2012

Strategic Plan
Department of Medicine Emory University
Presented to the Executive Committee May 2012

Dept of Medicine Emory University 1/1/2012

CONTENTS

TABLE OF CONTENTS

I. II.

ABOUT THE CHAIR THE DEPARTMENT OF MEDICINE AND ITS DIVISIONS

III. MISSION AND VISION IV. CORE VALUES V. OVERVIEW OF THE STRATEGIC PLAN VI. CLINICAL CARE VII. RESEARCH IMPACT VIII. TRAINING & EDUCATION IX. PEOPLE X. FINANCE, INFRASTRUCTURE AND PARTNERSHIPS XI. INFRASTRUCTURE & CONCLUSION XII. APPENDIX
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BOUT THE CHAIRMAN

R. Wayne Alexander, M.D., Ph.D. is the R. Bruce Logue Professor and Chair of the Department of Medicine at Emory University School of Medicine. Dr. Alexander received his Ph.D. in Physiology from Emory University and his M.D. from Duke University. His residency and cardiology fellowship training were also at Duke University. He was a staff associate at the National Heart and Lung Institute from 1971 to 1973. He was Associate Professor of Medicine at Harvard and the Brigham and Womens Hospital when 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 at Emory in 1999. He has been Vice President of Research and on the Board of Directors of 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 treatment and prevention of cardiovascular diseases. He has broad interests in health maintenance and preventive medicine. Many of the 30-plus trainees from Dr. Alexanders laboratory are now leaders of academic medicine in the United States and worldwide.

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 items for direction, and benchmarks for measurement of success. Emory Universitys Department of Medicine excels in the areas of education, clinical care and research. Our distinction in these areas is exemplified through our residency and fellowship rankings; regional, national and international academic recognitions; clinical reputation and research standing. The unparalleled caliber of our exceptional faculty makes all of this possible. Nevertheless, we must not rest on our laurels but must strive to continue to scrutinize all of our programs to ensure unremitting excellence. We must continue to improve the quality of our clinical care, increase the number of awarded research grants, create new and innovative faculty programs, optimize our administrative and resource management and create sustainable business models for all of our divisions. This strategic plan outlines how we intend to reach these goals in the coming years. The departments executive committee led this initiative in order to ensure that all of our missions are represented and that our leadership shares and supports the priorities, goals and initiatives set forth here. Numerous faculty and staff from across the department 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. I look forward to the outstanding department that we will become because of your dedication and passion.

Sincerely,

R. Wayne Alexander

position in research, and build on the strengths in our current programs, our strategic plan illustrates a future focused growth

To maintain our leading

THE DEPARTMENT OF MEDICINE

ABOUT THE DEPARTMENT OF MEDICINE

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

he Department of Medicine (DOM) is steeped in a rich tradition of excellence, built on the legacies 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 DOM has pioneered discoveries in medicine, education, scientific and clinical investigation, and clinical care. Our program offers students and residents the latest knowledge in treatment practices, scientific theories, research, and patient care. Located in one of the country's leading research institutions, Emory University, the DOM offers a stimulating atmosphere of scholarship that leads to success across many medical disciplines.

The Department of Medicine is known for teaching excellence, as evidenced by the historic contributions of Drs. Willis Hurst and Juha Kokko, both former chairs. Our Residency Training Program is the signature educational component of the department, and is complemented by superior subspecialty fellowship training in each of the divisions. A broad range of hospital and outpatient clinical teaching is conducted at six university-owned or -affiliated hospitals. Moreover, our access to a large and varied patient population provides residents and fellows with intriguing and often unique training opportunities. Our goal is to ensure a program dedicated to excellent teaching in the context of superb clinical care. Our residents routinely receive a 100 percent pass rate on the American Board of Internal Medicine (ABIM) exam, a reflection of our success. The faculty, fellows, and residents also conduct a significant portion of clinical teaching for Emory medical students. The Department of Medicine faculty receives the largest portion (20 percent) of the School of Medicine's extramural research funding and accounts for 16 percent of the university's sponsored research. We maintain a sustained effort to recruit the best researchers in our divisional areas and to invest in all ongoing programs. We also enjoy close collaborations with other on-campus and sister institutions, including the Yerkes Regional Primate Research Center, the Centers for Disease Control and 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 with diabetes at Grady Memorial Hospital. The Atlanta VA Medical Center is recognized for its clinical programs in Pulmonary and Critical Care Medicine and the treatment of HIV/AIDS. These areas reflect the comprehensive range of our clinical programs. Excellence is our standard in delivering care to patients. As we approach the next decade, we have developed a strategic plan that builds on our strengths and guides us to continually enhance the teaching, research, and clinical service missions of the department.
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STRUCTURE OF THE DOM

The Divisions
DIVISION OF CARDIOLOGY W. Robert Taylor, M.D., PhD
Emory University School of Medicine has a long-standing history of contributions to modern cardiology. Emory is recognized as one of the founding centers of interventional cardiology. The basic research program in vascular biology and medicine began in 1988 with the recruitment to Emory of Dr. R. Wayne Alexander, the current Chair of Medicine. Vascular research in the Division of Cardiology at Emory University has grown enormously during the past 20 years. Dr. Alexander recruited a world-class team of researchers who have made major contributions to our understanding of basic and clinical vascular 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 have attained international recognition for research in oxidative stress and vascular disease as well as regenerative medicine. Cardiology is entering an exciting new era in which advances will be made in clinical cardiology, basic cardiovascular research, and interventional and non-interventional technologies. As classical cardiovascular disease syndromes become better understood in the mechanistic terms of modern molecular and cellular biology, diagnostic and therapeutic approaches to cardiovascular disease will continue to change dramatically in the coming years. The Emory Division of Cardiology will continue as a 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 Frank Anania, 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 of interests encompass all areas of gastroenterology and hepatology, including advanced endoscopy, transplant hepatology, nutrition, motility, GI cancers and inflammatory bowel disease. The investigators are focused on the pathophysiological mechanisms of digestive diseases with a fundamental emphasis on clinical care, education and training. The division has four Veterans Affairs merit awards and four R01s . The Division has two advanced fellowships: one in interventional endoscopy and a second three-year advanced fellowship in Hepatology and Liver Transplantation. The GI unit at Emory has a comprehensive care approach for patients afflicted with chronic liver disease involving not just board certified Hepatologists, but also highly skilled surgeons, interventional radiologists, and pathologists.
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STRUCTURE OF THE DOM

DIVISION OF ENDOCRINOLOGY Roberto Pacifici, M.D.
The Division of Endocrinology, Metabolism and Lipids at Emory University is dedicated to research, education, and clinical care in Endocrinology and related areas. The faculty is composed of clinical, translational and basic researchers and educators with interests in all aspects of Endocrinology. Clinical care is delivered at three hospitals, as well as the Emory Clinic. The division has an NIH Training Grant, currently in its 30th year, to support the training of the next generation of Endocrinology researchers and scholars. Ongoing clinical investigations study osteoporosis, Vitamin D, nutrition and diabetes. Basic research into bone metabolism, osteoimmunology, nanoparticles, phosphate as a transcriptional regulator, mechanism of action of estrogen and PTH, gene therapy of diabetes, growth factor physiology and neuro-endocrinology is supported by NIH, VA, and ADA grants. Our fellowship training 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 William T. Branch, M.D.

The Division of General Medicine provides the bulk of clinical patient-care services in adult medicine at Grady Memorial Hospital and provides primary care services at the Emory University main campus and the Atlanta Veterans Affairs Medical Center. The Division's mission encompasses patient-care, teaching and research. The Division's faculty sees patients directly and provides hands-on supervision for every one of our patients seen by the Emory housestaff. We provide 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, the General Medical Clinic, and the Urgent Care Center. There are currently forty-one full-time faculty physicians working in the Division of General Medicine. The Division has expanded to more than double its size in the past five years and will continue to expand slowly in future years as additional patient-care responsibilities are added.

Hospital Medicine Alan Wang, M.D.

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

Emory Healthcare Hospitalists are board-certified internal medicine, family medicine and specialty physicians who specialize in the care of hospitalized patients. They are experienced in diagnosing and managing acute medical illnesses from which hospitalized patients commonly suffer. They also provide medical 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 the specialty, and advance hospital care through research and hospital medicine.

Apart from providing high value patient and family-centered care, the Division of Hospital Medicine helps provide many of the leaders throughout the health system, regionally and nationally in regards to care coordination, utilization, quality improvement, IT and medical education. Highly regarded as one of 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 quality improvement. The COP has been recognized nationally by the Society of Hospital Medicine for groundbreaking 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 Theodore Johnson, M.D., M.P.H.

The Division of Geriatric Medicine and Gerontology is dedicated to advancing the healthcare of the elderly population. Based primarily at the Wesley Woods Center of Emory University and the Atlanta Veterans Affairs Medical Center, the program has also expanded to establish a Geriatrics Center at Grady Memorial Hospital, a major site for training Emory students and residents. Excellence in clinical 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 faculty and 5 PhD researchers.

DIVISION OF INFECTIOUS DISEASES David Stephens, M.D.

During the past decade under the leadership of Dr. Stephens, the Emory Division of 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 Diseases Center, the Atlanta Veterans Affairs Medical Center, Emory University Hospital, Emory Midtown, Emory Orthopedic and Spine Hospital, the Emory Vaccine Center and the Wesley Woods Center, participate in patient care, teaching and research activities. Infectious Diseases Division members have recently garnered 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-funded Clinical Research Center for HIV/AIDS, the Southeastern Center for Emerging Biological Threats
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STRUCTURE OF THE DOM

(SECEBT), the NIH-funded Emory Vaccine Trials and Evaluation Unit, and the CDC-funded Georgia Emerging Infections Program. State-of-the-art HIV/AIDS outpatient care is provided at the full-service, Grady Ponce de Leon Infectious Diseases Center, at Emory Midtown, and at the Atlanta VA Medical Center, where ID faculty run 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 for Fellowship training in infectious diseases and one of the top programs in the country in areas such as epidemiology, HIV/AIDS, vaccine, tuberculosis, transplant ID, travel medicine and global infectious diseases. ID faculty members provide outstanding teaching for medical and graduate students, residents and other post-doctoral trainees. In collaboration with faculty from the Department of Microbiology, ID faculty assist with planning the month-long Prologue II segment of the first year medical school curriculum and approximately twenty-four ID faculty members participate in didactic and small group learning sessions during the course.

