McGill University Faculty of Medicine Administration Excellence Learning Collaboratives

1. McGill University Faculty of Medicine Administration Excellence Learning Collaboratives April 12 and 15, 2010

2. Agenda • Introduction • Summary of Peer Institution Interview Findings • Discussion of Models • Next Steps

3. Why Admin Excellence? • Feedback from Departmental Administrators: frequently expressed frustration concerning workload, lack of support, communication… • Became aware of serious vulnerabilities following contingency planning exercises • Need for immediate replacements when someone would fall absent or leave a position – no protection, lack of back-up systems, flexibility… When casuals are provided as an emergency backfill, they typically do not have training required to “jump in” to the position • Change/increase in the regulatory environment and workload; increasing demands on your time from your Chair/Faculty/Central…. • Non-stop requests for additional positions and re-classifications of current positions • All of this was in conjunction with an awareness that the financial situation at the Faculty was changing…there would be no additional resources forthcoming… • Faced with this situation, we made the commitment to “big picture” planning: finding a way to re-allocate current resources in a way that would provide you with additional support, reduce risk, and address your concerns.

4. Administration Excellence Goals Transform the Faculty of Medicine’s Administrative Support Services into one focused effort that will enable the best possible service levels in: • Student Centered Stewardship – undergrad to post-grad to doctoral to post-doctoral • Human Resources – recruitment to retirement or exit • Financial Services – financial management of the Faculty, its departments, and research funds • Facilities Management – responsible management of all facilities • Stakeholder Affairs – relations with donors, alumni, students & faculty

5. Project Objective and Approach McGill has engaged Huron to assist in developing alternative organizational models for the administration of the Faculty of Medicine’s academic/clinical units. • Working with the Project Team, Huron has developed possible alternative organizational models considering the following functional areas: • Huron has worked with the Project Team to analyze the anticipated benefits and challenges of alternative models that could help us to maximize the effectiveness and efficiency of our administrative resources.

6. Timeline Today’s Learning Collaborative marks the 20th week of this phase of the engagement. The project team has met weekly throughout this period.

7. Today’s Meeting Goals The goal of today’s meeting is to discuss three conceptual administrative support models identified by the Project Team. • Learning Collaborative members are asked to: • Review the interview findings to have an idea of what other organizations are doing • Discuss potential models (decentralized vs. centralized) of a new administrative organization: • Benefits to the Faculty of Medicine • Challenges to implementation and how to resolve • Provide you with the opportunity for further reflection on how this could work in your area; we are looking for your feedback in terms of concrete concerns and solutions for improvement

8. Summary of Peer Institution Interview Findings

9. Methodology Huron interviewed four Canadian Faculties of Medicine to augment information obtained from the literature and our work with academic health centers in the United States. • Interviews aimed to gain insight on the approaches and models used by other faculties of medicine in providing effective and efficient administrative support to academic departments, units and centres and their faculty members • Interview focus areas included: • Administration (overall structure) • Structure and distribution of responsibilities within the following functional areas: • Huron performed interviews with: • McMaster University • University of Alberta • University of British Columbia • University of Toronto • The following slides include interview findings as of March 9, 2010

10. Interview Institution Demographics Notes: Medical Students source: Academic Year 2009/10, AFMC (http://www.afmc.ca/pdf/Enrol2009-1.pdf) Residents and Fellows source: 2008 data, AFMC (http://www.afmc.ca/pdf/cmes/CMES2009.pdf ) Faculty source: Academic Year 2007/8 data, AFMC (http://www.afmc.ca/pdf/cmes/CMES2009.pdf ) Full-time faculty includes Professors, Associate Professors, Assistant Professors, Instructors and Other Residency Program source: Respective institution websites Department information source: Respective institution websites

