Printer Friendly Version

Jeffrey Miller, Senior Executive Associate Dean and Chief Operating Officer

Before I go through things like money and food, I want to pause and tell you that the numbers you've just heard are really phenomenal. There's not a medical school in the country that we've found that has grown its research space, proportionately, as fast as we have, or its education space for that matter. That doesn't mean that other schools aren't growing and building buildings bigger than ours. But an 88 percent increase in research space and 67 percent increase in education space, and the growth in the faculty, is really phenomenal. We're pleased that we were able to achieve it, and we're going to have to run faster the next five years to keep that pace up.

I'm going to talk about staff, IT, money, food, organizational changes that have happened in the last five years to give you another slice on the pace of change, affiliate relations, and our strategic plan.

We now have over 1,300 full-time staff members and research associates, a 37 percent increase since 2000. So we haven't just added faculty and space, we're growing the staff apace, as well. We're trying to keep everything in balance so everyone can get his or her job done. We have in partnership with NU Human Resources managed to significantly reduce the number of open positions at the medical school. Five years ago we had over 200 positions open. It's hard to do your work when there are a lot of empty desks and you're spending a lot of time recruiting. We still spend a lot of time recruiting, but we've cut in half the number of open positions by being a lot smarter about how we recruit. That's helped us achieve some of the success we've had.

I want to make a comment about employee commitment—not that I can tell you what it is or how to measure it. But it's the topic of an important discussion we've just started to have. There are people who believe you can measure employee commitment. The discussion used to be about employee motivation. We've gone beyond that and decided that commitment is what we want to measure, that there are tools we can measure it with, and that you can improve employee commitment by finding out what's important to employees and reacting to that. The discussion we've started involves more than the medical school and more than the University. It involves a couple of our key partners because many of you are in the situation of working side by side with employees of multiple organizations. We're beginning to understand the level of satisfaction, dissatisfaction, and commitment and what we can do about it. That's not to say that we have a problem. Sometimes we like to be ahead of the curve.

I don't have a very coherent message to deliver, but I thought that IT is so important that it's worth reflecting on. At the medical school, a very small subset of the school—the dean's administration, about 200 staff and faculty members—has deployed its own e-mail server because we've concluded that you can't assume e-mail will take care of itself. It's the way we communicate now. We need it backed up. We need to recognize that it's the official record of the enterprise. In the future we'll likely start treating e-mail campus-wide, school-wide, and University-wide the way it's treated in this small subset. I think it's coming and a recognition of how the world has changed.

Directory services
We've gotten better at directory services. It's easier to find people whether they're a member of the Northwestern Medical Faculty Foundation, Northwestern Memorial Hospital, or the north campus of the University. Again, we're running experiments with a subset of the population that we serve. This is critically important. There is no single phone book where you can find everybody you need. And I'm not going to try to create a phone book. I'm going to try to create an electronic directory so it doesn't matter if you know that Karen Turner is an NMFF employee and not a medical school employee. As long as you know her name, you can find her and get her e-mail address.

Financial systems
The University will spend in excess of $30 million in the next five years replacing a variety of administrative systems, most importantly, financial systems. Under the financial arrangement we have with the University, if they spend $30 million, a significant fraction will come from us. We have a vital stake in this not only because these systems serve us on the University side—processing grants, spending money, the things you need to do your job—but also because we have a huge financial stake in it. We're in a planning phase with these systems.

Identity management
We would like all staff and faculty members of the medical school to be able to access whatever systems they need to access—hospital, faculty foundation, library systems on this campus and on the north campus, HRIS—with one secure means of identifying themselves so they only need to learn one password instead of six or seven. That's easier said than done.

Clinical research data repository
This is more in the future. We have a challenge of translating research into treatment of patients, prevention of disease, and care. To do that, we hope to have a more robust IT environment for doing clinical research, and part of that relates to a clinical research data repository. This will be a joint responsibility of the school and faculty practice plan and the appropriate hospitals, but it'll be a major undertaking.

Delivering the curriculum
If you look around the country, Northwestern has had a well-deserved reputation for being a leader in education, though we find that other schools are doing more with IT in delivering the curriculum than we are. We envision spending some money and getting smart about how we teach medical students and residents and maybe even faculty physicians in delivering a curriculum electronically, taking advantage of what IT can offer.

