University of Louisville School of Medicine

1. University of Louisville School of Medicine Organizational Assessment Summary of Findings and Recommendations

2. Background and Context • The University of Louisville’s Interim Dean of the School of Medicine recently commissioned an external review of the School to further assess and evaluate its overall effectiveness and quality • The external review was conducted by Excelcor, a nationally recognized higher education consulting firm, during the months of May and June, 2012 • Excelcor performed its review by examining current and historical performance data, organizational structures, role descriptions, and by conducting in-depth interviews with the School’s key leaders and stakeholders • The interviews were conducted in a manner to surface and identify emerging themes and trends impacting the performance of the School

3. Findings Key Findings • The Interim Dean has significant support from Departmental Chairs, faculty and external partners to lead the School of Medicine • Many expressed the view that her talents provide the school with the right mix of skills, experiences and behaviors at the right time • Evolution of ULP along with new and evolving partnership relationships require high levels of collaboration, communication and alignment • Interim Dean is seen as a positive leader with excellent communication skills • She is collaborative by nature and seeks a broad selection of views and opinions before making decisions • In view of her lack of extensive research experience she will need to proactively demonstrate her commitment to building a stronger research portfolio for the School of Medicine and to addressing issues that limit research success

4. Findings Key Findings • In an era of significant change the school needs a clear and compelling vision for the future, shared strategies for achieving it, and clearly defined roles across partner institutions • Significant change in national and local health care economics are redefining the historical roles of the medical school, hospital partners, clinical practice plans, and physicians • The likely addition of a new partner through the RFP process will require clearly defined roles and responsibilities of the U of L, ULP, UMC and RFP partner • The successful evolution of ULP is reshaping clinical practices and physician relationships • The current revenue model for the School of Medicine is putting increased financial pressure on the School, and new sources of revenue will be critical to the future success of the school • A desire to grow research activity and expenditures will require purposeful strategies and investments • Most of those interviewed expressed the opinion that the school lacks a clear vision for the future but felt strongly that one is needed to align and prioritize investments, activities, organizations, and structures

5. Findings Key Findings • The current revenue model for the School of Medicine is putting increased financial pressure on the School, and will be an increasingly greater challenge if left unaddressed • The patient population emanating from the university's affiliated hospital is indigent and often unable to pay for its health care • Traditional funding levels from the university hospital are not sustainable going forward, creating the necessity for a successful hospital partnership • Some physicians pointed to a practice of referring patients to competing providers instead of to University clinical practices, resulting in a weak referral system and loss of patient revenues • There is a significant dependence on a successful RFP but no evidence of a financial plan if a new partnership is not reached • Concerns were raised that a future RFP partner will likely direct new resources into clinical areas and not into teaching or research

6. Findings Key Findings • While most had favorable comments about the need for an integrated practice plan and the current progress made by ULP many expressed concern about its lack of funding • The ULP is reportedly undercapitalized with too much debt raising concern that departmental revenues will be used to service debt instead of reinvesting back into the departments • Some expressed concern over the current economics and financial health of some clinical practices as they become part of ULP

7. Findings Key Findings • In recent years there has been a lack of investment and focus on building the medical school's research portfolio • The school is engaged in world class research but in too few disciplines and areas • The research agenda is not being driven by a well defined plan or strategy that leverages existing or emerging research strengths • The research infrastructure is in need of improvement (support for grant activities, IRB, Industry contracts, ineffective pre and post award services, etc.) • Research facilities and technologies are aging and are in need of upgrade • Research activities are poorly coordinated across the school with missed opportunities for interdisciplinary research • There is low accountability with respect to research activity throughout the School • Current economics and the related emphasis on growing clinical activities conflicts with enhanced research productivity

8. Findings Key Findings • As new funding models and partnerships unfold, the need for greater financial competencies and leadership will increase at the Health Affairs level and within the School of Medicine • The University’s EVP of Health Affairs will need active support to guide financial strategies and investments and to manage partnerships • The Health Affairs CFO is serving as both the financial leader for Health Affairs and the School of Medicine • Enhanced financial competencies at the School are needed to allow the CFO to serve the EVPHA more strategically and to coordinate financial operations of the departments and clinical practices • New financial leadership within the School will be needed to meet future demands

9. Findings Key Findings • Questions were raised about the need for the Vice Dean for Clinical Affairs position • The emergence of strong leadership within the ULP has likely rendered the Vice Dean of Clinical Affairs position unnecessary

