Dom Strategic Plan

Strategic Plan
Department of Medicine
Emory University

Presented to the Executive Committee May 2012

2012
Dept of Medicine
Emory University
1/1/2012

1

TABLE OF
CONTENTS

I. ABOUT THE CHAIR
II. THE DEPARTMENT
OF MEDICINE AND ITS DIVISIONS
III. MISSION AND VISION
IV. CORE VALUES
V. OVERVIEW OF THE STRATEGIC PLAN
VI. CLINICAL CARE
VII. RESEARCH IMPACT
VIII. TRAINING & EDUCATION
IX. PEOPLE
X. FINANCE, INFRASTRUCTURE AND PARTNERSHIPS
XI. INFRASTRUCTURE & CONCLUSION
XII. APPENDIX
CONTENTS

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BOUT THE
CHAIRMAN

R. Wayne Alexander, M.D., Ph.D. is
the R. Bruce Logue Professor and
Chair of the Department of Medicine
at Emory University School of
Medicine. Dr. Alexander received
his Ph.D. in Physiology from Emory
University and his M.D. from Duke
University. His residency and
cardiology fellowship training were
also at Duke University. He was a
staff associate at the National Heart and Lung Institute from 1971 to 1973. He was
Associate Professor of Medicine at Harvard and the Brigham and Womens Hospital
when he left in 1988 to become R. Bruce Logue Professor of Medicine and Director,
Division of Cardiology at Emory. He became Chair of the Department of Medicine at
Emory in 1999. He has been Vice President of Research and on the Board of Directors
of the American Heart Association. He is a Senior Editor of the Cardiology Textbook,
Hursts The Heart and has been on the editorial boards of numerous publications.
His major research interests are in the biology of blood vessels and in the treatment
and prevention of cardiovascular diseases. He has broad interests in health
maintenance and preventive medicine. Many of the 30-plus trainees from Dr.
Alexanders laboratory are now leaders of academic medicine in the United States and
worldwide.

A

3

MESSAGE FROM THE CHAIRMAN

I am pleased to introduce the FY2012-FY2017 Department of Medicine Strategic plan.
This plan provides the essential elements for an evolving and progressive modern
Department of Medicine: mission and vision for the future, committees and action items
for direction, and benchmarks for measurement of success.

Emory Universitys Department of Medicine excels in the areas of education, clinical
care and research. Our distinction in these areas is exemplified through our residency and
fellowship rankings; regional, national and international academic recognitions; clinical
reputation and research standing. The unparalleled caliber of our exceptional faculty
makes all of this possible.

Nevertheless, we must not rest on our laurels but must strive to continue to scrutinize
all of our programs to ensure unremitting excellence. We must continue to improve the
quality of our clinical care, increase the number of awarded research grants, create new
and innovative faculty programs, optimize our administrative and resource management
and create sustainable business models for all of our divisions. This strategic plan outlines
how we intend to reach these goals in the coming years.

The departments executive committee led this initiative in order to ensure that all of
our missions are represented and that our leadership shares and supports the priorities,
goals and initiatives set forth here. Numerous faculty and staff from across the
department dedicated much of their time to make this plan a reality. I thank each and
every one of you for your efforts to make the Department of Medicine the best it can be. I
look forward to the outstanding department that we will become because of your
dedication and passion.

Sincerely,

R. Wayne Alexander

To maintain our leading
position in research, and build
on the strengths in our current
programs, our strategic plan
illustrates a future focused
growth

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ABOUT THE DEPARTMENT OF MEDICINE

he Department of Medicine (DOM) is steeped in a rich tradition of excellence, built on the
legacies of medical leaders such as Eugene Stead, Paul Beeson, and more recently, Willis
Hurst and Juha Kokko. Through the work of its nine divisions and one center, the DOM
has pioneered discoveries in medicine, education, scientific and clinical investigation, and
clinical care. Our program offers students and residents the latest knowledge in treatment
practices, scientific theories, research, and patient care. Located in one of the country's
leading research institutions, Emory University, the DOM offers a stimulating atmosphere of
scholarship that leads to success across many medical disciplines.

The clear strength of the department is an outstanding faculty of physicians and scientists within
academic divisions that include Cardiology; Digestive Diseases; Endocrinology; General Medicine;
Geriatric Medicine & Gerontology; Hospital Medicine, Infectious Diseases; Pulmonary, Allergy and
Critical Care Medicine; Renal Medicine and Rheumatology. The faculty, many of whom are leaders in
their respective professions, have been crucial to our success in implementing our mission across the
divisions.

The Department of Medicine is known for teaching excellence, as evidenced by the historic
contributions of Drs. Willis Hurst and Juha Kokko, both former chairs. Our Residency Training Program
is the signature educational component of the department, and is complemented by superior sub-
specialty fellowship training in each of the divisions. A broad range of hospital and outpatient clinical
teaching is conducted at six university-owned or -affiliated hospitals.

Moreover, our access to a large and varied patient population provides residents and fellows with
intriguing and often unique training opportunities. Our goal is to ensure a program dedicated to
excellent teaching in the context of superb clinical care. Our residents routinely receive a 100 percent
pass rate on the American Board of Internal Medicine (ABIM) exam, a reflection of our success. The
faculty, fellows, and residents also conduct a significant portion of clinical teaching for Emory medical
students.

The Department of Medicine faculty receives the largest portion (20 percent) of the School of
Medicine's extramural research funding and accounts for 16 percent of the university's sponsored
research. We maintain a sustained effort to recruit the best researchers in our divisional areas and to
invest in all ongoing programs. We also enjoy close collaborations with other on-campus and sister
institutions, including the Yerkes Regional Primate Research Center, the Centers for Disease Control
and Prevention, Georgia Institute of Technology and the American Cancer Society.

The provision of superior clinical care is a hallmark for the Department of Medicine at Emory. We are
proud of our nationally ranked programs in Cardiology as well as the superb care given to patients with
diabetes at Grady Memorial Hospital. The Atlanta VA Medical Center is recognized for its clinical
programs in Pulmonary and Critical Care Medicine and the treatment of HIV/AIDS. These areas reflect
the comprehensive range of our clinical programs. Excellence is our standard in delivering care to
patients.

As we approach the next decade, we have developed a strategic plan that builds on our strengths and
guides us to continually enhance the teaching, research, and clinical service missions of the
department.
T
THE DEPARTMENT OF MEDICINE

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The Divisions

DIVISION OF CARDIOLOGY
W. Rober t Taylor , M.D., PhD

Emory University School of Medicine has a long-standing history of
contributions to modern cardiology. Emory is recognized as one of the
founding centers of interventional cardiology. The basic research program in
vascular biology and medicine began in 1988 with the recruitment to Emory of
Dr. R. Wayne Alexander, the current Chair of Medicine. Vascular research in the
Division of Cardiology at Emory University has grown enormously during the
past 20 years. Dr. Alexander recruited a world-class team of researchers who
have made major contributions to our understanding of basic and clinical
vascular biology. The current chief of Cardiology, Dr. W. Robert Taylor, has
spurred the division on to remain at the forefront of cardiovascular research. Its investigators have
attained international recognition for research in oxidative stress and vascular disease as well as
regenerative medicine.

Cardiology is entering an exciting new era in which advances will be made in clinical cardiology, basic
cardiovascular research, and interventional and non-interventional technologies. As classical
cardiovascular disease syndromes become better understood in the mechanistic terms of modern
molecular and cellular biology, diagnostic and therapeutic approaches to cardiovascular disease will
continue to change dramatically in the coming years. The Emory Division of Cardiology will continue as
a leader in bringing about these changes with internationally recognized expertise in many relevant
disciplines and is dedicated to training the next generation of academic cardiologists.

DIVISION OF DIGESTIVE DISEASES
Fr ank Anani a, M.D.

The faculty of the Division of Digestive Diseases consists of clinician educators,
clinical investigators, and physicians as well as basic scientists. The range of
interests encompass all areas of gastroenterology and hepatology, including
advanced endoscopy, transplant hepatology, nutrition, motility, GI cancers and
inflammatory bowel disease. The investigators are focused on the
pathophysiological mechanisms of digestive diseases with a fundamental
emphasis on clinical care, education and training. The division has four
Veterans Affairs merit awards and four R01s . The Division has two advanced
fellowships: one in interventional endoscopy and a second three-year advanced fellowship in
Hepatology and Liver Transplantation. The GI unit at Emory has a comprehensive care approach for
patients afflicted with chronic liver disease involving not just board certified Hepatologists, but also
highly skilled surgeons, interventional radiologists, and pathologists.

STRUCTURE OF THE DOM

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DIVISION OF ENDOCRINOLOGY
Rober to Paci fi ci , M.D.

The Division of Endocrinology, Metabolism and Lipids at Emory University is
dedicated to research, education, and clinical care in Endocrinology and related
areas. The faculty is composed of clinical, translational and basic researchers
and educators with interests in all aspects of Endocrinology. Clinical care is
delivered at three hospitals, as well as the Emory Clinic. The division has an
NIH Training Grant, currently in its 30
th
year, to support the training of the next
generation of Endocrinology researchers and scholars. Ongoing clinical
investigations study osteoporosis, Vitamin D, nutrition and diabetes. Basic
research into bone metabolism, osteoimmunology, nanoparticles, phosphate as
a transcriptional regulator, mechanism of action of estrogen and PTH, gene therapy of diabetes, growth
factor physiology and neuro-endocrinology is supported by NIH, VA, and ADA grants. Our fellowship
training program enrolls 4-5 fellows each year and is supported by federal grants as well as hospital
funds. Our mission is to provide a program dedicated to excellent teaching and superb clinical care.

DIVISION OF GENERAL MEDICINE
Wi lli am T. Br anch, M.D.

The Division of General Medicine provides the bulk of clinical patient-care
services in adult medicine at Grady Memorial Hospital and provides primary care
services at the Emory University main campus and the Atlanta Veterans Affairs
Medical Center. The Division's mission encompasses patient-care, teaching and
research. The Division's faculty sees patients directly and provides hands-on
supervision for every one of our patients seen by the Emory housestaff. We
provide services on Emory's Inpatient Units. The Division's attending physicians
supervise nine of the twelve patient-care teams on Emory's Inpatient Service in Internal Medicine, the
General Medical Clinic, and the Urgent Care Center. There are currently forty-one full-time faculty
physicians working in the Division of General Medicine. The Division has expanded to more than
double its size in the past five years and will continue to expand slowly in future years as additional
patient-care responsibilities are added.

Hospital Medicine
Alan Wang, M.D.
Emory Hospital Medicine is the largest academic hospital medicine program in
the nation. With nearly 120 physicians providing hospital medicine services at
eight hospitals in the greater metropolitan Atlanta area over a 110 mile diameter,
Emory hospitalists account for over 45,000 admissions a year, and total patient
encounters exceeding 200,000 annually. Diversity of hospital settings from the
Atlanta Veterans Affairs Medical Center to rural hospitals to long term acute care
hospitals and major tertiary academic medical centers allows the Emory Hospital
Medicine to firmly embrace the continuity of care required to take care of
complex patients. The Division of Hospital Medicine formed in September 2011
and is the tenth and latest Division of the Department of Medicine.

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Emory Healthcare Hospitalists are board-certified internal medicine, family medicine and specialty
physicians who specialize in the care of hospitalized patients. They are experienced in diagnosing and
managing acute medical illnesses from which hospitalized patients commonly suffer. They also provide
medical consultation for surgical and other specialty patients. The mission is to provide the highest
quality and value in care to hospitalized patients, educate future academic and practice leaders of the
specialty, and advance hospital care through research and hospital medicine.

Apart from providing high value patient and family-centered care, the Division of Hospital Medicine
helps provide many of the leaders throughout the health system, regionally and nationally in regards to
care coordination, utilization, quality improvement, IT and medical education. Highly regarded as one
of the top hospital medicine research programs nationally, The Divisions Clinical Outcomes Program
(COP) focuses on research around health services, models of care, the care continuum and quality
improvement. The COP has been recognized nationally by the Society of Hospital Medicine for
groundbreaking research. The Emory Division of Hospital Medicine remains a vibrant, growing,
nationally recognized and innovative Division in the Department of Medicine.

DIVISION OF GERIATRICS AND GERONTOLOGY
Theodor e J ohnson, M.D., M.P.H.

