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UNC School of Medicine Strategic Plan—Phase III: Implementation

Table of ContentsPhase III Membership:...........................................................................................................................................2

Research................................................................................................................................................................6

Strategic Priority 1: Set translational and multidisciplinary team science as a vision for UNC research, and provide tools needed to foster successful teams......................................................................................6

Strategic Priority 2: Stimulate team-based, translational research with targeted investments in key translational research areas..........................................................................................................................15

Strategic Priority 3: Streamline the organization and management of the research infrastructure to ensure it is best positioned to meet the future needs of SOM investigators..................................................36

APPENDIX (Research SP 3)......................................................................................................................54

Education.............................................................................................................................................................55

Strategic Priority 1: Restructure the curriculum to prepare students to be leaders of 21 st century medicine......................................................................................................................................................................55

Strategic Priority 2: Optimize student recruitment and admission practices and programs to provide physicians needed for North Carolina and the nation....................................................................................67

Appendix A (SP 2)....................................................................................................................................75

Appendix B: MED Enrollment Expansion with 50% increase...................................................................77

Strategic Priority 3: Develop and support infrastructure that will ensure our continued ability to train physicians within Chapel Hill and across the state........................................................................................78

Clinical Care.........................................................................................................................................................91

Strategic Priority 1: Establish a UNC HCS-wide quality program, building on existing efforts, to ensure the greatest possible patient safety and highest quality care for all...................................................................91

Strategic Priority 2: Establish a mechanism for innovation and entrepreneurship in clinical care delivery and financing .....................................................................................................................98

Strategic Priority 3: Institute a SOM-HCS informatics strategy to enable highest quality care and innovation ................................................................................................................................110

Faculty Development.........................................................................................................................................126

Strategic Priority 1: Enable data-driven management by defining and systematically tracking performance at both the institutional and individual levels........................................................................126

Appendix 1 (Faculty SP 1):...................................................................................................................136



Appendix 4 (Faculty SP 1)....................................................................................................................138

Strategic Priority 2: Align faculty performance expectations, evaluations and reward systems.................139

Strategic Priority 3: Establish the conditions to help faculty succeed, both generally and for specific sub-groups.........................................................................................................................................................148

Phase III Membership:Research:

Terry Magnuson (Oversight Committee representative) Leeanne Walker (Operations Committee representative) John Buse—Strategic Priority 1 Steward

o David Peden— Professor, Pediatrics, Medicine, Microbiologyo Giselle Corbie-Smith—Associate Professor, Social Medicineo Blossom Damania—Associate Professor, Microbiology and Immunologyo Nancy Thomas—Professor, Dermatologyo Kay Lund—Distinguished Professor, Cell & Molecular Physiology, Nutrition and Pediatricso Angelique Whitehurst—Assistant Professor, Pharmacologyo Evan Dellon—Assistant Professor, Medicineo Steve Soper—Professor, Biomedical Engineering and Chemistryo Bill Snider—Professor, Neurologyo Nancy DeMore—Associate Professor, Surgeryo Beth Mayer-Davis—Professor, Nutritiono Anna Spagnoli—Associate Professor, Pediatrics

Tim Carey—Strategic Priority 2 Stewardo Fulton Crews—Professor, Pharmacologyo Janet Rubin—Professor, Medicineo Wendy Brewster—Associate Professor, Obstetrics and Gynecologyo Caterina Gallippi—Assistant Professor, Biomedical Engineeringo Joe Piven—Distinguished Professor, Psychiatryo Ron Falk—Distinguished Professor, Medicineo Joanne Jordan—Distinguished Professor, Medicineo Bill Powers—Distinguished Professor and Chair, Neurologyo Joe Eron—Professor, Medicineo Karyn Stitzenberg—Assistant Professor, Surgeryo Eliana Perrin—Associate Professor, Pediatricso Chuck Perou—Distinguished Professor, Geneticso Gene Bober—Assistant Dean, Planning Officeo Rose Ann Laureto—Vice President and CIO, UNC Health Care System

Bob Duronio—Strategic Priority 3 Stewardo David Siderovski—Professor, Pharmacologyo John Rawls—Assistant Professor, Cell and Molecular Physiologyo George Retsch-Bogart—Associate Professor, Pediatricso Virginia Miller—Professor, Genetics and Microbiology and Immunologyo Leigh Thorne—Associate Professor, Pathology and Laboratory Medicineo Kim Rathmell—Associate Professor, Medicineo Mike Topal—Professor, Pathology and Laboratory Medicineo Steve Crews—Professor, Biochemistry and Biophysicso Corbin Jones—Professor, Biology