DIVISION OF PULMONOLOGY David Guidot, M.D.

The field of Pulmonary, Allergy and Critical Care Medicine is a dynamic area with continuing advances being made in discovering disease mechanisms and treatment. Our division is deeply involved in the development of these changes with internationally recognized expertise in many areas. New advances in pulmonary diseases and critical care medicine are utilized in the excellent patient care provided by the division members in the Emory Clinic. Our training program offers a balance of clinical and bench research experience, as well as superb clinical experience at Emory University Hospital, Grady Memorial Hospital, Emory University Hospital Midtown, and the Veterans Administration Hospital. A major research effort in the division includes basic, clinical and translational research in acute respiratory distress syndrome (ARDS), with particular emphasis on understanding 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 oxidant stress and redox regulation of pulmonary function and aging, lung immunity and asthma, pulmonary arterial hypertension, and the pathology of Cystic Fibrosis.

DIVISION OF NEPHROLOGY Jeff Sands, M.D.

The Division of Nephrology at Emory University School of Medicine is at the forefront of nephrology research, education, and clinical care. The clear strength of the division is an outstanding faculty of more than 30 physicians and scientists, many of who are leaders in their respective fields, and over 10 of who are principal investigators on NIH grants. The division also has several junior faculty supported by NIH K-awards who will become future leaders in their fields. The division is an acknowledged center for teaching excellence, with an NIH Training Grant, currently in its 21st year, to support the training of the next generation of nephrology researchers, both MDs and PhDs. Our faculty consistently win teaching awards within the Department of Medicine and School of Medicine. A broad range of hospital and
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STRUCTURE OF THE DOM

outpatient clinical teaching is conducted at five university-owned or affiliated hospitals. Moreover, a large and varied patient population provides fellows with stimulating and often unique training opportunities. We were the first renal division to offer training in both renal ultrasound and interventional nephrology. We have recently added a one-year Transplant Nephrology fellowship. Our goal 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 deliver high quality patient care and provide opportunities for clinical research in dialysis. The division consistently ranks in the top 25 in the US news and World Report ranking for kidney disease, and ranked 18th in 2011.

DIVISION OF RHEUMATOLOGY & IMMUNOLOGY Ignacio Sanz, M.D.

Rheumatology and Immunology at Emory is dedicated to excellence in the clinical care of patients and the education of medical students, medicine residents, and rheumatology subspecialty residents. The Division is also committed to involvement in research and playing an active role in the development of increased knowledge and new treatment regimens in the field of rheumatic diseases. We are comprised of seven full-time faculty who serve the clinical needs of the Grady Health System, the Veterans Affairs Medical Center, The Emory Clinic and Emory University Hospital, Emory Midtown. In addition, a team of three pediatric rheumatologists provides care and participates in research through the Emory Children's Center at the affiliated Children's Healthcare of Atlanta.

CORE VALUES

C ORE V ALUES
In the Emory DOM, our core values are inherent in all that we do. We achieve excellence in our missions by embracing:
Integrity & Trust

Ethical & Innovative Inquiry Collegiality & Collaboration Accountability & Quality Professionalism & Diversity

Empathy & Compassion

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MISSION AND VISION

M ISSION S TATEMENT
To serve humanity by improving health

V ISION S TATEMENT

To be a national leader and innovator in discovery, high quality patient care and education

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STRATEGIC PLAN

STRATEGIC PLAN 2012-2017 OVERVIEW

The Department of Medicines 2012 Strategic Plan was initiated at the beginning of 2011. The Executive Committee, convened from amongst Vice Chairs, Service Chiefs, Division Directors and Executive Administrators in the Department of Medicine, and chaired by Dr. R. Wayne Alexander, took the lead to spearhead the creation of a Strategic Plan. This committee came together to identify five departmental goals and their respective focus areas and initiatives to be carried out I. Clinical Care: Define, though inquiry, optimal through FY2017. The committee standards of care and dissemination tasked several subcommittees to address the five identified goal areas mechanisms. and create action items to address II. Research Impact: Collaborate to enable these initiatives. From August 2011 to discovery, translate knowledge, and advance May 2012, the five committees worked patient care. to create at least one action item to address each initiative. These action III. Training and Education: Collaborate to items will be implemented during the transform medical education and lead the next five years, according to a priority efforts to redefine residency training. recommended by the DOM Executive IV. People: Cultivate a collaborative environment Committee to Dr. Wayne Alexander.

GOALS

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.
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SUMMARY OF GOALS AND INITIATIVES

FOCUS AREAS & INITIATIVES SUMMARY

I. Clinical Care
I.1 Develop and implement quality programs in both inpatient and outpatient settings. I.2 Disseminate innovative discoveries and best practice models throughout the medical community and society. I.3 Improve service though operation efficiency and resource optimization. I.4. Create a sustainable model for inpatient care with mechanisms for subspecialty involvement at both inpatient and outpatient transitions. 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 (see also V.4).

IV. People
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 (see also V.5). IV.5. Continue to realign compensation to encompass all three missions of the department.

II. Enhance Research Impact

V. Finance, Infrastructure and Partnerships

III. Training & Education

III.1 Develop and implement creative and consistent approaches to 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.
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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 of 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).

GOAL I

CLINICAL CARE

Define, though inquiry, optimal standards of care and dissemination mechanisms

total of over one million visits per year in over 75 locations. Most of our clinical care and teaching of medical students and house staff is performed at the Emory Clinic and at five hospitals: Atlanta Veterans Affairs Medical Center (VAMC), Emory University Hospital (EUH), Emory University Hospital Midtown (EUHM), Grady Memorial Hospital and Wesley Woods Geriatric Hospital (WWGH). The Department 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 leading patient care at Emory, with the ever changing field of healthcare, we are faced with the challenge of keeping up with the always increasing standards of quality and creating new and best practice models for inpatient care and resource optimization.
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he clinical enterprise of the Department of Medicine is a large, rapidly expanding and vital part of our departments culture and success. The clinical services that are provided by the Department of Medicine span three major Atlanta healthcare organizations in which we see a

SWOT Analysis: CLINICAL CARE

Strengths:
Breadth of clinical specialty areas Large volume of patient encounters provides a substrate for clinical training, research and revenues 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

Opportunities:
Set national standards for quality and value Develop multidisciplinary, high performing clinical care models Become a national leader in developing fiscally responsible and effective models for disease prevention, diagnosis and management Take advantage of diverse patient population base for clinical research Develop a nationally recognized Hospitalist system Quality metrics rather than value as an endpoint for accountability Pay-for-performance reimbursement Increasingly sophisticated local competition that diminishes the advantage of being an AMC

Weaknesses:

Threats:

Incomplete permeation of quality mission in our culture Average quality performance by national standards Lack of standardization of processes, procedures and procurement Lack of organizational coherence in the DOM within the healthcare systems (subspecialties do not have equivalent representation at all hospitals)

Based on these strengths, weaknesses, opportunities and threats, the Executive Committee created four initiatives 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 in patient 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.

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GOAL I

I.

Create consistent and improved care through care pathways across the DOM, as developed by experts in each division within the Department of Medicine. Each division will nominate one quality improvement (QI) project to be implemented departmentally wide and will also develop and initiate at least on divisionspecific 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: 2nd item for significant improvement in patient care, throughput, or reduction of waste. d. Ensure quality infrastructure in all divisions; Integrate into Meet with Chair Day.

ACTION ITEMS

II.

Develop and implement quality programs across the DOM. This action item hopes to disseminate the knowledge and structure gained from Hospital Medicines pilot Accountable Care Unit. (Initiatives 1, 2 and 4)*

a. Name DOM quality program leaders at all sites and all Divisions. b. Select division led care-path initiative for identified most significant problem/highly variable care process in the area/field. c. Designate Inpatient Accountable Care Units (ACUs) at each site.

III.

Improve communication during dissemination of information between providers and health systems. (Initiative 2) a. Hold internal communication and consultation

standards conference. Yearly conference will be used in the future to present unit-level performance and outcomes data.

IV.

Improve communication during transitions of care and when disseminating best practice models. (Initiative 4) a. Roll out intra-communication standards and
monitoring plan.

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

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Begin 2011

Clinical Care Action Item Timeline

Create consistent and improved care through care pathways across the DOM (QI) Hold internal communication and consultation standards conference Nominate Quality Improvement projects per division

2012

Name DOM quality program leaders at all sites and all Divisions 2013 Select division led care-path initiative for care process in the area/field Integrate quality metrics and power plans into EMR

Develop and implement quality programs across the DOM

Improve communication during transitions of care and when disseminating best practice model Hold summer DOM Grand Rounds series on quality

2014

Hold department QI Committee review of Divisional- Department initiative roll-out

2015

Roll out intra-communication standards and monitoring plan Roll out division led care-path initiative to department level

Expansion of number of quality metrics plans for ACU

2016

Quality infrastructure into all divisions; Integrated into Meet with Chair Day

End 2017
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GOAL II

ENHANCE RESEARCH IMPACT

Collaborate to enable discovery, translate knowledge, and advance patient care

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 be home to 19 members of the Millipub Club, or 38% of the total membership, the most of any department in the school.

lthough discovery-based research in the Department of Medicine has been robust only for the last 25 years, the department is highly regarded for its contributions in several areas. Research funding 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 research portfolio, making up approximately 20% of the schools funding. The DOMs strong research presence has helped Emory University become 16th in the nation for research.