The Division of Geriatric Medicine and Gerontology is dedicated to advancing the
healthcare of the elderly population. Based primarily at the Wesley Woods
Center of Emory University and the Atlanta Veterans Affairs Medical Center, the
program has also expanded to establish a Geriatrics Center at Grady Memorial
Hospital, a major site for training Emory students and residents. Excellence in
clinical care of older adults in outpatient, acute hospital, and long-term care
settings remains a focus of the division. The Division has been led since inception by Drs. Herbert Karp
(1983-1990), Mario DiGirolamo (1990-1996), Joseph Ouslander (1996-2008), and Ted Johnson (2008-
). Under their leadership, the Division has doubled in size to its current 25 full-time physician faculty
and 5 PhD researchers.

DIVISION OF INFECTIOUS DISEASES
Davi d Stephens, M.D.

During the past decade under the leadership of Dr. Stephens, the Emory Division
of Infectious Diseases has experienced unparalleled growth and development.
There are currently fifty-nine faculty members in the Emory ID Division who,
between Grady Memorial Hospital/Grady Ponce de Leon Infectious Diseases
Center, the Atlanta Veterans Affairs Medical Center, Emory University Hospital,
Emory Midtown, Emory Orthopedic and Spine Hospital, the Emory Vaccine
Center and the Wesley Woods Center, participate in patient care, teaching and
research activities. Infectious Diseases Division members have recently
garnered in excess of $20 million in research funding per year. The Infectious
Disease Division plays leadership roles in the Emory Center for AIDS Research (CFAR), the NIH-funded
Clinical Research Center for HIV/AIDS, the Southeastern Center for Emerging Biological Threats

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(SECEBT), the NIH-funded Emory Vaccine Trials and Evaluation Unit, and the CDC-funded Georgia
Emerging Infections Program.
State-of-the-art HIV/AIDS outpatient care is provided at the full-service, Grady Ponce de Leon
Infectious Diseases Center, at Emory Midtown, and at the Atlanta VA Medical Center, where ID faculty
run the largest VA-affiliated HIV clinic in the nation. Transplant ID services have grown tremendously
at Emory University Hospital in the past decade. The Emory ID Program is a destination site for
Fellowship training in infectious diseases and one of the top programs in the country in areas such as
epidemiology, HIV/AIDS, vaccine, tuberculosis, transplant ID, travel medicine and global infectious
diseases. ID faculty members provide outstanding teaching for medical and graduate students,
residents and other post-doctoral trainees. In collaboration with faculty from the Department of
Microbiology, ID faculty assist with planning the month-long Prologue II segment of the first year
medical school curriculum and approximately twenty-four ID faculty members participate in didactic
and small group learning sessions during the course.

DIVISION OF PULMONOLOGY
Davi d Gui dot, M.D.

The field of Pulmonary, Allergy and Critical Care Medicine is a dynamic area
with continuing advances being made in discovering disease mechanisms
and treatment. Our division is deeply involved in the development of these
changes with internationally recognized expertise in many areas. New
advances in pulmonary diseases and critical care medicine are utilized in the
excellent patient care provided by the division members in the Emory Clinic.
Our training program offers a balance of clinical and bench research
experience, as well as superb clinical experience at Emory University
Hospital, Grady Memorial Hospital, Emory University Hospital Midtown, and the Veterans
Administration Hospital. A major research effort in the division includes basic, clinical and
translational research in acute respiratory distress syndrome (ARDS), with particular emphasis on
understanding the molecular basis for the effects of alcohol abuse and human immunodeficiency virus
(HIV) infection on the progression of ARDS. Other strengths in the division include research in oxidant
stress and redox regulation of pulmonary function and aging, lung immunity and asthma, pulmonary
arterial hypertension, and the pathology of Cystic Fibrosis.

DIVISION OF NEPHROLOGY
J eff Sands, M.D.

The Division of Nephrology at Emory University School of Medicine is at the
forefront of nephrology research, education, and clinical care. The clear
strength of the division is an outstanding faculty of more than 30 physicians
and scientists, many of who are leaders in their respective fields, and over
10 of who are principal investigators on NIH grants. The division also has
several junior faculty supported by NIH K-awards who will become future
leaders in their fields. The division is an acknowledged center for teaching
excellence, with an NIH Training Grant, currently in its 21
st
year, to support the training of the next
generation of nephrology researchers, both MDs and PhDs. Our faculty consistently win teaching
awards within the Department of Medicine and School of Medicine. A broad range of hospital and

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outpatient clinical teaching is conducted at five university-owned or affiliated hospitals. Moreover, a
large and varied patient population provides fellows with stimulating and often unique training
opportunities. We were the first renal division to offer training in both renal ultrasound and
interventional nephrology. We have recently added a one-year Transplant Nephrology fellowship. Our
goal is to provide a program dedicated to excellent teaching in the context of superb clinical care. To
enhance our clinical care mission, we recently opened three Emory Dialysis units, which will deliver
high quality patient care and provide opportunities for clinical research in dialysis. The division
consistently ranks in the top 25 in the US news and World Report ranking for kidney disease, and
ranked 18
th
in 2011.

DIVISION OF RHEUMATOLOGY & IMMUNOLOGY
I gnaci o Sanz, M.D.

Rheumatology and Immunology at Emory is dedicated to excellence in the
clinical care of patients and the education of medical students, medicine
residents, and rheumatology subspecialty residents. The Division is also
committed to involvement in research and playing an active role in the
development of increased knowledge and new treatment regimens in the
field of rheumatic diseases. We are comprised of seven full-time faculty who
serve the clinical needs of the Grady Health System, the Veterans Affairs
Medical Center, The Emory Clinic and Emory University Hospital, Emory
Midtown. In addition, a team of three pediatric rheumatologists provides
care and participates in research through the Emory Children's Center at the
affiliated Children's Healthcare of Atlanta.


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CORE VALUES

In the Emory DOM, our core values are inherent in all that we do.
We achieve excellence in our missions by embracing:

Integrity & Trust
Empathy & Compassion
Ethical & Innovative Inquiry
Collegiality & Collaboration
Professionalism & Diversity
Accountability & Quality

CORE VALUES

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MISSION STATEMENT
To serve humanity by improving health

VISION STATEMENT
To be a national leader and innovator in discovery, high quality patient
care and education

MISSION AND VISION

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GOALS
I. Clinical Care: Define, though inquiry, optimal
standards of care and dissemination
mechanisms.
II. Research Impact: Collaborate to enable
discovery, translate knowledge, and advance
patient care.
III. Training and Education: Collaborate to
transform medical education and lead the
efforts to redefine residency training.
IV. People: Cultivate a collaborative environment
of excellence that embraces diversity and
attracts, retains, and develops engaged faculty,
staff, and trainees.
V. Finance, Infrastructure & Partnerships:
Effectively develop and manage financial
resources to achieve excellence across all
missions.

STRATEGIC PLAN
2012-2017 OVERVIEW

The Department of Medicines 2012 Strategic Plan was initiated at the beginning of 2011. The
Executive Committee, convened from amongst Vice Chairs, Service Chiefs, Division Directors
and Executive Administrators in the Department of Medicine, and chaired by Dr. R. Wayne
Alexander, took the lead to spearhead the creation of a Strategic Plan. This committee came
together to identify five departmental
goals and their respective focus areas
and initiatives to be carried out
through FY2017. The committee
tasked several subcommittees to
address the five identified goal areas
and create action items to address
these initiatives. From August 2011 to
May 2012, the five committees worked
to create at least one action item to
address each initiative. These action
items will be implemented during the
next five years, according to a priority
recommended by the DOM Executive
Committee to Dr. Wayne Alexander.
STRATEGIC PLAN

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SUMMARY OF GOALS AND INITIATIVES
FOCUS AREAS & INITIATIVES SUMMARY
I. Clinical Care
I.1 Develop and implement quality programs
in both inpatient and outpatient settings.
I.2 Disseminate innovative discoveries and
best practice models throughout the
medical community and society.
I.3 Improve service though operation
efficiency and resource optimization.
I.4. Create a sustainable model for inpatient
care with mechanisms for subspecialty
involvement at both inpatient and
outpatient transitions.
II. Enhance Research Impact
II.1 Support innovation, integration and
translation of basic discoveries into
clinical care and health care delivery.
II.2 Enable future discovery by enriching the
scientific and administrative platforms for
basic and clinical research.
II.3 Streamline research administrative
procedures.
II.4. Advocate and facilitate the adoption of an
effective, user-friendly and integrated IT
infrastructure (see also V.4).
III. Training & Education
III.1 Develop and implement creative and
consistent approaches to medical
education.
III.2 Streamline educational administrative
procedures.
III.3 Provide development opportunities for
educational skill building.
III.4 Develop training programs to improve
patient-centered professionalism in all
trainees.

IV. People
IV.1 Optimize recruitment, retention and
promotion strategies for faculty, staff,
and trainees across divisions and
locations.
IV.2 Promote a sense of community with
shared values and goals, aligned with
our tripartite mission.
IV.3 Promote career growth and
development among faculty, staff, and
trainees.
IV.4. Support and increase faculty, staff, and
trainee involvement in local, national,
and international outreach and service
efforts (see also V.5).
IV.5. Continue to realign compensation to
encompass all three missions of the
department.
V. Finance, Infrastructure and
Partnerships
V.1 Optimize administrative structures and
processes throughout the DOM
V.2 Increase philanthropy and alternative
funding sources to enable strategic
investment
V.3 Explore opportunities for growth of the
clinical enterprise and financial stability
of the DOM.
V.4. Advocate and facilitate the adoption of
an effective, user-friendly and
integrated IT infrastructure (see also
II.4).
V.5. Support and increase faculty, staff, and
trainee involvement in local, national,
and international outreach and service
efforts (see also IV.4).

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CLINICAL CARE
Define, though inquiry, optimal standards of care and dissemination mechanisms

he clinical enterprise of the Department of Medicine is a large, rapidly expanding and vital part
of our departments culture and success. The clinical services that are provided by the
Department of Medicine span three major Atlanta healthcare organizations in which we see a
total of over one million visits per year in over 75 locations. Most of our clinical care and teaching of
medical students and house staff is performed at the Emory Clinic and at five hospitals: Atlanta
Veterans Affairs Medical Center (VAMC), Emory University Hospital (EUH), Emory University Hospital
Midtown (EUHM), Grady Memorial Hospital and Wesley Woods Geriatric Hospital (WWGH). The
Department of Medicine works jointly with Emory Healthcare to help with the progression of quality,
patient care and innovative healthcare at Emory. Although the DOM is intimately involved in leading
patient care at Emory, with the ever changing field of healthcare, we are faced with the challenge of
keeping up with the always increasing standards of quality and creating new and best practice models
for inpatient care and resource optimization.
T
GOAL I

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Strengths: Opportunities:
Breadth of clinical specialty areas
Large volume of patient encounters provides a
substrate for clinical training, research and
revenues
Focus on quality
Nationally ranked programs in Cardiology &
Geriatrics
Superb clinical care across multiple platforms
Serve a large and diverse patient population
throughout the State of Georgia
Reputation as a leader in clinical care
Set national standards for quality and value
Develop multidisciplinary, high performing
clinical care models
Become a national leader in developing fiscally
responsible and effective models for disease
prevention, diagnosis and management
Take advantage of diverse patient population
base for clinical research
Develop a nationally recognized Hospitalist
system
Weaknesses: Threats:
Incomplete permeation of quality mission in
our culture
Average quality performance by national
standards
Lack of standardization of processes,
procedures and procurement
Lack of organizational coherence in the DOM
within the healthcare systems (subspecialties
do not have equivalent representation at all
hospitals)
Quality metrics rather than value as an
endpoint for accountability
Pay-for-performance reimbursement
Increasingly sophisticated local
competition that diminishes the advantage
of being an AMC

Based on these strengths, weaknesses, opportunities and threats, the Executive Committee created four
initiatives to advance clinical care over the next five years and charged the Clinical Advisory Team
(CAT) with creating an action plan to achieve them. The DOM aims to become a national leader in
patient care.

I.1. Develop and implement quality programs in both inpatient and outpatient settings.
I.2. Disseminate discoveries and best practice models throughout the medical community and
society.
I.3. Improve service through operational efficiency and resource optimization.
I.4. Create a sustainable model for inpatient care with mechanisms for subspecialty
involvement at both inpatient and outpatient transitions.