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o Jim Bear—Associate Professor, Cell and Developmental Biologyo Annabelle Stein—TraCSo Pat Brennwald—Professor and Interim Chair, Cell and Developmental Biologyo Joan Taylor—Associate Professor, Pathology and Laboratory Medicine

Education: Warren Newton (Oversight Committee representative) Leeanne Walker (Operations Committee representative) Julie Byerley—Strategic Priority 1 Steward

o Marcia Hobbs—Associate Professor, Medicine and Microbiology and Immunologyo Carol Otey—Professor and Interim Chair, Cell and Molecular Physiologyo Alice Chuang—Associate Professor, Obstetrics and Gynecologyo Trisha White—Family Medicine, CMCo Kurt Gilliland—Assistant Professor, Cell and Developmental Biologyo Deb Bynum—Associate Professor, Medicineo Frank Church—Professor, Pathology and Laboratory Medicineo Nick Shaheen—Associate Professor, Medicineo Anthony Charles—Assistant Professor, Surgeryo Jeff Heck—Family Medicine, MAHECo Erin Malloy—Associate Professor, Psychiatryo Liz Dreesen—Assistant Professor, Surgeryo Larry Marks—Professor and Chair, Radiation Oncology

Tom Bacon—Strategic Priority 2 Stewardo Erin Fraher—Surgery, Family Medicine and Shepso John Perry—Associate Professor, Medicine, AHECo Sue Slatkoff—Associate Professor, Family Medicineo Cedric Bright—Professor, Medicineo William Mills—Assistant Professor, Pediatricso Jack Naftel—Professor, Psychiatryo Jim McDeavitt—Chief Academic Officer, Carolinas HealthCareo Kenya McNeal-Trice—Assistant Professor, Pediatricso Russ Harris—Professor, Medicineo Will Poe—MS 4o Don Pathman—Professor, Family Medicine; Director, Program on Health Professions and

Primary Care, Sheps Center Cam Enarson—Strategic Priority 3 Steward

o Alan Stiles—Distinguished Professor, Pediatricso Robyn Latessa—Family Medicine (MAHEC)o Mark Darrow—Medicine and Family Medicine (SEAHEC)o Ed Kernick—Instructor, Cell and Developmental Biologyo Rachel Hines—MS 4; former Whitehead Medical Society, Co-Presidento Kim Nichols—Assistant Professor, Anesthesiologyo Joe Stavas—Professor, Radiologyo Amy Shaheen—Associate Professor, Medicineo Barbara Welanetz—Associate Director, SOM Planning Officeo Kathleen Rao—Professor, Pediatricso Beat Steiner—Professor, Family Medicine

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Clinical Care: Al Daugird and Brian Goldstein (Oversight Committee representatives) Bruce Wicks (Operations Committee representative) Bob Sandler—Strategic Priority 1 Steward

o Robb Malone—Clinical Associate Professor, Medicineo Spencer Dorn—Assistant Professor, Medicineo Carmen Lewis—Associate Professor, Medicineo Raj Pruthi—Professor, Surgeryo Sam Weir—Associate Professor, Family Medicineo Larry Mandelkehr—Director, HCS Performance Improvemento Ashley Howard—UNC Hospitals, Director of Patient Accesso Tina Willis—Assistant Professor, Pediatrics and Anesthesiologyo Joanna Herath—Division Administrator, GIo Tony Lindsey—Professor, Psychiatry; Executive Associate Dean for Clinical Affairs; Chief

of Staff, UNC Hospitalso Darren DeWalt—Assistant Professor, Medicine

David Rubinow—Strategic Priority 2 Stewardo Seth Glickman—Assistant Professor, Emergency Medicineo Cam Patterson—Distinguished Professor, Medicineo Dave Gerber—Associate Professor, Surgeryo Rich Davis—Associate Professor, Ophthalmologyo Keith Kocis—Professor, Anesthesiology and Pediatricso Brent Lamm—Director, Information Technology, NC TraCS Instituteo Kate Menard—Professor, Obstetrics and Gynecologyo Bryant Murphy—Associate Professor, Anesthesiology o Tammie Stanton—VP of Post Acute Serviceso Carol Lewis—Instructor, Psychiatry

