Joanne's Journal - Thursday, December 7, 2017
As I described a few weeks ago, the Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock’s academic medical center (AMC) have a long history of supporting each other in meeting the needs of this community. While we may have had differences in opinions and at times lively debates over the years, our shared missions of education and research organized to advance medical knowledge and clinical service are the glue that keep us together.
The separate governance structure of each of our institutions requires that we work together to advance our shared missions. As part of Dartmouth College, the Geisel School of Medicine reports up to Dartmouth Board of Trustees and, similarly, Dartmouth-Hitchcock (D-H) reports up to its own Board of Trustees. This organization structure is not unique. Close to half of the traditional AMCs in the U.S. are in organizational structures where the medical school and the hospital are “owned and operated” by different entities. Examples of other AMCs in this category are Mass General, Brigham and Women’s, Cleveland Clinic, University of Vermont, Maine Medical Center, Vanderbilt University Medical Center and Yale New Haven Health System, to name a few.
However, this type of organizational structure does not stop these organizations or ours from working to advance on shared missions.
D-H and Geisel went through an extensive funds flow analysis two years ago that sought to understand and then align support for the programs and efforts of our shared academic medical center enterprise. Understanding who is supporting the programs we value and where they are occurring is critically important as we prepare for the challenges facing our organizations. This kind of financial rigor is important. It’s like good housekeeping!
This newfound clarity around who pays for what is the platform upon which we can build programs that we want to grow together. Notably, we still jointly support:
- The Norris Cotton Cancer Center (NCCC)
- The Dartmouth Institute for Health Policy and Clinical Practice (TDI)
- SYNERGY Clinical and Translational Science Institute
- The joint D-H and Geisel Development Office
Beyond direct programmatic support, we continue many academic funds flowing across our institutions, including support for those D-H providers formally participating in the clinical education of medical students and support for collaborative research efforts where associated costs may live with both organizations.
Duane and I have so many overlapping responsibilities that we meet weekly to make sure we are aligned in our approach.
In fact, we have been focused recently on growing our research portfolio. On Thursday, November 30, Duane and I hosted an event convening teams representing Neuroscience (led by Jeff Cohen, MD, chair of Neurology) Cancer (led by Steve Leach, MD, medical director for NCCC), TDI (led by Elliott Fisher, MD, MPH, director of TDI), Cardiovascular (led by Mark Creager, MD, medical director for Heart & Vascular Center) and Children’s Services (led by Keith Loud, MD, MSc, medical director for the Children’s Hospital at Dartmouth-Hitchcock and chair of Pediatrics). These teams participated in brainstorming to identify links within new research opportunities, clinical care, implementation science and education in an integrated way.
We asked these teams to think about program development in each of the areas that is a continuous progression across disciplines and the health system, as well as builds on strong foundations…which is why we selected areas where we already have robust research and clinical programs.
There were lots of wonderful ideas….some examples of the possibilities include:
- The Dartmouth Drug Development Network
- Dartmouth Center for Immuno-oncology
- Dartmouth-Hitchcock Center of Brain Science
The Dartmouth Institute (TDI):
- Patient-centered integrated practice units
- New learning systems
- Heart & Vascular Center for Community Education and Wellness
- Center for Cardiovascular Device Development and Outcomes
- Cardiovascular training and educational opportunities
- Child Health Research Institute
- High-value pediatric health initiative
- Enhance CHaD education and training programs
To see more details of these ideas, click on this link.
These are just a few examples of the great ideas that were shared that day. We asked these groups to think big and they did!
Academic medical centers and their partnering medical schools need to equip physicians to thrive in a health care system focused on population health, assisting providers with the transition from volume- to value-based care.
We also need to train the next generation of leaders in basic discovery science and create opportunities for clinical and translational research projects aimed at accelerating the application of research innovations to treatment options for patients. Basic discovery science forms the underpinnings for most of the recent medical breakthroughs and employs sophisticated genetic and imaging tools that have pushed discovery research into our clinics, hospitals and communities.
This is the power of partnership...
Duane and I welcome your feedback on the relationship between Geisel and D-H. And if you have other ideas related to our research efforts, please send them our way – simply reply to this email, send a note to me at Office.of.the.CEO@hitchcock.org or contact Duane at Gesiel.Dean’s.Office@dartmouth.edu.