Simulation
The same is true of simulation. If you're a fighter pilot, you have to crash your simulator several times in order to fly a real plane. There's a real set of skills to be learned. In fact I'm told that for fighter pilots who survive the first 10 missions, their likelihood of surviving the war goes up exponentially. So why not have your first 10 failures be on a simulator, where the only consequences are embarrassment and learning, as opposed to not being able to fly the next mission. I think the same is true of the complicated things that doctors do. It would be nice to practice on dummies that will "expire" instead of real patients so you learn what the right dosage is and what not to do. We have some nice simulation activities going on already, but they're pockets, they're not coordinated across the enterprise. It's important to move in that direction.

Voice over internet
Believe it or not, we're not paying long-distance charges anymore for calls in the United States. There's an ongoing discussion on the savings benefits of voice over internet and how to deploy it so the computer and phone are operating more seamlessly.

Electronic medical records
This is important not only to the clinical enterprise but also to the educational enterprise. When physicians are practicing in a world of electronic information, we need to teach students how that world works. We have a robust electronic medical records system on this campus, but we haven't quite figured out how to best deploy it for teaching.

This is really an incomplete agenda. We run an IT shop that mostly does administrative applications for the medical school. We're going to have to think more broadly about our IT function here in an age of the delivery of education through IT.

I said we'd talk about money. The medical school, as you all know, changed its financial relationship with the University five years ago. That has been a very successful change for us. We would not have seen the kind of growth numbers in space and recruitment that you've just heard if we hadn't made that change. It enabled us to change the path of our growth and to move up in the rankings. So far, so good. This slide shows the growth in total revenues, including the faculty practice plan, whose revenues don't run through the University. [2000: $548 million; 2004: $852 million] If you just look at the NU piece of our revenues, they've more than doubled in this five-year period. That's a result in part in the change of our financial model. Inside the medical school, we've adopted the same philosophy. To the extent that departments earn tuition or indirects on research, a substantial portion of that is returned to the departments, enabling them to plan for growth, such as more hiring and start-up packages—the things they need to do to grow the enterprise. We've also tried to introduce a level of transparency and accountability. We publish information on productivity for the whole enterprise. People pay attention to that. What gets measured gets managed, as they say in business school, and there's an element of truth to that. Finally, it allows us to provide incentives for the kinds of behavior that's necessary to grow the enterprise in the way we want to grow it.

The revenue picture has been good. I'm ever mindful of the threats out there. I'm as aware as you all are of the financial squeezing on the clinical side of the enterprise. We are fortunate to have a very successful faculty practice plan and successful affiliated hospitals. NIH funding has gone flat. We don't know for how long. We'll continue to try to hire people who are capable of being funded even in this environment. So far we have. Our research growth has been double-digit for the last five years. The last year and a half or so of that period included a time when the NIH budget was not growing. We tend to be conservative in our financial model so that we can withstand a downturn and still grow and make progress on our plans.

I like this graph a lot. It shows that the school's endowment has grown from $685 million in 2000 to more than $1 billion in 2005. I don't have benchmark data yet for other schools, but I would venture to guess we're in the top 20. Topping $1 billion in endowments is a nice landmark.

I said I'd talk about food. In January we expect to have the food court in operation here [in the Lurie Research Center]. We're thinking the hours will be 6:30 a.m. to 7 p.m., but that's flexible in response to demand. We want to serve the needs of the people in the building and on campus and have this be a convenient gathering place in the middle of campus. We have two food concepts coming in to start out. One is Jazzman's Café, serving coffee, baked goods, tea, salads. The other is Pandini's: pasta, pizza, sandwiches. Depending on demand, in the evening we're thinking of noodle dishes and other items. I'll also tell you something that shocked my colleagues in the dean's office: I had designed this to make no profit. Why would I not want to make money on food service? Because whatever complaints you have about food service, I don't want you to think that it's because we're skimming money off the operation. We've set the price point to cover the rent, equipment, and food, but we're not looking to make money on it. If you don't like it, we're happy to change the menu and price points. I don't want to lose money on it and subsidize it, but it's not a revenue source. We've made a conscious decision that the best thing we could do was offer the best priced service we can and see if it becomes a focal point on campus. I'm mindful of competing with food trucks.