Brent Lamm—Strategic Priority 3 Stewardo Mike Pignone—Associate Professor, Medicineo Tracey Parham—Information Technology Director for ISDo Don Spencer—Professor, Family Medicineo Shelley Earp—Distinguished Professor, Medicineo Sai Balu—Manager, LCCC Bioinformaticso Larry Klein—Professor, Medicine and Radiologyo Matt Ewend—Distinguished Professor and Chair, Neurosurgeryo Carolyn Viall Donohue—Associate VP Nursingo Chuck Esther—Assistant Professor, Pediatricso Tim Carey—Professor, Medicine and Social Medicineo Jim Evans—Professor, Genetics and Medicineo Carol Lewis—Instructor, Psychiatryo Dennis Schmidt—Director, SOM Office of Information Systems; HIPAA Security Officero Stan Ahalt—Director, RENCIo Peter Leese—Performance Improvement and Patient Safety Plan (PIPS)o Ramon Padilla—Deputy CIO, ITS

Faculty Development: Cam Enarson (Oversight Committee representative) Cam Enarson (Operations Committee representative)

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Cam Enarson—Strategic Priority 1 Stewardo Wayne Price—Associate Professor, Pediatricso Hunter Wagstaff—CFO, UNC Physicians & Associateso Jill Cunnup—Division Administrator, Endocrinology and Metabolismo Shannon Carson—Associate Professor, Medicineo Leslie Parise—Professor and Chair, Biochemistry and Biophysicso Matt Mauro—Distinguished Professor and Chair, Radiologyo Bobby Wunnava—Assistant Professor, Anesthesiologyo Nancy Fisher—Professor, Microbiology and Immunologyo Renae Stafford—Assistant Professor, Surgeryo Spencer Smith—Assistant Professor, Cell and Molecular Physiologyo Patsy Oliver—Assistant Dean, Finance and Business Operations

Paul Godley—Strategic Priority 2 Stewardo Magee Leigh—Professor, Pediatricso Peggy McNaull—Assistant Professor, Anesthesiology and Pediatricso Andrew Dudley—Assistant Professor, Cell and Molecular Physiologyo Scott Hultman—Distinguished Professor, Surgeryo Don Budenz—Professor and Chair, Ophthalmologyo Becky White—Assistant Professor, Medicineo Jean Cook—Professor, Biochemistryo Donna Culton—Assistant Professor, Dermatologyo Susan Fiscus—Professor, Microbiology and Immunology

Amelia Drake—Strategic Priority 3 Stewardo Stuart Gold—Professor, Pediatricso Andrea Azcarate-Peril—Assistant Professor, Cell and Molecular Physiologyo Rupa Redding-Lallinger—Associate Professor, Pediatrics o Eric Wallen—Professor, Surgeryo Hy Muss—Professor, Medicineo Ana Felix—Assistant Professor, Neurologyo Benny Joyner—Assistant Professor, Anesthesiology and Pediatricso Harvey Lineberry—Assistant Dean for HRo Steve Tilley—Associate Professor, Medicineo Ann Bailey—Professor, Anesthesiology and Pediatricso Channing Der—Kenan Professor, Pharmacologyo Rita Tamayo—Assistant Professor, Microbiology and Immunology o Jeff Spang—Assistant Professor, Orthopaedics

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Research

Strategic Priority 1: Set translational and multidisciplinary team science as a vision for UNC research, and provide tools needed to foster successful teams

Research Strategic Priority 1 Team Report

Team members and Departments:

John Buse, MD, PhD MedicineGiselle Corbie-Smith, MD, MSc Social Medicine and MedicineBlossom Damania, PhD Microbiology and ImmunologyEvan Dellon, MD, MPH MedicineNancy DeMore, MD Surgery Kay Lund, PhD Cell & Molecular Physiology, Nutrition, and PediatricsBeth Mayer-Davis, PhD Nutrition David Peden, MD Pediatrics, Medicine, MicrobiologyBill Snider, MD NeurologySteve Soper, PhD Biomedical Engineering and ChemistryAnna Spagnoli, MD Pediatrics Nancy Thomas, MD, PhD Dermatology Angelique Whitehurst, PhD Pharmacology

Leeanne Walker, JD; Operations Committee representativeTerry Magnuson, PhD; Oversight Committee leader

“Set translational and multidisciplinary team science as a vision for UNC research, and provide the tools needed to foster successful teams.”