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

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SWOT Analysis: RESEARCH

Strengths:
Multiple investigators with high scientific impact Largest portion (20%) of the SOMs extramural research funding and accounts for 16% of the Universitys sponsored research ECCRI* research unit generates significant independent funding and is also building collaborations with units across the University Historical increases in NIH funding Vibrant and diverse basic research in the department Extremely collaborative environment Inadequate research equipment & infrastructure Inadequate research space capacity/size and location Lack of coordinated and searchable IT databases Lack of internal research support and bridge funding Inadequate clinical research administrative infrastructure and lack of clarity of PI responsibilities Lack of systematic mechanisms for recruiting patients into clinical trials Few K Awardees and little infrastructure to support new awards and/or transition from Ks to Rs

Opportunities:
Develop our regenerative medicine, predictive health, 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 and CHOA Develop interdisciplinary research

Weaknesses:

Threats:
Reduced NIH funding Lack of standardization of processes and procedures, especially clinical research administrative structure

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

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

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

III. Create an Internal Visiting Professor Program to share research

IV. Create a comprehensive, user-friendly website to showcase research, V.

ACTION ITEMS

VI. VII. VIII.

Create a space policy by which space is allocated according to research success. (Initiative 2) Provide matching dollars for successful programs. (Initiative 2) Increase biostatistical support, availability and training. (Initiative 2)

promote collaboration and collate research administration best practices. (Initiatives 1, 2, 3 and 4).

IX. X.

XI.

Expand IT resources within the DOM to support basic and clinical research. (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. Work towards creating common platforms for patient data that can be queried by varied investigators. (Initiative 4)

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

Work with the Office of Business Process Improvement (OBPI) and the Administrative Restructuring Committee (ARC) to improve research administration. (Initiative 3)*

*The details of each program can be found in appendix 2.

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Begin 2011

Create an Internal Visiting Professor Program Appoint a Vice Chair for IT and create an IT advisory team

2012

Create Blue Sky Groups Create a comprehensive, userfriendly website Create a space policy

2013 Work with OBPI and ARC to improve research administration

2014 Increase biostatistical support, availability and training

Create post-award reporting mechanism that is data-driven and user-friendly 2015 Expand videoconferencing capabilities and support Provide matching dollars for successful programs 2016 Increase DOM IT budget to support research IT and infrastructure upgrades

Research, collate and advertise IT solutions currently available

Create pilot seed grants with two Principal Investigators Work towards creating common platforms for patient data that can be queried by varied investigators

Research Action Item Timeline

End 2017

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GOAL III

TRAINING & EDUCATION

Collaborate to transform medical education and lead the efforts to redefine residency training.

ducation is one of the three pillars of the School of Medicine. Across Emory University, the Department of Medicine is known for its excellent and innovative education programs. It is responsible for educating and training students, residents and fellows in the broad field of internal medicine as well as its subspecialties, and oversees the education of numerous graduate and postdoctoral students. The department is also known for its novel faculty education and continuing medical education programs. It contributes more education hours to the School of Medicine than any other clinical department, has the largest medicine residency program in the country and provides opportunities for faculty development in education to over 500 faculty members at Emory, and several hundred others outside of Emory. Over the course of one year, the department educates approximately 170 medical residents, 140 fellows, and 250 medical students. Offering both traditional and other training programs, the department strives to train highly competent physicians and leaders in medicine, regardless of ultimate career pathways. The department chair, the Vice Chair for Education, the residency program director and associate program directors, and medical student education leaders, along with numerous supporting staff members across the school, work collaboratively with each other to ensure that the educational programs in the Department of Medicine continue to meet the highest standards of innovation and quality.

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SWOT Analysis: EDUCATION

Strengths:
Training and Education are a core value of the Department High profile educators Diversity of the clinical experience offered by the residency program attracts a nationally competitive applicant pool with a 100% pass rate on the ABIM exams Robust fellowship training programs Focus on career development and satisfaction of outstanding clinicians enable their growth as educators and deliverers of outstanding service Provide superb training programs to clinicians who are then highly competitive nationally for subspecialty programs Largest portion of training in School of Medicine provided by DOM

Opportunities:
Offer new faculty development initiatives Expand NIH funded training programs Take a leadership role in redefining and developing solutions to the changing face of the Internal Medicine Residency training

Weaknesses:

Threats:
Reduction in residency training hours Increased rigidity of the regulatory environment involved in residency training Potential cuts to GME funding

Inconsistency in training experience at our 5 different training sites Sub-optimal performance in timely evaluation and feedback

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

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

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

23

GOAL III I.

II.

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)*

ACTION ITEMS

III.

IV.

Strengthen the accountability to which Division Chiefs and program directors are held for their educational programs. Consider the incorporation of education metrics into annual goals, career conference reports and incentives. (Initiative 1)* Create and implement periodic reviews of teaching faculty within the Department of Medicine to achieve the highest standards of teaching competency. (Initiative 3)*

Develop clear job descriptions and timelines for both faculty leaders and administrative staff in reference to their educational programs. Regularly review faculty/staff progress and hold them accountable for their duties. (Initiative 1)*

V.

VI.

Propose an education budget that supports the infrastructure of education, furthers the core education mission, and is based on national and local best practices. (Initiative 2)* Reorganize the residency education administrative team to increase efficiency and gain expertise. Along with enhanced administrative oversight, this will include two new positions; Information Analyst and Accountant. (Initiative 2)* Hire program coordinators to support more than one of the smaller fellowship programs as a model that allows for coordinators to focus on education. (Initiative 2)*

VII.

VIII. IX. X. XI.

Develop an online education resource for faculty. (Initiative 2)* Create yearly report on education. (Initiative 1)

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

*The details of each program can be found in appendix 3.

24

Begin 2011
Conduct teaching faculty reviews Reorganize the residency education administrative team Ensure every trainee and faculty member is imbued with professionalism

2012 Hire program coordinators

Create yearly report on education Strengthen the accountability to which Division Chiefs and program directors are held for their educational programs Develop an online education resource for faculty

2013

Develop clear job descriptions and timelines for both faculty leaders and administrative staff

2014 Propose an education budget

2015

Expand faculty development initiatives

Education Action Item Timeline

2016

Create a mini yearly development retreat

End 2017
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GOAL IV

PEOPLE

Cultivate a collaborative environment of excellence that embraces diversity and attracts, retains, and develops engaged faculty, staff, and trainees.

The department offers a wide range of opportunities for its faculty, staff and trainees. Several of the leaders within the department have come together throughout the past several years to create numerous faculty and staff development programs. These opportunities are designed to assist all faculty and staff to expand their professional skills and achieve their career aspirations. Programs have been developed to provide information and resources related to academic advancement, clinical service, research and teaching though orientations and career development courses.
26

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 and human health. Our challenges are to retain good people, to recognize their achievements in all missions and to strengthen our sense of community. We are committed to providing every employee with the career support they need to succeed. We also recognize that with our talented faculty and staff, there is much room to increase our service and outreach efforts so that we benefit the community at large and expand Emorys impact.

SWOT Analysis: PEOPLE

Strengths:
High profile researchers, clinicians, educators

Opportunities
Recruit new investigators to maintain strong research program Institute succession planning for senior clinicians Provide development opportunities for midcareer faculty and staff Recruit outstanding trainees and administrative staff Threats: Flux in divisional leadership positions (4 out of 9) No institutional strategy for enabling and coordinating senior recruitment

and administrative staff Closely aligned, coherent and collaborative organizational structure

Weaknesses:
Limited opportunity for clinical research Limited opportunities for regional and national service outreach efforts Limited promotion opportunities for Clinician Educators Lack of targeted leadership training opportunities

Based on the SWOT analysis above, the Executive Committee developed five initiatives that will help to improve 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 foundation for action items, which are designed to be implemented throughout years one through five. Below are the action items that will help accomplish and meet these initiatives.

27

GOAL IV I.

II.

Enhance mentoring by providing funds for CME meetings and educators, expanding mentoring for primary care external faculty and hospitalists, and defining career paths for staff. (Initiative 1) Promote sense of community by promoting DOM service efforts, e.g., Project IMPACT, outreach charity care, and create an online service catalog. (Initiatives 2 and 4) * Continue and expand existing faculty development programs. (Initiative 3)

ACTION ITEMS

III. IV. V. VI. VII.

Expand staff involvement in feedback (360 evaluations). (Initiative 3) Offer focus groups for faculty with like interests to identify their career development needs. (Initiative 3) Create a Lunch with the Chair program to facilitate interaction between faculty and DOM leadership. (Initiative 3)

VIII. IX. X. XI.

Increase staff development opportunities. Allow staff a certain number hours/year for development activities, such as personalized group sessions through Learning Services. (Initiative 3)*

Target faculty and staff for leadership development. Provide career coaching as needed. This will aid in succession planning. (Initiative 3) Revive and implement RVUs/citizenship metrics. (Initiative 5) Provide non-salary compensation to reward employees and improve moral, e.g., protected CME time and vacation time. (Initiative 5) Expand DOM website for staff development (Initiative 1 and 3)*

*The details of each program can be found in appendix 4.

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People Action Item Timeline

Begin 2011

Lunch with the Chair

2012

DOM service project: Project IMPACT Continue and expand existing faculty development programs

Increase staff development opportunities Offer focus groups for faculty with like interests to identify their career development needs

2013

Expand DOM website for staff development Target faculty and staff for leadership development

2014 Enhance mentoring Provide non-salary compensation to reward employees and improve morale

2015

Expand staff involvement in feedback

Increase outreach for charity care around Georgia 2016 Revive and implement RVUs/citizenship metrics

End 2017
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GOAL V

duties of the Department of Medicine rely heavily upon the success of the finance and accounting team. Within this group falls the responsibility of managing budgets, Effectively develop and manage financial resources to promoting growth of the clinical achieve excellence across all missions practice, increasing philanthropic support and expanding and pursing new partnerships, internally, locally, nationally and internationally. The department functions as two separate 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 our staff 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 the DOMs independence and ability to make large financial commitments and limits our options for five year planning. Thus, much of the effort for this goal is devoted towards working within the system to optimize and expand our resources.