SWOT Analysis: CLINICAL CARE

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I. Create consistent and improved care through care
pathways across the DOM, as developed by experts in
each division within the Department of Medicine. Each
division will nominate one quality improvement (QI)
project to be implemented departmentally wide and
will also develop and initiate at least on division-
specific QI project.*
a. Integrate quality metrics and power plans into EMR.
b. Create summer DOM Grand Rounds series on quality.
c. Roll out division led care-path initiative to
Department level: 2
nd
item for significant
improvement in patient care, throughput, or
reduction of waste.
d. Ensure quality infrastructure in all divisions;
Integrate into Meet with Chair Day.

II. Develop and implement quality programs across the
DOM. This action item hopes to disseminate the
knowledge and structure gained from Hospital
Medicines pilot Accountable Care Unit. (Initiatives 1, 2
and 4)*
a. Name DOM quality program leaders at all sites and all
Divisions.
b. Select division led care-path initiative for identified
most significant problem/highly variable care process
in the area/field.
c. Designate Inpatient Accountable Care Units (ACUs) at
each site.

III. Improve communication during dissemination of
information between providers and health systems.
(Initiative 2)
a. Hold internal communication and consultation
standards conference. Yearly conference will be used
in the future to present unit-level performance and
outcomes data.

IV. Improve communication during transitions of care and
when disseminating best practice models. (Initiative 4)
a. Roll out intra-communication standards and
monitoring plan.

*The details of each program can be found in appendix 1.
GOAL I

ACTION
ITEMS

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2012
2014
2015
2016
Begin
2011
End
2017
Clinical Care
Action Item
Timeline
Nominate Quality Improvement
projects per division
Develop and implement quality
programs across the DOM
Improve communication during
transitions of care and when
disseminating best practice model

2013
Name DOM quality program
leaders at all sites and all Divisions

Integrate quality metrics and
power plans into EMR
Select division led care-path
initiative for care process in the
area/field

Hold internal communication and
consultation standards conference
Hold summer DOM Grand Rounds
series on quality
Roll out intra-communication
standards and monitoring plan

Roll out division led care-path
initiative to department level
Create consistent and improved
care through care pathways across
the DOM (QI)
Hold department QI Committee
review of Divisional- Department
initiative roll-out
Quality infrastructure into all
divisions; Integrated into Meet
with Chair Day

Expansion of number of quality
metrics plans for ACU

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ENHANCE RESEARCH IMPACT
Collaborate to enable discovery, translate knowledge,
and advance patient care

lthough discovery-based research in the Department of Medicine has been robust only for the
last 25 years, the department is highly regarded for its contributions in several areas. Research
funding has increased two-fold since 2000, with Cardiology and Infectious Diseases as the two
highest-funded divisions. The department is a major component of the School of Medicines research
portfolio, making up approximately 20% of the schools funding. The DOMs strong research presence
has helped Emory University become 16
th
in the nation for research.

Two years ago, the School of Medicine inaugurated the Millipub Club, designed to recognize current
Emory faculty who have published papers that have been cited at least 1,000 times in the literature.
Such papers reflect the highest in scholarly achievement. The Department of Medicine is proud to be
home to 19 members of the Millipub Club, or 38% of the total membership, the most of any department
in the school.

It is our belief that academic departments have a mandate to perform basic, translational and clinical
research related to physiology, pharmacology and disease. Every division has funded investigators who
study important, clinically relevant questions from all perspectives. Nonetheless, we believe that
strategic planning will enable us to further expand our research program to meet the needs of a
changing healthcare and funding environment.

A
GOAL II

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Multiple investigators with high scientific
impact
Largest portion (20%) of the SOMs
extramural research funding and accounts for
16% of the Universitys sponsored research
ECCRI* research unit generates significant
independent funding and is also building
collaborations with units across the University
Historical increases in NIH funding
Vibrant and diverse basic research in the
department
Extremely collaborative environment
Develop our regenerative medicine, predictive
health, metabolism, translational research,
comparative effectiveness and immunology
programs
Take advantage of research opportunities at
Grady, especially in the areas of hypertension,
heart failure, and health care disparities
Expand research partnership with the VA and
CHOA
Develop interdisciplinary research
Inadequate research equipment &
infrastructure
Inadequate research space capacity/size
and location
Lack of coordinated and searchable IT
databases
Lack of internal research support and
bridge funding
Inadequate clinical research
administrative infrastructure and lack of
clarity of PI responsibilities
Lack of systematic mechanisms for
recruiting patients into clinical trials
Few K Awardees and little infrastructure
to support new awards and/or transition
from Ks to Rs
Reduced NIH funding
Lack of standardization of processes and
procedures, especially clinical research
administrative structure

Based on the existing strengths, weaknesses, opportunities, and threats, the Department of Medicine
designed four initiatives to improve research within the department:
II.1 Support innovation, integration and translation of basic discoveries into clinical care and
health care delivery.
II.2 Enable future discovery by enriching the scientific and administrative platforms for basic and
clinical research.
II.3 Streamline research administrative procedures.
II.4 Advocate and facilitate the adoption of an effective, user friendly, and integrated IT
infrastructure.

The Department of Medicine charged the Research Advisory Team (RAT) with the responsibility of
creating research action items to be implemented over the next five years.

SWOT Analysis: RESEARCH

20
I. Create pilot seed grants with two Principal Investigators who have never worked together before,
preferably a basic science PI and clinical PI to promote collaboration. (Initiative 1)*

II. Create Blue Sky Groups to promote new research ideas and collaborations. (Initiative 1)

III. Create an Internal Visiting Professor Program to share research
interests. (Initiative 1)

IV. Create a comprehensive, user-friendly website to showcase research,
promote collaboration and collate research administration best practices.
(Initiatives 1, 2, 3 and 4).

V. Create a space policy by which space is allocated according to research
success. (Initiative 2)

VI. Provide matching dollars for successful programs. (Initiative 2)

VII. Increase biostatistical support, availability and training. (Initiative 2)

VIII. Work with the Office of Business Process Improvement (OBPI) and the
Administrative Restructuring Committee (ARC) to improve research
administration. (Initiative 3)*

IX. Create post-award reporting mechanism that is data-driven and user-
friendly. (Initiative 3)

X. Expand IT resources within the DOM to support basic and clinical
research. (Initiative 4)*
- Increase DOM IT budget to support research IT and infrastructure
upgrades.
- Appoint a Vice Chair for IT and create an IT advisory team to prioritize
and facilitate IT efforts within the department.
- Research, collate and advertise IT solutions currently available.
- Expand videoconferencing capabilities
and support.

XI. Work towards creating common platforms for patient data that can
be queried by varied investigators. (Initiative 4)


ACTION
ITEMS

GOAL II

21

2012
2014
2013
2015
2016
Research
Action Item
Timeline
Create an Internal Visiting
Professor Program

Appoint a Vice Chair for IT and
create an IT advisory team
Create pilot seed grants with two
Principal Investigators
Begin
2011
End
2017
Work with OBPI and ARC to
improve research administration
Create a comprehensive, user-
friendly website
Research, collate and advertise IT
solutions currently available
Create Blue Sky Groups
Create post-award reporting
mechanism that is data-driven and
user-friendly
Expand videoconferencing
capabilities and support
Increase biostatistical support,
availability and training
Work towards creating common
platforms for patient data that
can be queried by varied
investigators
Provide matching dollars for
successful programs
Increase DOM IT budget to
support research IT and
infrastructure upgrades
Create a space policy

22
TRAINING & EDUCATION
Collaborate to transform medical education and lead the efforts to
redefine residency training.

ducation is
one of the
three pillars
of the School of
Medicine. Across
Emory University,
the Department of
Medicine is known
for its excellent and
innovative
education
programs. It is
responsible for
educating and
training students,
residents and
fellows in the broad
field of internal
medicine as well as
its subspecialties,
and oversees the
education of
numerous graduate
and postdoctoral
students. The
department is also known for its novel faculty education and continuing medical education programs. It
contributes more education hours to the School of Medicine than any other clinical department, has the
largest medicine residency program in the country and provides opportunities for faculty development in
education to over 500 faculty members at Emory, and several hundred others outside of Emory. Over the
course of one year, the department educates approximately 170 medical residents, 140 fellows, and 250
medical students. Offering both traditional and other training programs, the department strives to train
highly competent physicians and leaders in medicine, regardless of ultimate career pathways.

The department chair, the Vice Chair for Education, the residency program director and associate
program directors, and medical student education leaders, along with numerous supporting staff
members across the school, work collaboratively with each other to ensure that the educational
programs in the Department of Medicine continue to meet the highest standards of innovation and
quality.

E
GOAL III

23

Training and Education are a core value of the
Department
High profile educators
Diversity of the clinical experience offered by the
residency program attracts a nationally
competitive applicant pool with a 100% pass rate
on the ABIM exams
Robust fellowship training programs
Focus on career development and satisfaction of
outstanding clinicians enable their growth as
educators and deliverers of outstanding service
Provide superb training programs to clinicians
who are then highly competitive nationally for
subspecialty programs
Largest portion of training in School of Medicine
provided by DOM
Offer new faculty development initiatives
Expand NIH funded training programs
Take a leadership role in redefining and
developing solutions to the changing face of the
Internal Medicine Residency training
Inconsistency in training experience at our 5
different training sites
Sub-optimal performance in timely evaluation and
feedback
Reduction in residency training hours
Increased rigidity of the regulatory environment
involved in residency training
Potential cuts to GME funding

With the abundance of strengths listed above, the Department of Medicine was able to design three
initiatives to address our weaknesses, reduce external threats and take advantage of opportunities
within the department. They are as follows:
III.1 Develop and implement creative approaches and consistent processes for medical education
III.2 Streamline educational administrative procedures
III.3 Provide development opportunities for educational skill building
III.4 Develop training programs to improve patient-centered professionalism in all trainees

The Department of Medicine asked the Executive Education Committee (EEC) to design action items to
support these initiatives. These detailed plans will help the department move forward with each of
these initiatives over the next five years. Below are the proposed action items to be carried out and
implemented through FY2017.

SWOT Analysis: EDUCATION

24

I. Create a mini yearly development retreat to review processes,
procedures, and requirements for educational programs.
Require all to attend the New Innovations training offered yearly
by GME. (Initiative 2)*

II. Develop clear job descriptions and timelines for both faculty
leaders and administrative staff in reference to their educational
programs. Regularly review faculty/staff progress and hold them
accountable for their duties. (Initiative 1)*

III. Strengthen the accountability to which Division Chiefs and
program directors are held for their educational programs.
Consider the incorporation of education metrics into annual
goals, career conference reports and incentives. (Initiative 1)*

IV. Create and implement periodic reviews of teaching faculty
within the Department of Medicine to achieve the highest
standards of teaching competency. (Initiative 3)*

V. Propose an education budget that supports the infrastructure of
education, furthers the core education mission, and is based on
national and local best practices. (Initiative 2)*

VI. Reorganize the residency education administrative team to
increase efficiency and gain expertise. Along with enhanced
administrative oversight, this will include two new positions;
Information Analyst and Accountant. (Initiative 2)*

VII. Hire program coordinators to support more than one of the
smaller fellowship programs as a model that allows for
coordinators to focus on education. (Initiative 2)*

VIII. Develop an online education resource for faculty. (Initiative 2)*

IX. Expand faculty development initiatives focused on education and teaching. (Initiative 3)*

X. Create yearly report on education. (Initiative 1)

XI. Ensure every trainee and faculty member is imbued with professionalism through education,
feedback, and accountability for the behaviors outlined in the Emory Pledge. (Initiative 4)


GOAL III

ACTION
ITEMS

25

Begin
2011
End
2017
2012
2013
2016
2015
Conduct teaching faculty reviews

Reorganize the residency education
administrative team

Expand faculty development
initiatives

Develop clear job descriptions and
timelines for both faculty leaders and
administrative staff

Hire program coordinators

Create yearly report on
education

Propose an education budget
Develop an online education
resource for faculty

Create a mini yearly
development retreat

Education
Action Item
Timeline
2014
Ensure every trainee and faculty
member is imbued with
professionalism
Strengthen the accountability
to which Division Chiefs and
program directors are held for
their educational programs

26

PEOPLE
Cultivate a collaborative environment of excellence that embraces diversity and attracts,
retains, and develops engaged faculty, staff, and trainees.

ur people are our greatest resource. The Department of Medicine is fortunate to have creative,
energetic faculty and staff who work collaboratively to advance scientific knowledge and
human health. Our challenges are to retain good people, to recognize their achievements in all
missions and to strengthen our sense of community. We are committed to providing every employee
with the career support they need to succeed. We also recognize that with our talented faculty and
staff, there is much room to increase our service and outreach efforts so that we benefit the community
at large and expand Emorys impact.

