Below is a list of frequently asked questions and answers about the Transformative Excellence in Academic Medicine (TEAM) initiative for the School of Medicine and SLUCare.
Initiative Two of the University’s strategic plan calls for SLU to become “a market leader in health promotion and the highest quality medical care.” The TEAM initiative will focus on future growth to help us achieve that strategic initiative as we expand ways to integrate our clinical, research and education missions.
Through TEAM, we will seek to identify opportunities for improved patient experiences, operational/organizational efficiencies, cost savings and revenue growth that will help us pursue the strategic priorities of our academic health care practice. We will be poised to capitalize upon SLUCare’s position as an academic medical practice, a significant strength that sets us apart from most other medical groups in the region.
The arrival of a new medical school dean/VP for medical affairs in January 2017 provides a good opportunity to review SLU’s entire academic health care enterprise. In addition, with the groundbreaking of a new state-of-the-art hospital on August 31, we have the setting to imagine new opportunities for our medical school and physician practice. We are working in an increasingly complex and dynamic health care environment. Engaging in this collaborative process now will help us improve how we operate so that we are better positioned for success not just for today, but also for the future.
TEAM will take a deeper look into the operations of the medical school — as well as SLUCare. The Operational Excellence Program is now focused on improvements to university-wide operations and growth strategies. TEAM will help us address the bigger questions we need to ask moving forward as an academic health care system, an important part of the university mission. It is important to note that SLU’s clinical practice and academic responsibilities are significantly intertwined, and our success depends on the synergies we create to enhance our alignment, increase our productivity and advance our national reputation.
The program will broadly examine our structure and function across the clinical, research, education and service missions in the School of Medicine and SLUCare. This comprehensive evaluation will help us meet the needs of our patients, faculty, students, staff and stakeholders, all of whom will be partners and share in our success. Access, quality and an organizational structure that supports both are key in the transformation.
A Steering Committee comprised of representatives from the School of Medicine, SLUCare and senior representatives of the University will set the tone and focus for the initiative, providing recommendations to Dr. Kevin Behrns, dean of the School of Medicine and vice president for medical affairs. The TEAM Medical Advisory Council, seven senior physicians from various clinical and research departments, will share the expertise, critique data, provide input and facilitate communications while also providing recommendations and guidance. The Executive Leads will oversee the process that keeps TEAM moving forward, coordinating the efforts of faculty and staff who are responsible for specific aspects of the TEAM initiative. Faculty Advisors will engage faculty to participate in initiatives and represent the faculty perspective.
Decisions will be driven by data. TEAM began with a comprehensive assessment of all School of Medicine and SLUCare operations — a process that included collecting data, conducting surveys, interviewing stakeholders and reviewing performance benchmarks. Based upon those findings, the Steering Committee and TEAM Medical Advisory Council offered guidance to Dr. Behrns, who will make decisions related to TEAM. Dr. Behrns will coordinate decisions with President Pestello, as needed.
All medical school and SLUCare faculty, clinicians and staff were asked to complete a survey that focused on how the community’s culture supports our mission and goals. We also have established other ways to share input and ask questions, including open forums, department meetings, small group dialogues and one-on-one interviews and through emails.
We will communicate extensively because true transformation can occur only if we all understand and are a part of the process. In identifying opportunities to improve access and quality and more closely align research, education and patient care, we’re forming teams of faculty and staff to seek and implement solutions. Our goal is to implement change as thoughtfully and rapidly as possible, and we are committed to appraising you every step of the way. Your input, comments and questions along the way are encouraged.
This will be a multi-year program, which could take about three years. We have collected data, reviewed performance benchmarks, interviewed stakeholders, held open forums and conducted focus groups. We have designed a structure and developed action plans that will allow us to reach our goals. We have begun delivering on our promise, implementing change thoughtfully and as rapidly as possible to realize our potential.
We are seeking to become a regional leader in delivering world-class tertiary and quaternary care through our compassionate, patient-centered approach to medicine. In undertaking this program, we will strive to enhance the patient experience, particularly through improved access and measures focused on quality improvement, which are a top priorities.
