the department is an outstanding faculty of physicians and scientists withinacademic divisions that include Cardiology; Digestive Diseases; Endocrinology; General Medicine;Geriatric Medicine & Gerontology; Hospital Medicine, Infectious Diseases; Pulmonary, Allergy andCritical Care Medicine; Renal Medicine and Rheumatology. The faculty, many of whom are leaders intheir respective professions, have been crucial to our success in implementing our mission across the

divisions.

The Department of Medicine is known for teaching excellence, as evidenced by the historiccontributions of Drs. Willis Hurst and Juha Kokko, both former chairs. Our Residency Training Programis the signature educational component of the department, and is complemented by superior sub-specialty fellowship training in each of the divisions. A broad range of hospital and outpatient clinicalteaching is conducted at six university-owned or -affiliated hospitals.

Moreover, our access to a large and varied patient population provides residents and fellows withintriguing and often unique training opportunities. Our goal is to ensure a program dedicated toexcellent teaching in the context of superb clinical care. Our residents routinely receive a 100 percentpass rate on the American Board of Internal Medicine (ABIM) exam, a reflection of our success. Thefaculty, fellows, and residents also conduct a significant portion of clinical teaching for Emory medicalstudents.

The Department of Medicine faculty receives the largest portion (20 percent) of the School ofMedicine's extramural research funding and accounts for 16 percent of the university's sponsoredresearch. We maintain a sustained effort to recruit the best researchers in our divisional areas and toinvest in all ongoing programs. We also enjoy close collaborations with other on-campus and sisterinstitutions, including the Yerkes Regional Primate Research Center, the Centers for Disease Controland Prevention, Georgia Institute of Technology and the American Cancer Society.

The provision of superior clinical care is a hallmark for the Department of Medicine at Emory. We are

proud of our nationally ranked programs in Cardiology as well as the superb care given to patients withdiabetes at Grady Memorial Hospital. The Atlanta VA Medical Center is recognized for its clinicalprograms in Pulmonary and Critical Care Medicine and the treatment of HIV/AIDS. These areas reflectthe comprehensive range of our clinical programs. Excellence is our standard in delivering care topatients.

As we approach the next decade, we have developed a strategic plan that builds on our strengths andguides us to continually enhance the teaching, research, and clinical service missions of thedepartment.

T

THE DEPARTMENT OF MEDICINE


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The Divisions

DIVISION OF CARDIOLOGYW . Rober t T a y l o r , M .D . , PhD

Emory University School of Medicine has a long-standing history ofcontributions to modern cardiology. Emory is recognized as one of thefounding centers of interventional cardiology. The basic research program invascular biology and medicine began in 1988 with the recruitment to Emory ofDr. R. Wayne Alexander, the current Chair of Medicine. Vascular research in theDivision of Cardiology at Emory University has grown enormously during thepast 20 years. Dr. Alexander recruited a world-class team of researchers who

have made major contributions to our understanding of basic and clinicalvascular biology. The current chief of Cardiology, Dr. W. Robert Taylor, has

spurred the division on to remain at the forefront of cardiovascular research. Its investigators haveattained international recognition for research in oxidative stress and vascular disease as well asregenerative medicine.

Cardiology is entering an exciting new era in which advances will be made in clinical cardiology, basiccardiovascular research, and interventional and non-interventional technologies. As classicalcardiovascular disease syndromes become better understood in the mechanistic terms of modernmolecular and cellular biology, diagnostic and therapeutic approaches to cardiovascular disease willcontinue to change dramatically in the coming years. The Emory Division of Cardiology will continue asa leader in bringing about these changes with internationally recognized expertise in many relevant

disciplines and is dedicated to training the next generation of academic cardiologists.

DIVISION OF DIGESTIVE DISEASES

F r a n k An a n i a , M .D .

The faculty of the Division of Digestive Diseases consists of clinician educators,clinical investigators, and physicians as well as basic scientists. The range ofinterests encompass all areas of gastroenterology and hepatology, includingadvanced endoscopy, transplant hepatology, nutrition, motility, GI cancers and

inflammatory bowel disease. The investigators are focused on thepathophysiological mechanisms of digestive diseases with a fundamentalemphasis on clinical care, education and training. The division has fourVeterans Affairs merit awards and four R01s . The Division has two advanced

fellowships: one in interventional endoscopy and a second three-year advanced fellowship inHepatology and Liver Transplantation. The GI unit at Emory has a comprehensive care approach forpatients afflicted with chronic liver disease involving not just board certified Hepatologists, but alsohighly skilled surgeons, interventional radiologists, and pathologists.

STRUCTURE OF THE DOM


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DIVISION OF ENDOCRINOLOGY

Rober t o Paci f i c i , M .D .

The Division of Endocrinology, Metabolism and Lipids at Emory University isdedicated to research, education, and clinical care in Endocrinology and relatedareas. The faculty is composed of clinical, translational and basic researchersand educators with interests in all aspects of Endocrinology. Clinical care isdelivered at three hospitals, as well as the Emory Clinic. The division has anNIH Training Grant, currently in its 30thyear, to support the training of the nextgeneration of Endocrinology researchers and scholars. Ongoing clinicalinvestigations study osteoporosis, Vitamin D, nutrition and diabetes. Basicresearch into bone metabolism, osteoimmunology, nanoparticles, phosphate as

a transcriptional regulator, mechanism of action of estrogen and PTH, gene therapy of diabetes, growthfactor physiology and neuro-endocrinology is supported by NIH, VA, and ADA grants. Our fellowshiptraining program enrolls 4-5 fellows each year and is supported by federal grants as well as hospital

funds. Our mission is to provide a program dedicated to excellent teaching and superb clinical care.

DIVISION OF GENERAL MEDICINE

W i l l i am T . B r a n c h , M .D .

The Division of General Medicine provides the bulk of clinical patient-careservices in adult medicine at Grady Memorial Hospital and provides primary careservices at the Emory University main campus and the Atlanta Veterans AffairsMedical Center. The Division's mission encompasses patient-care, teaching andresearch. The Division's faculty sees patients directly and provides hands-onsupervision for every one of our patients seen by the Emory housestaff. Weprovide services on Emory's Inpatient Units. The Division's attending physicians

supervise nine of the twelve patient-care teams on Emory's Inpatient Service in Internal Medicine, theGeneral Medical Clinic, and the Urgent Care Center. There are currently forty-one full-time facultyphysicians working in the Division of General Medicine. The Division has expanded to more thandouble its size in the past five years and will continue to expand slowly in future years as additionalpatient-care responsibilities are added.

Hospital Medicine

A l a n W a n g , M . D .

Emory Hospital Medicine is the largest academic hospital medicine program in

the nation. With nearly 120 physicians providing hospital medicine services ateight hospitals in the greater metropolitan Atlanta area over a 110 mile diameter,Emory hospitalists account for over 45,000 admissions a year, and total patientencounters exceeding 200,000 annually. Diversity of hospital settings from theAtlanta Veterans Affairs Medical Center to rural hospitals to long term acute carehospitals and major tertiary academic medical centers allows the Emory HospitalMedicine to firmly embrace the continuity of care required to take care ofcomplex patients. The Division of Hospital Medicine formed in September 2011and is the tenth and latest Division of the Department of Medicine.



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Emory Healthcare Hospitalists are board-certified internal medicine, family medicine and specialtyphysicians who specialize in the care of hospitalized patients. They are experienced in diagnosing andmanaging acute medical illnesses from which hospitalized patients commonly suffer. They also providemedical consultation for surgical and other specialty patients. The mission is to provide the highest

quality and value in care to hospitalized patients, educate future academic and practice leaders of thespecialty, and advance hospital care through research and hospital medicine.

Apart from providing high value patient and family-centered care, the Division of Hospital Medicinehelps provide many of the leaders throughout the health system, regionally and nationally in regards tocare coordination, utilization, quality improvement, IT and medical education. Highly regarded as oneof the top hospital medicine research programs nationally, The Divisions Clinical Outcomes Program(COP) focuses on research around health services, models of care, the care continuum and qualityimprovement. The COP has been recognized nationally by the Society of Hospital Medicine forgroundbreaking research. The Emory Division of Hospital Medicine remains a vibrant, growing,nationally recognized and innovative Division in the Department of Medicine.

DIVISION OF GERIATRICS AND GERONTOLOGY

Theodo r e John son , M .D ., M .P.H.

