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Strategy Session: A Joint Conversation with Chancellor Washington, Dean Broome and Provost Kornbluth

Friday, April 15, 2016

Editor's Note: Look for the New Duke University School of Nursing Strategic Plan in the Summer Nursing Magazine coming in June.

As part of a comprehensive strategic planning process that involved diverse groups of faculty, staff, students, alumni, and donors from across the university and medical enterprise, the name Duke Medicine is changing to Duke Health, Chancellor A. Eugene Washington, MD, MSc, announced in January. “The decision to update our name stems from widespread deliberations involving many groups within Duke, and signals the health system’s renewed focus on health improvement,” said Chancellor Washington. “Duke Health signals our intention to explore more comprehensive approaches to health that extend beyond medical care and into other areas of population health improvement. Duke Health also represents a more inclusive and synergistic approach to maximizing contributions to health improvement from the diverse array of disciplines and schools that comprise Duke University, as well as our external partners.”

What do you see as the benefits of an all-inclusive strategic planning process?

Provost Kornbluth: First of all, to make sure we are putting our energies and efforts towards the most important things rather than the most urgent things. Also, in a time of constrained resources, we really want to think ahead about where we can strategically place our best bets. With this process, we have a School of Medicine, School of Nursing, and Duke Health writ large that’s well aligned with what’s going on in the larger campus community. Reaching across the aisle to medicine and nursing is an incredibly high priority for the university.

Chancellor Washingon: I would add that, in addition to helping us with resource allocation and prioritization, this process becomes a rallying point for the whole enterprise—for nursing, for all aspects of what we now call Duke Health as well as what for we’re doing across the campus, including Trinity College.

Dean Broome: The advantage it’s bringing to nursing is that having the university and Duke Health frameworks almost finalized helps our faculty to see the big picture. Now they’ll be able to put their work in the context of the whole university and Duke Health and I think they’re really excited about it.

When you think about aligning resources and creating synergies, what do you see as the major challenges for each area over the next three to five years?

Provost Kornbluth: I think the most important thing is to keep increasing faculty excellence. This means putting infrastructure and tools in the hands of the faculty to help them get the best out of their work, and offering the kind of mentoring and professional development that will enable them to be their best.

Chancellor Washington: Institutionally we’re quite vertical. Whether we’re in a nursing school or whether we’re in Trinity College, we’re vertical. So what we’re talking about in terms of drawing on the assets of Duke is actually being more horizontal. One of the significant challenges is getting our faculty, as collaborative and collegial as we are, working in groups in a more horizontal way. To overcome these barriers we need to show examples of where we’re already succeeding, and other areas that are ripe for some early victories.

What are some areas that you see as ripe for that?

Dean Broome: I can think of several—one is in the area of interprofessional education. That is the group I convened for the Chancellor’s strategic planning initiative. There’s already a fair amount of work in this area but the group’s feeling is that education needs to be more valued. At Duke, we don’t want to have an initiative that will make us look like everyone else. We want to know how we can uniquely lead in interprofessional education so that everybody’s going to say, oh, talk to Duke, they are doing it that way. That’s going to take a lot of creativity on the part of the faculty, but I’m convinced they can do it.

Is this about faculty educating other faculty?

Dean Broome: That’s part of it, but now faculty in medicine and nursing are looking at putting students together. And that is no easy task. Everybody in the country has struggled with it. The different disciplines are constrained, frankly, by their individual accrediting bodies. We also need to bring basic science into those health professions schools in a way that is integrated and not separated.

As you bring these various perspectives together to create energy around this interdisciplinary work, how do you ensure that you’re getting the right people around the table?

Provost Kornbluth: We all took a very broad catchment area and opportunity for faculty involvement. On the campus side, we did this through many, many open faculty dinners. Anybody could give input— faculty, students, and staff—and that continues.

Chancellor Washington: In Duke Health, we similarly started with focus groups and then we eventually established working groups in each of the core mission areas: education, research, community health improvement, global health, and clinical care. But we didn’t feel that was enough. Based on input and the work of those small groups we developed a survey that went out to all 32,000 people in Duke Health. The response rate was encouraging. Over 10,000 individuals responded, and over 2,000 wrote written comments. I agree with Sally, the process from our perspective was as important as the outcome, because we tapped into the voices all across the organization—that’s where our talent, our greatest asset is.

Did you feel like you got a mandate, a clear directive?

Dean Broome: In education, I was amazed at how quickly people came to the priorities and what was important. There were fascinating discussions that I think influenced all of us in that room. We got a lot of diverse perspectives, but in some magical way it all came together around interdisciplinary education and professional development.

Chancellor Washington: Each of these groups developed a mission statement. And I can tell you they labored over every word. In fact, the education group labored over whether we are about education or learning. It was a rich discussion. I actually went to the dictionary to make the distinction. There was a true distinction, and it’s reflected in the overarching vision statement and the goals.

How do we engage diverse alumni groups in this conversation?