The department offers a wide range of opportunities for its faculty, staff and trainees. Several of the
leaders within the department have come together throughout the past several years to create
numerous faculty and staff development programs. These opportunities are designed to assist all
faculty and staff to expand their professional skills and achieve their career aspirations. Programs have
been developed to provide information and resources related to academic advancement, clinical
service, research and teaching though orientations and career development courses.

O
GOAL IV

27
SWOT Analysis: PEOPLE

Strengths: Opportunities
High profile researchers, clinicians, educators
and administrative staff
Closely aligned, coherent and collaborative
organizational structure
Recruit new investigators to maintain strong
research program
Institute succession planning for senior clinicians
Provide development opportunities for mid-
career faculty and staff
Recruit outstanding trainees and administrative
staff
Limited opportunity for clinical research
Limited opportunities for regional and national
service outreach efforts
Limited promotion opportunities for Clinician
Educators
Lack of targeted leadership training
opportunities
Flux in divisional leadership positions (4 out of 9)
No institutional strategy for enabling and
coordinating senior recruitment

Based on the SWOT analysis above, the Executive Committee developed five initiatives that will help to
improve the work environment and career satisfaction for our faculty, staff and trainees.
IV.1 Optimize recruitment, retention and promotion strategies for faculty, staff, and trainees
across divisions and locations.
IV.2 Promote a sense of community with shared values and goals, aligned with our tripartite
mission.
IV.3 Promote career growth and development among faculty, staff, and trainees.
IV.4. Support and increase faculty, staff, and trainee involvement in local, national, and
international outreach and service efforts.
IV.5. Continue to realign compensation to encompass all three missions of the department.

As part of the Strategic Plan, the Department of Medicine asked the Faculty Development Committee
(FDC) to lead the effort in addressing the initiatives above. These initiatives will serve as the foundation
for action items, which are designed to be implemented throughout years one through five. Below are
the action items that will help accomplish and meet these initiatives.

28

I. Enhance mentoring by providing funds for CME meetings and
educators, expanding mentoring for primary care external faculty and
hospitalists, and defining career paths for staff. (Initiative 1)

II. Promote sense of community by promoting DOM service efforts, e.g.,
Project IMPACT, outreach charity care, and create an online service
catalog. (Initiatives 2 and 4) *

III. Continue and expand existing faculty development programs.
(Initiative 3)

IV. Expand staff involvement in feedback (360 evaluations). (Initiative 3)

V. Offer focus groups for faculty with like interests to identify their
career development needs. (Initiative 3)

VI. Create a Lunch with the Chair program to facilitate interaction
between faculty and DOM leadership. (Initiative 3)

VII. Increase staff development opportunities. Allow staff a certain
number hours/year for development activities, such as personalized
group sessions through Learning Services. (Initiative 3)*

VIII. Target faculty and staff for leadership development. Provide career
coaching as needed. This will aid in succession planning. (Initiative 3)

IX. Revive and implement RVUs/citizenship metrics. (Initiative 5)

X. Provide non-salary compensation to reward employees and improve
moral, e.g., protected CME time and vacation time. (Initiative 5)

XI. Expand DOM website for staff development (Initiative 1 and 3)*


GOAL IV

ACTION
ITEMS

29

2012
2014
2013
2015
2016
People
Action Item
Timeline
Increase staff development
opportunities
Target faculty and staff for
leadership development
Lunch with the Chair
Increase outreach for charity care
around Georgia
DOM service project: Project
IMPACT
Enhance mentoring
Provide non-salary compensation
to reward employees and improve
morale
Offer focus groups for faculty with
like interests to identify their
career development needs
End
2017
Begin
2011
Expand staff involvement in
feedback
Continue and expand existing
faculty development programs
Revive and implement
RVUs/citizenship metrics
Expand DOM website for staff
development

30

he everyday activities and
duties of the Department of
Medicine rely heavily upon the
success of the finance and
accounting team. Within this group falls
the responsibility of managing budgets,
promoting growth of the clinical
practice, increasing philanthropic
support and expanding and pursing
new partnerships, internally, locally, nationally and internationally. The department functions as two
separate financial entities: clinic and university. Both are critical to the departments success.
The department operates on a budget of over $220M, of which 71% goes to the support of our
staff and faculty. Although, the DOM is one of the largest revenue and grant producing departments in
the school, there exist a heavy reliance on financial support from The Emory Clinic. This hinders the
DOMs independence and ability to make large financial commitments and limits our options for five
year planning. Thus, much of the effort for this goal is devoted towards working within the system to
optimize and expand our resources.

T
GOAL V
FINANCE,
INFRASTRUCTURE &
PARTNERSHIPS
Effectively develop and manage financial resources to
achieve excellence across all missions

31

Strong financial base, especially over the past
9 years
Close collaborations with Yerkes, Grady, VA,
Georgia Tech, CDC, Morehouse, and GRA
Promote growth of the clinical practices in
outlying areas by acquisition or formal
affiliation with existing private practices
Re-examine the utilization of clinical and
clinical research space to maximize efficiency
and usage
Expand partnerships across the state of
Georgia, as well as national and international
collaborations
Pursue international partnerships and
business opportunities
Philanthropic support
Ability to develop and capture intellectual
property
A funding model that depends on TEC
revenue
Critical lack of IT infrastructure
Challenge of maintaining equipoise in
administrative and financial relationships
with Grady
Unstable and unpredictable financial models
and reimbursement schedules
Proposed CMS changes that impact
professional and technical reviews
Inequitable allocation of funds to the DOM
National economy

The SWOT analysis above identifies the numerous weaknesses and opportunities within the
departments financial arena. The initiatives below are designed to help minimize the weaknesses and
threats and increase the financial strengths within the DOM.

V.1. Optimize administrative structures and processes throughout the DOM.
V.2. Increase philanthropy and alternative funding sources to enable strategic investment.
V.3. Explore opportunities for growth of the clinical enterprise and financial stability in the
DOM.
V.4. Advocate and facilitate the adoption of an effective, user-friendly and integrated IT
infrastructure (see also II.4).
V.5. Support and increase faculty, staff, and trainee involvement in local, national, and
international outreach and service efforts (see also IV.4).

In order to address these initiatives, the Executive Committee charged the Finance, Infrastructure and
Partnerships Committee (FIP) to design action items that address these initiatives.
Note: Some action items imported from other sections.

SWOT Analysis: FINANCE & INFRASTRUCTURE

32

I. Integrate TEC-University infrastructure at divisional and
central levels. (Initiative 1)*

II. Establish a research space committee to develop a space
policy and allocate research space. (Initiative 1)*

III. Engage University, EUH and EUHM Administration in an
analysis of existing space allocation from the DOM.
Specifically, explore the use of the Old Nursing School
Building at EUH as well as other offsite space. (Initiative 1)*

IV. Launch an internal marketing campaign for development.
(Initiative 2)*

V. Assess development staffing strategy. (Initiative 2)

VI. Launch an internal marketing campaign for intellectual
property. Consider a spokesperson and/or navigator for the
process of working with the Office of Technology Transfer to
facilitate capture of intellectual property and turn it into a
potential revenue stream. (Initiative 3)*

VII. Increase DOM IT budget to support research IT and
infrastructure upgrades. (Initiative 4 and II.4)*

VIII. Appoint a Vice Chair for IT and create an IT advisory team to
prioritize and facilitate IT efforts within the department.
(Initiative 4 and II.4)*

IX. Work towards creating common platforms for patient data
that can be queried by varied investigators. (Initiative 4 and
II.4)

X. Promote sense of community by promoting DOM service
efforts, e.g., Project IMPACT (Internal Medicine Partnering
Across the Community). One project will be highlighted each
year and an online service catalogue will be developed to
showcase other DOM events. (Initiative 5 and IV.4)*


ACTION
ITEMS

GOAL V

33

2016
2015
2013
2014
2012
Launch an internal marketing
campaign for intellectual property
Launch an internal marketing
campaign for development
Engage University, EUH and EUHM
Administration in an analysis of
existing space allocation for the DOM
Establish a research space
committee to develop a space policy
and allocate research space
Integrate TEC-University
infrastructure at divisional and
central levels
Begin
2011
End
2017
Finance
Action Item
Timeline
GOAL V
Assess development staffing and
strategy
Appoint a Vice Chair for IT and create
an IT advisory team
Increase DOM IT budget to
support research IT and
infrastructure upgrades
Work towards creating common
platforms for patient data that can
be queried by varied investigators
DOM service project: Project
IMPACT

34
Prioritized Action Items
Initiatives
& Ideas
Goals &
Focus
Areas
Mission
and
Vision

PRIORITIZATION &
IMPLEMENTATION

The five focus areas and their respective action items represent a concrete roadmap to move
the Department forward to continued excellence over the following five years. However, in
the current financial environment, initiatives must be carefully prioritized for implementation
to align with the limited resources. The Executive Committee evaluated each action item
based on potential impact and required resources. Findings are summarized in the following
table. The colors reflect their respective focus area. Based on this analysis, and after
considering ongoing efforts and integrated needs, Dr. Alexander prioritized the action items as
outlined in the timelines for each focus area. Implementation will be the responsibility of the
appropriate standing committees (Clinical Advisory Team, Research Advisory Team, Education
Executive Committee, Faculty Development Committee) or the Executive Administrator of the
Department of Medicine in the case of finances and infrastructure, and progress will be
evaluated each year. Priorities may be adjusted yearly based upon availability of resources.

IMPLEMENTATION

35

5) Create space policy 1) Quality improvement Project 9) Create post-award reporting
mechanism

8) Work with OBPI and ARC to improve
research administration
2) Implement quality program
dissemination

10) Expand IT resources

11) Ensure residents are SIBR certified 4) Improve communication when
disseminating best practice models
11) Create common platforms for
patient data that can be queried
HIGH
1) Integrate TEC-University
infrastructure at divisional and central
levels.
1) Create pilot seed grants 5) Propose education budget

2) Establish a research space committee 7) Increase biostatistical support 7) Increase DOM IT budget

3) Expand faculty development programs

8) Target faculty and staff leadership
development

IMPACT 8) Appoint a Vice Chair for IT

3) Improve communication between
providers and health system
4) Create user friendly website to
showcase research

2) Create "Blue Sky Groups" 6) Provide matching dollars for successful
Programs

1) Create yearly mini-development
retreat
6) Reorganize the residency
administrative team

4) Implement periodic reviews of
teaching faculty
7) Hire program coordinators to support
fellowship programs

2) Develop clear job descriptions 7) Increase staff development
opportunities

MED.
3) Strengthen accountability of Division
Chiefs and program directors
11) Provide non-salary compensation to
reward employees

2) Promote DOM service efforts 12) Expand DOM website for staff
development

4) Expand staff involvement in feedback
evaluations
4) Launch internal marketing campaign
for development

3) Engage all of DOM in space allocation
analysis
6) Launch internal marketing campaign
for intellectual property

5) Assess development staffing strategy

3) Create "Internal Visiting Professor
Program"
1) Enhance mentoring by providing funds
for CME meetings and educators.

8) Develop online education resource for
faculty
10) Revive and implement RVUs and
citizenship metrics

LOW
9) Expand faculty development
initiatives focused on teaching

10) Create yearly report on education

5) Offer focus groups for faculty with like
interests

6) Create a Lunch with the Chair Program
LOW MEDIUM HIGH
RESOURCES
ANALYSIS OF ACTION ITEMS BY
RESOURCES AND IMPACT
IMPLEMENTATION

36

COSTS

37
IMPLEMENTATION COSTS

The estimated total five-year implementation cost of the Strategic Plan and all of its five goal
areas comes to a total of $5,994,192. The yearly costs per goal area are outlined below. The
fiscal year totals represent the cost of performing the action items as outlined in each sections
timeline schedule.