We will set the standards for quality patient-centric care and academic excellence, become the desired destination for faculty, staff and students by ensuring they are developed and empowered, and grow to achieve leading financial results and a leadership position in the market, benefiting our mission, faculty and staff.
TEAM is an all-encompassing transformation that touches on many aspects of the School of Medicine. TEAM focuses on six key areas: clinical quality; patient access; research and education; integrated organization; supporting capabilities; and strategic planning. Within each area are specific initiatives to meet goals. Together the 22 initiatives will drive a culture of excellence and accountability and deliver quality and growth in all we do.
Our very identity informs our emerging mission, which is “for you, we teach research-inspired, high-value, humanistic care.” It fuels our commitment to care for those who are in need, including those who are un- or under-insured. Our faculty will continue to pass along that tradition as they supervise our medical school students in activities such as caring for those who otherwise could fall through the cracks at our student-run medical clinic, the Health Resource Center. Our Jesuit values call upon all of us to ask the hidden questions, motivating students to think critically and prepare to create new and better medical protocols that will advance the practice of medicine.
Through our accreditation remediation plan, we will improve our medical education program and our processes. In the coming months, we will also craft a strategic plan designed to articulate our mission and vision for the School of Medicine to ensure that we continue to provide an excellent educational experience to our current and future students. These efforts will inform the larger, more comprehensive TEAM initiative, which ultimately will strengthen the medical school.
SLU is working diligently and as quickly as possible to correct issues that resulted in our School of Medicine being placed on probation. We developed a robust action plan and will answer detailed questions from the LCME, which will guide its follow-up site visit that is expected to occur next summer. The LCME's decision on lifting the probationary status, which is based on the site visit and answers to its questions, could come as early as fall of 2018, and no later than February 2019. It's important to note that our medical school remains accredited.
We are using our LCME remediation work as an opportunity to emerge as a more innovative and better school of Medicine and already have begun implementing aspects of the plan to strengthen our medical school.
Staffing levels and reporting structures will be evaluated as part of this program. It is too early to know whether adjustments will be recommended. Any decisions regarding personnel will be taken by our leadership, and potential changes to our organizational structure will be considered in a manner consistent with SLU’s mission and values.
It is too early to tell what impact the changes will have on individual positions. Our goal for this program is to achieve growth, but we will need to look differently as an organization to accomplish that. As the initiatives move forward and a clearer picture evolves on how this will impact people, we will be open and transparent about it. If decisions result in job eliminations, we will handle those decisions with care and professionalism and in a way that aligns with our values and principles.
Institutes are organized around conditions or concerns that reflect the patient perspective rather than the traditional boundaries of subspecialties that dictate departments and divisions. Institute team members work together to solve a patient’s underlying problem and deliver great outcomes, enhance our academic offerings, and propel research and scientific discover.
The dean and executive leadership team worked closely with the Medical Advisory Council – as well as other representatives and stakeholders across the School of Medicine – to define what the institute model will look like for SLU. In addition, as they researched institutes, they interviewed several leaders from other institute-based programs, such as the Cleveland Clinic. Throughout the process, the team has been open and receptive to input.
Our revised patient-centric, institute approach will be fundamental in integrating patient care, research, and teaching – and ultimately, in helping us to achieve our vision of quality and growth for the School of Medicine. Institutes place the patient at the center of all that we do, creating interprofessional teams that collaborate across disciplines and between areas of specialization. The institute model also helps us leverage scale, share a common infrastructure, and focus on growth, which ultimately will improve our financial results. Our model increases opportunities for researchers and clinicians to collaborate to advance our research capabilities. It enhances the education of our students, who gain deeper knowledge as they see this new approach to patient care and research modeled. This more integrated approach also aligns more effectively with our SSM partners.
Based on workshops, feedback and external research, we have identified 11 institutes and the groups within them. Institutes are: neurological diseases, heart and vascular, cancer, women’s, children’s, immunology, primary care, acute care, GI/liver/transplant, specialized care/surgery and diagnostics/services. Details are on these slides. Please note that we have not formalized names.
