Reflecting on Progress A Report

Office of the Senior Vice President  for Health Sciences  Frank B. Cerra, Sr. Vice President October 19, 2000

Vice Presidential Organization Review
Office of the Senior Vice President for Health Sciences
Academic Health Center
 

Introduction

The University’s Academic Health Center was created in 1970, following a critical review by a national panel of experts.  The panel, commissioned by the Regents, recommended a major restructuring of the University’s health sciences schools and colleges and the appointment of a senior administrative official for health sciences, reporting directly to the President.

While the organizational structure, services, and staffing of the Senior Vice President’s Office have changed over the years; its core purposes have remained the same:

• Provide leadership and oversight of the University’s health sciences academic and clinical programs
• Foster and support intercollegiate education, research, patient care, and service in the health sciences
• Provide academic and administrative support to AHC units, including those services most effectively and efficiently provided by pooling resources across units.

The University of Minnesota is in a nearly unique position to be a national leader in establishing a new paradigm of health education, research, and service ? one that leverages the strengths of the individual health professions into new interdisciplinary approaches to promoting and improving health.
 

Organizational Structure and Staffing

When I was appointed the head of the Academic Health Center in April 1996, I immediately ended the reengineering efforts that were underway and worked with the deans and faculty to develop a new strategic plan for the center.  The plan focused on enhancing our leadership in education and research, improving our competitiveness in clinical care, and strengthening our financial and administrative management.
The plan has been the basis for prioritizing our work in the AHC, for allocating resources, and for organizing and staffing my office for the past four years.

There are three major components to the AHC: the seven health professional schools; the intercollegiate academic programs and centers; and the Office of the Senior Vice President, whose role is to provide academic and administrative support to AHC units.

Attachment A includes current organizational charts of the Academic Health Center and the Office of the Senior Vice President for Health Sciences.  Also included is a chart of the major consultative, advisory, and operational groups for the Senior Vice President’s Office.   Let me highlight several things about the organizational structure and staffing.
 

• AHC Deans Council: I have regularly scheduled monthly meetings with each of seven AHC deans to discuss school-specific issues and meet twice monthly with them as a council to discuss and decide AHC-wide issues.

 
• AHC interscholastic centers and programs: The Deans Council has designated six academic units as AHC-wide centers and programs.  The directors report directly to me, as is the case with the Cancer Center and CUHCC, or to one of the academic assistant vice presidents.

 
• My senior management group consists of the assistant vice presidents for education and research, the chief of staff, the chief financial officer, the AHC general counsel, director of communications, and associate dean for clinical affairs in the Medical School.  We meet twice each week for two hours to discuss and make operational decisions.  I also meet individually with each of my senior managers weekly.

 
• Attachment B includes an FTE analysis of the Senior Vice President’s Office since 1996.  After building the core professional support units called for in the 1996 strategic plan, we have worked to reduce the overall administrative staffing in the Senior Vice President’s Office.  We have reduced staffing in the Senior Vice President’s Office itself, closed several administrative units, and reduced staffing in others. We have increased staffing in five areas: interscholastic academic programs; regulatory compliance, research animal resources; research services; and information technology.

We have just completed the development of a new strategic vision for the Academic Health Center and are now translating the vision into a prioritized strategic plan.  Development of the vision was a faculty-administrative partnership that took seven months.  The effort was lead by Dr. Martin Dworkin, Professor of Microbiology in the Medical School; Muriel Bebeau, chair of the AHC Faculty Consultative Committee; Terry Bock; and me.

The Regents approved the vision at their July 2000 meeting.  A copy of the executive summary of the vision is included in Attachment C.  The strategic plan will be presented to the Regents in November after consultation with AHC faculty and staff.  The strategic vision and plan will be the basis of the AHC’s compact decisions, resource allocations, and legislative requests for the next six years.  The metrics for evaluating our progress are being developed in conjunction with the prioritized strategic plan.
 

Academic Programs: Major Efforts and Accomplishments Since 1996

Education:

Leadership and Oversight:
 

• Sustaining the quality of educational programs.  All seven AHC schools and colleges have successfully passed accreditation visits in the last three years.  Dentistry; Nursing; Pharmacy; Public Health; the School of Medicine, Duluth; and Veterinary Medicine have sustained their top national rankings.  Student enrollments have remained steady in all schools; and the quality of entering students, graduation rates, and employment of our graduates have remained high.
• Working to increase funding for health professional education.  We have secured $8 million in recurring state funding to support health professional education at the University, and additional funding for institutions that provide clinical training sites for our students through the state’s medical education and research trust fund.
• Developing plans to increase enrollments to meet the growing shortage of health professionals.

Interscholastic Programs:
 

• Creating an investment pool and grant program to fund development of interscholastic education initiatives. We have awarded $2.2 million since 1998 to 8 faculty teams to develop intercollegiate initiatives in primary care, managed care, neurosciences, adolescent care, geriatrics, and care of the aging, in integrating the teaching of evidence-based skills into the curriculum and in developing web-enhanced learning modules.

 
• Beginning development of a new model of health professional education that is more interdisciplinary and community based, teaches a broader set of skills and knowledge needed by practitioners, and better utilizes information technology.

 

• Hiring an assistant vice president for education to lead the AHC’s interscholastic educational efforts, creating a community advisory board to provide assistance and advice, and creating an educational leaders forum of AHC associate deans of education and curriculum heads to coordinate and oversee the efforts.
• Investing $4.5 million to refurbish classrooms, build and equip student computer labs, improve computer technology in classrooms, and refurbish and add more student study space.