Year Clinical Care Research Education People Finance
FY 12

520,200

-

61,000

22,000

58,960
FY 13

675,890

61,960

61,000

27,000

108,960
FY 14

727,965

336,649

81,000

27,000

36,960
FY15

819,965

436,649

81,000

47,000

36,960
FY16

921,965

679,149

81,000

47,000

36,960

TOTAL**

3,665,985

1,514,407

365,000

170,000

278,800

** All costs are additive to the previous year.

CONCLUSION

38

CONCLUSION

The Executive Committee is proud to present
this strategic plan for the Department of
Medicine for 2012-2017. The plan allows us to
build upon our strengths to address our
weaknesses and external threats, and outlines a
path to exciting opportunities in all three
mission areas of clinical care, education and
research. It recognizes our people as our most
important asset and provides a roadmap to
improve our finance, partnerships and
infrastructure. Dr. Alexander and the Executive
Committee are confident that successful
achievement of this strategic plan will position
the Department of Medicine to be a national
leader and innovator in discovery, high
quality patient care and education.

39
DEPARTMENT OF MEDICINE
STRATEGIC PLANNING LEADERSHIP

EXECUTIVE COMMITTEE
GREG MARTIN, MD WILSON HOLLAND, MD
R. WAYNE ALEXANDER, MD MARK MULLIGAN, MD ADRIANA IOACHIMESCU, MD
ERICA BROWNFIELD, MD ROBERTO PACIFICI, MD BETH MCCONNELL, MD
STEVEN DONEY JEFF SANDS, MD LESLIE MILLER, MD
KATHY GRIENDLING, PHD LESLEE SHAW, PHD SYLVIA MORRIS, MD
PAUL HAMMONDS JASON STEIN, MD CAMILLE VAUGHAN, MD
TED JOHNSON, MD, MPH PETER THULE, MD MONNIE WASSE, MD
ELIZABETH KIMBERL
EXECUTIVE EDUCATION
PETER WILSON, MD
JEFF LENNOX, MD
COMMITTEE FINANCE,
JEFF LESESNE, MD ERICA BROWNFIELD, MD
INFRASTRUCTURE
DOUG MORRIS, MD WENDY ARMSTRONG, MD
AND PARTNERSHIPS
MARK NANES, MD LISA BERNSTEIN, MD
COMMITTEE
JEFF SANDS, MD SHAHED BROWN W. ROBERT TAYLOR, PHD, MD
JASON STEIN, MD DOMINIQUE COSCO, KEVIN ANDREWS
ROBERT TAYLOR, MD LORENZO DIFRANCESCO, MD STEVEN DONEY
BRYON WILLIAMS, MD DAN DRESSLER, MD ANA MARIA GALVEZ, MPH
CLINICAL ADVISORY
DUSTIN SMITH PAUL HAMMONDS
TEAM
JONATHAN FLACKER MICHAEL KILGORE
TED JOHNSON, MD, MPH STACY HIGGINS PAIGE MARTIN
MATTHEW BEDNAR DANIELLE JONES LEAH PHILIPS
NANCY COLLOP, MD LINDA HOWELL DAVID PROPP, MD
LINDA DELANEY, RN KAREN LAW SANDRA TALLEY, MPH
ANA MARIA GALVEZ, MPH KIMBERLY MANNING, MD
DAVID GUIDOT, MD RICHARD PITTMAN, MD
JEFF LENNOX, MD SUSAN RATLIFF
JEFF LESESNE, MD DAVID SCHULMAN
DAVID NEUJAHR, MD MAZIAR ZAFARI
ANDREW SMITH, MD JENNIFER ZRELOFF, MD
KATIE SPARKS, RN
FACULTY DEVELOPMENT

RESEARCH ADVISORY COMMITTEE

TEAM
KATHY GRIENDLING, PHD
KATHY GRIENDLING, PHD ERICA BROWNFIELD, MD
R. WAYNE ALEXANDER, PHD, MD JENNIFER CHRISTIE, MD
FRANK ANANIA, MD DAN DRESSLER, MD
KATHARINA ECHT MONICA FARLEY, MD
JENNIFER GOOCH MICAH FISHER, MD
C. MICHAEL HART, MD JENNIFER GOOCH, MD

40
APPENDIX 1
CLINICAL CARE:

Initiative 1, 2 & 4: 1) Develop and implement quality programs in both inpatient and outpatient settings.
2) Disseminate innovative discoveries and best practice models throughout the
medical community and society,
4) Create pilot accountable care unit/clinic structures with which to deliver the quality
initiatives determined in action item 1,

Action Item: Developing and Implementing Quality Programs

The DOM must build out care models, i.e. structure and process, capable of reliably and
durably producing the best possible outcomes and value. The DOM does have a successful
demonstration project that shows the benefit of this approach the implementation of unit-
based interdisciplinary care teams co-managed by a physician unit director and nurse unit
manager, so called accountable care units, or ACUs.

Each ACU, defined as a geographic care area consistently responsible for the clinical,
service, and cost outcomes it produces, has four core features: 1) unit based teams of
physicians, nurses, and allied health professionals to build consistency and mutual
accountability); 2) patient-family centered workflow guided by the principle of prepared,
proactive teamwork; 3) unit-level performance and outcomes data; and 4) active
management of unit outcomes by physician and nurse co-directors.

Time Span: This program will be progressively adopted by the DOM over the next 5 years. It
is the expectation of the CAT working group that these policies will continue to exist
indefinitely, with continuous revision.

The DOM ACU Demonstration Project has generated data supports a strategy of unit-based
re-design of structure, process, and management controls. Specifically, in the 12 months
after reorganizing a hospital ward at Emory University Hospital into an ACU, several
compelling clinical and utilization outcomes have improved.

This proposal will require both tangible financial resources (see below) as well as strong
engagement from all of the clinical divisions and many clinical faculty within the DOM. We
anticipate that eventually each division will require that the division director be invested in
this process as well as multiple quality representatives per division (perhaps 20% of the
division). We estimate that ultimately this initiative will be cost neutral or even cost
effective, but this estimate requires some assumptions. First, the quality initiatives here will
be the substrate used for external funding from sources such as the National Institutes of
Health from institutes such as the AHRQ. Second, we believe that in demonstrating our
commitment to established quality metrics, the DOM will improve reimbursement for
services paid by CMS and other third party payors. Third, improvement in health of our
patients will decrease expenses.

Time Span: Year 1: Key decisions: Division directors will select one quality representative
per clinical unit and engage faculty and decide upon which initial quality metrics are to be
tracked within each unit. This will initially be piloted within 2 units per large division and 1
unit in smaller divisions.

41
Key infrastructure: Working with IT quality metrics will be directly integrated into the EMR
system. By the end of the first year, the system will track compliance with quality metrics
at the individual provider level, the individual patient level, the geographic location and
within divisions.

Key innovation: By the end of year one, the EMR system will be integrated with the quality
measures chosen by each division. This will include power-plans that directly link a
patients problem list (using either CPT or snowmed codes) to the provider and a quality
initiative. Ultimately the EMR interface will allow the provider to interact with the quality
metric of interest and this data will be tracked in the clinical data warehouse.

Pilot ACUs will require participation by multiple members of the hospital staff. For the DOM
ACU at EUH, the SIBR rounds consist of an attending physician, nurse manager, social
worker, pharmacist, and physical therapist. Development of ACUs does not require
increased funding to support these services (as these services already exist), but for an ACU
to be successful, parties beyond those in the DOM have to embrace this concept. Therefore,
our expectation is that the quality representative at each pilot ACU will need to devote a
significant amount of initial effort to educate other members of the team and generated
engagement to this process.

Year 2: Implement the quality model in year 1 into two additional clinical units per division.
Development of divisional dashboards that tracks compliance with quality metrics as
decided upon in CAT action item 1. This will require coordination with IT, the
programming architects for EMR and the data warehouse. The dashboard will indicate
within divisions how closely quality targets are being met. Divisional reports for the
quality dashboard would be run no less than twice a year and the results disseminated to
individual members of each division. The primary responsibility for making the divisional
reports will be through the administrator in the DOM (see personal below).

Key infrastructure: Work with research and IT to improve data warehouse to provide
necessary data to physicians and leadership with reliable and accurate reports.

Year 3: Implement quality infrastructure within all clinical units in all divisions. Work with
leadership to align all incentives and compensation plans within respective units. Roll out
of initial reports on compliance using the compliance dashboards for each division. The
specifics of how these data are disseminated at the divisional level and individual level are
addressed in action item 2 of this proposal.

At the end of year 3, we propose to actively survey the DOM faculty on their experience with
the tracking of these quality metrics. The primary tool for this will be surveys, but
additional tools will include the use of one of the Medicine Grand Rounds as well as each
divisions Meet with the Chair Day. This feedback will be used to solicit new metrics to be
added to the Dashboard, as well as consideration of removal for quality metrics for which
the utility of such measures is doubtful.

Year 3-5. The expectation is that adherence to quality metrics will increase over time. This
will be directly tested every year. The anticipated successful results are discussed in the
metrics section.

Metrics: Given that the key quality measures that each division will embrace have not yet been
determined, we do not yet have data on the degree to which DOM faculty adhere to established
quality metrics. Between year 1 and 2, we expect to generate baseline data from which future
comparisons will be made. We acknowledge that the faculty will be informed that these
measures will be tracked and this may dramatically affect behavior by itself (the Hawthorne

42
effect). At the division level, the expectation is that quality measures, which are division-
specific, will be embraced by all divisions. Further, the expectation is that all divisions will
utilize the quality dashboards and will track adherence to quality measures by all faculty.

This endeavor will involve significant human and real capital. The data output will be
invaluable. Our expectation is that by year 2, this project will yield sufficient quality substrate
for at least 1 RO1 level health care quality grant, with much of the direct and indirect costs
used to continue this endeavor.

Full-Time Equivalents (year 1):
1) ACU Medical Directors: Each ACU Medical Director will have 15% less clinical time to enable service as a
frontline manager. In year 1, the larger divisions will have two geographic units each with a medical
director. Smaller divisions will have a pilot in only 1 unit.
2) Director, Data Management 1.0 FTE
3) Biostatistician/clinical epidemiologist (employed directly by the DOM) 0.3 FTE

Title FTE Total Salary & Fringe
ACU Medical Directors, cumulative (physicians) 2.55 $ 520,200
Director, Data Management (data analyst) 1.0 $ 92,000
Biostatistician/clinical epidemiologist (MD MPH) 0.3 $ 65,490
Data Analyst 1.0 $ 52,075
TOTAL $ 729,765

Ongoing operating costs:
Each additional year is estimated to cost an additional $30,060 per quality representative. Note that most of
these costs may be offset by improvements in clinical revenue, as well as potential external grant funding.

Initiative 3: Improve service through operational efficiency and resource optimization

Action Item: Create consistent and improved care through care pathways across the DOM, as developed by
experts in each division within the Department of Medicine. Each division will nominate 1 quality
improvement (QI) project to be implemented departmental wide and will also develop and initiate at least
one division-specific QI project.

This initiative will assist in developing a culture of embracing quality improvement in the DOM,
which will better prepare faculty and staff for governmental or payer mandated payfor
performance or accountable care organization standards. Accomplishing this task will assist the
DOM and the individual divisions in identifying personnel to develop and implement such
strategies, and in assessing the resources required to do so.

In order to improve care standards and operational efficiency, each division should suggest one
process that could improve patient care, throughput, or reduce waste that can be implemented
department-wide. The division should also identify, at a minimum, one important disease state or
highly variable process under their purview.

In order for the standards to be effective, there must be a method for updating these pathways at
least biannually, and for feedback from clinicians outside the division to be considered. Faculty
must also be aware of the standards, be able to access them rapidly at the patient care setting,
have their efficiency improved through the use of standardized templates and order sets, and see
measurable outcomes in both service delivery and patient care.

43
Initial identification of departmental-wide and division specific projects will take place over the
first 6 months. For the departmental wide project, the chief quality officer will appoint a
departmental committee to identify the top quality initiatives and develop an implementation
strategy over the next 6 months. The departmental initiative will begin at Year 2 with
departmental analysis yearly thereafter. Decisions about beginning other initiatives will be at the
discretion of the departmental QI committee pending the outcome of the initial project.