Initiative 1: Establish team and translational science as an institutional priority, and set goals for increasing team and translational science at UNC

Initiative 2: Facilitate the establishment of teams by providing top-down guidance as well as tools to facilitate bottom-up investigator-driven team formation

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Background

As envisioned in the “Strategic Plan for the University of North Carolina School of Medicine”, for UNC “to distinguish ourselves as one of the most successful research institutions in the coming era, we must develop a forward-looking research vision that capitalizes on our particular strengths to succeed in this rapidly evolving research landscape. This means maintaining and improving our research infrastructure, embracing the shift towards team-based basic and translational research and simultaneously continuing to invest in the basic mechanistic research programs upon which these translational efforts depend. This recognizes the need for our faculty to conduct research locally, regionally, nationally and internationally in order to address critical health-related research questions.”

The focus of our workgroup was on SP1: “Set translational and multidisciplinary team science as a vision for UNC research, and provide the tools needed to foster successful teams”. Our group divided into two to more intensively grapple with each of the proposed initiatives:

Initiative 1: Establish team and translational science as an institutional priority, and set goals for increasing team and translational science at UNC

Initiative 2: Facilitate the establishment of teams by providing top-down guidance as well as tools to facilitate bottom-up investigator-driven team formation

As the two initiatives “establish” and “facilitate the establishment” of team science are quite linked, the output of the two groups was remarkably concordant. We thus present our recommendations aggregated for the two initiatives. The key elements identified in the strategic plan for these two initiatives are listed as follows. Words in italics are modifications felt appropriate by the team.

Make an explicit institutional commitment to team and translational science at the senior leadership level that encompasses the full spectrum of basic and clinical research

Facilitate the role of Centers as a key interface between faculty across the translational spectrum (basic, clinical, community, population and policy researchers)

Structure graduate education programs as a focal point for organizing and catalyzing interdisciplinary research teams and training a new generation of team scientists

Identify best practices from those research teams at UNC that have demonstrated the greatest success in translational science

Set institutional goals for team and translational science, including the formation of investigative teams (which include individuals with expertise that spans a broad range of research knowledge and technologies) and acquisition of extramural funding, and monitor progress towards these goals

Emphasize potential for and track record of team building in recruitment and retention of investigators

Incorporate these goals and metrics into annual Chair reviews Institute a regular top-down review of potential interdisciplinary team opportunities overseen

by the Office of Research led by the Vice Dean for Research Hire personnel focused on responding quickly to RFAs for large multidisciplinary grants

built around faculty research interests and strengths. E.g., EPA non-faculty PhDs as critical members of the research team who understand the full spectrum of translational science and can help with proposal preparation and program management once the proposal is funded.

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This would greatly expand the capabilities offered by NC TraCS, which is limited in scope and availability.

Build and expand a series of databases that provide ready access to potential collaborators and resources. E.g., expand the Reach NC website (reachnc.org) and provide resources to ensure continual updates and accuracy

Require all faculty (both researchers and clinicians) to keep SOM-linked web profiles up to date and accurate and use existing online interfaces to facilitate the upkeep (e.g. Ramses, IRB online submission)

Charge the Office of Research to identify needs and develop additional tools and databases to enable team research. E.g., enable access for clinical experts to defined patient populations; create a database of available UNC biostatisticians and bioinformaticians; ensure systems to manage complex datasets generated by interdisciplinary research; catalog other tools for research such as mice portfolios and animal models of disease (via IACUC), antibodies, drugs, reagents and imaging applications.

Plan design elements

Herein multidisciplinary teams refer to two or more investigators from at least two points in the translational spectrum (basic, clinical, community, population and policy). The broader the expertise of the team, the more truly multidisciplinary it is. Multidisciplinary teams could be formed within Divisions, Departments or Schools or institutions, but institutional diversity is strength.

The committee as a whole and both its subgroups whole-heartedly support the idea that creating interdisciplinary teams is essential for UNC’s continued success in federal funding rankings and research training programs. We felt that these efforts were likely to be most competitive nationally when they took advantage of our institutional strength based on close collaboration between the School of Medicine and other schools within UNC-CH, the UNC System and regional partner institutions. We felt that there should be institutional investment across the entire spectrum of translational research, and not just in the T1-T2 “bench to bedside” definition of translational research. Our greatest opportunities will come from clever and strategic multidisciplinary team formation to address areas of research that cannot be easily replicated elsewhere.

