The Ochsner medical institutions were founded on the premise that physicians and institutions could provide the highest quality of patient care, while at the same time pursuing research and continuing to educate future physicians. This tradition was well grounded in the five founding fathers' experiences at Tulane School of Medicine. Over the past 60 years, particularly with the move from the “Splinter Village” to the Foundation Hospital on Jefferson Highway, the Alton Ochsner Medical Foundation has developed into a true academic medical center.
Over the last 4 decades, the Ochsner medical institutions were successful in meeting the goals of these principles. Physicians/faculty were recruited from top medical institutions throughout the United States; the residencies and other postgraduate training programs were competitive and sought after; academic publications, including original research, were published continually. The reputation of the Ochsner medical institutions became very strong not just regionally but throughout the United States and the world.
However, with the uncertain health economics of the new millennium, how can Ochsner medical institutions, as well as other academic medical centers, maintain the focus not only on providing the highest quality healthcare, but also on continuing the pursuit of first class academics? Obviously there are no easy answers. However, at Ochsner we believe that we have developed a plan to allow our institution to be successful. We also believe there are lessons to be learned in our experience that other academic medical centers can use in mapping their own strategies.
Setting the Road Map
In 1999, it was recognized that we needed to have clear definable objectives for our academic enterprise. We needed to know where we are going, what our specific objectives are, and what the milestones are that need to be achieved along the journey. It became evident that it was necessary to establish specific responsibilities with defined accountability.
The physicians at Ochsner recognize that the academic mission is critical to the success of the entire organization. Accordingly, many of the physicians would not be here at Ochsner were it not for the academic programs. In fact, there are many in this organization who believe that the Ochsner structure may allow better teaching for future physicians than university-based teaching hospitals because it provides an environment similar to one in which they will eventually practice. Ochsner's status as an academic medical center contributes greatly to its image in the community and its ability to attract charitable donations. However, just as in many university settings, physicians struggle to dedicate adequate time to teaching and research as a result of a financial need to maximize clinical time and productivity.
The objective of the academic enterprise at Ochsner is to support our mission to deliver innovative, superlative, effective healthcare to benefit the community. This can be accomplished only by providing an intellectually challenging and professionally satisfying environment that enables Ochsner to attract and to retain a cadre of outstanding physicians, scientists, educators, residents, students, and other healthcare professionals. By assuring objectively measurable, continually improving healthcare, teaching, and research methods, one realizes enhanced patient outcomes and satisfaction.
To establish our academic vision, we have developed the following academic goals:
To foster clinical excellence and patient satisfaction
To support innovative patient care, education, and research
To increase the quality of education and research at Ochsner
To conduct high quality education and research programs in a fiscally responsible manner
To continue to monitor the financial impact of the academic programs on the institution
To establish and maintain a system of objective performance measurements for the education and research programs by which improvements in patient care, education, and research can be continually evaluated
To represent an acceptable financial investment relative to the benefits that accrue to Ochsner and the community, recognizing that investments in academic excellence do not always generate short-term return
To support and complement Ochsner's development of an integrated delivery system to improve the health of the people in its region
To foster accountability for academic performance at the department, division, and institution levels
To enable Ochsner physicians to attract referrals as a result of the quality of patient care, reputation for academic excellence and clinical expertise, association with academic physicians, and strong alumni relations
To demonstrate the benefits of patient care provided in an academic setting
To foster a disciplinary approach to patient care
Specific Goals
The goals are integral in establishing our road map. The following section lists specific institutional goals.
Education
To contribute to society and the advancement of the medical profession by providing educational programs that meet the community's need for medical expertise
To keep abreast of new technology and to contribute to educational advances
To provide education to enable physicians, medical students, residents, and other trainees to apply the technologies that are or soon will be widely practiced in their specialties
To maintain accreditations by operating within the Accreditation Council for Graduate Medical Education (ACGME), the Accreditation Council for Continuing Medical Education (ACCME), and Allied Health guidelines
To enhance the quality of patient care, education, and research and, therefore, Ochsner's competitive position in each of these areas
To provide patients with continuous physician coverage
To enhance patient access to physicians by extending physician outreach to underserved areas
To demonstrate the value of completing a residency in Ochsner's environment of efficient focused patient care
To support Ochsner's research programs
Research
To enhance the quality of patient care, education, and research and, hence, Ochsner's competitive position in each of these areas by providing new therapeutics, diagnostic insights, and consultative contacts to our patients
To contribute to society and the overall advancement of the medical profession by developing new treatments, diagnostic tests, drugs, and devices for enhanced patient care
To communicate findings and advancements to the community
To keep abreast of new technology and research activity
To contribute to advances in research methods
To conduct and support research in an acceptable financial investment relative to benefit
To facilitate interdepartmental research activities, acquisition of research funds, and research project administration
To support Ochsner's education programs in general and to foster their ability to encourage and provide mechanisms for Ochsner physicians and other medical professionals to be involved in research
To attract research fellows to the education programs
To maintain accreditations
Performance Measures
Specific performance measurements are necessary to monitor achievements, recognize the attainment of specific milestones, and ensure accountability. We have agreed on measurements for both our education and research programs.
Education
To measure the quality of our education program as indicated by the applicant pool. Specific measures will include residency positions filled through the match as a percentage of approved positions (this is then benchmarked to the specialty nationwide), the level on the match list at which the program fills, resident/trainee retention statistics, and applicants per slot compared with other programs locally and nationwide.
To determine education program quality as indicated by various academic factors. Specific measures include the accreditation status of the programs, resident/trainee evaluations of the program and teaching quality, resident and faculty participation in peer reviewed journals and national scientific meetings, and the number of extramural professional awards given to program faculty.
To determine education program quality as indicated by the success of graduates. Specific measurements include board examination results, patient feedback regarding interactions with residents, and post-training success, i.e. employment rate.
To measure education program financial performance. Specific measures include contribution to cost effectiveness and care delivery, financial performance measured against budgets, total program expenses per resident, the need for resident rotation beyond local academic affiliations and partnerships, and the number of full-time equivalents beyond the Medicare cap.
Other education program contributions to Ochsner's mission. These specific measures are interdependency programs, resident/fellow/trainee contribution to service delivery, regional and national workforce trends, and program congruence with institutional strategic initiatives and the extent to which the program is essential to the support of clinical programs.
Research
Research program quality. Measures include the number of publications in peer reviewed journals, the number of research proposals funded and the amount of funding, the number of extramural professional awards given to researchers, presentations to top scientific associations, innovation in research initiatives, number of chapter or book publications, study section participation, and percentage of faculty participating in editorial roles or peer reviews.
Financial performance. Measures include extramural funding as a percentage of total cost, external funding trends within areas of research, availability of external funding for area of research, and indirect cost recovery rate.
Research contributions to the Ochsner mission. Specific measures are congruence with institutional strategic initiatives and with national and regional vision for future growth areas in research and research priorities, the percentage of faculty participating in training programs, and the number of proposals submitted for external funding.
Conclusion
Using specific tools to track the educational program and research performances, Ochsner will be able to monitor and evaluate on an annual basis the performance of specific programs. Academic productivity and efficiency will be enhanced significantly through this formal approach to the management of Ochsner academics. Just as in any other business line in an institution, setting strategic objectives and goals, establishing and utilizing measures against these goals and objectives, and leadership accepting their roles of responsibility and accountability are extremely vital to success
William W. Pinsky, MD
- Ochsner Clinic and Alton Ochsner Medical Foundation
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