FINANCE, INFRASTRUCTURE & PARTNERSHIPS

he everyday activities and

30

SWOT Analysis: FINANCE & INFRASTRUCTURE

Strengths:
Strong financial base, especially over the past 9 years Close collaborations with Yerkes, Grady, VA, Georgia Tech, CDC, Morehouse, and GRA

Opportunities:

Weaknesses:
Philanthropic support Ability to develop and capture intellectual property A funding model that depends on TEC revenue Critical lack of IT infrastructure Challenge of maintaining equipoise in administrative and financial relationships with Grady

Threats:

Promote growth of the clinical practices in outlying areas by acquisition or formal affiliation with existing private practices Re-examine the utilization of clinical and clinical research space to maximize efficiency and usage Expand partnerships across the state of Georgia, as well as national and international collaborations Pursue international partnerships and business opportunities Unstable and unpredictable financial models and reimbursement schedules Proposed CMS changes that impact professional and technical reviews Inequitable allocation of funds to the DOM National economy

The SWOT analysis above identifies the numerous weaknesses and opportunities within the departments 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 and Partnerships Committee (FIP) to design action items that address these initiatives. Note: Some action items imported from other sections.

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GOAL V I. II. III.

Integrate TEC-University infrastructure at divisional and central levels. (Initiative 1)* Establish a research space committee to develop a space policy and allocate research space. (Initiative 1)*

ACTION ITEMS

IV. V. VI.

Launch an internal marketing campaign for development. (Initiative 2)* Assess development staffing strategy. (Initiative 2)

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

VII. VIII.

Launch an internal marketing campaign for intellectual property. Consider a spokesperson and/or navigator for the process of working with the Office of Technology Transfer to facilitate capture of intellectual property and turn it into a potential revenue stream. (Initiative 3)* Increase DOM IT budget to support research IT and infrastructure upgrades. (Initiative 4 and II.4)*

IX.

Appoint a Vice Chair for IT and create an IT advisory team to prioritize and facilitate IT efforts within the department. (Initiative 4 and II.4)* Work towards creating common platforms for patient data that can be queried by varied investigators. (Initiative 4 and II.4)

X.

Promote sense of community by promoting DOM service efforts, e.g., Project IMPACT (Internal Medicine Partnering Across the Community). One project will be highlighted each year and an online service catalogue will be developed to showcase other DOM events. (Initiative 5 and IV.4)*

*The details of each program can be found in appendix 5.

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GOAL V

Begin 2011

Appoint a Vice Chair for IT and create an IT advisory team

2012

DOM service project: Project IMPACT Assess development staffing and strategy

Establish a research space committee to develop a space policy and allocate research space Engage University, EUH and EUHM Administration in an analysis of existing space allocation for the DOM

2013

Launch an internal marketing campaign for development

2014

Integrate TEC-University infrastructure at divisional and central levels Launch an internal marketing campaign for intellectual property

Work towards creating common platforms for patient data that can be queried by varied investigators

2015 Increase DOM IT budget to support research IT and infrastructure upgrades

2016

Finance Action Item Timeline

End 2017
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IMPLEMENTATION

PRIORITIZATION & IMPLEMENTATION

The five focus areas and their respective action items represent a concrete roadmap to move the Department forward to continued excellence over the following five years. However, in the current financial environment, initiatives must be carefully prioritized for implementation to align with the limited resources. The Executive Committee evaluated each action item based on potential impact and required resources. Findings are summarized in the following table. The colors reflect their respective focus area. Based on this analysis, and after considering ongoing efforts and integrated needs, Dr. Alexander prioritized the action items as outlined in the timelines for each focus area. Implementation will be the responsibility of the appropriate standing committees (Clinical Advisory Team, Research Advisory Team, Education Executive Committee, Faculty Development Committee) or the Executive Administrator of the Department of Medicine in the case of finances and infrastructure, and progress will be evaluated each year. Priorities may be adjusted yearly based upon availability of resources.

Goals & Focus Areas

Mission and Vision Initiatives & Ideas

Prioritized Action Items

34

ANALYSIS OF ACTION ITEMS BY RESOURCES AND IMPACT

5) Create space policy 1) Quality improvement Project 2) Implement quality program dissemination 1) Create pilot seed grants 4) Improve communication when disseminating best practice models

IMPLEMENTATION

8) Work with OBPI and ARC to improve research administration 11) Ensure residents are SIBR certified 1) Integrate TEC-University infrastructure at divisional and central levels.

9) Create post-award reporting mechanism 10) Expand IT resources 11) Create common platforms for patient data that can be queried 5) Propose education budget 7) Increase DOM IT budget

HIGH

2) Establish a research space committee

7) Increase biostatistical support

3) Expand faculty development programs 8) Target faculty and staff leadership development

IMPACT 3) Improve communication between providers and health system 2) Create "Blue Sky Groups" 1) Create yearly mini-development retreat 4) Implement periodic reviews of teaching faculty 2) Develop clear job descriptions MED.

8) Appoint a Vice Chair for IT

4) Create user friendly website to showcase research 6) Reorganize the residency administrative team

6) Provide matching dollars for successful Programs 7) Hire program coordinators to support fellowship programs 7) Increase staff development opportunities 11) Provide non-salary compensation to reward employees 12) Expand DOM website for staff development 4) Launch internal marketing campaign for development 6) Launch internal marketing campaign for intellectual property

3) Strengthen accountability of Division Chiefs and program directors 2) Promote DOM service efforts 4) Expand staff involvement in feedback evaluations 3) Engage all of DOM in space allocation analysis 5) Assess development staffing strategy 3) Create "Internal Visiting Professor Program" 9) Expand faculty development initiatives focused on teaching

8) Develop online education resource for faculty LOW 10) Create yearly report on education

1) Enhance mentoring by providing funds for CME meetings and educators. 10) Revive and implement RVUs and citizenship metrics

5) Offer focus groups for faculty with like interests LOW

6) Create a Lunch with the Chair Program MEDIUM RESOURCES HIGH

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COSTS

36

IMPLEMENTATION COSTS
The estimated total five-year implementation cost of the Strategic Plan and all of its five goal areas comes to a total of $5,994,192. The yearly costs per goal area are outlined below. The fiscal year totals represent the cost of performing the action items as outlined in each sections timeline schedule.
Year FY 12 FY 13 FY 14 FY15 FY16 Clinical Care 520,200 675,890 727,965 819,965 921,965 61,960 336,649 436,649 679,149 1,514,407 Research Education 61,000 61,000 81,000 81,000 81,000 365,000 22,000 27,000 27,000 47,000 47,000 170,000 People Finance 58,960 108,960 36,960 36,960 36,960 278,800

TOTAL** 3,665,985

** All costs are additive to the previous year.

CONCLUSION

37

CONCLUSION
The Executive Committee is proud to present this strategic plan for the Department of Medicine for 2012-2017. The plan allows us to build upon our strengths to address our weaknesses and external threats, and outlines a path to exciting opportunities in all three mission areas of clinical care, education and research. It recognizes our people as our most important asset and provides a roadmap to improve our finance, partnerships and infrastructure. Dr. Alexander and the Executive Committee are confident that successful achievement of this strategic plan will position the Department of Medicine to be a national leader and innovator in discovery, high quality patient care and education.

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DEPARTMENT OF MEDICINE STRATEGIC PLANNING LEADERSHIP

EXECUTIVE COMMITTEE
R. WAYNE ALEXANDER, MD ERICA BROWNFIELD, MD STEVEN DONEY KATHY GRIENDLING, PHD PAUL HAMMONDS TED JOHNSON, MD, MPH ELIZABETH KIMBERL JEFF LENNOX, MD JEFF LESESNE, MD DOUG MORRIS, MD MARK NANES, MD JEFF SANDS, MD JASON STEIN, MD ROBERT TAYLOR, MD BRYON WILLIAMS, MD GREG MARTIN, MD MARK MULLIGAN, MD ROBERTO PACIFICI, MD JEFF SANDS, MD LESLEE SHAW, PHD JASON STEIN, MD PETER THULE, MD WILSON HOLLAND, MD ADRIANA IOACHIMESCU, MD BETH MCCONNELL, MD LESLIE MILLER, MD SYLVIA MORRIS, MD CAMILLE VAUGHAN, MD MONNIE WASSE, MD PETER WILSON, MD

EXECUTIVE EDUCATION COMMITTEE

ERICA BROWNFIELD, MD WENDY ARMSTRONG, MD LISA BERNSTEIN, MD SHAHED BROWN DOMINIQUE COSCO, LORENZO DIFRANCESCO, MD DAN DRESSLER, MD DUSTIN SMITH JONATHAN FLACKER STACY HIGGINS DANIELLE JONES LINDA HOWELL KAREN LAW KIMBERLY MANNING, MD RICHARD PITTMAN, MD SUSAN RATLIFF DAVID SCHULMAN MAZIAR ZAFARI JENNIFER ZRELOFF, MD KATHY GRIENDLING, PHD ERICA BROWNFIELD, MD JENNIFER CHRISTIE, MD DAN DRESSLER, MD MONICA FARLEY, MD MICAH FISHER, MD JENNIFER GOOCH, MD
39

FINANCE, INFRASTRUCTURE AND PARTNERSHIPS COMMITTEE

CLINICAL ADVISORY TEAM

TED JOHNSON, MD, MPH MATTHEW BEDNAR NANCY COLLOP, MD LINDA DELANEY, RN ANA MARIA GALVEZ, MPH DAVID GUIDOT, MD JEFF LENNOX, MD JEFF LESESNE, MD DAVID NEUJAHR, MD ANDREW SMITH, MD KATIE SPARKS, RN

W. ROBERT TAYLOR, PHD, MD KEVIN ANDREWS STEVEN DONEY ANA MARIA GALVEZ, MPH PAUL HAMMONDS MICHAEL KILGORE PAIGE MARTIN LEAH PHILIPS DAVID PROPP, MD SANDRA TALLEY, MPH

RESEARCH ADVISORY TEAM

FACULTY DEVELOPMENT COMMITTEE

KATHY GRIENDLING, PHD R. WAYNE ALEXANDER, PHD, MD FRANK ANANIA, MD KATHARINA ECHT JENNIFER GOOCH C. MICHAEL HART, MD

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 the medical community and society, 4) Create pilot accountable care unit/clinic structures with which to deliver the quality initiatives determined in action item 1, Action Item: Developing and Implementing Quality Programs

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 of physicians, nurses, and allied health professionals to build consistency and mutual accountability); 2) patient-family centered workflow guided by the principle of prepared, proactive teamwork; 3) unit-level performance and outcomes data; and 4) active management of unit outcomes by physician and nurse co-directors.