This chart shows how many organizational changes have been made since 2000. At the NU level there's a new vice president for development and for research. At the medical school, there's a new associate dean for development and we've created a new position: executive associate dean for clinical and translational research. We've added the position of associate dean for minority and cultural affairs. We have a senior associate dean for graduate medical education who has made huge progress in making ours an extraordinarily well-run program. We have an acting chair of microbiology—immunology; new chairs of anesthesiology, dermatology, family medicine, medicine, obstetrics and gynecology, physical therapy and human movement sciences, and surgery; a new department and chair in emergency medicine; a new center and director in genetic medicine; a new head of the General Clinical Research Center; a new institute and leader in health care studies; and a newly renamed and new leader at Children's Memorial Research Center.

That's a lot of change. It's not unexpected. Some of it was planned, but most of it was people going on to bigger opportunities. For us it's an opportunity to strengthen the organization by bringing in people who help us move faster and smarter, become deeper in research, move us on the path we want to move on.

Now I'd like to forecast the change that will happen in the next five years. At the top of the chart, the president has not announced his intention to leave, although I got a call from my counterpart at the University of Pennsylvania this afternoon, who asked where she should send resumes for nominees for the presidency of the Northwestern. I asked, "Northwestern Hospital or Northwestern University?" and she said the University. I told her that to my knowledge neither of those positions was open. However, I think you can predict that in the next five years there will be a vacancy at the top of the University. The provost has said he will leave within a reasonable time frame of the president's leaving. I doubt that the dean of the medical school will be in his post in five years. I'd like to think he'd be in it forever, but he's in a position to retire if he so desires. I think we can expect in the next five years that that will happen.

We're recruiting for a new chair of microbiology—immunology. The chair of the Department of Pathology after years of distinguished service has expressed to us his interest in having us form a search committee to find a new chair. We're in the late stages of recruiting a new leader for physical therapy. We have an acting chair in psychiatry and will launch a search there soon. We are in the late stages of a search for a Feinberg Cardiovascular Research Institute leader. We will create a stem cell research center to be headed by Dr. Jack Kessler. Dr. Kessler's successful grant application for this center received the highest score in the country. We will also create a center, institute, or program for clinical and translational research to serve as a home base for our efforts in this area.

A medical school can't succeed with out a faculty practice plan and affiliated hospitals that share its vision and contribute to the goals of the collective enterprise. We have the best relations we've had in my 13 years here among the medical school, University, faculty practice plan, and Northwestern Memorial Hospital. It's a climate that now lets us work together to figure out how to do better. It's enormously exciting and invigorating. We've seen progress on several fronts—clinical, research, and educational—and will continue to see progress. This academic medical center is, I would say, among the best positioned in the country. As long as we keep working together and supporting each other, we'll be hard to stop. As I talk to my colleagues around the country, they feel that their universities don't understand or appreciate them. Here we have a university that is as supportive of the medical school as I think one could imagine. And we have a president who is our chief fund-raiser.

One of the other fronts that's exciting is our relationships with our hospitals. Again, we have the best relations we've ever had and a shared vision with Northwestern Memorial Hospital. That's extraordinarily powerful. We need to work at it every day to make sure minor issues don't become major issues. It's a lot like a marriage in that regard. The results are palpable. For the second time in the history of the medical school we held a joint University-NMH board meeting.

At Children's Memorial Hospital we've enjoyed a long affiliation and an excellent relationship. Children's is agonizing over where to relocate their hospital and research enterprise. Children's assessment is that there would be a $100 million incremental additional price tag for locating to the Chicago campus compared with other options. It's the nature of this campus and how vertical the buildings have to be [because of the lack of real estate]. There's no getting around issues such as parking and traffic, as well. I don't know when they'll decide.

With Evanston Northwestern Healthcare, again the relationship is better than it has ever been. They provide some support to the medical school and University to support the research mission. We're in negotiations to increase that support so we can move further faster.

In terms of the Rehabilitation Institute of Chicago, it's delightful to bask in the glow of the number one rehabilitation hospital in the nation. What RIC does it does very well. Their connections to our research enterprise include...amazing devices that can help people who have lost limbs hold glasses without crushing them. And at the nano-level, they've replaced nerves that have been damaged and figured out how the signals get sent so artificial limbs move like real limbs. Their work is awe-inspiring. If you have a chance, attend one of their presentations on this. You'll be blown away by what they do.

Our relationship with the VA is still important, but less so than it was five years ago. It's a credit to the leadership of this organization that we can absorb the VA's departure from our campus and still have better residency programs overall. Some residents now travel across town to the VA's West Side hospital for some of their training. We've made other arrangements as needed for training. The departure of the VA is unfortunate. It was the oldest VA-medical school relationship in the country. But the VA had to decide which parcel of land was worth more: the one here or on the West Side, and it was a no-brainer. The good news is that the land was acquired by the academic medical center: NMH and RIC.