Dean Broome: We sent the survey to our alumni, and I think to date 384 responded. Our pre-1984 alumni don’t ever hesitate to e-mail me. They are very invested. They remember Duke as one campus. They don’t think just about Duke Health. Many married Trinity grads, and they are very dedicated to Duke University as a whole, so we can’t forget that. That’s going to only reinforce the notion that we have to continue to build these collaborative groups across the campus and across Duke Health.

Chancellor Washington: We have engaged with alumni across the health enterprise, but I’ve also had the opportunity to address the broader Duke University leadership, the Duke University Alumni Council. Many of them have health care backgrounds but most are from other sectors—business, philanthropy, education. They have said they want to be engaged, especially given that we’ve articulated that when we think of Duke Health it starts with the health enterprise, but at Duke University there are major health programs in the other schools, including divinity, law, engineering, public policy, business, and certainly major programs in the college.

How did the decision to change from Duke Medicine to Duke Health evolve and what is the advantage of the word “health” over the word “medicine?”

Chancellor Washington: It came out of the process. Which was great! Quite simply, the ultimate goal is health, not medicine. That’s one advantage, and two, it’s more inclusive.

Dean Broome: I think it really fits well with the whole University’s strategic plan, because health is much more than just not being sick. It’s actually much more than promoting health. It involves all the social determinants of health: education, spirituality, all of the legal system and the support or not that we have there, engineering and the kind of support structures in our society that do or don’t facilitate the use of new technology. I think our society is becoming more cognizant of the fact that health is not just the responsibility of health professionals. But rather, individuals, society as a whole, we really have to spend more energy taking care of ourselves. So I think the timing of this just really perfect.

What’s the importance of transparency in a process like this?

Provost Kornbluth: Getting diverse input is going to lead to a much better plan. You can lead all you want, but you can turn around and nobody’s following. Plans are only going to be executed if there’s great buy-in. People are going to buy in if there’s a good element of grass roots input.

Dean Broome: All of us have been part of strategic plans that came from the top down, because that’s the way it used to happen. Then people splinter off, and the really outstanding people just do their outstanding work, but it’s not really connected to the whole. I don’t see that here, and it’s a real credit to Duke. I keep going back to when I read the biography of the Duke family. The phrase “knowledge in service of society” constantly comes up. Duke is a university that’s really living what it’s always believed at its core.

What do you wish people understood better about just what is happening here?

Chancellor Washington: A couple of things jump out for me. One is, as a community and organization, I would like for us to have a keen appreciation for the moment—just how special this moment is, in health, in science, in education. In terms of what we know about human biology, what we know about care delivery, also in terms of what’s happening in health care reform—the Affordable Care Act, but also the changing demography and the need that’s there. Another is that this moment there are really only a handful of institutions that are as well positioned, as well resourced, and have the traditions that we enjoy. For us this is not just an opportunity, it’s an obligation to take advantage of this moment—drawing on who we are, so that we become greater, and in the process we do greater things.

Provost Kornbluth: For me, part of the process is having people articulate their finest aspirations without necessarily thinking about what the resources will be. Resourcing will be important, but we also want people to dream, and then we can figure out what things we can actually do within our resource envelope.

How is this moment an opportunity for the School of Nursing and the nursing profession? How is nursing positioned to lead in this new universe of collaboration?

Dean Broome: There are many schools in the top 10 that have put all their eggs in the research basket. There are challenges there. Our school put a lot of people on the faculty who are so dedicated to improving clinical practice. They work with heart failure patients, they work with cardiac patients. They teach, they run entire programs, but what gets them up in the morning are those heart failure patients or whatever patients their clinic specializes in. To have nurse leaders who are grounded in education and can say “There are better models of care that we can evaluate” embedded with other top practitioners—very few schools in the top 10 have that kind of clinical faculty leadership. Of course we also have stellar researchers who are very well funded. The challenge is getting those two groups together and helping an NIH-funded researcher understand that it’s really important to test out this new model of care with patients. Now people are getting on board with that and getting really excited.

What excites you about the future?

Provost Kornbluth: We have a lot of great raw material here—great faculty, great programs! We have the sort of Duke special sauce, where collegiality, collaboration, and the ability to work together can constantly spin up new ideas that are difficult to anticipate.

Chancellor Washington: I like what we’re doing across our mission areas. The one that’s not completely new but that we’re adding a dimension to is community engagement. We want to evolve beyond community engagement to what we’re now calling community health improvement. It’s not enough to have our faculty, students, and staff engaged in lots of projects. That was an important first step. Now we want to collect them all and assemble them in a manner that allows us to form the partnerships needed to actually improve health of the community. We recognize that if we really want to improve health, it’s not just about health care. It really is about behavior, it’s very much about social determinants, it’s very much about the environment. So what excites me in addition to helping us continue to excel is that I believe we are going to show the rest of the academic health systems how you effectively partner to improve the health of the communities we serve.

**This story originally ran in the Winter 2016 Nursing Magazine and was written by Duke Forward - Development.