11. Interview Summary While interviews revealed some variation across Faculties, several key common themes emerged. • Most transactions occurred at the department / unit / centre level with approval and oversight at the Faculty and / or University level • Administrative structures of the departments / units / centres varied considerably; structures were largely a factor of size, complexity and history • Institutions interviewed did not report having a benchmark for support in the functional areas • There has been a movement towards “professionalizing” the administrators within the departments / units / centres • Some institutions have focused on creating a career ladder for these positions • Some have created forums for sharing best practices and professional development activities • All interviewees continue to monitor the balance between centralization and decentralization of functions. Sample strategies include: • Designation of department / unit / centre-focused personnel within central Faculty functional offices • Grouping of departments / units / centres into “schools” with an administrative lead Interview themes were highly correlated with Huron’s experience with medical school and academic health center administration in the U.S.

12. McMaster University Huron conducted a phone interview with Kevin Sulewski, Director of Clinical Services and Susan Birnie, Director of Education Services on February 19th, 2010. • Department chairs have 5-year terms, limited to 2 terms. The same individual serves as Chair and Chief for clinical departments • Business manager positions were “professionalized” approximately 15 years ago: require an MBA • Have recently undergone tremendous growth, doubling size of MD, Nursing and PA programs • There is a centralized clinical practice plan, which actively manages physician compensation and business arrangements • Research institutes are joint ventures on behalf of university and hospital • Structure is a “decentralized federation”; departments can spend funds as they wish as long as they remain within annual budget approved by the Finance Committee • McMaster has instituted a structure with 3 key administrative leads in the deans’ office: Clinical Services, Education Services, and Research Services • Administrative structures within departments and across missions/functional units vary considerably. Examples include: • HR (functions autonomously from University): 3 HR consultants, 3 assistants, 2 managers • Finance: 4 managers, 5 transactional • Education: ranges from 4 in PA program to 20 each in UME and PGME • Administrative structure within departments and within the deans’ office supports a career ladder for administrative staff

13. University of Alberta Huron conducted a phone interview with Dr. Verna Yiu, Vice Dean, Faculty Affairs at the University of Alberta on February 8th, 2010. • The University of Alberta has recently remodeled its organizational structure, creating eight schools, which were designed to achieve better synergies within research and education as well as to improve communication and collaboration. The structure is too new to determine how effectively and efficiently it functions. There is a general sense that it “can’t be worse”. • The reporting structure still primarily is to the department chair, but each school has a lead that sits on a faculty management committee, which functions in an oversight capacity • Each school has a research lead, an education lead and an administrative lead. Each school also has a coordinating committee, which is responsible for communication, policy development, and more local level issues. • The Dean’s Office is involved in the recruitment of administrators (APOs). The Executive Director meets monthly with the APOs. Some smaller departments have combined APOs. • Most of the administrative functions of interest to this engagement are handled in a similar way: • A central office is responsible for the oversight of activities, but the departments also have local personnel to perform the functions • Staffing and organization are largely functions of historical decisions; there are not standards for administrative support in these areas • Each department has a fixed budget and must manage resources within these parameters • Significant resistance to this restructuring and no new money was expended. The Dean has played a key leadership role throughout

14. University of British Columbia Huron conducted a phone interview with Tammy Brimner, Executive Director for Faculty Affairs, on February 19th, 2010. • Department administrative structures vary by size and activity level. Range is described below: • Small departments have 1 administrator and 1 staff person who handles HR, finance • Largest department has 1 director, 1 staff member in finance and in HR and support staff • Across functions, departments largely perform transactional activities and approval occurs at Faculty and University levels. Exceptions include: • Graduate biomedical science support largely exists within the department • CME is largely centrally managed • Research grants are typically assembled at department level and then approved by Faculty and University. Post-award and pre-award expertise is at the PI-level. • Some functions have instituted departmental support in central Faculty areas (e.g., Finance), where support staff are located in the central functional office, but their activity is focused on a specific department(s) • Departments can use their money as they see fit, as long as they remain within budget • HR, Finance and Faculty Affairs: Faculty/University provides central support, departments handle transactions • Major challenges include: • Provincial model of the Faculty and corresponding geographic challenges • Achieving the appropriate balance between department and Faculty responsibilities