10. Findings Key Findings • Effective communication and collaboration are lacking across key partners (the Medical School, ULP, and University Hospital) • Effective communication and collaboration across the School, ULP and the University Hospital could be improved • The principals of these organizations expressed the need for enhanced information sharing and proactive discussions about key issues and priorities, and the alignment activities, investments, and plans • There are clear signs of improvement in communication and collaboration with the new Interim Dean, and continued efforts to enhance communication and engage in regular dialogue and information sharing across all entities will help to build strong partnerships and effectively align activities and strategies

11. Findings Miscellaneous Findings A number of miscellaneous issues surfaced as part of the assessment, and while not as significant as the key findings, they should be considered in moving the School of Medicine forward • The education of medical students and the student experience are perceived as being of high quality • However, increased pressure to raise clinical revenue may be diminishing the focus and effort on quality teaching • A passionate commitment to the School’s success is found among its faculty and staff • The School is missing opportunities to leverage its successes to generate private gifts, philanthropy and fundraising • There is a perception that too many nonproductive centers exist draining central resources from other areas of the school • Technology services are ineffective and not responsive to the needs of the faculty • The School of Medicine website needs to be enhanced and upgraded

12. Findings • Miscellaneous Findings (continued) • The Simulation Center is in need of upgrade • There is an aging infrastructure with no identifiable strategy to improve it • Faculty are spending significant amounts of time on administrative activities (budget, grant administration) to the detriment of research and clinical and scholarly activity • Standard operating procedures are reportedly missing for areas involving finance and budget, as well as promotion and tenure processes

13. Recommendations Recommendations

14. Recommendations • The assessment surfaced a number of issues and challenges facing the School of Medicine, at a time of great change and opportunity • With new dynamic leadership within the EVPHA and the School of Medicine, the formation of ULP, the potential for a new major clinical partner, and the economic uncertainty of the School, it is critically important to establish a common vision with clearly defined strategies and roles for the School and its key partners • As a result, Excelcor recommends that the School engage in a collaborative and inclusive long term strategic planning process that addresses the following: • The future vision and direction of the School of Medicine • A sustainable revenue and funding model • Formulating scenarios with a new partner and without a new partner • An enhanced research portfolio • Support the prior recommendation to create a senior research position at the Health Affairs level • A comprehensive plan to address the aging infrastructure • We recommend that the School develop an approach to strategic planning that is inclusive, in whole or in part, with ULP, University Hospital and any new partner

15. Recommendations • In addition, we recommend that the School eliminate the Vice Dean of Clinical Affairs position • A new structure with ULP and solid leadership within the ULP has likely rendered this position unnecessary • After vacating the position for a period of time, the School can further assess whether the position is needed • Future financial demands at the EVPHA level and at the School will require added financial competencies • We recommend that the School of Medicine create a new financial leadership position within the School of Medicine (see Attachment A) • The new position should be at the Director of Financial Affairs level • The position could possibly be funded by resources freed up by eliminating the Vice Dean of Clinical Affairs position

16. Recommendations • The School is missing opportunities to leverage its successes to generate private gifts, philanthropy and fundraising • The School’s marketing, communications and fundraising efforts could all be enhanced for greater results • As a result, we recommend that the School engage in a process for developing a comprehensive development, marketing and communications plan • Build new competencies for communications across the Schools • Build a targeted development strategy • Build a grateful patient program • Work closely with VP of University Advancement to move the effort forward • Along with an effective strategic plan integrating the School of Medicine with its strategic partners it will be important to ensure that communications with key stakeholders and partners are frequent and collaborative • We recommend that a deliberate communication plan with effective structures and processes be developed to foster and promote on-going communication

17. Recommended Next Steps To advance the recommendations, we recommend the following next steps: • Share the Assessment Findings and Recommendations with key leaders • EVP Health Affairs • EVP Academic Affairs and University Provost • EVP Research and Innovation • Departmental Chairs • School of Medicine Academic and Administrative Leaders • ULP Leadership • Solicit input and modify the recommendations as appropriate • Share Assessment Findings and Results with School of Medicine • Launch a comprehensive and inclusive strategic planning process • Excelcor to recommend an appropriate strategic planning framework • Identify individuals to support a strategic planning initiative • Define role and job description for Director of Finance position and launch recruitment

18. Recommended Next Steps • Convene a meeting of the requisite development and communication resources and begin to formulate a comprehensive development, marketing and communications plan • Identify required resources and investments to build new competencies • Develop action plan, timelines , milestones and success measures • Excelcor to facilitate if appropriate and needed • Conduct a communications assessment • Identify communication targets, messengers, communication vehicles, communication tools, and communication structure • Develop an effective set of communications plans and processes

19. Attachment A Financial Administration EVPHA AVP Finance and CFO Health Affairs Dean of the School of Medicine Consider funding the added position with VD Clinical Affairs funds Director of Finance School of Medicine Departmental Unit Business Mangers ULP CFO