For the divisional project, the implementation should begin at 6 months with regular assessments
at 6-month intervals. As with the departmental project, initiation of a second project would be at
the discretion of the divisional subcommittee with the hope that the original and subsequent
projects would at a minimum span the following five years.

The departmental committee chair will oversee the departmental project(s) and act as a
consultant to each divisional committee. It is anticipated that this person will require 0.5FTE to
act in this role. In addition, 2-3 FTE will be needed to assist with implementation, data entry and
monitoring. It is anticipated that baseline data will have to be acquired as well as ongoing data
throughout the life of the projects. These personnel will need access to all hospital systems EMR
as well.

FINANCES:
Please include estimations and explanations for the following financial areas. An excel file should be
attached.
Administrative Support:
1. Departmental Chair to assist with major departmental initiatives and to act as liaison for divisional
projects (0.5 FTE)
2. Each division will have a chair or champion to help with implementation of departmental initiative
and development/implementation of divisional initiative, I figured about 2 hrs/week = 0/05 FTE x
10 division (0.5 FTE)
3. Data entry and administrative personnel to get all projects up and running, both departmental and
divisional (2.5 FTE)
4. Partial FTE to develop software programs and/or EEMR links to get data collected and maintained
(0.5 FTE)

Initial Investment: $356,000

Action Item 3 FTE COST
STAFF
Committee Chair 0.5 $ 102,000.00
Divisional Champion (0.05 each div x 10) 0.5 $ 102,000.00
Data entry 2.5 FTE $ 96,900.00
Programmer/EMR Software Architect 0.5 $ 90,200.00
OTHER
Start Ups Cost - $ 10,000.00
Ongoing $ 25,000.00
TOTAL YEAR 1 $ 426,100.00

44
Initiative 4: Create a sustainable model for inpatient care with mechanisms for subspecialty involvement
at both inpatient and outpatient transitions
Action Item: Communication standards, both between providers and between health systems and
providers, would be helpful to assure best possible clinical outcomes.
The DOM believes that great clinical communication is essential to excellent quality patient
care. The DOM can and should be the leader in this effort. Each major entity within the DOM
has some communication standards that exist and are required, or work in concert with other
accrediting bodies such as the Joint Commission; and these standards should be met. A
comprehensive departmental approach will include these minimal standards. We suggest a
local group that recommends specifics for our entities that both complies with their
requirements and will help to improve patient care and insure proper safety.

In order to improve the quality of our clinical care, all Department of Medicine faculty should be
practicing in a work environment where there are quality monitors and metrics. A concerted
effort in dissemination of such monitors and metrics is essential to ensure that the faculty are
utilizing these measures. In order for the faculty to aspire to these metrics, faculty members
need to be included and notified in advance and in writing as to how these indicators were
determined and measured. The faculty, including Division Directors, should all be included in
the determination of applicable quality metrics per Division and unit, thus, unifying the quality
goals in each area. The Faculty should be offered regular and actionable feedback on their
individual performance no less than quarterly, and should be allowed to comment on the
applicability of these standards to our unique clinical practice settings. Additionally, it is
essential that faculty be provided with information that allows them to compare their
performance on quality measures to peers in the same field.

In order to improve outcomes for our patients, all Department of Medicine faculty should be
employing effective communications practices. A concerted effort in making certain that strong
practices are agreed upon, adopted, monitored, and improved is essential to ensure the best
outcomes. There is recognition that many sites have communication directives that may be site
specific, however, a smaller group that can create common standards in this environment will
be beneficial to patients and families.

In order for the faculty to embark upon such an endeavor, the following must take place: 1)
input from faculty and partners as to their assessment of the current state of communication; 2)
metrics about desired communication practices; 3) a review of potential models for
communication (such as SBAR); 4) an agreed upon method for communication specific to the
practice site; 5) audits for adherence to an agreed upon plan; 6) aligning incentives for strong
performance with the plan; and 7) readjustment of the plan.

The faculty should be offered regular and actionable feedback on their individual performance
no less than quarterly. They should be allowed to comment on the applicability of these
standards to our unique clinical practice settings.

Timeline for all of the action items above and their sub-action items:
(Year 0.0) Health system(s) Department contract on timely roll-out of quality performance
measures and quarterly reporting
(Year 0.0) Name DOM quality program leaders at all sites and all Divisions

(Year 0.25) Designation of Inpatient Accountable Care Units (ACUs) at each site

45
(Year 0.40) Division led care-path initiative for identified most significant problem/highly
variable care process in the area/field

(Year 0.5) Division Director / Health System collaborative for ACOs for tracking metrics

(Year 0.75) Designate physician director/ nurse manager pairs; 2 units per large Division, 1
unit per small

(Year 0.8) Internal communication and consultation standards conference

(Year 1.0) Integrate quality metrics and power plans into EMR

(Year 1.1) Summer DOM Grand Rounds series on quality

(Year 1.2) Evaluation of timeliness on quality measure contracts and reporting

(Year 1.4) Roll out of intra-communication standards and monitoring plan

(Year 1.5) Unit-level performance and outcomes data first annual conference

(Year 1.75) Division led care-path initiative roll out to Department level: 2nd item for
significant improvement in patient care, throughput, or reduction of waste

(Year 1.8) Roll out of communication standard to cross-department processes

(Year 2) Two additional ACU clinical units per Division

(Year 2.2)

(Year 2.5) Department QI Committee review of Divisional Department initiative roll-out

(Year 3) Quality infrastructure into all divisions; Integrated into Meet with Chair Day

(Year 4) Expansion of number of quality metrics plans for ACU

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APPENDIX 2
RESEARCH:

Initiative 1: Support innovation, integration and translation of basic discoveries into clinical care and
health care delivery

Action Item: Create pilot seed grants (designed to facilitate the acquisition of extramural support for basic
and clinical research efforts of beginning faculty) with two Principal Investigators (PIs) who have never
worked together before. Preference will be given to researchers from different divisions and to
applications with both a basic science PI and a clinical PI.

Increase collaboration across divisions, stimulate interactions that may not have otherwise
taken place, which can lead to additional awards and increase external grant award success.
Estimated dollars awarded versus dollars returned is just under 1200% based on data from
current DOM seed grant program (see Appendix A)

The seed grants will be offered once a year for 5 years with the hope of continuing the program
by obtaining philanthropic support.

Cost: $100,000 per year for five years, $500,000 total (two seed grants offered per year at a
one-time award of $50,000 each). 0.05 FTE Program Coordinator administer the program

Targets:
1) Seed grants announced, reviewed and awarded (annually)
2) Progress reports collected (annually)
3) Metrics analyzed yearly after year 3

Outcomes will be measured in terms of:
1) Quantitative data - dollars awarded versus dollars returned, and
2) Qualitative data impact on the recipients career, successes that the seed grant allowed
the recipient to achieve (e.g., publications)
These data will be collected through mandatory annual progress reports from the recipients.
(See Appendix B).

Initiative 2: Streamline research administrative procedures

Action Item: Work with Office of Business Process Improvement (OBPI) and Administrative Restructuring
Committee (ARC) to improve research administration.

Preliminary work by ARC has been completed, and recommendations have been submitted to
Dr. Alexander. These recommendations include items that need to be addressed within the
DOM and suggestions for how to improve research administration in the central SOM and
university offices. This action item addresses several deficiencies noted by ARC. Briefly,

1. DOM research administration is understaffed.
Solution: Targeted hiring to improve efficiency.
2. Research staff need additional training and career development opportunities.
Solution: Create online and in person training sessions by Saundy Berry, and create career
paths for research administrators.

47
3. Post-award monitoring is time-consuming and labor intensive and is not being completed in
a timely manner, if at all.
Solution: Rests partly with central offices, but includes development of reporting tools, and
hiring additional personnel.
4. Pre-award processing is inconsistent and drawn out.
Solution: Rests partly with central offices, but includes greater accountability and monitoring
and standardization of departmental processes.

Benefits:
1) Improved speed of proposal routing
2) Back up staff to cover during vacations and vacancies of regular staff
3) Consistent processes across divisions
4) Fewer errors in submitted proposals due to increased training
5) Decreased staff turnover due to clear career paths
6) Ability to keep up with growth in grants and increased regulatory requirements
7) Adequate oversight of post-award spending and compliance, thus reducing risk
8) Timely post-award monitoring and reporting to PIs
9) More user-friendly, accurate electronic systems for grant management
10) Clearer understanding of what standards are necessary for each job title
Resources:
1) Staff:
a) Two new, highly specialized staff for the central office for post-award monitoring,
account cleanup and divisional backup
b) Additional FTEs for understaffed divisions (1 FTE Cardiology, 1 FTE ID/Geriatrics, 0.5
FTE Renal)
2) Space: Office space needed for central staff
3) Time dedicated to creating training and mentoring programs for research director
4) Software: Purchase or develop grants management software ($50,000 for 4 users) or work
with WHSC Research IT office to create one for DOM ($65/hour)
5) Time dedicated to developing standard processes for research director
Metrics:
1) Gather data from OSP/OGCA regarding speed of proposal routing
2) Gather data from HR regarding research administration staff turnover rates
3) Survey DOM research administrators as to opinion of overall process improvement
4) Report from central office detailing process improvements
5) Comparison of FTE per total funding ratio with other departments

FINANCES:

Position Salary
Financial Analyst (1 FTE) $ 75,098.00
Financial Analyst (1 FTE) $ 75,098.00
Research Coordinator (.5 FTE) $ 31,046.00
Research Coordinator (1 FTE) $ 62,092.00
Research Assistant (1 FTE) $ 56,355.00
Total $ 299,689.00

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Initiative 3: Advocate and facilitate the adoption of an effective, user-friendly, and integrated IT
infrastructure

Action Item: Expand IT resources within the DOM to support basic and clinical research.

Currently, DOM IT resources are focused on desktop support. A survey of other departments
shows that they have more effectively utilized SOM resources to support research. Bringing
such systems into the SOM will require a significant monetary investment, but progress can be
made by bringing together interested parties and making research IT a priority for the
department. Specifically,
1. Create Associate Vice Chair for IT to advocate for and oversee the development of IT
solutions for research.
2. Create a standing IT committee to oversee direction of DOM IT and interface with SOM
IT, UTS, and Research and Health Sciences IT, charged with oversight of not only
desktop support, website design and network services, but also approving
initiatives/projects that require IT support and investment, such as data
analysis/management, software development, etc. This group should include clinical
and research faculty, a full time research IT staff member, a biostatistician,
administrators, research and health services IT support personnel, DOM IT personnel,
and an informatics expert (after successful surgery model).
3. Increase DOM IT budget to support research IT and infrastructure upgrades.
4. Expand videoconferencing capabilities and support.
Benefits:
1) Platform for enhanced clinical research
2) Research IT resources funded, more readily available and easier to access
3) Fair and balanced assessment of IT initiatives; continued advocating of research IT
needs.
Targets:
1) Appointment of Associate Vice Chair for IT
2) Hiring of research IT staff member
3) Creation of IT committee
4) Implementation of at least one major research database project
5) Creation and implementation of hardware replacement schedule
6) Purchase and installation of videoconferencing equipment
Metrics:
1) IT committee generates a yearly report on progress on reported number of project
requests, computer replacements, videoconferencing usage, etc.
2) Survey research faculty/staff on overall satisfaction of research IT
3) Regular meetings between IT committee and business managers/division directors to
discuss ongoing issues/outcomes
FINANCES:

Position Salary
Vice Chair Salary Support (.2 FTE) $ 10,000
Research IT Staff (1 FTE) $ 70,000
Associate Vice Chair Support (.2 FTE) $ 60,000
Video Conferencing (5 sites) $ 2,500
Research Project Funds $ 50,000
Equipment Upgrades (every 4 years) $ 50,000
Total $ 242,500

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APPENDIX 3
EDUCATION:

Initiative 1: Develop and implement creative and consistent approaches to medical education.

Action Item: For new (and existing) program coordinators and the residency administrative team: create a
mini development retreat to review processes, procedures, and requirements for educational programs.
(Propose to do this yearly as a half-day update.) Require all to attend New Innovations training that GME
offers every year.
An annual retreat reviewing processes, procedures, and requirements for educational programs
would both inform and emphasize consistent approaches in education that apply to all
programs.

TIME SPAN:
Annually, beginning Spring 2012.