The Division of Geriatric Medicine and Gerontology is dedicated to advancing thehealthcare of the elderly population. Based primarily at the Wesley WoodsCenter of Emory University and the Atlanta Veterans Affairs Medical Center, theprogram has also expanded to establish a Geriatrics Center at Grady MemorialHospital, a major site for training Emory students and residents. Excellence inclinical care of older adults in outpatient, acute hospital, and long-term care

settings remains a focus of the division. The Division has been led since inception by Drs. Herbert Karp

(1983-1990), Mario DiGirolamo (1990-1996), Joseph Ouslander (1996-2008), and Ted Johnson (2008-). Under their leadership, the Division has doubled in size to its current 25 full-time physician facultyand 5 PhD researchers.

DIVISION OF INFECTIOUS DISEASES

Da v i d St ephens, M .D .

During the past decade under the leadership of Dr. Stephens, the Emory Divisionof Infectious Diseases has experienced unparalleled growth and development.There are currently fifty-nine faculty members in the Emory ID Division who,

between Grady Memorial Hospital/Grady Ponce de Leon Infectious DiseasesCenter, the Atlanta Veterans Affairs Medical Center, Emory University Hospital,Emory Midtown, Emory Orthopedic and Spine Hospital, the Emory VaccineCenter and the Wesley Woods Center, participate in patient care, teaching andresearch activities. Infectious Diseases Division members have recentlygarnered in excess of $20 million in research funding per year. The Infectious

Disease Division plays leadership roles in the Emory Center for AIDS Research (CFAR), the NIH-fundedClinical Research Center for HIV/AIDS, the Southeastern Center for Emerging Biological Threats



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(SECEBT), the NIH-funded Emory Vaccine Trials and Evaluation Unit, and the CDC-funded GeorgiaEmerging Infections Program.

State-of-the-art HIV/AIDS outpatient care is provided at the full-service, Grady Ponce de LeonInfectious Diseases Center, at Emory Midtown, and at the Atlanta VA Medical Center, where ID facultyrun the largest VA-affiliated HIV clinic in the nation. Transplant ID services have grown tremendously

at Emory University Hospital in the past decade. The Emory ID Program is a destination site forFellowship training in infectious diseases and one of the top programs in the country in areas such asepidemiology, HIV/AIDS, vaccine, tuberculosis, transplant ID, travel medicine and global infectiousdiseases. ID faculty members provide outstanding teaching for medical and graduate students,residents and other post-doctoral trainees. In collaboration with faculty from the Department ofMicrobiology, ID faculty assist with planning the month-long Prologue II segment of the first yearmedical school curriculum and approximately twenty-four ID faculty members participate in didacticand small group learning sessions during the course.

DIVISION OF PULMONOLOGY

Dav i d Gu i d o t , M .D .

The field of Pulmonary, Allergy and Critical Care Medicine is a dynamic areawith continuing advances being made in discovering disease mechanismsand treatment. Our division is deeply involved in the development of thesechanges with internationally recognized expertise in many areas. Newadvances in pulmonary diseases and critical care medicine are utilized in theexcellent patient care provided by the division members in the Emory Clinic.Our training program offers a balance of clinical and bench researchexperience, as well as superb clinical experience at Emory University

Hospital, Grady Memorial Hospital, Emory University Hospital Midtown, and the VeteransAdministration Hospital. A major research effort in the division includes basic, clinical and

translational research in acute respiratory distress syndrome (ARDS), with particular emphasis onunderstanding the molecular basis for the effects of alcohol abuse and human immunodeficiency virus(HIV) infection on the progression of ARDS. Other strengths in the division include research in oxidantstress and redox regulation of pulmonary function and aging, lung immunity and asthma, pulmonary

arterial hypertension, and the pathology of Cystic Fibrosis.

DIVISION OF NEPHROLOGY

Je f f San ds , M .D .

The Division of Nephrology at Emory University School of Medicine is at the

forefront of nephrology research, education, and clinical care. The clearstrength of the division is an outstanding faculty of more than 30 physiciansand scientists, many of who are leaders in their respective fields, and over10 of who are principal investigators on NIH grants. The division also hasseveral junior faculty supported by NIH K-awards who will become futureleaders in their fields. The division is an acknowledged center for teaching

excellence, with an NIH Training Grant, currently in its 21styear, to support the training of the nextgeneration of nephrology researchers, both MDs and PhDs. Our faculty consistently win teachingawards within the Department of Medicine and School of Medicine. A broad range of hospital and



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outpatient clinical teaching is conducted at five university-owned or affiliated hospitals. Moreover, alarge and varied patient population provides fellows with stimulating and often unique trainingopportunities. We were the first renal division to offer training in both renal ultrasound andinterventional nephrology. We have recently added a one-year Transplant Nephrology fellowship. Ourgoal is to provide a program dedicated to excellent teaching in the context of superb clinical care. To

enhance our clinical care mission, we recently opened three Emory Dialysis units, which will deliverhigh quality patient care and provide opportunities for clinical research in dialysis. The divisionconsistently ranks in the top 25 in the US news and World Report ranking for kidney disease, andranked 18thin 2011.

DIVISION OF RHEUMATOLOGY & IMMUNOLOGY

I gn ac i o San z, M .D .

Rheumatology and Immunology at Emory is dedicated to excellence in theclinical care of patients and the education of medical students, medicine

residents, and rheumatology subspecialty residents. The Division is alsocommitted to involvement in research and playing an active role in thedevelopment of increased knowledge and new treatment regimens in thefield of rheumatic diseases. We are comprised of seven full-time faculty whoserve the clinical needs of the Grady Health System, the Veterans AffairsMedical Center, The Emory Clinic and Emory University Hospital, EmoryMidtown. In addition, a team of three pediatric rheumatologists providescare and participates in research through the Emory Children's Center at the

affiliated Children's Healthcare of Atlanta.



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COREVALUES

In the Emory DOM, our core values are inherent in all that we do.We achieve excellence in our missions by embracing:

Integrity & TrustEmpathy & CompassionEthical & Innovative InquiryCollegiality & CollaborationProfessionalism & DiversityAccountability & Quality

CORE VALUES


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MISSION STATEMENTTo serve humanity by improving health

VISION STATEMENTTo be a national leader and innovator in discovery, high quality patientcare and education

MISSION AND VISION


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GOALSI. Clinical Care: Define, though inquiry, optimal

standards of care and dissemination

mechanisms.

II. Research Impact: Collaborate to enable

discovery, translate knowledge, and advance

patient care.

III. Training and Education: Collaborate to

transform medical education and lead the

efforts to redefine residency training.

IV. People: Cultivate a collaborative environment

of excellence that embraces diversity and

attracts, retains, and develops engaged faculty,staff, and trainees.

V. Finance, Infrastructure & Partnerships:

Effectively develop and manage financial

resources to achieve excellence across all

missions.

STRATEGIC PLAN

2012-2017 OVERVIEW

The Department of Medicines 2012 Strategic Plan was initiated at the beginning of 2011. TheExecutive Committee, convened from amongst Vice Chairs, Service Chiefs, Division Directorsand Executive Administrators in the Department of Medicine, and chaired by Dr. R. WayneAlexander, took the lead to spearhead the creation of a Strategic Plan. This committee cametogether to identify five departmentalgoals and their respective focus areasand initiatives to be carried outthrough FY2017. The committeetasked several subcommittees toaddress the five identified goal areas

and create action items to addressthese initiatives. From August 2011 toMay 2012, the five committees workedto create at least one action item toaddress each initiative. These actionitems will be implemented during thenext five years, according to a priorityrecommended by the DOM ExecutiveCommittee to Dr. Wayne Alexander.

STRATEGIC PLAN


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SUMMARY OF GOALS AND INITIATIVES

FOCUSAREAS &INITIATIVES SUMMARY

I. Clinical Care

I.1 Develop and implement quality programsin both inpatient and outpatient settings.

I.2 Disseminate innovative discoveries andbest practice models throughout themedical community and society.

I.3 Improve service though operationefficiency and resource optimization.

I.4. Create a sustainable model for inpatientcare with mechanisms for subspecialty

involvement at both inpatient andoutpatient transitions.

II. Enhance Research Impact

II.1 Support innovation, integration andtranslation of basic discoveries intoclinical care and health care delivery.

II.2 Enable future discovery by enriching thescientific and administrative platforms forbasic and clinical research.