The DOM must build out care models, i.e. structure and process, capable of reliably and durably producing the best possible outcomes and value. The DOM does have a successful demonstration project that shows the benefit of this approach the implementation of unitbased interdisciplinary care teams co-managed by a physician unit director and nurse unit manager, so called accountable care units, or ACUs.

Time Span: This program will be progressively adopted by the DOM over the next 5 years. It is the expectation of the CAT working group that these policies will continue to exist indefinitely, with continuous revision. The DOM ACU Demonstration Project has generated data supports a strategy of unit-based re-design of structure, process, and management controls. Specifically, in the 12 months after reorganizing a hospital ward at Emory University Hospital into an ACU, several compelling clinical and utilization outcomes have improved.

This proposal will require both tangible financial resources (see below) as well as strong engagement from all of the clinical divisions and many clinical faculty within the DOM. We anticipate that eventually each division will require that the division director be invested in this process as well as multiple quality representatives per division (perhaps 20% of the division). We estimate that ultimately this initiative will be cost neutral or even cost effective, but this estimate requires some assumptions. First, the quality initiatives here will be the substrate used for external funding from sources such as the National Institutes of Health from institutes such as the AHRQ. Second, we believe that in demonstrating our commitment to established quality metrics, the DOM will improve reimbursement for services paid by CMS and other third party payors. Third, improvement in health of our patients will decrease expenses.

Time Span: Year 1: Key decisions: Division directors will select one quality representative per clinical unit and engage faculty and decide upon which initial quality metrics are to be tracked within each unit. This will initially be piloted within 2 units per large division and 1 unit in smaller divisions.
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Key infrastructure: Working with IT quality metrics will be directly integrated into the EMR system. By the end of the first year, the system will track compliance with quality metrics at the individual provider level, the individual patient level, the geographic location and within divisions.

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

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 as decided upon in CAT action item 1. This will require coordination with IT, the programming architects for EMR and the data warehouse. The dashboard will indicate within divisions how closely quality targets are being met. Divisional reports for the quality dashboard would be run no less than twice a year and the results disseminated to individual members of each division. The primary responsibility for making the divisional reports will be through the administrator in the DOM (see personal below). Key infrastructure: Work with research and IT to improve data warehouse to provide necessary data to physicians and leadership with reliable and accurate reports.

Pilot ACUs will require participation by multiple members of the hospital staff. For the DOM ACU at EUH, the SIBR rounds consist of an attending physician, nurse manager, social worker, pharmacist, and physical therapist. Development of ACUs does not require increased funding to support these services (as these services already exist), but for an ACU to 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 a significant amount of initial effort to educate other members of the team and generated engagement to this process.

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

At the end of year 3, we propose to actively survey the DOM faculty on their experience with the tracking of these quality metrics. The primary tool for this will be surveys, but additional tools will include the use of one of the Medicine Grand Rounds as well as each divisions Meet with the Chair Day. This feedback will be used to solicit new metrics to be added to the Dashboard, as well as consideration of removal for quality metrics for which the utility of such measures is doubtful. Year 3-5. The expectation is that adherence to quality metrics will increase over time. This will be directly tested every year. The anticipated successful results are discussed in the metrics section.

Metrics: Given that the key quality measures that each division will embrace have not yet been determined, we do not yet have data on the degree to which DOM faculty adhere to established quality metrics. Between year 1 and 2, we expect to generate baseline data from which future comparisons will be made. We acknowledge that the faculty will be informed that these measures will be tracked and this may dramatically affect behavior by itself (the Hawthorne
41

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 medical director. Smaller divisions will have a pilot in only 1 unit. 2) Director, Data Management 1.0 FTE 3) Biostatistician/clinical epidemiologist (employed directly by the DOM) 0.3 FTE Title ACU Medical Directors, cumulative (physicians) Director, Data Management (data analyst) Biostatistician/clinical epidemiologist (MD MPH) Data Analyst FTE 2.55 1.0 0.3 1.0 $ $ $ $ $ Total Salary & Fringe 520,200 92,000 65,490 52,075 729,765

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

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

TOTAL

Ongoing operating costs: Each additional year is estimated to cost an additional $30,060 per quality representative. Note that most of these 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 by experts in each division within the Department of Medicine. Each division will nominate 1 quality improvement (QI) project to be implemented departmental wide and will also develop and initiate at least one division-specific QI project.

In order for the standards to be effective, there must be a method for updating these pathways at least biannually, and for feedback from clinicians outside the division to be considered. Faculty must 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 see measurable outcomes in both service delivery and patient care.
42

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

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 payfor performance or accountable care organization standards. Accomplishing this task will assist the DOM and the individual divisions in identifying personnel to develop and implement such strategies, and in assessing the resources required to do so.

 For the divisional project, the implementation should begin at 6 months with regular assessments at 6-month intervals. As with the departmental project, initiation of a second project would be at the discretion of the divisional subcommittee with the hope that the original and subsequent projects would at a minimum span the following five years. The departmental committee chair will oversee the departmental project(s) and act as a consultant to each divisional committee. It is anticipated that this person will require 0.5FTE to act in this role. In addition, 2-3 FTE will be needed to assist with implementation, data entry and monitoring. It is anticipated that baseline data will have to be acquired as well as ongoing data throughout the life of the projects. These personnel will need access to all hospital systems EMR as well.

Initial identification of departmental-wide and division specific projects will take place over the first 6 months. For the departmental wide project, the chief quality officer will appoint a departmental committee to identify the top quality initiatives and develop an implementation strategy over the next 6 months. The departmental initiative will begin at Year 2 with departmental 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.

FINANCES: Please include estimations and explanations for the following financial areas. An excel file should be attached. 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 x 10 division (0.5 FTE) 3. Data entry and administrative personnel to get all projects up and running, both departmental and divisional (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 STAFF Committee Chair Divisional Champion (0.05 each div x 10) Data entry Programmer/EMR Software Architect OTHER Start Ups Cost Ongoing FTE 0.5 0.5 2.5 FTE 0.5 $ $ $ $ COST 102,000.00 102,000.00 96,900.00 90,200.00

TOTAL YEAR 1

$ 10,000.00 $ 25,000.00

$ 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 and providers, would be helpful to assure best possible clinical outcomes. The DOM believes that great clinical communication is essential to excellent quality patient care. The DOM can and should be the leader in this effort. Each major entity within the DOM has some communication standards that exist and are required, or work in concert with other accrediting bodies such as the Joint Commission; and these standards should be met. A comprehensive departmental approach will include these minimal standards. We suggest a local group that recommends specifics for our entities that both complies with their requirements 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 be practicing in a work environment where there are quality monitors and metrics. A concerted effort in dissemination of such monitors and metrics is essential to ensure that the faculty are utilizing these measures. In order for the faculty to aspire to these metrics, faculty members need 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 in the determination of applicable quality metrics per Division and unit, thus, unifying the quality goals in each area. The Faculty should be offered regular and actionable feedback on their individual performance no less than quarterly, and should be allowed to comment on the applicability of these standards to our unique clinical practice settings. Additionally, it is essential that faculty be provided with information that allows them to compare their performance on quality measures to peers in the same field. In order to improve outcomes for our patients, all Department of Medicine faculty should be employing effective communications practices. A concerted effort in making certain that strong practices are agreed upon, adopted, monitored, and improved is essential to ensure the best outcomes. There is recognition that many sites have communication directives that may be site specific, however, a smaller group that can create common standards in this environment will be beneficial to patients and families.

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
44

The faculty should be offered regular and actionable feedback on their individual performance no less than quarterly. They should be allowed to comment on the applicability of these standards to our unique clinical practice settings.

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 for communication (such as SBAR); 4) an agreed upon method for communication specific to the practice site; 5) audits for adherence to an agreed upon plan; 6) aligning incentives for strong performance with the plan; and 7) readjustment of the plan.