15. University of Toronto Huron conducted a phone interview with Catherine Whiteside, Dean on February 19th, 2010. • Key position of Chief Administrative Officer (CAO) works closely with the Dean and CFO • Departmental administration has a senior executive/business manager, who reports to the Chair with a dotted line report to the CAO. Amount of support staff within the departments varies by size and activity level • Business managers/administrators have formed a group which meets regularly to share best practices, provide input to the Faculty on key issues and conduct professional development activities • Rule of thumb used for budgeting at the Faculty is 80% of budget should be in faculty support, 20% on administrative costs (including salaries). Some tolerance for deviation from these percentages, but used as a guideline. • Recently initiated department grouping into sectors with some direction to identify economies of scale; however, program has had minimal success to date • In general, transactions are handled at the department level; oversight is central (Faculty/University) • Each year, chairs present a 5-year budget for central approval. Onus is on the academic heads to review management reports on a monthly basis • Have decentralized practice plans. Department chairs work closely with the practice plans to ensure appropriate distribution of revenue for research and education activities

16. Literature Review: University of Minnesota The University of Minnesota (UMMS) formed administrative centers for support of their academic departments and units in the late 1990s. Key objectives in developing the model at the University of Minnesota are outlined below. • Key Objectives: • Departmental access to high quality service • Improved oversight of administrative functions within department • Enhanced recruitment and retention of professional administrators • Opportunities to develop best practices, policies, standards • Administrative Costs • By late 2005, five administrative centers were created to serve the clinical departments: • Subsequent centers were formed for additional clinical and basic science departments Source: Mitsch, Peter; Campbell Jensen, Allison. Academic Medicine, Vol. 82, No. 3 / March 2007

17. UMMS – Example Organizational Structure An overview of the UMMS administrative center model is presented below; the structure varies slightly by administrative center due to customization. Oversees administrative services and Department Administrators; reports up to Department Heads and Dean’s Office • Differentiated structures meet department needs (e.g. some functions such as GME remain based in the departments; some place second-tier administrators throughout the departments) Source: Mitsch, Peter; Campbell Jensen, Allison. Academic Medicine, Vol. 82, No. 3 / March 2007

18. UMMS – Successes and Challenges The administrative center model has overcome several initial challenges to achieve the appropriate balance between “efficient” centralization and “locally responsive” decentralization. A formal evaluation of the model was completed in 2005. Lessons learned via implementation: • Smoothest transitions were where one “anchor” dept with robust infrastructure is built upon • Not one size fits all; grouping departments based on similarities matters 2005 evaluation findings: • Finance and HR functions require focused expertise and use of information systems best provided at the administrative center level • Post-graduate medical education department-based model is appropriate, but recommended adding a center-level PGME supervisor position for consistency (could be filled internally) • Responsibilities and reporting roles not always consistent across centers; the medical school director of finance and administration would officially oversee this Source: Mitsch, Peter; Campbell Jensen, Allison. Academic Medicine, Vol. 82, No. 3 / March 2007

19. Discussion of Administrative Models

20. Organizational Effectiveness The success of any organizational structure is highly dependent upon a set of key characteristics. • Generally, effective organizations reveal the following characteristics: • Organizational structures are designed to support streamlined processes, provide for effective delegation, and eliminate unnecessary layers of management • Balanced process control (centralized versus decentralized) exists within and across organizations to maximize administrative efficiency and empowerment • Organizational structures provide for defined accountability and are supported by formal performance measurement and evaluation systems • Organizational structures provide for effective communication channels among the different units involved in the overall process, specifically at transition points between units • In our experience, there is no best practice for organizational structures – the best organizational structure is the one which best fits your organization: • Centralized, decentralized, and hybrid models can all be effective, provided leadership is strong and lines of communication promote transparency and responsiveness , and high-quality service is delivered to constituents • Working with the Project Team and using the information obtained from the interviews conducted, published literature and Huron’s academic health center consulting experiences, three models were developed for consideration by the Steering Committee