II.3 Streamline research administrativeprocedures.

II.4. Advocate and facilitate the adoption of aneffective, user-friendly and integrated ITinfrastructure (see also V.4).

III. Training & Education

III.1 Develop and implement creative andconsistent approaches to medicaleducation.

III.2 Streamline educational administrativeprocedures.

III.3 Provide development opportunities foreducational skill building.

III.4 Develop training programs to improvepatient-centered professionalism in alltrainees.

IV. People

IV.1 Optimize recruitment, retention andpromotion strategies for faculty, staff,and trainees across divisions andlocations.

IV.2 Promote a sense of community withshared values and goals, aligned withour tripartite mission.

IV.3 Promote career growth anddevelopment among faculty, staff, and

trainees.IV.4. Support and increase faculty, staff, and

trainee involvement in local, national,and international outreach and serviceefforts (see also V.5).

IV.5. Continue to realign compensation toencompass all three missions of thedepartment.

V. Finance, Infrastructure andPartnerships

V.1 Optimize administrative structures andprocesses throughout the DOM

V.2 Increase philanthropy and alternativefunding sources to enable strategicinvestment

V.3 Explore opportunities for growth of theclinical enterprise and financial stabilityof the DOM.

V.4. Advocate and facilitate the adoption ofan effective, user-friendly andintegrated IT infrastructure (see alsoII.4).

V.5. Support and increase faculty, staff, andtrainee involvement in local, national,and international outreach and serviceefforts (see also IV.4).


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CLINICAL CAREDefine, though inquiry, optimal standards of care and dissemination mechanisms

he clinical enterprise of the Department of Medicine is a large, rapidly expanding and vital partof our departments culture and success. The clinical services that are provided by theDepartment of Medicine span three major Atlanta healthcare organizations in which we see a

total of over one million visits per year in over 75 locations. Most of our clinical care and teaching ofmedical students and house staff is performed at the Emory Clinic and at five hospitals: AtlantaVeterans Affairs Medical Center (VAMC), Emory University Hospital (EUH), Emory University HospitalMidtown (EUHM), Grady Memorial Hospital and Wesley Woods Geriatric Hospital (WWGH). TheDepartment of Medicine works jointly with Emory Healthcare to help with the progression of quality,patient care and innovative healthcare at Emory. Although the DOM is intimately involved in leadingpatient care at Emory, with the ever changing field of healthcare, we are faced with the challenge ofkeeping up with the always increasing standards of quality and creating new and best practice modelsfor inpatient care and resource optimization.

T

GOAL I


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Strengths: Opportunities:

Breadth of clinical specialty areas Large volume of patient encounters provides a

substrate for clinical training, research andrevenues

Focus on quality Nationally ranked programs in Cardiology &

Geriatrics

Superb clinical care across multiple platforms Serve a large and diverse patient population

throughout the State of Georgia

Reputation as a leader in clinical care

Set national standards for quality and value Develop multidisciplinary, high performing

clinical care models

Become a national leader in developing fiscallyresponsible and effective models for diseaseprevention, diagnosis and management

Take advantage of diverse patient populationbase for clinical research

Develop a nationally recognized Hospitalistsystem

Weaknesses: Threats: Incomplete permeation of quality mission in

our culture

Average quality performance by nationalstandards

Lack of standardization of processes,procedures and procurement

Lack of organizational coherence in the DOMwithin the healthcare systems (subspecialtiesdo not have equivalent representation at allhospitals)

Quality metrics rather than value as anendpoint for accountability

Pay-for-performance reimbursement Increasingly sophisticated local

competition that diminishes the advantageof being an AMC

Based on these strengths, weaknesses, opportunities and threats, the Executive Committee created fourinitiatives to advance clinical care over the next five years and charged the Clinical Advisory Team(CAT) with creating an action plan to achieve them. The DOM aims to become a national leader inpatient care.

I.1. Develop and implement quality programs in both inpatient and outpatient settings.

I.2. Disseminate discoveries and best practice models throughout the medical community and

society.

I.3. Improve service through operational efficiency and resource optimization.

I.4. Create a sustainable model for inpatient care with mechanisms for subspecialty

involvement at both inpatient and outpatient transitions.

SWOT Analysis: CLINICAL CARE


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I. Create consistent and improved care through carepathways across the DOM, as developed by experts in

each division within the Department of Medicine. Eachdivision will nominate one quality improvement (QI)project to be implemented departmentally wide andwill also develop and initiate at least on division-specific QI project.*

a. Integrate quality metrics and power plans into EMR.b. Create summer DOM Grand Rounds series on quality.c. Roll out division led care-path initiative to

Department level: 2nditem for significantimprovement in patient care, throughput, orreduction of waste.

d. Ensure quality infrastructure in all divisions;Integrate into Meet with Chair Day.

II. Develop and implement quality programs across theDOM. This action item hopes to disseminate theknowledge and structure gained from HospitalMedicines pilot Accountable Care Unit. (Initiatives 1, 2and 4)*

a. Name DOM quality program leaders at all sites and allDivisions.

b. Select division led care-path initiative for identifiedmost significant problem/highly variable care processin the area/field.

c. Designate Inpatient Accountable Care Units (ACUs) ateach site.

III. Improve communication during dissemination ofinformation between providers and health systems.(Initiative 2)

a. Hold internal communication and consultationstandards conference. Yearly conference will be usedin the future to present unit-level performance andoutcomes data.

IV. Improve communication during transitions of care andwhen disseminating best practice models. (Initiative 4)

a. Roll out intra-communication standards andmonitoring plan.

*The details of each program can be found in appendix 1.

GOAL I

ACTION

ITEMS


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2012

2014

2015

2016

Begin2011

End2017

Clinical CareAction Item

Timeline

Nominate Quality Improvementprojects per division

Develop and implement qualityprograms across the DOM

Improve communication duringtransitions of care and whendisseminatin best ractice model

2013

Name DOM quality programleaders at all sites and all Divisions

Integrate quality metrics andpower plans into EMR

Select division led care-pathinitiative for care process in the

area/field

Hold internal communication andconsultation standards conference

Hold summer DOM Grand Roundsseries on quality

Roll out intra-communicationstandards and monitoring plan

Roll out division led care-pathinitiative to department level

Create consistent and improvedcare through care pathways acrossthe DOM (QI)

Hold department QI Committeereview of Divisional- Departmentinitiative roll-out

Quality infrastructure into alldivisions; Integrated into Meet

with Chair DayExpansion of number of qualitymetrics plans for ACU


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ENHANCE RESEARCH IMPACTCollaborate to enable discovery, translate knowledge,and advance patient care

lthough discovery-based research in the Department of Medicine has been robust only for thelast 25 years, the department is highly regarded for its contributions in severalareas. Researchfunding has increased two-fold since 2000, with Cardiology and Infectious Diseases as the two

highest-funded divisions. The department is a major component of the School of Medicines researchportfolio, making up approximately 20% of the schools funding. The DOMs strong research presencehas helped Emory University become 16thin the nation for research.

Two years ago, the School of Medicine inaugurated the Millipub Club, designed to recognize current

Emory faculty who have published papers that have been cited at least 1,000 times in the literature.Such papers reflect the highest in scholarly achievement. The Department of Medicine is proud to behome to 19 members of the Millipub Club, or 38% of the total membership, the most of any departmentin the school.

It is our belief that academic departments have a mandate to perform basic, translational and clinicalresearch related to physiology, pharmacology and disease. Every division has funded investigators whostudy important, clinically relevant questions from all perspectives. Nonetheless, we believe thatstrategic planning will enable us to further expand our research program to meet the needs of achanging healthcare and funding environment.

A

GOAL II


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Multiple investigators with high scientificimpact

Largest portion (20%) of the SOMsextramural research funding and accounts for16% of the Universitys sponsored research

ECCRI* research unit generates significantindependent funding and is also buildingcollaborations with units across the University

Historical increases in NIH funding Vibrant and diverse basic research in the

department

Extremely collaborative environment

Develop our regenerative medicine, predictivehealth, metabolism, translational research,comparative effectiveness and immunology

programs Take advantage of research opportunities at

Grady, especially in the areas of hypertension,heart failure, and health care disparities

Expand research partnership with the VA andCHOA

Develop interdisciplinary research

Weaknesses: Threats:

Inadequate research equipment &infrastructure

Inadequate research space capacity/sizeand location

Lack of coordinated and searchable ITdatabases

Lack of internal research support andbridge funding

Inadequate clinical researchadministrative infrastructure and lack ofclarity of PI responsibilities

Lack of systematic mechanisms forrecruiting patients into clinical trials

Few K Awardees and little infrastructureto support new awards and/or transitionfrom Ks to Rs

Reduced NIH funding Lack of standardization of processes and

procedures, especially clinical researchadministrative structure

Based on the existing strengths, weaknesses, opportunities, and threats, the Department of Medicinedesigned four initiatives to improve research within the department:

II.1 Support innovation, integration and translation of basic discoveries into clinical care and

health care delivery.