Strengthening Our Research Mission
As an academic medical center, Dartmouth-Hitchcock (D-H) has a three-pronged mission—patient care, clinical research and education. Medical Director of Research Operations Richard I. Rothstein, MD, and Vice President for Research Operations Leigh Burgess, MHA, MEd, MA, serve as a bridge to D-H’s partners within the Geisel School of Medicine at Dartmouth, D-H’s Norris Cotton Cancer Center (NCCC), the Dartmouth SYNERGY, The Dartmouth Institute for Health Policy and Clinical Practice (TDI) and Dartmouth’s Thayer School of Engineering. They will be working in close collaboration with Chief Nursing Executive Susan Reeves, EdD, RN, who was recently named the senior leader responsible for our research and education efforts. Reeves, Rothstein and Burgess are now concentrating on helping D-H sharpen its focus on research.
“We have an extraordinary opportunity to build an effective infrastructure for research within D-H and to reinvigorate our academic mission,” says Rothstein, a gastroenterologist who is the Joseph M. Huber Professor and Chair of the Department of Medicine, and the senior associate dean for Clinical Affairs at Geisel. “That’s exciting for me, for our researchers and for our patients, since the research we do should ultimately improve the lives of the people in our region and beyond.”
To help build this infrastructure, Rothstein recruited Burgess, “a sophisticated VP for research operations,” to D-H from the Duke Cancer Institute. She started her new role in January 2017 and is responsible for providing strategic vision, direction and the day-to-day management and oversight of all research operations, including clinical trial activities occurring at D-H. She also provides support and guidance to affiliated Dartmouth institutions that are conducting clinical research.
Dr. Conroy Encourages Collaboration to Build a Healthy Upper Valley
“I want to talk about the role of a health system in creating a healthy community,” Dr. Joanne M. Conroy, CEO and President of Dartmouth-Hitchcock (D-H), said recently at the annual meeting of the Public Health Council of the Upper Valley.
“Social problems in communities can only be resolved by communities working together,” she said. As a health system, D-H “has a role as one of the major employers in the community and one of the major suppliers of health care.”
Describing D-H to the council’s leaders, Conroy said, “There are so many issues in the communities that we need to prioritize on what will have the greatest impact.” Those priorities need to be identified and driven by the community leaders, such as the Public Health Council, she noted. “The question is how do you move it from a conversation to action planning to investments?”
“We don’t want to duplicate efforts of things already working in the community,” she assured the Public Health Council leaders. “It’s figuring out what we want to work on together.”
Conroy said one of the challenges for D-H is creating a health system that looks at keeping people well rather than treating people who are sick. She said the answer is not for D-H to get bigger but to get better.
Working with regional critical access hospitals, some as D-H affiliates, is critical to the organization’s success. “We want to make sure they stay financially viable in their communities. To succeed, D-H needs to embrace five conditions of collective success: have a common agenda, use shared measurement systems, mutually reinforce activities, have continuous communication and support other organizations.”
Among the current organizational challenges for D-H is sustaining a full workforce with a tight labor market, including attracting a younger workforce. Potential solutions include finding affordable housing and reasonable transportation. She also said that health systems need to talk about the design of benefits because high-deductible health plans may have detrimental effects on overall health of individuals and families.
Did You Know? D-H Community Group Practice
We’re starting a new feature in Joanne’s Journal called “Did You Know?” This regular feature will include interesting facts and figures about the Dartmouth-Hitchcock health system. This week, we’re focusing on the D-H Community Group Practice in the southern region. Now that the individual clinics (D-H Manchester, Concord and Nashua, along with satellite practices) are considered one "business unit," we are referring to these sites as a singular Community Group Practice.
Did you know?
- Approximately 118,000 patients are seen in Primary Care and 120,000 patients in Specialty Care each year.
- There are 565,000 patient appointments, 500,000 lab specimens and 100,000 radiology tests per year.
- There are more than 200 physicians and 95 associate providers as part of this practice.
- There is a total net revenue impact of more than $330 million to the system (including lab and patients from southern New Hampshire seen at DHMC).
This feature will appear on a regular basis, and we need your help. If you have any interesting facts and figures from your area, department or site, please send them to D-H.Today@hitchcock.org. For example, do you know how many light bulbs the Engineering staff maintains at DHMC? (The answer is about 40,000 in the buildings and another 450 plus in the parking lots.)
Reminder Facebook Live with Dr. Joanne Conroy – Wed., December 13 at 4 pm
On Wed., December 13 at 4 pm, Dr. Conroy will participate in the second of her Facebook Live series where she will continue to address topics of interest to D-H employees, patients and the community.
And, as a reminder for those who want to tune in, go to the D-H Facebook page at the above date and time. To comment on or share the video, you will need to have a personal Facebook profile, but you can view the D-H Facebook page even if you are not logged in. On that day, if you are logged into your Facebook account and already "like" the D-H page, you will likely see a notification that the session is live. Submit questions in advance to firstname.lastname@example.org.