21. Structure • How is McGill’s administration organized? • The reporting relationships among people and units • Strategy • What is McGill’s strategy? • The set of actions describing how superior services will be delivered, given resource constraints • Style • How do leaders behave? • The way administrative management communicates shared values and information • Systems • How does work get done? • The procedures, processes, and information used to administratively manage Shared Values McGill’s history and the values it holds • Skills • What are McGill’s core skills as an organization? • The administrative capabilities that McGill possesses • Staff • Who is in the organization? • McGill’s administrative, personnel described collectively Framework – 7-S Model The 7-S Model recognizes that organizations cannot be described by their structures alone. Rather, the interplay and alignment between all seven dimensions must be considered. *Note: Originally developed by McKinsey & Co.

22. Considerations in Determining an Appropriate Administrative Model There are a number of factors which can influence the appropriateness of a model within a particular organization. These factors are described below. • Department / Unit Factors: • Geography • Size: (e.g., faculty, trainee, revenues and expenditures, # of grants, # of accounts) • Complexity of academic structure (e.g., divisions) • Mission emphasis • Hospital / institute / other responsibilities • Management style of the Chair • Functional Factors: • Technology and other available resources • Risk / complexity • Level of competence required for administrative staff (e.g., generalist vs. specialist) • Funding • Incentives • Implementation Factors: • Culture • Training • Resource availability • Expectations for service levels • Timing / staging • Culture can have a considerable influence on whether or not a structure / model functions in the way in which it was designed.

23. Faculty of Medicine’s Current Support Model Each unit has a dedicated administrator responsible for all functions; however, administrative staffing levels and functions within the units varies. • Advantages: • Flexibility, local decision-making and autonomy • Local expertise and resources to meet faculty needs • Physical proximity of team • Disadvantages: • Administrators must be “jack of all trades”; spread thin, not able to fully specialize in any one area • Decision-making processes and transactions not consistent across units • Potentially duplicative resources and efforts may result in higher costs than more centralized operations • Limited cross-coverage for administrative functions • Limited incentives to share resources and / or best practices • Limited central control results in a potential for higher risk • Silo-ed communication • Potential for isolation of administrative staff Report to Unit Heads and Director of Administration; Liaise with Other Central Faculty Administrative Offices Unit A Unit B Unit C Dedicated Unit Admin Staff Dedicated Admin Staff Unit B Dedicated Admin Staff Unit C Dedicated Admin Staff Unit A All Units Note: The term “unit” is used in the following slides in reference to departments, schools, centres, and institutes

24. Model #1: Function-Dependent Support Units have dedicated administrators for certain functions within a given area and centralized support services for other functions. Report to Unit Heads and Director of Administration Mix of Unit Admin Staff and Centralized Support Services, Based on Function Within centralized support services, staff may be “assigned’ to units Functions 2 & 3 Centralized Support Services within Central Faculty of Medicine Offices Function 1 Unit Admin Staff Unit A Function 1 Unit Admin Staff Unit B Function 1 Unit Admin Staff Unit C Unit C Unit A Unit B

25. Function-Dependent Support Model – Advantages & Disadvantages • Advantages: • Balance between “efficient” centralization and “locally responsive” decentralization • Dedicated administrators for functions requiring local expertise and resources to better meet faculty needs • Adaptability and customization based on unit and functional needs • Centralized administrative pool allows for efficiencies resulting from economies of scale, potential financial savings, shared expertise • Seamless administrative coverage for centralized functions • Centralization of functions represents a departure from a structure with “jack of all trades” administrators. This may allow for greater specialization of knowledge and skills, create opportunities to build a professional “career ladder” for administrative staff and enhance satisfaction and retention • Can serve as a first point of transition to an administrative centre model • Disadvantages: • Potentially duplicative resources and efforts may result in higher costs for non-centralized functions • Consistency of processes and transactions may not hold across units for non-centralized functions • Limited cross-coverage for non-centralized administrative functions • Communication can be challenging across units and with the central Faculty • Within shared functions, prioritization between various unit needs may be challenging • Merging previously independent teams and creating a new “identity” may be difficult