II.2 Enable future discovery by enriching the scientific and administrative platforms for basic and

clinical research.

II.3 Streamline research administrative procedures.II.4 Advocate and facilitate the adoption of an effective, user friendly, and integrated IT

infrastructure.

The Department of Medicine charged the Research Advisory Team (RAT) with the responsibility ofcreating research action items to be implemented over the next five years.

SWOT Analysis: RESEARCH


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I. Create pilot seed grants with two Principal Investigators who have never worked together before,preferably a basic science PI and clinical PI to promote collaboration. (Initiative 1)*

II.Create Blue Sky Groups to promote new research ideas and collaborations. (Initiative 1)

III.Create an Internal Visiting Professor Program to share researchinterests. (Initiative 1)

IV.Create a comprehensive, user-friendly website to showcase research,promote collaboration and collate research administration best practices.(Initiatives 1, 2, 3 and 4).

V.Create a space policy by which space is allocated according to researchsuccess. (Initiative 2)

VI.Provide matching dollars for successful programs. (Initiative 2)

VII.Increase biostatistical support, availability and training. (Initiative 2)

VIII.Work with the Office of Business Process Improvement (OBPI) and theAdministrative Restructuring Committee (ARC) to improve researchadministration. (Initiative 3)*

IX.Create post-award reporting mechanism that is data-driven and user-friendly. (Initiative 3)

X.Expand IT resources within the DOM to support basic and clinicalresearch. (Initiative 4)*- Increase DOM IT budget to support research IT and infrastructure

upgrades.- Appoint a Vice Chair for IT and create an IT advisory team to prioritize

and facilitate IT efforts within the department.- Research, collate and advertise IT solutions currently available.- Expand videoconferencing capabilities

and support.

XI.Work towards creating common platforms for patient data that canbe queried by varied investigators. (Initiative 4)


ACTION

ITEMS

GOAL II


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2012

2014

2013

2015

2016

ResearchAction Item

Timeline

Create an Internal VisitingProfessor Program

Appoint a Vice Chair for IT andcreate an IT advisory team

Create pilot seed grants with twoPrincipal Investigators

Begin2011

End2017

Work with OBPI and ARC toimprove research administration

Create a comprehensive, user-friendly website

Research, collate and advertise ITsolutions currently available

Create Blue Sky Groups

Create post-award reportingmechanism that is data-driven and

user-friendly

Expand videoconferencingcapabilities and support

Increase biostatistical support,availability and training

Work towards creating commonplatforms for patient data thatcan be queried by variedinvestigators

Provide matching dollars forsuccessful programs

Increase DOM IT budget tosupport research IT andinfrastructure upgrades

Create a space policy


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TRAINING &EDUCATIONCollaborate to transform medical education and lead the efforts to

redefine residency training.

ducation isone of thethree pillars

of the School ofMedicine. AcrossEmory University,the Department ofMedicine is knownfor its excellent and

innovativeeducationprograms. It isresponsible foreducating andtraining students,residents andfellows in the broadfield of internalmedicine as well asits subspecialties,and oversees the

education ofnumerous graduateand postdoctoralstudents. Thedepartment is also known for its novel faculty education and continuing medical education programs. Itcontributes more education hours to the School of Medicine than any other clinical department, has thelargest medicine residency program in the country and provides opportunities for faculty development ineducation to over 500 faculty members at Emory, and several hundred others outside of Emory. Over thecourse of one year, the department educates approximately 170 medical residents, 140 fellows, and 250medical students. Offering both traditional and other training programs, the department strives to trainhighly competent physicians and leaders in medicine, regardless of ultimate career pathways.

The department chair, the Vice Chair for Education, the residency program director and associateprogram directors, and medical student education leaders, along with numerous supporting staffmembers across the school, work collaboratively with each other to ensure that the educationalprograms in the Department of Medicine continue to meet the highest standards of innovation andquality.

E

GOAL III


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Training and Education are a core value of theDepartment

High profile educatorsDiversity of the clinical experience offered by the

residency program attracts a nationallycompetitive applicant pool with a 100% pass rateon the ABIM exams

Robust fellowship training programsFocus on career development and satisfaction of

outstanding clinicians enable their growth aseducators and deliverers of outstanding service

Provide superb training programs to clinicianswho are then highly competitive nationally forsubspecialty programs

Largest portion of training in School of Medicineprovided by DOM

Offer new faculty development initiativesExpand NIH funded training programsTake a leadership role in redefining and

developing solutions to the changing face of theInternal Medicine Residency training

Weaknesses: Threats:Inconsistency in training experience at our 5

different training sites

Sub-optimal performance in timely evaluation andfeedback

Reduction in residency training hoursIncreased rigidity of the regulatory environment

involved in residency training

Potential cuts to GME funding

With the abundance of strengths listed above, the Department of Medicine was able to design threeinitiatives to address our weaknesses, reduce external threats and take advantage of opportunitieswithin the department. They are as follows:

III.1 Develop and implement creative approaches and consistent processes for medical education

III.2 Streamline educational administrative procedures

III.3 Provide development opportunities for educational skill building

III.4 Develop training programs to improve patient-centered professionalism in all trainees

The Department of Medicine asked the Executive Education Committee (EEC) to design action items tosupport these initiatives. These detailed plans will help the department move forward with each ofthese initiatives over the next five years. Below are the proposed action items to be carried out andimplemented through FY2017.

SWOT Analysis: EDUCATION


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I. Create a mini yearly development retreat to review processes,procedures, and requirements for educational programs.Require all to attend the New Innovations training offered yearly

by GME. (Initiative 2)*

II. Develop clear job descriptions and timelines for both facultyleaders and administrative staff in reference to their educationalprograms. Regularly review faculty/staff progress and hold themaccountable for their duties. (Initiative 1)*

III. Strengthen the accountability to which Division Chiefs andprogram directors are held for their educational programs.Consider the incorporation of education metrics into annualgoals, career conference reports and incentives. (Initiative 1)*

IV. Create and implement periodic reviews of teaching facultywithin the Department of Medicine to achieve the higheststandards of teaching competency. (Initiative 3)*

V. Propose an education budget that supports the infrastructure ofeducation, furthers the core education mission, and is based onnational and local best practices. (Initiative 2)*

VI. Reorganize the residency education administrative team toincrease efficiency and gain expertise. Along with enhancedadministrative oversight, this will include two new positions;

Information Analyst and Accountant. (Initiative 2)*

VII. Hire program coordinators to support more than one of thesmaller fellowship programs as a model that allows forcoordinators to focus on education. (Initiative 2)*

VIII. Develop an online education resource for faculty. (Initiative 2)*

IX. Expand faculty development initiatives focused on education and teaching. (Initiative 3)*

X. Create yearly report on education. (Initiative 1)

XI. Ensure every trainee and faculty member is imbued with professionalism through education,feedback, and accountability for the behaviors outlined in the Emory Pledge. (Initiative 4)


GOAL III

ACTION

ITEMS


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Begin2011

End2017

2012

2013

2016

2015

Conduct teaching faculty reviews

Reorganize the residency educationadministrative team

Expand faculty developmentinitiatives

Develop clear job descriptions andtimelines for both faculty leaders and

administrative staff

Hire program coordinators

Create yearly report oneducation

Propose an education budgetDevelop an online educationresource for faculty

Create a mini yearlydevelopment retreat

EducationAction Item

Timeline

2014

Ensure every trainee and facultymember is imbued with

rofessionalism

Strengthen the accountabilityto which Division Chiefs andprogram directors are held fortheir educational programs


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PEOPLECultivate a collaborative environment of excellence that embraces diversity and attracts,

retains, and develops engaged faculty, staff, and trainees.

ur people are our greatest resource. The Department of Medicine is fortunate to have creative,energetic faculty and staff who work collaboratively to advance scientific knowledge andhuman health. Our challenges are to retain good people, to recognize their achievements in all

missions and to strengthen our sense of community. We arecommitted to providing every employeewith the career support they need to succeed. We also recognize that with our talented faculty andstaff, there is much room to increase our service and outreach efforts so that we benefit the communityat large and expand Emorys impact.