To this end, we felt that the most important implementation question for the Strategic Plan vis-à-vis multidisciplinary team formation, development and success is whether such efforts are best accomplished through the Vice Dean for Research’s office or through the Translational and Clinical Science (TraCS) Institute, which by definition has a broader audience on this campus as well as across the state. We felt that transformation of TraCS, if appropriate based on the yet to be released RFA, to an organization fundamentally focused on identifying, nurturing and assisting teams does hold unique promise for effective team building. As the Strategic Planning process and the TraCS CTSA grant are both led by Dr. Runge, he is uniquely positioned to make and operationalize this decision. However, it should be emphasized that such transformation should ensure representation of the role of basic scientists as well as clinical scientists as key and contributing elements of translational research.

The specific recommendations regarding Research Strategic Priority 1 are as follows:

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Proposal 1: Reconfigure TraCS or establish an Office of Translational Research and Team Science within the Office of the Vice Dean for Research tasked with establishing and supporting research teams, facilitating rapid and effective response to RFA’s for large multidisciplinary or multi-PI grants, identifying key initiatives and new research areas for funding along the translational spectrum, and supporting multidisciplinary teams with pre-award and post-award management outside of the traditional Departmental structures. Components might include:

o Associate Executive Dean salary support to lead the officeo Pre-award submission team under supervision of a PhD or MD scientist with

expertise in project management, liaising with funding agencies, grant writing, budget preparation, editorial/graphics support

o Post-award staff skilled in subcontracts with the ability to identify, procure and manage affordable and flexible support (project management, project coordinators, biostatistics, informaticians, programming/database development/management, research assistants)

o Salary support and administrative support for senior investigators who participate in key decision-making committees for funding agencies; e.g., NIH Roadmap, Common Fund Steering Committee, PCORI. This would encourage participation and provide directives and expectations to share information on research trends and upcoming RFA’s with Office staff as well as directing future initiatives that would take advantage of our existing strengths.

o Develop cross-campus Team Science Retreats to encourage and facilitate team formation. Themes and potential participants would be identified by both office staff and investigators. Processes would need to be established to follow-up with participants to track funding applications, funding, publications, job satisfaction, and on-going collaborations. Funding for retreats would be competitive based on a relatively short application. We would propose 5 retreats per year for 5 years (25 total). These would be marketed through the Dean’s Advisory Committee and the Vice Dean for Research’s meetings with Department Chairs and Center Directors.

o Specifically encourage partnerships and facilitate cross-fertilization with regional partners where synergy is obvious and competition modest; e.g., NC State University, historically black universities and colleges, CRO’s, local pharmaceutical and device companies particularly with early stage programs, the NC Biotechnology Center.

o Further develop REACH-NC in such a way that profiles are built organically through RAMASES and PUB-MED independent of data entry by faculty, Departments or Centers.

o Further develop registries for reagents and resources (equipment, databases) on campus as well as encourage sharing of such with others through incentives or institutional barter mart.

o Develop resources required to facilitate team research – staff resources, temporary space, conferencing facilities, and secure/redundant/reliable virtual workspaces for data sharing. Teams will hopefully include many investigators off campus for whom these resources will be essential.

o Recognition that team science is encouraged by the very nature of Centers. However, many faculty as well as existing and potential multidisciplinary research programs are

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not members of current Centers. These investigators may need additional attention from the Office.

Proposal 2: Charge a committee to identify 4-6 multidisciplinary teams on this campus or elsewhere that have been particularly successful in translational research; e.g., Angelman syndrome project, virtual lung, SPORES, contributions of commensal microbiota to disease. The purpose would be to identify a range of best practices in developing multidisciplinary teams vis-à-vis defining the scope of a project/projects, identifying and engaging appropriate collaborators, resource needs (space, IT, pilot funds), funding opportunities, internal and external communications, governance, and demonstrated success in training both scientist and clinician trainees to pursue team, cross-discipline and translational research. The learnings from this exercise should be summarized and shared broadly.