We take planning seriously and the progress report you've heard today would not have been possible had we not developed a strategic plan defining where we were trying to go and the priorities we wanted to spend our money on.

We aim to begin construction in the next five years of a 15-story research tower adjacent to the Lurie Research Center. That will probably take three years to build at a cost of about $150 million. If we don't start building it in the next three years, we'll run out of space, considering the numbers of researchers we plan to bring here and the rate at which we're hiring. We need to keep growing to move up the ranks.

The strategic plan includes hiring more than 100 new tenure-track faculty members, mostly in research. We'll hire new leadership as well. Again, this is an opportunity, but we need to make sure these new leaders are sympathetic to the mission of the medical school and to our vision. We have an opportunity to create a shared vision across the academic medical center—with NMFF, NMH, and the medical school—so we're all trying to accomplish the same thing. We had in the last six months some discussions about the metrics by which we will jointly measure the success of our efforts. We'll collectively look at what we're trying to accomplish and measure the ways that we all have to contribute to be successful. That's very powerful. If we pull it off, we'll go a long way toward reaching our vision. Also, we have to be more nimble. We have to be more responsive, change the things we need to change, grab opportunities, and say no sometimes when an opportunity that arises is not geared toward our vision.

Let me wrap it up. I have three points to make:

There are external threats. We have private health insurance programs that are collapsing and companies like United Airlines walking away from pension and employee health obligations. You have United Auto Workers opening up their contracts to health care givebacks. We have companies that have decided to no longer offer health care benefits. That's all worrisome. The cost of health care in America is our revenue. When employers cut back on health care, that hurts us. On the public side, you have Medicaid and Medicare programs that are simply not sustainable as they're designed now.

We have very generous donors. I don't know what the threats are there, but I can tell you that the competition is fierce. Every academic medical center, museum, and university is in a fund-raising campaign or planning one. We're all competing for the same donors. We have to have compelling stories to tell. I've read about donor fatigue, but I think that's more on the disaster-relief side than among donors who are willing to support basic and translational research. We have encountered donors who want to have an impact in a way that causes us to say, 'Gosh, we're not sure you can do this.' An example is a donor who wants to fund an endowed chair and wants to tell us who the chair-holder should be. We don't work that way. That's a decision the University makes. On the research funding side, our major source of funding, the NIH, can't sustain the kind of growth that we've seen in the last five years and has already flattened out. Some outstanding proposals aren't getting funded. That's unnerving when you've just constructed large amounts of new research space.

We've made incredible progress. I can't think of any other way to say it. What has happened here in the last five years is extraordinary. It's a credit to the leadership and all the hard work you've done. It's been a good run.

I think we're very well positioned for future success.

Finally, there are keys to success:

Leadership
I think about leadership day in and day out. Leadership doesn't just mean presidents and deans. Every single person has a chance to lead, change the organization, and have an impact, whatever your role is. Leadership is a broad concept, and we need to celebrate some of the leadership throughout the school.

Alignment
We need to make sure we're all trying to get to the same place. We can't waste our energy fighting each other. If we collectively figure out where we're going and how to get there and what roles we need to play to make that happen, we'll be unstoppable.

Social contract
We need to pay attention to this. Academic medical centers have taken a lot of resources from society. We've made money and said that it's justified: we've done research, created new knowledge, trained the next cohort of scientists and physicians, cared for a disproportionate measure of the indigent and needy in society. That's all true. But we need to make it even more true going forward. We need to tell the decision makers who cut the Medicare program that they can't afford to cut it in a way that precludes academic medical centers from doing what they do best. Academic medical centers are places where medical miracles do happen, where you can rest assured that the best evidence available to apply to care is being applied to patient care and where the next batch of best evidence is being developed. That social contract is very important. If we ever lose the confidence of the rank-and-file citizens that we're worth investing in, we're in serious trouble.

Strategic plan
We need to keep it current and execute it. Many strategic plans sit on the shelf collecting dust. We can't let that happen to ours.

Culture
Culture at academic medical centers need to change in a couple ways. There's the attitude that "these are the rules, and I have to comply with them, but I don't really want to." The regulations are there for a purpose—to protect patients, research subjects, and the integrity of science. We need to embrace them. We also need a culture that's collaborative and cooperative. That's not a description of every member of our faculty or staff. We need to reward behavior that contributes to the good of the enterprise.