26. Function-Dependent Support Model – Illustration For illustrative purposes, the function-dependent support model at the Faculty of Medicine could function as depicted below. Specific tasks within each functional area could be centralized to achieve efficiencies. Report to Unit Heads and Director of Administration Centralized Support Services • Human Resources: • Payroll transactions – academic and admin • Performance process • Screen and interview admin candidates • Job descriptions • Immigration • Education: • Coordinate UME student/advisor match • Manage clerkship scheduling system • Finance • Establish policies, procedures & controls • Purchasing • Process Expense Reports • Research: • Pre-review grant submissions • Monitor post-award • finances Unit Admin Staff • Finance: • Approve purchasing requests • Manage unit resources • Education: • Set clerkship rotation schedules • Advise students • Research: • Grant writing • Human Resources: • Timesheets • Performance reviews • Determines job duties • Tenure and promotion dossier

27. Model #2A: Administrative Centre Grouped units are served by an Administrative Centre. A Centre Manager partners with the Unit Heads, overseeing high-level strategy, managing ad hoc projects and overseeing high-level operations. Supervisors oversee day-to-day operations and are supported by a team of transactional personnel. Unit Head A Directorof Administration Unit Head B Administrative Centre Manager • Functional Supervisors also have dual reporting to respective central Faculty of Medicine offices: • Finance • Education • Research • HR Finance Supervisor Education Supervisor Research Supervisor HR Supervisor Transactional Personnel(e.g., expense reports) Transactional Personnel (e.g., scheduling) Transactional Personnel (e.g., grant coordination) Transactional Personnel (e.g., job requisitions)

28. Administrative Centre Model - Advantages & Disadvantages • Advantages: • Balance between “efficient” centralization and “locally responsive” decentralization • Specialization allows individuals to build expertise in a rapidly changing environment and focus efforts without being distracted by other priorities • Uniformity and quality-control of decision-making and processes; can develop “best practices” within and across centres • Centralized administrative pool allows for efficiencies resulting from economies of scale, potential financial savings, shared expertise • Seamless administrative coverage • Establishes Administrative Center Manager as point person for unit heads • Centralization of functions represents a departure from a structure with “jack of all trades” administrators. This may allow for greater specialization of knowledge and skills and enhance satisfaction and retention • Centre structures allow for the creation of management positions in various functional areas, generating opportunities for staff to further develop their knowledge/skills and progress in their careers • Disadvantages: • Complex role of Centre Managers in balancing operational and strategic needs as well as needs of multiple unit heads and Faculty • Communication and accountability across units and with the Faculty may be challenging • Merging previously independent teams / creating a centre “identity” may be difficult

29. Model #2B: Administrative Centre Grouped units are served by an Administrative Centre. An executive-level Strategic Advisor partners with the Unit Head, overseeing high-level strategy and managing ad hoc projects. Functional supervisors oversee day-to-day operations and are supported by a team of transactional personnel and report to the Director of Administration. Strategic Advisor Unit Head B Unit Head A Directorof Administration • Functional Supervisors also have dual reporting to respective central Faculty of Medicine offices: • Finance • Education • Research • HR Finance Supervisor Education Supervisor Research Supervisor HR Supervisor Transactional Personnel(e.g., expense reports) Transactional Personnel (e.g., scheduling) Transactional Personnel (e.g., grant coordination) Transactional Personnel (e.g., job requisitions)

