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April 18, 2005

Medical School Governance Updated

The School of Medicine is undertaking a new process of governance that’s updated, inclusive, and conforms to today’s national standards.

Recommendations were suggested by a faculty panel looking at modernizing the school’s governance and were adopted by the Health Center’s Board of Directors March 1. The University’s Board of Trustees approved aspects of the plan April 12.

The new process is designed to enhance decision-making and be more inclusive, involving various faculty committees in the development of policies and plans at an early stage. The goal is to achieve greater integration of education, research, and clinical activity at the medical school, activities that traditionally have operated in parallel. It also emulates the structure of the Health Center’s Board of Directors, where work is delegated to committees and their suggestions – after investigation, consultation, and deliberation – are viewed as effective recommendations.

“We entered into this with the goal of getting the faculty significantly involved in the front-end of decision-making,” said Mary Casey Jacob, professor of psychiatry and obstetrics and gynecology, and chair of the Guidelines Revision Committee, the faculty committee working to devise the new process. “Formerly, the role of elected faculty councils was seen as reactive rather than proactive. We’ve designed a structure that moves from something oppositional to something collaborative and collegial.

“It’s going to require more time on the part of the faculty to participate,” she added. “If you’re going to do real work, it requires more time, but the faculty involved will have policy development input and prerogative.”

The plan calls for the creation of six new faculty committees. Five will pertain to policy and planning, and four will address traditional medical school domains: education, research, community outreach, and clinical affairs.

The work of those committees will be reviewed by the Dean’s Council, a smaller group charged with ensuring that integration takes place. This committee – the fifth – will specifically look at how actions in one area might affect actions in another area.

The committee will investigate, for instance, how a change in clinical operations might affect the school or curriculum, and communicate that information to the dean, other relevant committees, and the faculty.

The sixth committee is an oversight group consisting of elected faculty only.

The oversight group has multiple functions, but its principal task is to make sure the new governance process works. The group will ensure that regular reviews of departments and centers take place; it will control the faculty forums, meetings called by the faculty to gain input about issues and build consensus; and most importantly, it will offer recommendations on amendments and by-law changes, and oversee the process of making those changes.

“The governance structure as written specifically tries to ensure a tremendous amount of communication takes place,” said Dr. Scott Wetstone, assistant professor of community medicine and director of health affairs policy planning. Wetstone was the administration’s liaison to the Guidelines Revision Committee.

“Communication is an absolute requirement in the new governing process,” he said. “The level of openness in governance is formalized and considered important. The design of the plan speaks to transparency in many places: meeting minutes will be published promptly; and faculty forums can be held as frequently as needed.”

The trend in governance of medical schools nationally is towards increasing faculty participation. That trend was already under way at the Health Center, where Dr. Jon Goldberg, professor of prosthodontics, is a member of the Board of Directors. Faculty members hold four of nine seats on the Academic Affairs Subcommittee and five of 12 seats on the Clinical Affairs and Peer Review subcommittees.

Faculty also play key roles in policy- and decision-making by the Clinical Operations Group. There, Wetstone said, concerned and interested faculty stepped beyond their role providing patient treatment and investigated how the clinics operated.

“The members of the Clinical Operations Group invested a tremendous amount of time in learning about clinical operations,” he said. “We had a series of individuals who were interested in improving the management of the practice, and their efforts paid off. They have been successful.”

The process of revising the governance structure offers insight into how the new structure will work. Speed and flexibility are key. In the wake of a visit by the Liaison Committee on Medical Accreditation in 2003, the Guidelines Revision Committee was established to update the school’s governance process. Two years later, its work is done and the faculty committees are scheduled to be elected in the fall.

“The committee set land-speed records in getting from the start to the finish in such a substantial revision,” said Wetstone. “The process included open communication with the faculty, tons of meetings with departments and department heads, council meetings, and a focused consensus-building process.

The approval process began with the dean, and approval was then obtained from the Dean’s Advisory Committee (unanimous); the School of Medicine Council (77 percent in favor); voting faculty (84 percent in favor); and the Board of Directors (unanimous).

Both Casey Jacob, chair of the Guidelines Revision Committee, and Wetstone say the new method of governance will provide some challenges, such as what to do about the time required for committee members to engage in policy discussions that will take them away from their primary responsibilities, and how to promote rapid decision-making when a slow consensus-building process isn’t feasible.

“Academic speed is slower than business speed,” Wetstone said. “If the committee operates too slowly, it might not be productive.

“But the structure allows you to get a much wider range of opinion from some very smart people looking at a problem in a different way and building consensus,” he said. “There are a variety of ways this can enhance the decision-making process.”

“The configuration allows us to amend it as we learn what’s effective and what’s not,” Casey Jacob said. “The key thing is that we’ve made the process more collaborative and gotten the faculty involved.”