Proposal 3: Develop funding mechanisms to encourage the development and refinement of multidisciplinary teams. It was perceived that by developing proposals that compete for substantial funding opportunities (up to $1 million dollars), teams would form opportunistically, whether they in the end received institutional funding or not. Though the rationale for “matching” funds as for current TraCS proposals is well understood, it was thought that these awards should proceed without required matching with additional review criteria based on need (lack of other plausible support mechanisms), other resources provided in support of the team (in kind or dollar commitments from other sources), sustainability and institutional impact. These awards could comprise the match for TraCS pilot grants that went to multidisciplinary teams. Each proposal should define metrics for evaluation of the team’s progress towards measurable goals. The group perceived a variety of funding vehicles that had the potential to facilitate team development:

o “Transformation grants” for investigative areas in which a major investment would need to be made to take an institutional strength to the next level; e.g., recruitment of a clinical and population scientist to enable a strong basic research group to move forward to clinical trials. Envisioned as 3-5 awards of up to $1 million.

o “Planning grants” for senior investigators to more fully develop evidence of an effective multidisciplinary team and generate preliminary results in preparation for large funding opportunities, as currently funded through TraCS. Envisioned as $500,000/year for 4 years apportioned as up to $100k awards which could be spent over 2 years.

o “Pilot awards” for senior or junior investigators to develop preliminary results in preparation for extramural funding from multidisciplinary teams, as currently funded through TraCS. Envisioned as $5-50k awards totaling $500,000/year for 4 years.

o “Trainee awards” for established investigators from at least two departments to fully or partially fund a graduate student, post-doc or junior faculty member in the pursuit of multidisciplinary translational research. Would be funded from the “Pilot Awards” dollar totals.

o “Senior Investigator Team Science (SITS) Award” is envisioned as a “MacArthur award” for senior faculty to devote time to developing a multidisciplinary team. The critical points are that such an award would have to have sufficient institutional prestige as to encourage successful translational researchers to step out from their usual endeavors with salary support for 3-6 months and resources (e.g., facilitator,

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access to conference facilities, discretionary funds) to develop new ideas and collaborations. Envisioned as 1 award per year of $150k plus administrative support from the Office.

Proposal 4: Encourage the development of training programs for medical students, graduate students, basic and clinical scientists at the postdoctoral level that are interdisciplinary in nature such as the recent Burroughs-Wellcome applications and Howard Hughes Medical Institute Med into Grad program. It is recognized that trainees play a critical role in interdisciplinary team formation as they take mentors out of their comfort zone and provide glue for meaningful collaboration. This could be accomplished through the “trainee award” above, as well as by promoting, requiring or rewarding interdisciplinary involvement for current training awards; e.g., medical student summer research programs, HHMI Med into Grad program, T32, K01, K08, K12, KL2 awards. Consider novel strategies to foster interactions between PhD and MD students and postdoctoral trainees from the earliest stages of their careers.

Proposal 5: Create a climate on campus where multidisciplinary teams can succeed based on policies for faculty evaluation, compensation, retention, recruitment and promotion. Department Chairs should be specifically evaluated on the proportion of their faculty involved in multidisciplinary research teams, funding for their translational projects, publications from their translational projects, and retention/promotion of faculty involved in multidisciplinary projects. Faculty retention and promotion processes should reward active multidisciplinary team participation. Recognition that clinician’s time must be specifically protected to encourage participation in multidisciplinary teams as there are often disincentives based on common evaluation and compensation procedures. New strategies such as support for mini-sabbaticals or bridge funding for faculty to acquire new team-driven skill sets, develop collaborations or transition to new areas of research or from fully clinical to combined clinical and investigative work. These policies to encourage multidisciplinary team participation must be developed collaboratively with UNC-CH and specifically tracked, promoted and enforced throughout the SOM and UNC-CH to be successful.

Timing and Sequencing of Activities

Summer 2012:1. With publication of the CTSA RFA, Dean’s Office to determine whether to reconfigure

TraCS or establish an Office of Translational Research and Team Science within the Office of the Vice Dean for Research. In either case, this SOM initiative should be highlighted in the CTSA renewal application.

2. Empanel committee to identify and profile 4-6 successful multidisciplinary teams across the translational spectrum (T1-T4). The panel should report within 3 months their top-line findings to inform team development on campus.

3. More fully develop RFA’s for funding initiatives to encourage team development as well as proposal evaluation and program evaluation metrics.

4. Work with other Strategic Plan Priority teams (Education SP1, SP2 and SP3 as well as Faculty SP1, SP2 and SP3) to flesh out details regarding training and faculty development components of our recommendations.