The department offers a wide range of opportunities for its faculty, staff and trainees. Several of theleaders within the department have come together throughout the past several years to createnumerous faculty and staff development programs. These opportunities are designed to assist allfaculty and staff to expand their professional skills and achieve their career aspirations. Programs havebeen developed to provide information and resources related to academic advancement, clinicalservice, research and teaching though orientations and career development courses.

O

GOAL IV


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SWOT Analysis: PEOPLE

Strengths: Opportunities High profile researchers, clinicians, educators

and administrative staff Closely aligned, coherent and collaborative

organizational structure

Recruit new investigators to maintain strongresearch program

Institute succession planning for senior cliniciansProvide development opportunities for mid-

career faculty and staff

Recruit outstanding trainees and administrativestaff

Weaknesses: Threats:

Limited opportunity for clinical researchLimited opportunities for regional and national

service outreach efforts

Limited promotion opportunities for ClinicianEducatorsLack of targeted leadership training

opportunities

Flux in divisional leadership positions (4 out of 9)No institutional strategy for enabling and

coordinating senior recruitment

Based on the SWOT analysis above, the Executive Committee developed five initiatives that will help toimprove the work environment and career satisfaction for our faculty, staff and trainees.

IV.1 Optimize recruitment, retention and promotion strategies for faculty, staff, and trainees

across divisions and locations.

IV.2 Promote a sense of community with shared values and goals, aligned with our tripartite

mission.

IV.3 Promote career growth and development among faculty, staff, and trainees.

IV.4. Support and increase faculty, staff, and trainee involvement in local, national, and

international outreach and service efforts.

IV.5. Continue to realign compensation to encompass all three missions of the department.

As part of the Strategic Plan, the Department of Medicine asked the Faculty Development Committee(FDC) to lead the effort in addressing the initiatives above. These initiatives will serve as the foundationfor action items, which are designed to be implemented throughout years one through five. Below arethe action items that will help accomplish and meet these initiatives.


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I.Enhance mentoring by providing funds for CME meetings andeducators, expanding mentoring for primary care external faculty andhospitalists, and defining career paths for staff. (Initiative 1)

II.Promote sense of community by promoting DOM service efforts, e.g.,Project IMPACT, outreach charity care, and create an online servicecatalog. (Initiatives 2 and 4) *

III.Continue and expand existing faculty development programs.(Initiative 3)

IV.Expand staff involvement in feedback (360 evaluations). (Initiative 3)

V.Offer focus groups for faculty with like interests to identify their

career development needs. (Initiative 3)

VI.Create a Lunch with the Chair program to facilitate interactionbetween faculty and DOM leadership. (Initiative 3)

VII. Increase staff development opportunities. Allow staff a certainnumber hours/year for development activities, such as personalizedgroup sessions through Learning Services. (Initiative 3)*

VIII.Target faculty and staff for leadership development. Provide careercoaching as needed. This will aid in succession planning. (Initiative 3)

IX.Revive and implement RVUs/citizenship metrics. (Initiative 5)

X.Provide non-salary compensation to reward employees and improvemoral, e.g., protected CME time and vacation time. (Initiative 5)

XI.Expand DOM website for staff development (Initiative 1 and 3)*


GOAL IV

ACTION

ITEMS


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2012

2014

2013

2015

2016

PeopleAction Item

Timeline

Increase staff developmentopportunities

Target faculty and staff forleadership development

Lunch with the Chair

Increase outreach for charity carearound Georgia

DOM service project: ProjectIMPACT

Enhance mentoring

Provide non-salary compensation

to reward employees and improvemorale

Offer focus groups for faculty withlike interests to identify theircareer development needs

End2017

Begin2011

Expand staff involvement infeedback

Continue and expand existingfaculty development programs

Revive and implementRVUs/citizenship metrics

Expand DOM website for staffdevelo ment


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he everyday activities and

duties of the Department ofMedicine rely heavily upon thesuccess of the finance and

accounting team. Within this group fallsthe responsibility of managing budgets,promoting growth of the clinicalpractice, increasing philanthropicsupport and expanding and pursing

new partnerships, internally, locally, nationally and internationally. The department functions as twoseparate financial entities: clinic and university. Both are critical to the departments success.

The department operates on a budget of over $220M, of which 71% goes to the support of ourstaff and faculty. Although, the DOM is one of the largest revenue and grant producing departments in

the school, there exist a heavy reliance on financial support from The Emory Clinic. This hinders theDOMs independence and ability to make large financial commitments and limits our options for fiveyear planning. Thus, much of the effort for this goal is devoted towards working within the system tooptimize and expand our resources.

T

GOAL V

FINANCE,

INFRASTRUCTURE &PARTNERSHIPSEffectively develop and manage financial resources to

achieve excellence across all missions


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Strengths: Opportunities: Strong financial base, especially over the past

9 years Close collaborations with Yerkes, Grady, VA,

Georgia Tech, CDC, Morehouse, and GRA

Promote growth of the clinical practices inoutlying areas by acquisition or formalaffiliation with existing private practices

Re-examine the utilization of clinical andclinical research space to maximize efficiencyand usage

Expand partnerships across the state ofGeorgia, as well as national and internationalcollaborations

Pursue international partnerships andbusiness opportunities

Weaknesses: Threats: Philanthropic support Ability to develop and capture intellectual

property

A funding model that depends on TECrevenue

Critical lack of IT infrastructure Challenge of maintaining equipoise in

administrative and financial relationshipswith Grady

Unstable and unpredictable financial modelsand reimbursement schedules

Proposed CMS changes that impactprofessional and technical reviews

Inequitable allocation of funds to the DOM National economy

The SWOT analysis above identifies the numerous weaknesses and opportunities within thedepartments financial arena. The initiatives below are designed to help minimize the weaknesses and

threats and increase the financial strengths within the DOM.

V.1. Optimize administrative structures and processes throughout the DOM.

V.2. Increase philanthropy and alternative funding sources to enable strategic investment.

V.3. Explore opportunities for growth of the clinical enterprise and financial stability in the

DOM.

V.4. Advocate and facilitate the adoption of an effective, user-friendly and integrated IT

infrastructure (see also II.4).

V.5. Support and increase faculty, staff, and trainee involvement in local, national, and

international outreach and service efforts (see also IV.4).

In order to address these initiatives, the Executive Committee charged the Finance, Infrastructure andPartnerships Committee (FIP) to design action items that address these initiatives.Note: Some action items imported from other sections.

SWOT Analysis: FINANCE & INFRASTRUCTURE


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I. Integrate TEC-University infrastructure at divisional andcentral levels. (Initiative 1)*

II. Establish a research space committee to develop a spacepolicy and allocate research space. (Initiative 1)*

III. Engage University, EUH and EUHM Administration in ananalysis of existing space allocation from the DOM.Specifically, explore the use of the Old Nursing SchoolBuilding at EUH as well as other offsite space. (Initiative 1)*

IV. Launch an internal marketing campaign for development.(Initiative 2)*

V.