 (Year 0.40) Division led care-path initiative for identified most significant problem/highly variable care process in the area/field (Year 0.5) Division Director / Health System collaborative for ACOs for tracking metrics (Year 0.8) Internal communication and consultation standards conference (Year 0.75) Designate physician director/ nurse manager pairs; 2 units per large Division, 1 unit per small (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 2) Two additional ACU clinical units per Division (Year 1.8) Roll out of communication standard to cross-department processes

(Year 2.2)

(Year 3) Quality infrastructure into all divisions; Integrated into Meet with Chair Day (Year 4) Expansion of number of quality metrics plans for ACU

(Year 2.5) Department QI Committee review of Divisional Department initiative roll-out

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APPENDIX 2
RESEARCH:
Initiative 1: Support innovation, integration and translation of basic discoveries into clinical care and health care delivery Action Item: Create pilot seed grants (designed to facilitate the acquisition of extramural support for basic and clinical research efforts of beginning faculty) with two Principal Investigators (PIs) who have never worked together before. Preference will be given to researchers from different divisions and to applications with both a basic science PI and a clinical PI. Increase collaboration across divisions, stimulate interactions that may not have otherwise taken 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 from current DOM seed grant program (see Appendix A) Cost: $100,000 per year for five years, $500,000 total (two seed grants offered per year at a one-time award of $50,000 each). 0.05 FTE Program Coordinator administer the program

The seed grants will be offered once a year for 5 years with the hope of continuing the program by obtaining philanthropic support. Targets: 1) Seed grants announced, reviewed and awarded (annually) 2) Progress reports collected (annually) 3) Metrics analyzed yearly after year 3

Initiative 2: Streamline research administrative procedures Action Item: Work with Office of Business Process Improvement (OBPI) and Administrative Restructuring Committee (ARC) to improve research administration. Preliminary work by ARC has been completed, and recommendations have been submitted to Dr. 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 and university 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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Outcomes will be measured in terms of: 1) Quantitative data - dollars awarded versus dollars returned, and 2) 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).

 Benefits: 1) Improved speed of proposal routing 2) Back up staff to cover during vacations and vacancies of regular staff 3) Consistent processes across divisions 4) Fewer errors in submitted proposals due to increased training 5) Decreased staff turnover due to clear career paths 6) Ability to keep up with growth in grants and increased regulatory requirements 7) Adequate oversight of post-award spending and compliance, thus reducing risk 8) Timely post-award monitoring and reporting to PIs 9) More user-friendly, accurate electronic systems for grant management 10) 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, 0.5 FTE Renal) 2) Space: Office space needed for central staff 3) Time dedicated to creating training and mentoring programs for research director 4) Software: Purchase or develop grants management software ($50,000 for 4 users) or work with WHSC Research IT office to create one for DOM ($65/hour) 5) Time dedicated to developing standard processes for research director Metrics: 1) Gather data from OSP/OGCA regarding speed of proposal routing 2) Gather data from HR regarding research administration staff turnover rates 3) Survey DOM research administrators as to opinion of overall process improvement 4) Report from central office detailing process improvements 5) Comparison of FTE per total funding ratio with other departments FINANCES: Position Financial Analyst (1 FTE) Financial Analyst (1 FTE) Research Coordinator (.5 FTE) Research Coordinator (1 FTE) Research Assistant (1 FTE) Total Salary $ 75,098.00 $ 75,098.00 $ 31,046.00 $ 62,092.00 $ 56,355.00 $ 299,689.00

3. Post-award monitoring is time-consuming and labor intensive and is not being completed in a timely manner, if at all. Solution: Rests partly with central offices, but includes development of reporting tools, and hiring additional personnel. 4. Pre-award processing is inconsistent and drawn out. Solution: Rests partly with central offices, but includes greater accountability and monitoring and standardization of departmental processes.

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Initiative 3: Advocate and facilitate the adoption of an effective, user-friendly, and integrated IT infrastructure Action Item: Expand IT resources within the DOM to support basic and clinical research.

Benefits: 1) Platform for enhanced clinical research 2) Research IT resources funded, more readily available and easier to access 3) Fair and balanced assessment of IT initiatives; continued advocating of research IT needs. Targets: 1) Appointment of Associate Vice Chair for IT 2) Hiring of research IT staff member 3) Creation of IT committee 4) Implementation of at least one major research database project 5) Creation and implementation of hardware replacement schedule 6) Purchase and installation of videoconferencing equipment Metrics: 1) IT committee generates a yearly report on progress on reported number of project requests, computer replacements, videoconferencing usage, etc. 2) Survey research faculty/staff on overall satisfaction of research IT 3) Regular meetings between IT committee and business managers/division directors to discuss ongoing issues/outcomes FINANCES: Position Vice Chair Salary Support (.2 FTE) Research IT Staff (1 FTE) Associate Vice Chair Support (.2 FTE) Video Conferencing (5 sites) Research Project Funds Equipment Upgrades (every 4 years) Total
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Currently, DOM IT resources are focused on desktop support. A survey of other departments shows that they have more effectively utilized SOM resources to support research. Bringing such systems into the SOM will require a significant monetary investment, but progress can be made by bringing together interested parties and making research IT a priority for the department. Specifically, 1. Create Associate Vice Chair for IT to advocate for and oversee the development of IT solutions for research. 2. Create a standing IT committee to oversee direction of DOM IT and interface with SOM IT, UTS, and Research and Health Sciences IT, charged with oversight of not only desktop support, website design and network services, but also approving initiatives/projects that require IT support and investment, such as data analysis/management, software development, etc. This group should include clinical and research faculty, a full time research IT staff member, a biostatistician, administrators, research and health services IT support personnel, DOM IT personnel, and an informatics expert (after successful surgery model). 3. Increase DOM IT budget to support research IT and infrastructure upgrades. 4. Expand videoconferencing capabilities and support.

Salary $ 10,000 $ 70,000 $ 60,000 $ 2,500 $ 50,000 $ 50,000 $ 242,500

APPENDIX 3
EDUCATION:
Initiative 1: Develop and implement creative and consistent approaches to medical education. Action Item: For new (and existing) program coordinators and the residency administrative team: create a mini development retreat to review processes, procedures, and requirements for educational programs. (Propose to do this yearly as a half-day update.) Require all to attend New Innovations training that GME offers every year. An annual retreat reviewing processes, procedures, and requirements for educational programs would both inform and emphasize consistent approaches in education that apply to all programs. RESOURCES: Computer lab and classroom space in SOM. Optimally, would like GME to help facilitate with residency program director, Vice Chair for Education and residency administrative team. TIME SPAN: Annually, beginning Spring 2012.

TARGETS: Increase consistency in procedures around evaluations, PIFs, duty hours, procedure logs, quality improvement projects, etc METRICS: Annual audit by residency program director, Vice Chair for Education and residency administrative team to ensure consistent practices are achieved by each educational program. FINANCES: Administrative Support: See above. Full-Time Equivalents: Initial Investment: Ongoing Operating Costs: Yearly cost approximately $500 for food during the retreat.

Action Item: Develop clear job descriptions and timelines for both faculty leaders and administrative staff for requirements of their educational programs. Regularly assess their progress and hold them accountable for their duties. Provide regular review of requirements such as PIFs, evaluation reports, duty hour logs, etc. The Vice Chair for Education and The Residency Program Director will lead this review process. By clearly defining expectations, education leaders and staff are better equipped to succeed and be held accountable for their efforts. TIME SPAN: Initial development of a manual for our educational programs that would supplement and delineate the ACGME standards. Such a manual would be a compilation of best practices and timeline of educational programs that lists all duties of program directors and coordinators, as well as DOM expectations. Would like to complete manual in Spring 2012.

METRICS: Each education program adopts expected and best practices regarding all educational efforts (i.e., New Innovations is used consistently for all evaluations, logging duty hours, etc)
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Action Item: To strengthen the accountability which Division Chiefs and program directors are held for their educational programs, we recommend that incorporating education metrics into annual goals, career conference reports and incentives be considered. By including incentives for division chiefs and program directors, this might provide further value to education-related tasks they are doing, in addition to accomplishing specific education-related goals.

Action Item: Create and implement periodic reviews of faculty teaching within the department of medicine to achieve highest standards of teaching competency. By regularly reviewing the teaching performance of our faculty, we have the opportunity to target faculty in need of further faculty development, as well as identify and decrease/discontinue defined teaching roles for those faculty with consistent low performance. TIME SPAN: Quarterly reviews of faculty by residency program director, Vice Chair for Education, Department Chair with notification to division chiefs and individual faculty. FINANCES: No monetary costs. Faculty development time investment by individual faculty members.

Initiative 2: Re-examine funds flow to ensure the financial strength (and education mission) of the department.

Action Item: Define an education budget that supports the infrastructure of education, furthers the core education mission, and is based on national and local best practices. Clearly defining an education budget for the department will allow us to: a) quantify educational costs incurred by the department; b) provide leadership with more decisionmaking freedom to prioritize education-related spending; c) create more simple accounts for education to track easier; and d) leverage accountability with financial support.

TIME SPAN: Starting in November 2011, the beginning of creating an education division in terms of budgets will be decided by the School of Medicine. If approved, leadership will begin to define an education budget for central costs incurred by the department (i.e., student and housestaff programs). For now, fellowship programs (funded by individual divisions) will remain in the division budgets. METRICS: A well-defined budget outlining education costs in the department of medicine for student and housestaff programs. Ability for leadership to make choices of how to spend educational dollars.

Initiative 3: Optimize administrative structures and processes throughout the department.

Action Item: For fellowship programs with more than 5 fellows, the program director should receive at a minimum 20% protected time to run the program. Some program directors will need more based on the demands of their fellowship programs. For fellowships that have less than 5 fellows, 5-10% support should be given. ACGME requirement department needs to be in compliance with standards. Giving recommended support to PDs will give further value to what they are doing. METRICS: PD with 50% support; APDs with 25% support; Fellowship PDs with 20% support

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Action Item: Reorganize the residency education administrative team to increase efficiency and gain expertise. This includes two new positions of Information Analyst and Accountant, as well as enhanced administrative oversight. The future roles/responsibilities are delineated in (Appendix 1). Provides administrative support for educational programs that is optimal to meet the needs of ACGME requirements as well as support innovation.