We recognize that being affiliated with an academic department is important to our faculty and staff. Departments will continue to exist and will be incorporated within institutes as part of a matrix organizational model. As a practical matter, faculty will work and practice through an institute and still belong to an academic department. Academic departments will focus on teaching, training programs, and continuing to develop our faculty through continuing education and extramural organizations. Institutes will manage the institute-level strategy, including the delivery of patient-centric care and financial results.
Academic department chairs will focus on teaching, training programs, and continuing to develop our faculty through continuing education and extramural organizations – within their given discipline. The institute directors will define and manage the institute-level strategy, which will include both clinical and research goals across all of the associated specialties and departments.
We are reviewing each clinical faculty member’s area of expertise, and shared each clinical faculty member’s proposed institute affiliation by the end of November. Final decisions for placement of clinical faculty are expected in January. Placement of basic science faculty members will come later.
Generally, faculty titles will not change as faculty members will still be associated with an academic department as well as their given specialty within an institute.
While interim institute directors have been announced, permanent institute leaders have yet to be determined. Specific timing and criteria have not yet been established as the institutes themselves are still a work in process. However, we will look for people with strong leadership skills, who are interested in being innovators in their field. We will look for people who will be able to lead their individual institute, but also recognize they are part of the overall medical enterprise and work collaboratively with other institute leaders to promote the entire medical enterprise.
Yes, we want to teach in a highly collaborative environment that reflects the future of healthcare systems where our students, residents and fellows will care for patients and be leaders. We will prepare our students and trainees to do more than follow standard protocols. We will prepare them to create new protocols to elevate the practice of medicine. We also will teach medical, nursing and allied health students to collaborate in caring for patient through our interprofessional education approach.
Departments are key and central for professional identity and for education program training, and will continue to exist with institutes as part of a matrix organizational model. Residencies will be housed within departments.
We are looking at ways to enhance the Ph.D. and M.D./Ph.D. research programs, which will continue to operate within departments.
We will make decisions based upon our shared values, mission and principles that put the patient first and call for us to treat each other with dignity and respect. In creating 11 institutes, we are not building 11 new siloes. We will operate as a matrixed organization that is committed to patient-centered care, high quality education and research, which will drive leading quality and high financial performance.
We will measure our success based on reaching our goals. We will deliver high-value patient-centered care. We will attract the best and brightest as the preferred destination for faculty, staff and students. We will achieve high financial performance.
SSM Health fully supports our move to the institute model.
Not in the immediate future, but perhaps eventually. The medical center campus will look different with the construction of our new ambulatory care center, which can be configured to accommodate institutes; SSM Health Saint Louis University Hospital, which is set to open in 2020; and Biology Extension Building (formerly the Imagine School).
Our Board of Trustees and president have set a strategic priority for the university – increase our sponsored research activity. We currently are underperforming when compared to other private universities with medical schools. Our compensation for research faculty does not align with trends in research funding. Some of our researchers are fully supported by the university. For SLU to be considered a research institution and not an institution where research is conducted, we must increase our research funding. Doing what we’ve always done is not sustainable. We must and will make a change.
We will focus on what we already do well and on areas of promise. We will make targeted investments and pursue additional large programmatic grants in established research programs of excellence that already are thriving. At the same time, we will develop new research programs of opportunity to fuel growth in clinical programs, faculty recruitment and student engagement.
We envision all research faculty reporting to an institute director who will oversee the research component of their work; the academic chair will coordinate the educational programs supported by the faculty member. Institute directors are charged with furthering SLU’s research mission as well as bolstering the reach of our clinical practice. Research funding support (external sponsors and university-funded) will be incorporated into the budget of institutes and hard dollars (primarily for our educational mission) will be part of the budgets of departments. Institute directors and academic chairs will work closely together to ensure the success of researchers. Because institute leadership will be accountable for developing their scientific programs, it is in their best interest to be supportive of research faculty as well as attentive to clinical needs. Our vision for the School of Medicine integrates these missions and does not separate them as parallel organizations.