Assess development staffing strategy. (Initiative 2)

VI. Launch an internal marketing campaign for intellectualproperty. Consider a spokesperson and/or navigator for theprocess of working with the Office of Technology Transfer tofacilitate capture of intellectual property and turn it into apotential revenue stream. (Initiative 3)*

VII. Increase DOM IT budget to support research IT andinfrastructure upgrades. (Initiative 4 and II.4)*

VIII. Appoint a Vice Chair for IT and create an IT advisory team toprioritize and facilitate IT efforts within the department.(Initiative 4 and II.4)*

IX. Work towards creating common platforms for patient datathat can be queried by varied investigators. (Initiative 4 andII.4)

X. Promote sense of community by promoting DOM serviceefforts, e.g., Project IMPACT (Internal Medicine PartneringAcross the Community). One project will be highlighted each

year and an online service catalogue will be developed toshowcase other DOM events. (Initiative 5 and IV.4)*


ACTION

ITEMS

GOAL V


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2016

2015

2013

2014

2012

Launch an internal marketingcampaign for intellectual property

Launch an internal marketingcampaign for development

Engage University, EUH and EUHMAdministration in an analysis ofexisting space allocation for the DOM

Establish a research spacecommittee to develop a space policyand allocate research space

Integrate TEC-Universityinfrastructure at divisional and

central levels

Begin2011

End2017

FinanceAction Item

Timeline

GOAL V

Assess development staffing andstrategy

Appoint a Vice Chair for IT and createan IT advisory team

Increase DOM IT budget tosupport research IT andinfrastructure upgrades

Work towards creating commonplatforms for patient data that canbe queried by varied investigators

DOM service project: ProjectIMPACT


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Prioritized Action Items

Initiatives& Ideas

Goals &FocusAreas

Missionand

Vision

PRIORITIZATION &

IMPLEMENTATION

The five focus areas and their respective action items represent a concrete roadmap to movethe Department forward to continued excellence over the following five years. However, inthe current financial environment, initiatives must be carefully prioritized for implementation

to align with the limited resources. The Executive Committee evaluated each action itembased on potential impact and required resources. Findings are summarized in the followingtable. The colors reflect their respective focus area. Based on this analysis, and afterconsidering ongoing efforts and integrated needs, Dr. Alexander prioritized the action items asoutlined in the timelines for each focus area. Implementation will be the responsibility of theappropriate standing committees (Clinical Advisory Team, Research Advisory Team, EducationExecutive Committee, Faculty Development Committee) or the Executive Administrator of theDepartment of Medicine in the case of finances and infrastructure, and progress will beevaluated each year. Priorities may be adjusted yearly based upon availability of resources.

IMPLEMENTATION


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5) Create space policy 1) Quality improvement Project 9) Create post-award reportingmechanism

8) Work with OBPI and ARC to improveresearch administration

2) Implement quality programdissemination 10) Expand IT resources

11) Ensure residents are SIBR certified 4) Improve communication whendisseminating best practice models

11) Create common platforms forpatient data that can be queried

HIGH

1) Integrate TEC-Universityinfrastructure at divisional and centrallevels.

1) Create pilot seed grants 5) Propose education budget

2) Establish a research space committee 7) Increase biostatistical support 7) Increase DOM IT budget

3) Expand faculty development programs

8) Target faculty and staff leadershipdevelopment

IMPACT 8) Appoint a Vice Chair for IT

3) Improve communication between

providers and health system

4) Create user friendly website to

showcase research2) Create "Blue Sky Groups" 6) Provide matching dollars for successful

Programs

1) Create yearly mini-developmentretreat

6) Reorganize the residencyadministrative team

4) Implement periodic reviews ofteaching faculty

7) Hire program coordinators to supportfellowship programs

2) Develop clear job descriptions 7) Increase staff developmentopportunities

MED.

3) Strengthen accountability of DivisionChiefs and program directors

11) Provide non-salary compensation toreward employees

2) Promote DOM service efforts 12) Expand DOM website for staffdevelopment

4) Expand staff involvement in feedbackevaluations

4) Launch internal marketing campaignfor development

3) Engage all of DOM in space allocationanalysis

6) Launch internal marketing campaignfor intellectual property

5) Assess development staffing strategy

3) Create "Internal Visiting ProfessorProgram"

1) Enhance mentoring by providing fundsfor CME meetings and educators.

8) Develop online education resource forfaculty

10) Revive and implement RVUs andcitizenship metrics

LOW

9) Expand faculty developmentinitiatives focused on teaching

10) Create yearly report on education

5) Offer focus groups for faculty with likeinterests

6) Create a Lunch with the Chair Program

LOW MEDIUM HIGH

RESOURCES

ANALYSISOFACTIONITEMSBY

RESOURCESANDIMPACT

IMPLEMENTATION


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COSTS


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IMPLEMENTATION COSTS

The estimated total five-year implementation cost of the Strategic Plan and all of its five goalareas comes to a total of $5,994,192. The yearly costs per goal area are outlined below. Thefiscal year totals represent the cost of performing the action items as outlined in each sectionstimeline schedule.

Year Clinical Care Research Education People Finance

FY 12 520,200 - 61,000 22,000 58,960

FY 13 675,890 61,960 61,000 27,000 108,960

FY 14 727,965 336,649 81,000 27,000 36,960

FY15 819,965 436,649 81,000 47,000 36,960

FY16 921,965 679,149 81,000 47,000 36,960

TOTAL** 3,665,985 1,514,407 365,000 170,000 278,800

** All costs are additive to the previous year.

CONCLUSION


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CONCLUSION

The Executive Committee is proud to presentthis strategic plan for the Department ofMedicine for 2012-2017. The plan allows us tobuild upon our strengths to address ourweaknesses and external threats, and outlines apath to exciting opportunities in all threemission areas of clinical care, education andresearch. It recognizes our people as our most

important asset and provides a roadmap toimprove our finance, partnerships andinfrastructure. Dr. Alexander and the ExecutiveCommittee are confident that successfulachievement of this strategic plan will positionthe Department of Medicine to be a nationalleader and innovator in discovery, high

quality patient care and education.


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DEPARTMENT OF MEDICINE

STRATEGIC PLANNING LEADERSHIP

EXECUTIVE COMMITTEE GREG MARTIN,MD WILSON HOLLAND,MD

R.WAYNEALEXANDER,MD MARK MULLIGAN,MD ADRIANA IOACHIMESCU,MDERICA BROWNFIELD,MD ROBERTO PACIFICI,MD BETH MCCONNELL,MDSTEVEN DONEY JEFF SANDS,MD LESLIE MILLER,MDKATHY GRIENDLING,PHD LESLEE SHAW,PHD SYLVIA MORRIS,MDPAUL HAMMONDS JASON STEIN,MD CAMILLE VAUGHAN,MDTED JOHNSON,MD,MPH PETER THULE,MD MONNIE WASSE,MDELIZABETH KIMBERL EXECUTIVE EDUCATION PETER WILSON,MD

JEFF LENNOX,MD COMMITTEE FINANCE,

JEFF LESESNE,MD ERICA BROWNFIELD,MD INFRASTRUCTUREDOUG MORRIS,MD WENDY ARMSTRONG,MD AND PARTNERSHIPSMARK NANES,MD LISA BERNSTEIN,MD COMMITTEEJEFF SANDS,MD SHAHED BROWN W.ROBERT TAYLOR,PHD,MDJASON STEIN,MD DOMINIQUE COSCO, KEVIN ANDREWSROBERT TAYLOR,MD LORENZO DIFRANCESCO,MD STEVEN DONEYBRYON WILLIAMS,MD DAN DRESSLER,MD ANA MARIA GALVEZ,MPH

CLINICALADVISORY DUSTIN SMITH PAUL HAMMONDS

TEAM JONATHAN FLACKER MICHAEL KILGORE

TED JOHNSON,MD,MPH STACY HIGGINS PAIGE MARTINMATTHEW BEDNAR DANIELLE JONES LEAH PHILIPS

NANCY COLLOP,MD LINDA HOWELL DAVID PROPP,MDLINDA DELANEY,RN KAREN LAW SANDRA TALLEY,MPHANA MARIA GALVEZ,MPH KIMBERLY MANNING,MDDAVID GUIDOT,MD RICHARD PITTMAN,MDJEFF LENNOX,MD SUSAN RATLIFFJEFF LESESNE,MD DAVID SCHULMANDAVID NEUJAHR,MD MAZIAR ZAFARIANDREW SMITH,MD JENNIFER ZRELOFF,MDKATIE SPARKS,RN FACULTY DEVELOPMENT

RESEARCHADVISORY COMMITTEE

TEAM KATHY GRIENDLING,PHD

KATHY GRIENDLING,PHD ERICA BROWNFIELD,MDR.WAYNE ALEXANDER,PHD,MD JENNIFER CHRISTIE,MDFRANK ANANIA,MD DAN DRESSLER,MDKATHARINA ECHT MONICA FARLEY,MDJENNIFER GOOCH MICAH FISHER,MDC.MICHAEL HART,MD JENNIFER GOOCH,MD


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APPENDIX 1

CLINICAL CARE:

Initiative 1, 2 & 4: 1) Develop and implement quality programs in both inpatient and outpatient settings.2) Disseminate innovative discoveries and best practice models throughout themedical community and society,4) Create pilot accountable care unit/clinic structures with which to deliver the qualityinitiatives determined in action item 1,

Action Item: Developing and Implementing Quality Programs

The DOM must build out care models, i.e. structure and process, capable of reliably anddurably producing the best possible outcomes and value. The DOM does have a successfuldemonstration project that shows the benefit of this approach the implementation of unit-based interdisciplinary care teams co-managed by a physician unit director and nurse unit

manager, so called accountable care units, or ACUs.