Action Item: Hire one new program coordinator to support smaller fellowship programs (i.e., endo and rheum). This coordinator will focus on education. This shared coordinator position will be developed over 1-2 years and used to build a model that other educational programs in the department can replicate if desired/necessary. Allows for more consistency in educational programs, consolidation of efforts and increase opportunity to develop expertise in education. Action Item: Develop a clear reporting structure for the educational program leadership and support staff. (See Appendix 2). The reporting structure holds the core program responsible for the fellowship programs as required by ACGME. The structure adds more accountability for the administrative support staff. The Vice Chair for Education is also more clearly responsible for educational programs. The proposed reporting structure also adds more collaborative input by all involved in education to develop core standards and best practices.

Initiative 4: Disseminate innovative discoveries and best practice models throughout the medical community and society.

Action Item: Develop an incentive compensation for program coordinators who met/exceed their responsibilities. Similar to incentives for PDs and division chiefs, incentives for program coordinators would provide external validation of their efforts as well as help meet goal of consistency in our educational programs. Financial Assessment: Propose a $2000 yearly incentive to all clerkship, residency, fellowship program coordinators to be given if defined goals achieved (consistent procedures, meeting deadlines, etc). This would cost approximately $32,000 per year for the department. Action Item: Develop online core resources for all educational programs to use to fulfill ACGME requirements (such as core educational requirements that are similar for all fellowship programs) and for all faculty, fellows, and residents to use to give talks, bedside teaching points, etc. Would provide a tremendous education resource for all programs to meet certain ACGME standards, as well as help our teaching faculty to have readily available resources that can aid them in their teaching efforts. It also helps with consistency in what we are teaching in the DOM. Would love to implement in Fall of 2012. Need online site to house such resources i.e., Blackboard or website. Could monitor how many resources were accessed online, get feedback from users, monitor use by training programs in meeting ACGME requirements. Action Item: Expand faculty development initiatives focused on education and teaching. Continuing faculty development in education is essential for our department to ensure highquality teaching. Consistent outstanding evaluations of our teaching faculty. No monetary costs unless food offered.
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Initiative 5: Promote career growth and development among faculty, staff, and trainees.

APPENDIX 4
PEOPLE:
Initiative 1: Optimize recruitment, retention and promotion strategies for faculty, staff, and trainees across divisions and locations Initiative 3: Promote career growth and development among faculty, staff, and trainees Action item: Career Development for Faculty and Staff Develop an extension of the website with on-line offerings such as informational articles, videos, webinar links, links to internal training opportunities, etc. - These could be grouped by type of skills, job skills/technical skills, productivity, etc. - These items would be useful for both faculty and staff although some might be more useful for particular job groups such as administrative skills. - The goal would be to keep the site frequently updated with list of free webinars, articles, videos etc. - This new site could be communicated via email and flyers/posters to faculty and staff. - We could also cross promote any faculty development offerings that may be beneficial to staff (for example, Faculty Development Day). TIMESPAN: Develop website in the next 3-6 months. TARGETS: Frequently updated and visited development website, building of bench strength within divisions and higher retention.

Action item: Career Development for Faculty and staff Learning Services offers personalized group sessions. Given direction from the areas leadership, they will perform an assessment, and based on resources, will design either a one-time class or a group of classes that can be taken over an extended period of time. There is no cost for this service, only for the materials used by the individuals attending the course. - This service could be performed at the DOM level or within a division to make it even more specialized. As a start, the DOM could have Learning Services come in perhaps early next year (after the staff survey) to perform an assessment. We already have the Faculty Life Survey that may shed light on some areas that need focus as well (e.g., communication). - As there are basic and more advanced skills from which individuals across the DOM could benefit, this could be an on-going process that offers advanced learning as time progresses. TIMESPAN: Have the course/session outline determined in the next 6-9 months. TARGETS: Develop additional key skills within the DOM, which will in turn build a stronger department across the board. FINANCES:
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Will need administrative support from: Communications Specialist, Administrative Fellow, Faculty Development Program Manager, Senior HR Associate and Executive Administrator. Initiative 2: Promote sense of community with shared values and goals, aligned with our tripartite mission Initiative 4: Support and increase faculty, staff, and trainee involvement in local, national, and international outreach and service efforts (**Also present in Finance, Infrastructure and Partnership section) Action item: Promote sense of community with shared values and goals, aligned with our tripartite mission DOM Service Project: Project IMPACT - Internal Medicine Partnering Across the Community - Every year Project IMPACT will highlight a main event for the DOM to rally behind. A Project IMPACT Coordination Team (Faculty Lead Coordinator, faculty/staff/trainee members) will be formed to decide upon the annual event and coordinate project implementation. For 2011-2012, we have chosen the Hunger Walk on March 11th, 2012 to support the Atlanta Community Food Bank (ACFB). Emory DOM will sponsor a team and lead fundraising effort (faculty, staff, trainees with their families will be encouraged to participate). For 2012, team registration/fundraising will be coordinated through the ACFB online web portal http://www.hungerwalkrun.org/ - Project IMPACT will involve the development of an Online Service Catalogue placed on the DOM Website where faculty/staff can highlight current projects in which they are involved Emory Universitys Volunteer Emory has a website that can serve as an example: http://www.volunteer.emory.edu/WWA_Faces_of_VE.php TIMESPAN: Will the project be ongoing over 5 years or have a definite ending period? We plan to implement a sustainable program that will develop and grow over the next 5 years and would encompass service opportunities at local/regional/international levels.

The online service catalogue will facilitate increased participation in multiple ongoing projects that have been led by our own faculty/staff/trainees or in which DOM members already serve. These projects could include speaking to local groups on health topics, mentoring programs, refugee assistance, rural GA farm workers programs, and international assistance programs in Ethiopia, Haiti, Republic of Georgia. Staff and IT support will be crucial to maximize this opportunity.

The annual main event will be an event that will involve the entire DOM (e.g., Hunger Walk/Run for the ACFB). The Project IMPACT coordination team will meet as needed to lead the implementation strategy, which will include coordination of the fundraising/volunteering and publicity for the event. Support from the dedicated faculty lead coordinator, staff support from communications/faculty development will be essential for the program to be a sustainable success.

TARGETS: Increase Emory DOM partnership with community organizations to improve public health/wellness Increase sense of satisfaction with being a member of the DOM and improved sense of community among faculty/staff/trainees within the DOM Highlight IMPACTful faculty/staff/trainees on a monthly basis through the service tab of the DOM website.
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METRICS: Number of hours worked by DOM faculty/staff/trainees (though a website portal for DOM members to log their hours) Funds raised - aim to raise $2,000 for Hunger Walk 2012 Satisfaction rating in next DOM Faculty Life Survey (2016)

FINANCES: Will need: Administrative support from Communications Specialist, IT, and faculty leader, an ongoing budget of $2,000 to support the annual event (t-shirts and refreshments) and .1 FTE for staff support, to coordinate the annual DOM event, and .05 FTE for faculty coordinator.

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APPENDIX 5
FINANCE:
Initiative 1: Optimize administrative structures and processes throughout the DOM Action item: Integrate TEC-University Infrastructure at Divisional and Central Levels Decrease duplicated efforts common to both the University and TEC. Improve effectiveness of staff and faculty in leadership positions.

METRICS: Time spent from business managers on the university side generating reports. Division Directors and facultys satisfaction rating with new reports (research, financial, quality). Improved financial understanding from both the clinic to university, and vice versa.
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TARGETS: Integrate projects and common tasks between the University and TEC, as a start to streamlining administration at divisional levels. Areas of particular interest are: Finance -Example: Ensure that all finance staff are aware of financial and budgetary issues on both the clinic and university sides. Human Resources -Example: Increase collaboration and communication between HR representatives and respective faculty/staff. Faculty and Staff Management -Example: Ensure that staff on clinic and university sides are aware of the effort distribution, active duties and responsibilities for each faculty/staff member. Grants accounting/Report Generation -Use clinic and university skills to assist and administer financial analysis and generation of financial reports. Eventually, merge accounting and financial knowledge from both sides of the street to produce more cost effective and time effective reports.

The action item will consist of three phases: 1. Identify Division Directors interested in improving TEC-University communication and administration. Interested directors will meet to identify challenges and barriers within their division that can be minimized with increased communication and collaboration. These challenges/barriers will be compiled to form a pilot administrative structure, in the interested divisions. 2. Pilot new administrative system and structure in 1-3 divisions (1-2 years). 3. Implement, if successful, administrative structure in all divisions (2-10 years).

Introduce new pilot administrative structure in 1-2 divisions by January 2013.

The goal of this action item is to identify common projects between the clinic and university to reduce redundancy and streamline administration at the divisional levels. Currently, there is a lack of communication between clinic and university staff and faculty, which, at times, results in a lack of efficiency and duplication of efforts. As a whole, this inhibits tactical and forward thinking for the Department administration and the divisions. Streamlining administrative structures will not only help to unify the DOM, but also allows for the ability and time to make strategic decisions for all leaders in the department.

Action Item: Establish a research space committee to develop a space policy and allocate research space 1) Ensure appropriate distribution of current space 2) Allow acquisition of additional clinical research space 3) Improve efficiency of clinical research operations Action Item: Engage University, EUH and EUHM Administration in an analysis of existing research space allocation for the DOM Specifically explore the use of Old Nursing School Building at EUH as well as other offsite University space that has the potential for use for outpatient clinical research. Increase clinical research space and research productivity. TARGETS: Acquisition of space Reassignment of Space Develop a mechanism and scheduling system to allow use of unused clinic exam room space

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

Action Item: Launch an internal marketing campaign for development. Increased understanding and engagement of faculty, which is imperative to successful fundraising for the Department of Medicine the end result is increased philanthropic support of the DOM. While we will continue educating and engaging faculty indefinitely, the thrust of this campaign will take place over 18 months. While continuing the efforts outlined below, we will launch an internal marketing campaign for development.