We are taking a phased approach to making the changes to improve our School of Medicine and SLUCare. We first focused on the clinical piece to advance collectively as a School of Medicine, and now are putting equal emphasis on research programs. In the coming weeks, we plan to send a survey to each researcher. We will outline the institutes where we see most researchers aligning and ask for feedback to make sure we are not missing anything. We also will solicit fresh ideas and request each researcher’s suggestion for his or her alignment and for research teams. We already have been meeting with researchers and meetings will continue. We see the alignment process as highly collaborative.
To maintain a pipeline of strong researchers, we will continue to support mid-level scientists. Sometimes that support means providing bridge funding between projects, a decision that will be made by institute directors who will have the resources to do so. Further, mid-level scientists will continue to have a strong relationship with their department chairs, who will be among their best advocates to institute directors. The goal is to broadly support and advance research across the entire School of Medicine instead of taking a siloed approach that is defined by departments or individual investigators.
Yes, certainly. You can continue your research collaborations with clinicians who are not affiliated with SLU, but we want to build more and highly effective teams of SLU researchers and clinicians who will work together to find better treatments and cures for patients. The teams can build upon our scientific knowledge and expand our areas of expertise. We plan to add more clinical scientists who have research funding to our faculty. Who we hire next will say a lot about who we become and how seriously we believe in clinician-scientist collaboration.
Yes, we will continue to do discovery science. Good basic science is a must-have for a medical school, as our students depend on experts and effective instruction in many scientific disciplines. Translational findings start with a basic science idea, so that discovery work continues to be integral to the research process. It is important to recognize that grant funding is growing for research that has clinical application and a relationship with a clinical partner. Grant funding for discovery science, while essential for advancing science and critical to humankind, is not growing due to shifts in federal priorities over the past couple decades.
They will be part of one institute – the institute that reflects the lion’s share of their work – but can continue to work on projects in multiple areas. We will work with scientists to find the best alignment, surveying and meeting with them. Our goal is to increase research funding.
Yes, those investments in research will flow through institutes.
We want to provide services that facilitate and simplify the processes of submitting grants and supporting researchers. We see those functions as being centralized and will begin working on details in early 2018.
We do not see any material changes to the tenure and promotion process for faculty members. It is expected that a promotion and tenure portfolio for a faculty member under consideration would include contributions from academic chairs and institute directors who would be among many attesting to the quality and significance of scientific work.
No decisions have been made yet. However, we anticipated that some staff positions will be moved into centralized units that will support all of the institutes. There will also likely be some staff positions embedded within the institutes. These types of decisions will be made after the first of the year, and as plans develop we will share more information. Final decisions on the TEAM initiatives will be made by the program sponsors, Dr. Behrns and Dr. Heaney.
Our new centralized Clinical Affairs organization will provide infrastructure support to institutes, such as clinical staffing, scheduling and our patient contact center. Staff who work in these areas will report to the Clinical Affairs organization. This more efficient approach will offer talented staff members increased opportunities for professional development and advancement and allow us to better manage our faculty to focus on research-inspired, high-value humanistic care. Not all support staff will be centralized; some will work within institutes. We currently are working to determine the right institute placement for clinical faculty, and plan to focus on staff placements in January 2018. As was the case with faculty, staff members will have opportunities to provide input and feedback.
One of our guiding principles is to be as open as possible about the process, and we are committed to seeking significant input from the community. Stakeholders will provide input via interviews, focus groups, and open forums. Throughout the process, Dr. Behrns and others will provide regular updates. Information also will be available on our dedicated website, slu.edu/team. In addition, faculty representatives Ravi Nayak, M.D., and Sameer Siddiqui, M.D., are meeting one-on-one or in small groups with those interested in discussing TEAM and TEAM leaders are available to attend department meetings. Those with suggestions or comments can share them through email@example.com and in the feedback portion of on our website.
Standing pat is not an option. The field of healthcare is in the midst of tremendous change and we must change accordingly to keep pace. We have great people who are committed to moving us forward, and they will be instrumental in leading us to success.