Each ACU, defined as a geographic care area consistently responsible for the clinical,service, and cost outcomes it produces, has four core features: 1) unit based teams ofphysicians, nurses, and allied health professionals to build consistency and mutualaccountability); 2) patient-family centered workflow guided by the principle of prepared,proactive teamwork; 3) unit-level performance and outcomes data; and 4) activemanagement of unit outcomes by physician and nurse co-directors.

Time Span: This program will be progressively adopted by the DOM over the next 5 years. Itis the expectation of the CAT working group that these policies will continue to existindefinitely, with continuous revision.

The DOM ACU Demonstration Project has generated data supports a strategy of unit-basedre-design of structure, process, and management controls. Specifically, in the 12 monthsafter reorganizing a hospital ward at Emory University Hospital into an ACU, severalcompelling clinical and utilization outcomes have improved.

This proposal will require both tangible financial resources (see below) as well as strongengagement from all of the clinical divisions and many clinical faculty within the DOM. Weanticipate that eventually each division will require that the division director be invested inthis process as well as multiple quality representatives per division (perhaps 20% of thedivision). We estimate that ultimately this initiative will be cost neutral or even costeffective, but this estimate requires some assumptions. First, the quality initiatives here willbe the substrate used for external funding from sources such as the National Institutes ofHealth from institutes such as the AHRQ. Second, we believe that in demonstrating our

commitment to established quality metrics, the DOM will improve reimbursement forservices paid by CMS and other third party payors. Third, improvement in health of ourpatients will decrease expenses.

Time Span: Year 1: Key decisions: Division directors will select one quality representativeper clinical unit and engage faculty and decide upon which initial quality metrics are to betracked within each unit. This will initially be piloted within 2 units per large division and 1unit in smaller divisions.


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Key infrastructure: Working with IT quality metrics will be directly integrated into the EMRsystem. By the end of the first year, the system will track compliance with quality metricsat the individual provider level, the individual patient level, the geographic location andwithin divisions.

Key innovation: By the end of year one, the EMR system will be integrated with the qualitymeasures chosen by each division. This will include power-plans that directly link apatients problem list (using either CPT or snowmed codes) to the provider and a qualityinitiative. Ultimately the EMR interface will allow the provider to interact with the qualitymetric of interest and this data will be tracked in the clinical data warehouse.

Pilot ACUs will require participation by multiple members of the hospital staff. For the DOMACU at EUH, the SIBR rounds consist of an attending physician, nurse manager, socialworker, pharmacist, and physical therapist. Development of ACUs does not requireincreased funding to support these services (as these services already exist), but for an ACUto be successful, parties beyond those in the DOM have to embrace this concept. Therefore,our expectation is that the quality representative at each pilot ACU will need to devote asignificant amount of initial effort to educate other members of the team and generated

engagement to this process.

Year 2: Implement the quality model in year 1 into two additional clinical units per division.Development of divisional dashboards that tracks compliance with quality metrics asdecided upon in CAT action item 1. This will require coordination with IT, theprogramming architects for EMR and the data warehouse. The dashboard will indicatewithin divisions how closely quality targets are being met. Divisional reports for thequality dashboard would be run no less than twice a year and the results disseminated toindividual members of each division. The primary responsibility for making the divisionalreports will be through the administrator in the DOM (see personal below).

Key infrastructure: Work with research and IT to improve data warehouse to providenecessary data to physicians and leadership with reliable and accurate reports.

Year 3: Implement quality infrastructure within all clinical units in all divisions. Work withleadership to align all incentives and compensation plans within respective units. Roll outof initial reports on compliance using the compliance dashboards for each division. Thespecifics of how these data are disseminated at the divisional level and individual level areaddressed in action item 2 of this proposal.

At the end of year 3, we propose to actively survey the DOM faculty on their experience withthe tracking of these quality metrics. The primary tool for this will be surveys, butadditional tools will include the use of one of the Medicine Grand Rounds as well as eachdivisions Meet with the Chair Day. This feedback will be used to solicit new metrics to beadded to the Dashboard, as well as consideration of removal for quality metrics for whichthe utility of such measures is doubtful.

Year 3-5. The expectation is that adherence to quality metrics will increase over time. Thiswill be directly tested every year. The anticipated successful results are discussed in themetrics section.

Metrics: Given that the key quality measures that each division will embrace have not yet beendetermined, we do not yet have data on the degree to which DOM faculty adhere to establishedquality metrics. Between year 1 and 2, we expect to generate baseline data from which futurecomparisons will be made. We acknowledge that the faculty will be informed that thesemeasures will be tracked and this may dramatically affect behavior by itself (the Hawthorne


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effect). At the division level, the expectation is that quality measures, which are division-specific, will be embraced by all divisions. Further, the expectation is that all divisions willutilize the quality dashboards and will track adherence to quality measures by all faculty.

This endeavor will involve significant human and real capital. The data output will beinvaluable. Our expectation is that by year 2, this project will yield sufficient quality substratefor at least 1 RO1 level health care quality grant, with much of the direct and indirect costsused to continue this endeavor.

Full-Time Equivalents (year 1):1) ACU Medical Directors: Each ACU Medical Director will have 15% less clinical time to enable service as a

frontline manager. In year 1, the larger divisions will have two geographic units each with a medicaldirector. Smaller divisions will have a pilot in only 1 unit.

2) Director, Data Management 1.0 FTE3) Biostatistician/clinical epidemiologist (employed directly by the DOM) 0.3 FTE

Title FTE Total Salary & Fringe

ACU Medical Directors, cumulative (physicians) 2.55 $ 520,200Director, Data Management (data analyst) 1.0 $ 92,000

Biostatistician/clinical epidemiologist (MD MPH) 0.3 $ 65,490

Data Analyst 1.0 $ 52,075

TOTAL $ 729,765

Ongoing operating costs:Each additional year is estimated to cost an additional $30,060 per quality representative. Note that most ofthese costs may be offset by improvements in clinical revenue, as well as potential external grant funding.

Initiative 3: Improve service through operational efficiency and resource optimization

Action Item: Create consistent and improved care through care pathways across the DOM, as developed byexperts in each division within the Department of Medicine. Each division will nominate 1 qualityimprovement (QI) project to be implemented departmental wide and will also develop and initiate at leastone division-specific QI project.

This initiative will assist in developing a culture of embracing quality improvement in the DOM,which will better prepare faculty and staff for governmental or payer mandated payforperformance or accountable care organization standards. Accomplishing this task will assist theDOM and the individual divisions in identifying personnel to develop and implement suchstrategies, and in assessing the resources required to do so.

In order to improve care standards and operational efficiency, each division should suggest oneprocess that could improve patient care, throughput, or reduce waste that can be implementeddepartment-wide. The division should also identify, at a minimum, one important disease state orhighly variable process under their purview.

In order for the standards to be effective, there must be a method for updating these pathways atleast biannually, and for feedback from clinicians outside the division to be considered. Facultymust also be aware of the standards, be able to access them rapidly at the patient care setting,have their efficiency improved through the use of standardized templates and order sets, and seemeasurable outcomes in both service delivery and patient care.


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Initial identification of departmental-wide and division specific projects will take place over thefirst 6 months. For the departmental wide project, the chief quality officer will appoint adepartmental committee to identify the top quality initiatives and develop an implementationstrategy over the next 6 months. The departmental initiative will begin at Year 2 withdepartmental analysis yearly thereafter. Decisions about beginning other initiatives will be at the

discretion of the departmental QI committee pending the outcome of the initial project.

For the divisional project, the implementation should begin at 6 months with regular assessmentsat 6-month intervals. As with the departmental project, initiation of a second project would be atthe discretion of the divisional subcommittee with the hope that the original and subsequentprojects would at a minimum span the following five years.