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Fall 2012:1. Formalize planning for the administrative structure to facilitate team science initiatives,

develop final budgets, and establish personnel needs and positions for new hires.2. Publish a draft report on methods and metrics for successful multidisciplinary teams in

translational research.3. Publish RFA’s for funding initiatives.4. Draft recommendations for training programs to encourage team science5. Draft recommendations for faculty development to encourage team science in collaboration

with the Provost’s Office

Winter 2013:1. Establish Office of Translational Research and Team Science (within TraCS or in Vice Dean

for Research’s purview). Develop outreach programs with regional partners where synergy in research is obvious. Hold first Team Science Retreat.

2. Develop final report on methods and metrics for successful multidisciplinary team in translational research

3. Review and make funding decision on an initial round of funding initiatives, specifically for the MacArthur-like award and particularly compelling Transformation Grants.

4. Implement recommendations for training programs to encourage team science.5. Implement recommendations for faculty development to encourage team science in School of

Medicine and campus wide.

Spring 2013:1. Fully implement programs of the Office of Translational Research and Team Science2. Fully implement all funding opportunities and evaluation process for this Strategic Priority3. Fully implement recommendations and evaluation process for training programs to

encourage team science4. Fully implement recommendations and evaluation process for faculty development to

encourage team science.

Metrics

The primary metrics to evaluate the success of this Strategic priority will be tracked by the Office and include:

The number of multidisciplinary teams involving faculty of the School of Medicine The number of extramural funding proposals made by these teams

o The number of extramural funding proposals funded and their dollar amounts The number of publications from these teams Awards, national/international recognition for these teams and/or their work

In collaboration with other Strategic Priority teams, metrics will be established with regards to training and faculty development, but should include:

Trainingo Number of multidisciplinary training programs

Grant support

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o Number/type of trainees participating in team/translational projects Publications Updated position and funding Recognition awards Number of faculty involved in mentoring trainees in translational and

multidisciplinary research Faculty development

o Number of faculty involved in multidisciplinary team science Nature and extent of involvement Funding Publication Promotion Retention

o Chairs’ evaluations regarding promoting multidisciplinary team science

Further analysis of the nature of multidisciplinary teams formed through these initiatives should also examine the engagement of SOM faculty with faculty in UNC-CH Schools outside of SOM, UNC System institutions, other academic institutions, non-profit and for-profit entities.

For these purposes, multidisciplinary teams would refer to two or more investigators from at least two points in the translational spectrum (basic, clinical, community, population and policy). The broader the expertise of the team, the more truly multidisciplinary it would be. Multidisciplinary teams could be formed within Divisions, Departments or Schools or institutions, but again diversity in this regard should similarly be viewed favorably.

Resources Required

Proposal 1: The resources required for the Office have not been established as they are entirely dependent on whether it is housed within TraCS or the Office of the Vice Chairman. The costs could be largely subsumed within TraCS if it would be responsive to the RFA.

It is estimated that the budget for the Office would be on the order of $500k to $1 million per year ($2-$4million total).

Proposal 2: Minimal staff support.

Proposal 3: Transformation grants $3-5 million Planning grants $2 million Pilot awards/training awards $2 million Senior Investigator Team Science (SITS) Award $750k

Proposal 4: Though this proposal is less well developed and needs to be integrated with the work on the Education component of the implementation plan, seed funds to catalyze programs such as the recent Burroughs-Wellcome applications and HHMI Med into Grad program are requested, Similar funds could be requested though Proposal 3 grant/awards. These funds would cover tuition, stipends, other costs related to novel training opportunities in preparation for external funding applications.

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2-5 awards at $100k-$200k $500k-$1 million

Proposal 5: Though this proposal is less well developed and needs to be integrated with the work on the Faculty component of the implementation plan, providing incentives to Chairs (in addition to metrics) to develop multidisciplinary teams in the form of mini-sabbaticals or transition funds for faculty to acquire new skills or transition from fully clinical to clinical/investigative careers are requested. Similar funds could be requested through Proposal 3 grants/awards. Though we envisioned these funds would be used to liberate time from current duties to transition, it is imagined that in some cases, supplemental payments for additional effort or incentive payments might be required to provide inducements for key transitions.

