Semiannual Medical Staff Meeting

I had the great privilege of giving an address to our medical staff at their semiannual meeting last Wednesday, and wanted to post my remarks here to share them even more broadly.

Several hundred UNC Health Care doctors and medical staff attended the meeting. It was a pleasure to meet many of them to discuss what was on their minds and how we can continue to improve the patient experience at our hospitals and clinics.

Click on the “More” below to read my speech in its entirety.

Two-and-a-half years ago I was privileged to be chosen to lead your School of Medicine and our health care system. I sought this role because I love the university and because I believe in our historic mission leading, teaching, and especially caring for all of the people of North Carolina. I also wanted to directly contribute to our historic excellence in patient care, research, teaching and community service.

Last year, we proposed an updated vision for our enterprise to become the nation's leading public academic health care system. This statement recognizes our past and present success, but also explicitly challenges us to reach even higher.

Our health care system is now well positioned to focus our collective energies on this vision. Thus, tonight I want to foster a dialogue about what it means to be the leading public academic medical center, and I want to formally ask for your help and input into how we can together realize this goal.

Before I became dean/CEO in 2004, I had served on our health care system board of directors for five years. I knew that to continue to build the kind of health care system you and I want for our patients and for our state, we had to address the acute economic threats to our viability. Payments to doctors and hospitals from all sources have not kept pace with the cost of providing care; as a public academic medical center we have been especially hard hit by Medicare and Medicaid cuts. More recently the School of Medicine has faced slowed, and now stagnant, NIH funding growth nationally.

I know that some of you take issue with at least some of the steps we took to stabilize our financial situation. If we had it to do over again, there are some things we would do differently; but I believe we were right about the need to face this challenge head-on. More to the point of our future, I am very aware that our success so far in improving our finances is the result of your work, and the work of many others in the UNC Health Care System family. And I also know that we cannot continue to ask all of you to simply continue to make do with less and to continue to run faster on the same treadmill.

Fortunately, we now have an opportunity to have a different conversation, a more welcome conversation, about how to move towards our vision to be the leading public academic health care system. The environment we are in also makes this a good time to talk about how we move to an even higher level of excellence and achievement in teaching, in patient care, and in basic, clinical, and translational research.

Insurers are increasingly willing to consider the importance of safe and high quality care when directing patients and setting reimbursement. Clearly, we will continue to have to fight for every bit of our fair share of the health care dollar; but in so-called pay for performance programs, we may see a real return for our investments in improving quality and safety.

Second, the finances of our state right now are improving; and even more important, our legislators remain very supportive of the University and particularly of our School of Medicine and our Hospitals. This is a good time to make a case for additional public investment in our drive to serve all of our citizens with the best care and the best research.

Our new president of the UNC System, Erskine Bowles, understands the complexity of our enterprise and its central role at Carolina and among the entire university system. President Bowles and Chancellor Moeser have made clear their priority to nurture and retain outstanding faculty, to invest in health sciences facilities and infrastructure, and to find additional support for research. These are all vital drivers for our success.

The NIH's welcome emphasis on interdisciplinary and translational science has meanwhile already helped us to leverage our culture of strong cross-departmental and cross-school collaboration into success with Roadmap grants that stacks up against any other center, public or private.

Finally, our health care system board of directors is increasingly and appropriately focused on helping all parts of our health care system to work together to achieve our vision. Our board understands better than ever that scholarly excellence, innovation, and an enduring commitment to quality are all essential to our long-term success.

With all of these stars moving into alignment, we have perhaps the best chance since the founding of the four year medical school and the North Carolina Memorial Hospital in 1952 to fundamentally lift our organization to an even higher level.

So, what does it mean to be the nation's leading public academic health care system? And, how will we get there? Over the next several weeks I will be asking all of you to help me to answer these questions as I think it is important that we forge a common and more specific set of answers.

To start the dialogue, let me tell you tonight what I think it means:

1. We will continue to serve the people of North Carolina, including our most vulnerable and needy citizens. Our mission to serve the public strengthens us. It gives us focus and helps us to overcome the burdens and the hassles that interfere with care delivery. It motivates us to put aside our personal differences for the good of our patients.

Our service mission reminds us every day why we chose to devote our lives to the healing arts. I say unambiguously that the UNC Health Care System will succeed because of what we are, not in spite of what we are. We know how difficult it is to maintain this commitment to the public in the midst of our nation's irrational and sometimes immoral means for health care financing. But we will not waiver from this commitment.

2. We will accelerate our pursuit and dissemination of new knowledge for the benefit of humankind. We will continue to recruit and retain outstanding scholars, scientists, and teachers; and we will make sure that we have state-of-the-art facilities and support. With the help of all of you, and because of you, we will design and take the necessary steps to position our Health Care System to become a top 10 recipient of NIH research awards and indeed of research dollars from all sources.

3. We will intensify our investments in people not only the researchers I mentioned just now, but everyone who makes up the UNC Health Care community. Clearly, this is a complex endeavor and many details will need to be worked out. For now, let me say that I intend to work with the Chancellor and with President Bowles on a commitment to our School of Medicine Faculty that aligns with President Bowles' recent University Day promise to seek support for all University faculty.

In the forthcoming legislative session, President Bowles will be seeking tens of millions of dollars in addition to annual cost of living raises to increase the baseline compensation of faculty in comparison with counterparts at respective peer institutions. Mind you, we will each of us be accountable to one another for working hard and delivering results. However, in return, we need a renewed covenant with those of you who give so much of yourself for your patients and for our citizens.

4. Finally, with regard to our clinical services, we must continue our quest to simultaneously improve the quality of care, the efficiency with which we work, the safety of our care environment, and our service to all customers, internal and external. To be the nation's leading public academic health care system, we need to do all of those things; and we need the help of every one of you to achieve it. There are some who say that we cannot afford to simultaneously improve quality, efficiency, and service. I am convinced of the opposite we cannot afford not to do so. We will draw from lessons within and outside of our profession to try to improve what we do. We will invest prudently but consistently in innovative ways to work together to care for patients.

All of you know that we have significant cultural and organizational barriers to overcome to further improve quality, efficiency, safety, and service. We will need to let go of old ways of doing things; and we will need to stop thinking in terms of our own silos, our own units, our own departments, our own buildings. The UNC Health Care System's mission is to serve and that mission is fixed. It is our North Star around which everything we do revolves, and around which all of the inside and outside forces that buffet us must align.

Also fixed, in my view, is our destiny to achieve that mission as an integrated system. We cannot meet our commitments to our patients by maintaining walls between our component parts, or by splitting up those parts. Therefore, we must learn to work smarter together. Our physician group must learn to be a more integrated multi-specialty group practice. UNC physicians and UNC Hospitals must bear, and must share, the responsibility to improve the clinical operations of our office practices and our wards.

The commitments I have described to public service, to scholarly endeavor, to support for caregivers, and to quality fostered by integration are not new. But if we are serious about becoming the leading public academic health care system, we will need to rededicate ourselves to them, and bring even more energy to the task.

I believe we are privileged to have the opportunity to take the steadfast support of our neighbors and our friends across North Carolina and turn it into something truly special an enterprise that empowers today's healers, and trains tomorrow's; and that pushes the boundaries of knowledge to fight disease and suffering. I remain very proud to be a part of what you do, day in and day out.

In the coming weeks, I will continue to work with the clinical department chairs and the health care system leadership to seek your feedback and complete the outline of our vision. I look forward to working with you on the detailed and important task of making it happen.

Thank you very much.

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