The departmental committee chair will oversee the departmental project(s) and act as aconsultant to each divisional committee. It is anticipated that this person will require 0.5FTE toact in this role. In addition, 2-3 FTE will be needed to assist with implementation, data entry andmonitoring. It is anticipated that baseline data will have to be acquired as well as ongoing datathroughout the life of the projects. These personnel will need access to all hospital systems EMR

as well.

FINANCES:Please include estimations and explanations for the following financial areas. An excel file should beattached.

Administrative Support:1. Departmental Chair to assist with major departmental initiatives and to act as liaison for divisional

projects (0.5 FTE)2. Each division will have a chair or champion to help with implementation of departmental initiative

and development/implementation of divisional initiative, I figured about 2 hrs/week = 0/05 FTE x10 division (0.5 FTE)

3. Data entry and administrative personnel to get all projects up and running, both departmental anddivisional (2.5 FTE)

4. Partial FTE to develop software programs and/or EEMR links to get data collected and maintained(0.5 FTE)Initial Investment: $356,000

Action Item 3 FTE COST

STAFF

Committee Chair 0.5 $ 102,000.00

Divisional Champion (0.05 each div x 10) 0.5 $ 102,000.00

Data entry 2.5 FTE $ 96,900.00

Programmer/EMR Software Architect 0.5 $ 90,200.00

OTHER

Start Ups Cost - $ 10,000.00

Ongoing $ 25,000.00

TOTAL YEAR 1 $ 426,100.00


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Initiative 4: Create a sustainable model for inpatient care with mechanisms for subspecialty involvement

at both inpatient and outpatient transitions

Action Item: Communication standards, both between providers and between health systems andproviders, would be helpful to assure best possible clinical outcomes.

The DOM believes that great clinical communication is essential to excellent quality patientcare. The DOM can and should be the leader in this effort. Each major entity within the DOMhas some communication standards that exist and are required, or work in concert with otheraccrediting bodies such as the Joint Commission; and these standards should be met. Acomprehensive departmental approach will include these minimal standards. We suggest alocal group that recommends specifics for our entities that both complies with theirrequirements and will help to improve patient care and insure proper safety.

In order to improve the quality of our clinical care, all Department of Medicine faculty should bepracticing in a work environment where there are quality monitors and metrics. A concertedeffort in dissemination of such monitors and metrics is essential to ensure that the faculty areutilizing these measures. In order for the faculty to aspire to these metrics, faculty membersneed to be included and notified in advance and in writing as to how these indicators were

determined and measured. The faculty, including Division Directors, should all be included inthe determination of applicable quality metrics per Division and unit, thus, unifying the qualitygoals in each area. The Faculty should be offered regular and actionable feedback on theirindividual performance no less than quarterly, and should be allowed to comment on theapplicability of these standards to our unique clinical practice settings. Additionally, it isessential that faculty be provided with information that allows them to compare theirperformance on quality measures to peers in the same field.

In order to improve outcomes for our patients, all Department of Medicine faculty should beemploying effective communications practices. A concerted effort in making certain that strongpractices are agreed upon, adopted, monitored, and improved is essential to ensure the bestoutcomes. There is recognition that many sites have communication directives that may be sitespecific, however, a smaller group that can create common standards in this environment will

be beneficial to patients and families.

In order for the faculty to embark upon such an endeavor, the following must take place: 1)input from faculty and partners as to their assessment of the current state of communication; 2)metrics about desired communication practices; 3) a review of potential models forcommunication (such as SBAR); 4) an agreed upon method for communication specific to thepractice site; 5) audits for adherence to an agreed upon plan; 6) aligning incentives for strongperformance with the plan; and 7) readjustment of the plan.

The faculty should be offered regular and actionable feedback on their individual performanceno less than quarterly. They should be allowed to comment on the applicability of thesestandards to our unique clinical practice settings.

Timeline for all of the action items above and their sub-action items: (Year 0.0) Health system(s) Department contract on timely roll-out of quality performance

measures and quarterly reporting

(Year 0.0) Name DOM quality program leaders at all sites and all Divisions

(Year 0.25) Designation of Inpatient Accountable Care Units (ACUs) at each site


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(Year 0.40) Division led care-path initiative for identified most significant problem/highlyvariable care process in the area/field

(Year 0.5) Division Director / Health System collaborative for ACOs for tracking metrics (Year 0.75) Designate physician director/ nurse manager pairs; 2 units per large Division, 1unit per small (Year 0.8) Internal communication and consultation standards conference (Year 1.0) Integrate quality metrics and power plans into EMR (Year 1.1) Summer DOM Grand Rounds series on quality (Year 1.2) Evaluation of timeliness on quality measure contracts and reporting (Year 1.4) Roll out of intra-communication standards and monitoring plan (Year 1.5) Unit-level performance and outcomes data first annual conference (Year 1.75) Division led care-path initiative roll out to Department level: 2nd item for

significant improvement in patient care, throughput, or reduction of waste

(Year 1.8) Roll out of communication standard to cross-department processes (Year 2) Two additional ACU clinical units per Division (Year 2.2) (Year 2.5) Department QI Committee review of DivisionalDepartment initiative roll-out (Year 3) Quality infrastructure into all divisions; Integrated into Meet with Chair Day (Year 4) Expansion of number of quality metrics plans for ACU


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APPENDIX 2

RESEARCH:

Initiative 1: Support innovation, integration and translation of basic discoveries into clinical care andhealth care delivery

Action Item:Create pilot seed grants (designed to facilitate the acquisition of extramural support for basicand clinical research efforts of beginning faculty) with two Principal Investigators (PIs) who have neverworked together before. Preference will be given to researchers from different divisions and toapplications with both a basic science PI and a clinical PI.

Increase collaboration across divisions, stimulate interactions that may not have otherwisetaken place, which can lead to additional awards and increase external grant award success.Estimated dollars awarded versus dollars returned is just under 1200% based on data fromcurrent DOM seed grant program (see Appendix A)

The seed grants will be offered once a year for 5 years with the hope of continuing the programby obtaining philanthropic support.

Cost: $100,000 per year for five years, $500,000 total (two seed grants offered per year at aone-time award of $50,000 each). 0.05 FTE Program Coordinator administer the program

Targets:1) Seed grants announced, reviewed and awarded (annually)2) Progress reports collected (annually)3) Metrics analyzed yearly after year 3

Outcomes will be measured in terms of:1) Quantitative data - dollars awarded versus dollars returned, and2) Qualitative data impact on the recipients career, successes that the seed grant allowed

the recipient to achieve (e.g., publications)These data will be collected through mandatory annual progress reports from the recipients.(See Appendix B).

Initiative 2: Streamline research administrative procedures

Action Item:Work with Office of Business Process Improvement (OBPI) and Administrative RestructuringCommittee (ARC) to improve research administration.

Preliminary work by ARC has been completed, and recommendations have been submitted toDr. Alexander. These recommendations include items that need to be addressed within the

DOM and suggestions for how to improve research administration in the central SOM anduniversity offices. This action item addresses several deficiencies noted by ARC. Briefly,

1. DOM research administration is understaffed.Solution: Targeted hiring to improve efficiency.

2. Research staff need additional training and career development opportunities.Solution: Create online and in person training sessions by Saundy Berry, and create career

paths for research administrators.


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3. Post-award monitoring is time-consuming and labor intensive and is not being completed ina timely manner, if at all.

Solution: Rests partly with central offices, but includes development of reporting tools, andhiring additional personnel.

4. Pre-award processing is inconsistent and drawn out.

Solution: Rests partly with central offices, but includes greater accountability and monitoringand standardization of departmental processes.

Benefits:1) Improved speed of proposal routing2) Back up staff to cover during vacations and vacancies of regular staff3) Consistent processes across divisions4) Fewer errors in submitted proposals due to increased training5) Decreased staff turnover due to clear career paths6) Ability to keep up with growth in grants and increased regulatory requirements7) Adequate oversight of post-award spending and compliance, thus reducing risk8) Timely post-award monitoring and reporting to PIs9) More user-friendly, accurate electronic systems for grant management10)Clearer understanding of what standards are necessary for each job title

Resources:1) Staff:

a) Two new, highly specialized staff for the central office for post-award monitoring,account cleanup and divisional backup

b) Additional FTEs for understaffed divisions (1 FTE Cardiology, 1 FTE ID/Geriatrics, 0.5FTE Renal)

2) Space: Office space needed for central staff3) Time dedicated to creating training and mentoring programs for research director4) Software: Purchase o

dom strategic plan 2012

Documents