RESOURCES:
Computer lab and classroom space in SOM. Optimally, would like GME to help facilitate with
residency program director, Vice Chair for Education and residency administrative team.

TARGETS:
Increase consistency in procedures around evaluations, PIFs, duty hours, procedure logs, quality
improvement projects, etc

METRICS:
Annual audit by residency program director, Vice Chair for Education and residency
administrative team to ensure consistent practices are achieved by each educational program.

FINANCES:
Administrative Support: See above.
Full-Time Equivalents:
Initial Investment:
Ongoing Operating Costs: Yearly cost approximately $500 for food during the retreat.

Action Item: Develop clear job descriptions and timelines for both faculty leaders and administrative staff
for requirements of their educational programs. Regularly assess their progress and hold them accountable
for their duties. Provide regular review of requirements such as PIFs, evaluation reports, duty hour logs,
etc. The Vice Chair for Education and The Residency Program Director will lead this review process.
By clearly defining expectations, education leaders and staff are better equipped to succeed and
be held accountable for their efforts.

TIME SPAN:
Initial development of a manual for our educational programs that would supplement and
delineate the ACGME standards. Such a manual would be a compilation of best practices and
timeline of educational programs that lists all duties of program directors and coordinators, as
well as DOM expectations. Would like to complete manual in Spring 2012.

METRICS:
Each education program adopts expected and best practices regarding all educational efforts (i.e.,
New Innovations is used consistently for all evaluations, logging duty hours, etc)

50
Action Item: To strengthen the accountability which Division Chiefs and program directors are held for
their educational programs, we recommend that incorporating education metrics into annual goals, career
conference reports and incentives be considered.
By including incentives for division chiefs and program directors, this might provide further
value to education-related tasks they are doing, in addition to accomplishing specific
education-related goals.

Action Item: Create and implement periodic reviews of faculty teaching within the department of medicine
to achieve highest standards of teaching competency.
By regularly reviewing the teaching performance of our faculty, we have the opportunity to
target faculty in need of further faculty development, as well as identify and
decrease/discontinue defined teaching roles for those faculty with consistent low
performance.

TIME SPAN:
Quarterly reviews of faculty by residency program director, Vice Chair for Education, Department
Chair with notification to division chiefs and individual faculty.

FINANCES:
No monetary costs. Faculty development time investment by individual faculty members.

Initiative 2: Re-examine funds flow to ensure the financial strength (and education mission) of the
department.

Action Item: Define an education budget that supports the infrastructure of education, furthers the core
education mission, and is based on national and local best practices.
Clearly defining an education budget for the department will allow us to: a) quantify
educational costs incurred by the department; b) provide leadership with more decision-
making freedom to prioritize education-related spending; c) create more simple accounts for
education to track easier; and d) leverage accountability with financial support.

TIME SPAN:
Starting in November 2011, the beginning of creating an education division in terms of budgets
will be decided by the School of Medicine. If approved, leadership will begin to define an
education budget for central costs incurred by the department (i.e., student and housestaff
programs). For now, fellowship programs (funded by individual divisions) will remain in the
division budgets.

METRICS:
A well-defined budget outlining education costs in the department of medicine for student and
housestaff programs. Ability for leadership to make choices of how to spend educational dollars.

Action Item: For fellowship programs with more than 5 fellows, the program director should receive at a
minimum 20% protected time to run the program. Some program directors will need more based on the
demands of their fellowship programs. For fellowships that have less than 5 fellows, 5-10% support
should be given.
ACGME requirement department needs to be in compliance with standards. Giving
recommended support to PDs will give further value to what they are doing.
METRICS:
PD with 50% support; APDs with 25% support; Fellowship PDs with 20% support

Initiative 3: Optimize administrative structures and processes throughout the department.

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Action Item: Reorganize the residency education administrative team to increase efficiency and gain
expertise. This includes two new positions of Information Analyst and Accountant, as well as enhanced
administrative oversight. The future roles/responsibilities are delineated in (Appendix 1).
Provides administrative support for educational programs that is optimal to meet the needs of
ACGME requirements as well as support innovation.

Action Item: Hire one new program coordinator to support smaller fellowship programs (i.e., endo and
rheum). This coordinator will focus on education. This shared coordinator position will be developed over
1-2 years and used to build a model that other educational programs in the department can replicate if
desired/necessary.
Allows for more consistency in educational programs, consolidation of efforts and increase
opportunity to develop expertise in education.

Action Item: Develop a clear reporting structure for the educational program leadership and support staff.
(See Appendix 2).
The reporting structure holds the core program responsible for the fellowship programs as
required by ACGME. The structure adds more accountability for the administrative support
staff. The Vice Chair for Education is also more clearly responsible for educational programs.
The proposed reporting structure also adds more collaborative input by all involved in
education to develop core standards and best practices.

Action Item: Develop an incentive compensation for program coordinators who met/exceed their
responsibilities.
Similar to incentives for PDs and division chiefs, incentives for program coordinators would
provide external validation of their efforts as well as help meet goal of consistency in our
educational programs.
Financial Assessment: Propose a $2000 yearly incentive to all clerkship, residency,
fellowship program coordinators to be given if defined goals achieved (consistent procedures,
meeting deadlines, etc). This would cost approximately $32,000 per year for the department.

Initiative 4: Disseminate innovative discoveries and best practice models throughout the medical
community and society.

Action Item: Develop online core resources for all educational programs to use to fulfill ACGME
requirements (such as core educational requirements that are similar for all fellowship programs) and for
all faculty, fellows, and residents to use to give talks, bedside teaching points, etc.
Would provide a tremendous education resource for all programs to meet certain ACGME
standards, as well as help our teaching faculty to have readily available resources that can aid
them in their teaching efforts. It also helps with consistency in what we are teaching in the
DOM.
Would love to implement in Fall of 2012.
Need online site to house such resources i.e., Blackboard or website.
Could monitor how many resources were accessed online, get feedback from users, monitor
use by training programs in meeting ACGME requirements.

Initiative 5: Promote career growth and development among faculty, staff, and trainees.

Action Item: Expand faculty development initiatives focused on education and teaching.
Continuing faculty development in education is essential for our department to ensure high-
quality teaching.
Consistent outstanding evaluations of our teaching faculty.
No monetary costs unless food offered.

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APPENDIX 4

PEOPLE:

Initiative 1: Optimize recruitment, retention and promotion strategies for faculty, staff, and trainees
across divisions and locations
Initiative 3: Promote career growth and development among faculty, staff, and trainees
Action item: Career Development for Faculty and Staff
Develop an extension of the website with on-line offerings such as informational articles, videos,
webinar links, links to internal training opportunities, etc.
- These could be grouped by type of skills, job skills/technical skills, productivity, etc.
- These items would be useful for both faculty and staff although some might be more useful
for particular job groups such as administrative skills.
- The goal would be to keep the site frequently updated with list of free webinars, articles,
videos etc.
- This new site could be communicated via email and flyers/posters to faculty and staff.
- We could also cross promote any faculty development offerings that may be beneficial to
staff (for example, Faculty Development Day).
TIMESPAN:
Develop website in the next 3-6 months.

TARGETS:
Frequently updated and visited development website, building of bench strength within divisions
and higher retention.

Action item: Career Development for Faculty and staff
Learning Services offers personalized group sessions. Given direction from the areas leadership,
they will perform an assessment, and based on resources, will design either a one-time class or a
group of classes that can be taken over an extended period of time. There is no cost for this
service, only for the materials used by the individuals attending the course.
- This service could be performed at the DOM level or within a division to make it even
more specialized. As a start, the DOM could have Learning Services come in perhaps
early next year (after the staff survey) to perform an assessment. We already have the
Faculty Life Survey that may shed light on some areas that need focus as well (e.g.,
communication).
- As there are basic and more advanced skills from which individuals across the DOM
could benefit, this could be an on-going process that offers advanced learning as time
progresses.

TIMESPAN:
Have the course/session outline determined in the next 6-9 months.

TARGETS:
Develop additional key skills within the DOM, which will in turn build a stronger department across
the board.

FINANCES:

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Will need administrative support from: Communications Specialist, Administrative Fellow, Faculty
Development Program Manager, Senior HR Associate and Executive Administrator.

Initiative 2: Promote sense of community with shared values and goals, aligned with our tripartite
mission

Initiative 4: Support and increase faculty, staff, and trainee involvement in local, national, and
international outreach and service efforts (**Also present in Finance, Infrastructure and Partnership
section)

Action item: Promote sense of community with shared values and goals, aligned with our tripartite
mission
DOM Service Project: Project IMPACT - Internal Medicine Partnering Across the Community
- Every year Project IMPACT will highlight a main event for the DOM to rally behind. A
Project IMPACT Coordination Team (Faculty Lead Coordinator, faculty/staff/trainee
members) will be formed to decide upon the annual event and coordinate project
implementation. For 2011-2012, we have chosen the Hunger Walk on March 11th, 2012
to support the Atlanta Community Food Bank (ACFB). Emory DOM will sponsor a team
and lead fundraising effort (faculty, staff, trainees with their families will be encouraged
to participate). For 2012, team registration/fundraising will be coordinated through the
ACFB online web portal http://www.hungerwalkrun.org/
- Project IMPACT will involve the development of an Online Service Catalogue placed on
the DOM Website where faculty/staff can highlight current projects in which they are
involved Emory Universitys Volunteer Emory has a website that can serve as an
example: http://www.volunteer.emory.edu/WWA_Faces_of_VE.php
TIMESPAN:
Will the project be ongoing over 5 years or have a definite ending period?
We plan to implement a sustainable program that will develop and grow over the next 5 years and
would encompass service opportunities at local/regional/international levels.

The annual main event will be an event that will involve the entire DOM (e.g., Hunger Walk/Run for
the ACFB). The Project IMPACT coordination team will meet as needed to lead the implementation
strategy, which will include coordination of the fundraising/volunteering and publicity for the event.
Support from the dedicated faculty lead coordinator, staff support from communications/faculty
development will be essential for the program to be a sustainable success.

The online service catalogue will facilitate increased participation in multiple ongoing projects that
have been led by our own faculty/staff/trainees or in which DOM members already serve. These
projects could include speaking to local groups on health topics, mentoring programs, refugee
assistance, rural GA farm workers programs, and international assistance programs in Ethiopia,
Haiti, Republic of Georgia. Staff and IT support will be crucial to maximize this opportunity.

TARGETS:
Increase Emory DOM partnership with community organizations to improve public health/wellness
Increase sense of satisfaction with being a member of the DOM and improved sense of community
among faculty/staff/trainees within the DOM
Highlight IMPACTful faculty/staff/trainees on a monthly basis through the service tab of the DOM
website.

54

METRICS:
Number of hours worked by DOM faculty/staff/trainees (though a website portal for DOM members
to log their hours)
Funds raised - aim to raise $2,000 for Hunger Walk 2012
Satisfaction rating in next DOM Faculty Life Survey (2016)

FINANCES:
Will need: Administrative support from Communications Specialist, IT, and faculty leader, an ongoing
budget of $2,000 to support the annual event (t-shirts and refreshments) and .1 FTE for staff
support, to coordinate the annual DOM event, and .05 FTE for faculty coordinator.

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APPENDIX 5
FINANCE:

Initiative 1: Optimize administrative structures and processes throughout the DOM

Action item: Integrate TEC-University Infrastructure at Divisional and Central Levels
Decrease duplicated efforts common to both the University and TEC.
Improve effectiveness of staff and faculty in leadership positions.

The goal of this action item is to identify common projects between the clinic and university to
reduce redundancy and streamline administration at the divisional levels. Currently, there is a
lack of communication between clinic and university staff and faculty, which, at times, results
in a lack of efficiency and duplication of efforts. As a whole, this inhibits tactical and forward
thinking for the Department administration and the divisions. Streamlining administrative
structures will not only help to unify the DOM, but also allows for the ability and time to make
strategic decisions for all leaders in the department.

Introduce new pilot administrative structure in 1-2 divisions by January 2013.

The action item will consist of three phases:
1. Identify Division Directors interested in improving TEC-University communication and
administration. Interested directors will meet to identify challenges and barriers within
their division that can be minimized with increased communication and collaboration.
These challenges/barriers will be compiled to form a pilot administrative structure, in the
interested divisions.
2. Pilot new administrative system and structure in 1-3 divisions (1-2 years).
3. Implement, if successful, administrative structure in all divisions (2-10 years).

