Administrators at Duke Medicine kicked off the New Year by coming together to consider critical issues Duke Medicine will face due to impending national health care reform.
Dr. Victor Dzau, chancellor for health affairs and president and CEO of Duke University Health System, has launched enterprise-wide planning throughout Duke Medicine to confront the changing nature of health care and uncertainties in future funding due to federal budget cuts. The six-month program will use four committees, which held their first meetings Jan.7, to examine areas of the health system that need improvement, which include: clinical alignment, education redesign, areas of distinction and research optimization.
“We have to reduce the costs and improve the quality of health,” Dzau said. “We want to continue planning on how we can achieve both.”
Changes in health care and financial concerns motivated the institutional reforms, said Dzau, who made a presentation outlining this four-pronged strategy to the Board of Trustees in December.
The fact that NIH’s resources will likely shrink in the coming year is one of the main motivations for this planning, said Dr. Joseph St. Geme, co-chair of the research optimization committee and the chair of the Department of Pediatrics.
“We recognize that we will not likely have the same level of NIH support both at Duke and across the country,” St. Geme said.
Dzau added, however, that Duke Medicine will not be limiting itself and instead seek to become more efficient through these changes.
Finding the best model
Dr. William Fulkerson, executive vice president of DUHS and co-chair of the clinical alignment committee, said his committee will discuss what clinical care models provide the highest quality care with the least amount of cost. The committee’s charge is to find a structure of clinical care that uses efficient decision-making to provide the highest quality care, while enabled to respond to different market opportunities quickly.
“Our goal is to step back and see if we are positioned to really have the optimal clinical product in a way that it needs to be configured in the next five years,” Fulkerson said.
Duke’s current health care model incorporates the Private Diagnostic Clinic—commonly known as Duke Clinic. Fulkerson, former executive medical director of the PDC, added that the health system will also try to open more care to more people and examine if the private clinic model is the best option for the future.
“We are doing a deeper dive now on five to six different models and trying to talk about variables like cost [and] future change... and then trying to bring a recommendation,” he said. “We have to understand the implications of any organizational changes that we might suggest.”
The co-chairs of the education redesign committee, Dr. Haywood Brown and Dr. Edward Buckley, could not be reached for to comment. Brown is the chair of the obstetrics and gynecology department and Buckley is the vice dean of medical education at the School of Medicine.
Uniting research and clinical care
The areas of distinction committee is responsible for identifying Duke’s especially promising clinical research programs and applying their strategies to improve other programs, said Sally Kornbluth, co-chair of the committee and vice dean for research at the School of Medicine.
The committee will work on identifying between five and seven top programs.
“The optimal program would be strong both clinically and in terms of research,” Kornbluth said. “We want to... see where we get synergies between research and clinical care and [find] strategies [for them] to grow and enhance.”
In terms of research, St. Geme said his committee will look to achieve two goals: enhancing Duke’s world class research enterprise and transforming medicine, science and innovation.
“In some areas, I suspect we will have recommendations we can implement without any discussion,” St. Geme added, noting that others will require more planning to implement.
An overall steering committee—comprised of the co-chairs of each of the four committees among others—will manage these discussion and any areas of overlap. In six months, Duke Medicine plans to have targeted the key areas for improvement.
“We are a step ahead of the game in undertaking this process, considering the change we are amidst and the change that is inevitable in the near future,” he said.
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