Ongoing development efforts Alumni engagement (including former residents and fellows) Corporate & foundation relations Planned giving Building case for support Collateral materials & community outreach/education Grateful patient engagement Major & annual gift approaches We will identify and leverage opportunities for development to have a presence with faculty, to educate faculty about what philanthropy means to donors and what it can mean for their programs, to share and celebrate successes and to illustrate what is made possible by philanthropy. We recognize that the best way development can build a brand with faculty is for faculty to see the merit in partnering with development officers: as faculty learn of gifts that made possible programs or research that otherwise would not have been funded, they will be encouraged to participate in development efforts. In addition to the "Development 101" presentations to faculty, development officers and faculty should share successes as they occur and walk faculty through the process of garnering a major gift. We will increase faculty participation in the Advancement Resources workshop, a training designed to help equip physicians to talk to patients and patient families about fundraising. The workshops clarify that the faculty members role is not to ask for money or to do anything outside of his/her comfort zone, but to listen for cues from patients and connect the grateful patient with the development officer, whose job is to match the interests of philanthropists with opportunities to fund research, education, and patient care. Initiatives include road shows by development officers and select faculty at division and department meetings. It is helpful for faculty to hear from peers about their fundraising successes and how they handle conversations around development with grateful patients. For
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Action Item: Assess development staffing and strategy. Better understanding of development staffing needs and optimization of philanthropy efforts Focus and time of leadership if additional staffing determined appropriate, FTE ~$65,000/FTE for each additional development staff member

faculty who do not participate in the Advancement Resources training, it is important to share the overall messaging and videos of Emory donors who gave because they were grateful for the care they received at Emory. It is valuable to have faculty exposed to development early in their tenure we will identify appropriate ways to include development in new faculty orientation and as part of faculty development.

Initiative 3: Explore opportunities for growth of clinical enterprise and financial stability in the DOM

Determine if the current paradigm is the best? Are there mechanisms to explore this better? Assess staffing and reporting structure. Is number of staff appropriate? Is there anything outside of the box we should be considering?

Action Item: Launch an internal marketing campaign for intellectual property. Consider a spokesperson and/or navigator for the process of working with the Office of Technology Transfer to facilitate the capture of intellectual property and turn it into a potential revenue stream. Better understanding of how to identify commercial viability, protect intellectual property and administer the protection process used (e.g., patent, trademark, copyright), market intellectual property, negotiate license arrangements for intellectual property, etc. and to facilitate the development of start-up companies based on Emory intellectual property. To educate researchers and faculty about the intellectual property and technology transfer process consider highlighting successes at Department faculty meetings and in newsletters. Continue Todd Sherer presentations at faculty and staff meetings. Identify a poster child (maybe consider success story versus poster child) to whom faculty can relate. Determine a way to get buy-in from division directors. Consider inclusion in new faculty orientation and perhaps add to Faculty Development lecture series (e.g., propose incorporating OTT and development into curriculum). Consider department beyond faculty consider this part of the education of med students, residents and fellows. Consider a coach to work with faculty in Department could be faculty member, administrator, or co-coaches (one administrator, one faculty member) to assist faculty members in process. Streamline the paperwork process and decode the technology transport capture form to make it more palatable. Administrative Support: Communication Specialist used to provide announcements, communicate initiatives and provide accomplishments through newsletters and website updates.

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APPENDIX 6
Overview of Goals and Initiatives

GOAL: CLINICAL CARE

Weaknesses/ Opportunities Incomplete permeation of quality mission in our culture

Define, through inquiry, optimal standards of care and dissemination mechanisms.

Initiatives 1 1

Average quality performance by national

standards

Lack of standardization of processes,

procedures and procurement Lack of organizational coherence in the DOM within the healthcare systems (subspecialties do not have equivalent representation at all hospitals) Set national standards for quality and value Develop multidisciplinary, high performing clinical care models

3 3
1, 2, 3, 4

Action Items/ Metrics Incorporate formal and hands on training of quality concepts into educational curriculum Incorporate formal and hands on training of quality concepts into educational curriculum

1, 2, 4

Become a national leader in developing

fiscally responsible and effective models for disease prevention, diagnosis and management. Take advantage of diverse patient population base for clinical research Develop a nationally recognized Hospitalist System

1, 2, 4 3

Medical Home Team Approaches- 2G, 3G, 5G, 6G- Jason Stein Develop patient and family centered models of care Improve Patient Satisfaction scores

1, 2, 3, 4

Action Committee: Clinical Advisory Team- Jeff Lesesne, Ted Johnson, Jason Stein, Jeff Lennox, Jennifer Christie, Marjan Khosravanipour, David Guidot, Andy Smith, Nancy Collop, David Neujhar, Katie Sparks, Linda Delaney, Matt Bednar
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Final Initiatives: 1. Develop and implement quality programs in both inpatient and outpatient settings 2. Disseminate innovative discoveries and best practice models throughout the medical community and society 3. Improve service through operational efficiency and resource optimization 4. Create a sustainable model for inpatient care with mechanisms for subspecialty involvement at both inpatient and outpatient transitions

Incorporate formal and hands on training of quality concepts into educational curriculum Create a division of Hospital Medicine

GOAL: ENHANCE RESEARCH IMPACT

Weaknesses/ Opportunities Inadequate research equipment & infrastructure Inadequate research space capacity/size and location Lack of coordinated and searchable IT databases Lack of internal research support and bridge funding Inadequate clinical research administrative infrastructure and lack of clarity of PI responsibilities Lack of systematic mechanisms for recruiting patients into clinical trials

Collaborate to enable discovery, translate knowledge, and advance patient care

Initiative 2 Action Items/ Metrics Audit current system

2
4

3, 4

Audit current system

Take advantage of diverse patient

population base for clinical research Develop our regenerative medicine, predictive health, 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 and CHOA Few K Awardees and little infrastructure to support new awards and /or transition from Ks to Rs

1, 2, 4

1, 2

1, 2, 4 1, 2, 3, 4 1, 2

Develop interdisciplinary research

1, 2, 3, 4

Focus group with current awardees Approach the school about bonus mechanisms to resolve salary shortfalls Develop internal visiting professorship

Final Initiatives: 1. Support innovation, integration and translation of basic discoveries into clinical care and health care delivery 2. Enable future discovery by enriching the scientific and administrative platforms for basic and clinical research 3. Streamline research administrative procedures 4. Advocate and facilitate the adoption of an effective, user friendly, and integrated IT infrastructure Action Committee: Research Advisory Team- R. Wayne Alexander, Sam Lim, Frank Anania, Greg Martin, Saundra Berry, Mark Mulligan, Katharina Echt , Roberto Pacifici, Jennifer Gooch, Jeff Sands, Kathy K. Griendling, Leslee Shaw, Michael Hart, Jason Stein, Elizabeth Kimberl, Peter Thule
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GOAL: TRAINING AND EDUCATION

Weaknesses/ Opportunities Inconsistency in training experience at our 5 different training sites Sub-optimal performance in timely evaluation and feedback Offer new faculty development initiatives Expand NIH funded training programs Take a leadership role in redefining and developing solutions to the changing face of the Internal Medicine Residency training

Collaborate to transform medical education and lead the efforts to redefine residency training.
Initiative 1 2 3 Action Items/ Metrics

1 1

Action Team: Education Executive Committee

Final Initiatives: 1. Develop and implement creative approaches and consistent processes for medical education 2. Streamline educational administrative procedures 3. Provide development opportunities for educational skill building 4. Develop training programs to improve patient-centered professionalism in all trainees

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GOAL: PEOPLE

Cultivate a collaborative environment of excellence that embraces diversity and attracts, retains, and develops engaged faculty, staff, and trainees
Weaknesses/ Opportunities Limited opportunity for clinical research Limited opportunities for regional and national service outreach efforts Limited promotion opportunities for Clinician Educators Lack of targeted leadership training opportunities Recruit new investigators to maintain strong research program Institute succession planning for senior clinicians Provide development opportunities for mid-career faculty and staff Recruit outstanding trainees and administrative staff Initiative 3, 2 Action Items/ Metrics Increase FAME grants

5, 2 1 3 1 3 3 1

Increase K- Award success rate

Final Initiatives: 1. Optimize recruitment, retention and promotion strategies for faculty, staff, and trainees across divisions and locations 2. Promote sense of community with shared values and goals, aligned with our tripartite mission 3. Promote career growth and development among faculty, staff, and trainees 4. Support and increase faculty, staff, and trainee involvement in local, national, and international outreach and service efforts (**Also, present in Finance, Infrastructure and Partnership section) 5. Continue to realign compensation to encompass all three missions of the department Action Committee: Faculty Development Committee

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GOAL: FINANCE, INFRASTRUCTURE AND PARTNERSHIPS

Weaknesses/ Opportunities Philanthropic support Ability to develop and capture intellectual property A funding model that depends on TEC revenue Promote growth of the clinical practices in outlying areas by acquisition or formal affiliation with existing private practices Re-examine the utilization of clinical and clinical research space to maximize efficiency and usage Critical lack of IT infrastructure Expand partnerships across the state of Georgia, as well as national and international collaborations Pursue international partnerships and business opportunities. Challenge of maintaining equipoise in administrative and financial relationships with Grady Initiative 2 2 2, 3 3, 5

Effectively develop and manage financial resources to achieve excellence across all missions
Action Items/ Metrics

1 4 3, 5

2, 5
1, 3

Final Initiatives: 1. Optimize administrative structures and processes throughout the DOM 2. Increase philanthropy and alternative funding sources to enable strategic investment 3. Explore opportunities for growth of clinical enterprise and financial stability in the DOM 4. Advocate and facilitate the adoption of an effective, user friendly, and integrated IT infrastructure 5. Support and increase faculty, staff, and trainee involvement in local, national, and international outreach and service efforts Action Committee: Finance Advisory Team- Bob Taylor, Kevin Andrews, Paul Hammonds, Steve Doney, Sandra Talley, Paige Martin, Michael Kilgore, Leah Fernandez, David Propp

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