TARGETS:
Integrate projects and common tasks between the University and TEC, as a start to streamlining
administration at divisional levels.
Areas of particular interest are:
Finance
-Example: Ensure that all finance staff are aware of financial and budgetary issues on both the
clinic and university sides.
Human Resources
-Example: Increase collaboration and communication between HR representatives and respective
faculty/staff.
Faculty and Staff Management
-Example: Ensure that staff on clinic and university sides are aware of the effort distribution,
active duties and responsibilities for each faculty/staff member.
Grants accounting/Report Generation
-Use clinic and university skills to assist and administer financial analysis and generation of
financial reports. Eventually, merge accounting and financial knowledge from both sides of the
street to produce more cost effective and time effective reports.

METRICS:
Time spent from business managers on the university side generating reports.
Division Directors and facultys satisfaction rating with new reports (research, financial, quality).
Improved financial understanding from both the clinic to university, and vice versa.

56
Action Item: Establish a research space committee to develop a space policy and allocate research space
1) Ensure appropriate distribution of current space
2) Allow acquisition of additional clinical research space
3) Improve efficiency of clinical research operations

Action Item: Engage University, EUH and EUHM Administration in an analysis of existing research space
allocation for the DOM
Specifically explore the use of Old Nursing School Building at EUH as well as other offsite
University space that has the potential for use for outpatient clinical research.
Increase clinical research space and research productivity.

TARGETS:
Acquisition of space
Reassignment of Space
Develop a mechanism and scheduling system to allow use of unused clinic exam room space

Initiative 2: Increase philanthropy and alternative funding sources to enable strategic investment.

Action Item: Launch an internal marketing campaign for development.
Increased understanding and engagement of faculty, which is imperative to successful fundraising for the
Department of Medicine the end result is increased philanthropic support of the DOM.
While we will continue educating and engaging faculty indefinitely, the thrust of this campaign
will take place over 18 months.
While continuing the efforts outlined below, we will launch an internal marketing campaign for
development.

Ongoing development efforts
Alumni engagement (including former residents and fellows)
Corporate & foundation relations
Planned giving
Building case for support
Collateral materials & community outreach/education
Grateful patient engagement
Major & annual gift approaches
We will identify and leverage opportunities for development to have a presence with faculty, to
educate faculty about what philanthropy means to donors and what it can mean for their
programs, to share and celebrate successes and to illustrate what is made possible by
philanthropy. We recognize that the best way development can build a brand with faculty is for
faculty to see the merit in partnering with development officers: as faculty learn of gifts that
made possible programs or research that otherwise would not have been funded, they will be
encouraged to participate in development efforts. In addition to the "Development 101"
presentations to faculty, development officers and faculty should share successes as they occur
and walk faculty through the process of garnering a major gift.
We will increase faculty participation in the Advancement Resources workshop, a training
designed to help equip physicians to talk to patients and patient families about fundraising. The
workshops clarify that the faculty members role is not to ask for money or to do anything
outside of his/her comfort zone, but to listen for cues from patients and connect the grateful
patient with the development officer, whose job is to match the interests of philanthropists with
opportunities to fund research, education, and patient care.
Initiatives include road shows by development officers and select faculty at division and
department meetings. It is helpful for faculty to hear from peers about their fundraising
successes and how they handle conversations around development with grateful patients. For

57
faculty who do not participate in the Advancement Resources training, it is important to share
the overall messaging and videos of Emory donors who gave because they were grateful for the
care they received at Emory.
It is valuable to have faculty exposed to development early in their tenure we will identify
appropriate ways to include development in new faculty orientation and as part of faculty
development.

Action Item: Assess development staffing and strategy.
Better understanding of development staffing needs and optimization of philanthropy efforts

Focus and time of leadership if additional staffing determined appropriate, FTE
~$65,000/FTE for each additional development staff member

Determine if the current paradigm is the best? Are there mechanisms to explore this better?
Assess staffing and reporting structure. Is number of staff appropriate? Is there anything
outside of the box we should be considering?

Initiative 3: Explore opportunities for growth of clinical enterprise and financial stability in the DOM

Action Item: Launch an internal marketing campaign for intellectual property.
Consider a spokesperson and/or navigator for the process of working with the Office of
Technology Transfer to facilitate the capture of intellectual property and turn it into a potential
revenue stream.
Better understanding of how to identify commercial viability, protect intellectual property and
administer the protection process used (e.g., patent, trademark, copyright), market intellectual
property, negotiate license arrangements for intellectual property, etc. and to facilitate the
development of start-up companies based on Emory intellectual property.
To educate researchers and faculty about the intellectual property and technology transfer
process consider highlighting successes at Department faculty meetings and in
newsletters. Continue Todd Sherer presentations at faculty and staff meetings. Identify a
poster child (maybe consider success story versus poster child) to whom faculty can
relate. Determine a way to get buy-in from division directors. Consider inclusion in new faculty
orientation and perhaps add to Faculty Development lecture series (e.g., propose incorporating
OTT and development into curriculum). Consider department beyond faculty consider this
part of the education of med students, residents and fellows. Consider a coach to work with
faculty in Department could be faculty member, administrator, or co-coaches (one
administrator, one faculty member) to assist faculty members in process. Streamline the
paperwork process and decode the technology transport capture form to make it more
palatable.
Administrative Support: Communication Specialist used to provide announcements,
communicate initiatives and provide accomplishments through newsletters and website
updates.

58
APPENDIX 6
Overview of Goals and Initiatives
GOAL: CLINICAL CARE
Define, through inquiry, optimal standards of care and dissemination mechanisms.
Weaknesses/ Opportunities Initiatives Action Items/ Metrics
Incomplete permeation of quality mission
in our culture
1 Incorporate formal and hands on
training of quality concepts into
educational curriculum
Average quality performance by national
standards
1 Incorporate formal and hands on
Lack of standardization of processes,
procedures and procurement
3
Lack of organizational coherence in the
DOM within the healthcare systems
(subspecialties do not have equivalent
representation at all hospitals)
3

Set national standards for quality and
value
1, 2, 3, 4
Develop multidisciplinary, high
performing clinical care models
1, 2, 4 Medical Home
Team Approaches- 2G, 3G, 5G, 6G- Jason
Stein
Become a national leader in developing
fiscally responsible and effective models
for disease prevention, diagnosis and
management.
1, 2, 4 Develop patient and family centered
models of care

Improve Patient Satisfaction scores
Take advantage of diverse patient
population base for clinical research
3
Develop a nationally recognized
Hospitalist System
1, 2, 3, 4

Incorporate formal and hands on
Create a division of Hospital Medicine
Final Initiatives:
1. Develop and implement quality programs in both inpatient and outpatient settings
2. Disseminate innovative discoveries and best practice models throughout the medical community
and society
3. Improve service through operational efficiency and resource optimization
4. Create a sustainable model for inpatient care with mechanisms for subspecialty involvement at
both inpatient and outpatient transitions
Action Committee: Clinical Advisory Team- Jeff Lesesne, Ted Johnson, Jason Stein, Jeff Lennox, Jennifer
Christie, Marjan Khosravanipour, David Guidot, Andy Smith, Nancy Collop, David Neujhar, Katie Sparks,
Linda Delaney, Matt Bednar

59
GOAL: ENHANCE RESEARCH IMPACT
Collaborate to enable discovery, translate knowledge, and advance patient care
Weaknesses/ Opportunities Initiative Action Items/ Metrics
Inadequate research equipment &
infrastructure
2 Audit current system
Inadequate research space
capacity/size and location
2
Lack of coordinated and searchable IT
databases
4
Lack of internal research support and
bridge funding
2
Inadequate clinical research
administrative infrastructure and lack
of clarity of PI responsibilities
3, 4 Audit current system
Lack of systematic mechanisms for
recruiting patients into clinical trials
1
Take advantage of diverse patient
population base for clinical research
1, 2, 4
Develop our regenerative medicine,
predictive health, metabolism,
translational research, comparative
effectiveness and immunology
programs
1, 2
Take advantage of research
opportunities at Grady, especially in
the areas of hypertension, heart
failure, and health care disparities
1, 2, 4
Expand research partnership with the
VA and CHOA
1, 2, 3, 4
Few K Awardees and little
infrastructure to support new awards
and /or transition from Ks to Rs
1, 2 Focus group with current awardees
Approach the school about bonus
mechanisms to resolve salary shortfalls
Develop interdisciplinary research 1, 2, 3, 4

Develop internal visiting professorship

Final Initiatives:
1. Support innovation, integration and translation of basic discoveries into clinical care and health care
delivery
2. Enable future discovery by enriching the scientific and administrative platforms for basic and clinical
research
3. Streamline research administrative procedures
4. Advocate and facilitate the adoption of an effective, user friendly, and integrated IT infrastructure
Action Committee: Research Advisory Team- R. Wayne Alexander, Sam Lim, Frank Anania, Greg
Martin, Saundra Berry, Mark Mulligan, Katharina Echt , Roberto Pacifici, Jennifer Gooch, Jeff Sands,
Kathy K. Griendling, Leslee Shaw, Michael Hart, Jason Stein, Elizabeth Kimberl, Peter Thule

60
GOAL: TRAINING AND EDUCATION
Collaborate to transform medical education and lead the efforts to redefine residency training.
Inconsistency in training
experience at our 5 different
training sites
1
Sub-optimal performance in
timely evaluation and
feedback
2
Offer new faculty development
initiatives
3
Expand NIH funded training
programs
1
Take a leadership role in
redefining and developing
solutions to the changing face
of the Internal Medicine
Residency training
1

Final Initiatives:
1. Develop and implement creative approaches and consistent processes for medical education
2. Streamline educational administrative procedures
3. Provide development opportunities for educational skill building
4. Develop training programs to improve patient-centered professionalism in all trainees
Action Team: Education Executive Committee

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GOAL: PEOPLE
Cultivate a collaborative environment of excellence that embraces diversity and attracts, retains, and
develops engaged faculty, staff, and trainees
Limited opportunity for
clinical research
3, 2 Increase FAME grants
Limited opportunities for
regional and national service
outreach efforts
5, 2
Limited promotion
opportunities for Clinician
Educators
1
Lack of targeted leadership
training opportunities
3
Recruit new investigators to
maintain strong research
program
1 Increase K- Award success rate
Institute succession planning
for senior clinicians
3
Provide development
opportunities for mid-career
faculty and staff
3
Recruit outstanding trainees
and administrative staff
1

Final Initiatives:
1. Optimize recruitment, retention and promotion strategies for faculty, staff, and trainees across
divisions and locations
2. Promote sense of community with shared values and goals, aligned with our tripartite mission
3. Promote career growth and development among faculty, staff, and trainees
4. Support and increase faculty, staff, and trainee involvement in local, national, and
international outreach and service efforts (**Also, present in Finance, Infrastructure and
Partnership section)
5. Continue to realign compensation to encompass all three missions of the department
Action Committee: Faculty Development Committee

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GOAL: FINANCE, INFRASTRUCTURE AND PARTNERSHIPS
Effectively develop and manage financial resources to achieve excellence across all missions
Philanthropic support 2
Ability to develop and capture
intellectual property
2

A funding model that depends
on TEC revenue
2, 3

Promote growth of the clinical
practices in outlying areas by
acquisition or formal
affiliation with existing private
practices
3, 5
Re-examine the utilization of
clinical and clinical research
space to maximize efficiency
and usage
1
Critical lack of IT infrastructure 4
Expand partnerships across
the state of Georgia, as well as
national and international
collaborations
3, 5
Pursue international
partnerships and business
opportunities.
2, 5

Challenge of maintaining
equipoise in administrative
and financial relationships
with Grady
1, 3

Final Initiatives:
1. Optimize administrative structures and processes throughout the DOM
2. Increase philanthropy and alternative funding sources to enable strategic investment
3. Explore opportunities for growth of clinical enterprise and financial stability in the DOM
4. Advocate and facilitate the adoption of an effective, user friendly, and integrated IT infrastructure
5. Support and increase faculty, staff, and trainee involvement in local, national, and international
outreach and service efforts
Action Committee: Finance Advisory Team- Bob Taylor, Kevin Andrews, Paul Hammonds, Steve
Doney, Sandra Talley, Paige Martin, Michael Kilgore, Leah Fernandez, David Propp

63

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