30. Administrative Centre Model - Advantages & Disadvantages • Advantages: • Balance between “efficient” centralization and “locally responsive” decentralization • Specialization allows individuals to build expertise in a rapidly changing environment and focus efforts without being distracted by other priorities • Uniformity and quality-control of decision-making and • processes; can develop “best practices” within and across centres • Centralized administrative pool allows for efficiencies resulting from economies of scale, potential financial savings, shared expertise • Seamless administrative coverage • Centralization of functions represents a departure from a structure with “jack of all trades” administrators. This may allow for greater specialization of knowledge and skills and enhance satisfaction and retention • Centre structures allow for the creation of management positions in various functional areas, generating opportunities for staff to further develop their knowledge/skills and progress in their careers • Advisor functions as strategic partner to unit heads, without day-to-day operational distractions • Disadvantages: • Complex role of functional supervisors in balancing needs of multiple unit heads and Faculty • Multiple point persons for unit heads may be confusing • Communication and accountability across units and with the Faculty may be challenging • Merging previously independent teams / creating a centre “identity” may be difficult

31. Administrative Centre Model: Illustration For illustrative purposes, hiring a secretary and submitting a grant application within the administrative centre model could function at the Faculty of Medicine as depicted below. Illustrative Example: Hiring a Secretary Illustrative Example: Submitting a Grant Application • Identify need for position • Would like to pay from grant PI PI • Scientific proposal FinanceSupervisor HR Supervisor ResearchSupervisor FinanceSupervisor ResearchSupervisor HRSupervisor • If staffing needs, advise on classification • Contribute budgetary information • Confirm allowability for particular grant • Confirm funding source and availability • Review/advise on budget HR Transactional Personnel Research Transactional Personnel • Work with PI to develop the budget • Confirm compliance with funding agency, Faculty and University policy • Ensure resources exist and/or are planned (space, equipment, etc.) • Job description • Job posting • Interviewing of candidates • Joint selection

32. Administrative Centre Model: Illustration For illustrative purposes, the self-study process in the administrative centre model could function at the Faculty of Medicine as depicted below. • Assist in drafting self-study • Analysis of data • Draft highlights • Benchmarking and external trends • Must complete a self-study for reappointment Chair Strategic Advisor ResearchSupervisor Finance Supervisor HR Supervisor Education Supervisor Transactional Personnel Transactional Personnel Transactional Personnel Transactional Personnel • Compile data and appendices • Summarize trends and key points • Compile data and appendices • Summarize trends and key points • Compile data and appendices • Summarize trends and key points • Compile data and appendices • Summarize trends and key points

33. Administrative Centre Model: Illustration

34. Discussion

35. Next Steps • Learning Collaborative members to review documentation • Provide written feedback – pros and challenges/cons, with recommendations for improvement, to Christine and Melina by April 23rd • Obtain feedback from key stakeholders • Steering Committee (on-going) • Medical Managers • Deanery and FLC • Additional meeting targeted for mid-end of June to review and synthesize feedback • Make modifications and perform further analysis • Describe implementation considerations, key milestones, and timeline

36. Implementation Considerations The following questions will assist in developing an implementation plan for the administrative model selected. • Culture: • What aspects of the Faculty of Medicine’s culture support these models? • What aspects will create barriers to implementation? What can be done to address these? • Staffing: • What core competencies are needed in each of the key administrative positions? • What staffing levels will be appropriate in the new model? • Are there enough individuals at the Faculty today to fill all key positions? • Processes: • Do processes in each area function in an efficient and effective manner? • What changes need to be made? • Resource availability: • What systems (technological, other) exist today to facilitate activities in each functional area? • What functional areas need existing resources? • Training: • What training should be developed to fill any knowledge and / or skill gaps? • Expectations for service levels: • Within each functional area, what is the service expectation for faculty members, administrators, and the central Faculty? • Timing / staging: • What is the appropriate timeframe for implementation? • Should implementation occur in phases? If so, how?