Leadership and Oversight:

• Investing in areas of emerging faculty research interest.  We have established new centers including the Biomedical Genomics Center, the Center for Bioinformatics, Center for Spirituality and Healing, Center for Cellular and Molecular Therapy, and the National Institute for Health Policy, in collaboration with the University of St. Thomas.
• Creating a faculty research seed grant program, awarding more than $750,000 over the last three years to individual investigators.
• Providing more than $1.2 million over the past four years to assist schools in faculty recruitment and retention.
• Securing comprehensive status for the Cancer Center from the National Cancer Institute.
• Providing increased oversight of AHC research to ensure compliance with regulatory requirements.

• Creating an investment pool and grant program to fund intercollegiate research projects.  We have awarded $4.8 million since 1998 to 22 intercollegiate faculty research teams.  We are currently gathering information on the results of the awards in terms of scientific discoveries, publications, external funding, technology transfer, and other measures.

 

• Hiring an assistant vice president for research to lead the AHC’s interscholastic research efforts, creating a community advisory board to provide assistance and advice, and creating a council of AHC associate research deans to coordinate and oversee efforts.
• Improving research facilities, including opening the Basic Sciences and Bioengineering Building, remodeling Jackson Hall, building the magnetic resonance facility, and beginning construction of a new Molecular and Cellular Biology Building.
• Expanding privately funded research by establishing a Research Services Organization in 1997 to facilitate interface between AHC faculty and industry.  Developing plans to enhance technology transfer.

• Negotiating the sale of the hospital and clinics to Fairview Health Services.  Working to assure the success of the new affiliation with Fairview by

• defining and implementing a cost accounting model to support education and research in the hospital -- "The Bucket"
• creating a $2 million investment pool for new joint University-Fairview initiatives
• opening a new primary care clinic in collaboration with UMP
• improving clinical facilities
• developing and implementing a plan to increase market share for Fairview University Medical Center, and to meet our public mission to the other health provider systems in the state
• conducting an external review to assess the effectiveness of the affiliation and ways to improve it.

• Merging 19 private practice plans into a single practice, University of Minnesota Physicians.   Consolidating administrative operations; developing and implementing a plan to increase market share; successfully competing for inclusion as a provider under the state health plan; improving performance so that the clinics are operating at community cost and quality benchmarks.

 
• Developing plans to sustain the viability of the Dentistry and Veterinary Medicine clinical practices in the changing health care market place.

 
• Strengthening the Community-University Health Care Center in the Phillips neighborhood of Minneapolis.

 

Implementation of the 1996 strategic plan began with an external assessment of administrative services in the AHC by the state’s Management Analysis Division.  Their critical assessment of services provided both centrally and by AHC units and schools was the basis for a comprehensive administrative improvement plan.
 

• Redesigning and implementing administrative processes in the areas of finance, information services, communications, facilities, and human resources.  The various models provide for distributed decision-making with oversight and accountability.

 
• Implementing more rigorous financial oversight systems and processes by:
• Organizing a new annual all-funds budget development and allocation process
• Introducing a position management program
• Forming a strategic investment pool for funding new education and research initiatives
• Linking the annual budget process to long-range financial planning
• Linking programmatic decisions and needs to the planning and budget process
• Instituting a financial performance reporting system
• Designing new and adapting current financial management information systems
• Implementing an audit process that periodically audits all units and provides for follow up on the audit results, using the university audit function

Attachment D includes a more complete listing of accomplishments of both the academic and administrative service units.
 

Service Evaluation and Outcomes

As part of the current audit underway of the Senior Vice President’s Office, the University’s auditors conducted a survey of deans, department heads, and fiscal officers.  A copy is included in Attachment E.  There is overall satisfaction and approval of the Senior Vice President’s Office management and administrative support.  Also included in Attachment E is a recent article from AHC Community News reporting the results of our survey of faculty and staff about AHC internal publications.  It is illustrative of the feedback we routinely collect on our services.

Each of our major academic support and administrative service units has completed an analysis of their key service outcomes with the exception of the Assistant Vice President for Education.  (Those service outcomes will be completed by the end of 2000.)   See Attachment F. We will be gathering more detailed information to better measure the effectiveness of our various education, research, patient care, service, and administrative programs.
 

Joint Efforts with Other Executive Officers

With the Provost, I share responsibility for

• Development of the University operating and capital budgets
• Development, review, and oversight of AHC unit compacts
• Review and oversight of AHC promotion and tenure decisions
• Oversight of the Enterprise Project
• Development and oversight of University-wide academic programs including reorganization and strengthening of the biological sciences, and development of neuro-behavioral programs

• Increasing public and privately funded research
• Developing and implementing new models to strengthen the University’s technology transfer
• Designing, implementing, and overseeing a new grants management system
• Providing executive leadership to the development of a work plan for NIH compliance to remove the University’s exceptional status designation
• Implementing a clinical research compliance program
• Revamping and strengthening the conflict of interest review process
• Developing new controlled substances policy
• Increasing training and technical assistance on regulatory compliance issues for researchers and research staff.

Issues and Challenges

Following are what we believe to be the major challenges facing the Academic Health Center:

• Implementing the strategic vision and plan
• Rebuilding the Medical School
• Breaking down barriers and leveraging the collective strengths of the AHC schools to meet the state’s changing health education, research, patient care, and service needs
• Leveraging new technologies to transform how we educate, conduct research, provide service, and improve administrative work
• Finding the optimal balance of centralized and decentralized administrative functions
• Accessing timely, reliable management information
• Balancing oversight and independence; focusing on results, not process
• Making bureaucracies responsive and nimble.