5-10 awards at $50k-$100k $1 million

Prioritization

All components of the plan were viewed as essential. Proposals 4 and 5 on training and faculty development should be more robustly examined in collaboration with the Education and Faculty implementation teams, but are essential components of the plan; training is clearly an effective catalyst for multidisciplinary team formation and without appropriate attention to faculty development, efforts to expand team science will fail. Proposal 3, the funding for multidisciplinary team science was viewed as absolutely essential to provide meaningful progress in multidisciplinary team formation and development. Specifically, we felt that senior investigators could not be adequately motivated to examine new areas of research without substantial funding opportunities. We felt that the Senior Investigator Team Science Award, the Planning Grants and the Transformation Grants had highest potential for high impact but are high dollar awards. The smaller awards will be more easily accessed by large numbers of teams and in that way could have higher impact on the formation of teams, but with the more modest resources, perhaps are less likely to result in extramural support. Without an overarching infrastructure investment (either through the CTSA renewal process or through the Office of the Vice Dean for Research) in the Office of Translational Research and Team Science, we feel that an investment in developing multidisciplinary team science is less likely to be optimally effective. Providing resources to investigators will only move us so far in this transformational process; we need infrastructure to facilitate the spontaneous and opportunistic development of multidisciplinary teams.

Sustainability Because the proposed programs should be viewed as long-term initiatives to continuously foster the development of team-oriented research by sustaining current teams and spawning the formation of new teams that are responding to changes in both the basic and translational research landscape, sources of funds to support successful initiatives over the long-term should be considered. These could emanate from F&A monies secured from successful team-directed research projects, funds secured from private, state or federal agencies or direct allocations made by the SOM.

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Strategic Priority 2: Stimulate team-based, translational research with targeted investments in key translational research areas


Team members and Departments:Tim Carey, MD MedicineJanet Rubin, MD MedicineWendy Brewster, MD, PhD Obstetrics and Gynecology Caterina Gallippi, PhD Biomedical EngineeringJoe Piven, MD Psychiatry Ron Falk, MD MedicineJoanne Jordan, MD MedicineBill Powers, MD NeurologyJoe Eron, MD MedicineKaryn Stitzenberg, MD SurgeryEliana Perrin PediatricsChuck Perou GeneticsGene Bober Planning OfficeRose Ann Laureto CIO, UNC HCS


“Stimulate team-based, translational research with targeted investments in key translational research areas.”

Initiative 1: Leverage the success of NC TraCS and the SOM’s multidisciplinary research centers as primary homes for translational research at UNC.

Initiative 2: Use the Center for Health Care Innovation as a platform for translational research.

Initiative 3: Expand efforts and invest additional resources in key areas identified for basic and translational research.

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SOM Strategic Plan Implementation—Research SP 2: Plan Elements

The plan elements within SP2 were divided into three initiatives. The first 2 (leveraging TraCS and the Innovation Center as a research platform) each have one major component. The third component within SP2 has multiple components, each of which will be discussed separately below.

Initiatives:

1. Leverage the success of the NC TraCS Institute and the SOM’s multidisciplinary research centers as primary homes for translational research at UNC.

The purpose of the NC TraCS Study Section is to establish a stable pool of faculty supporting an array of investigative teams by awarding pilot funds for basic, translational, and clinical research. Study Section members review pilot funding proposals requesting from $5,000 to $50,000. One of the primary goals for reviewers is to provide critiques of each proposal that include a numerical score resulting in the improvement of individual proposals as well as the underlying research program. Additional functions of the Study Section are to suggest translational counterparts to basic science investigators and vice-versa. Individuals or teams with promising proposals, whether funded or not, are assigned to a member of the Study Section who may act as a mentor for the investigator(s). Study Section members help foster interdisciplinary teams and participate in identifying TraCS resources for individual applicants with the assistance of navigators. Members of the Study Section may conduct presubmission reviews on proposals that request TraCS resources and serve as real-time consultants to research navigators. The need for funds will be somewhat contingent on the success of the TraCS renewal process.

Tactics to Achieve Initiatives: – Continue TraCS study section– Emphasis on mentoring as well as funding– Increase emphasis on interdisciplinary research– Increase engagement between basic science and clinical units on campus

2. Use the Center for Health Care Innovation as a platform for translational research.

The UNC Innovation Center (IC) has the potential to markedly improve the engagement of UNCHCS with the translational and quality improvement research process. However, in order to realize this potential, clinical researchers much be fully engaged with the IC and the IC must readily assist UNC researchers in timely preparation of preliminary data for proposal submissions.

Tactics to Achieve Initiatives: – Clinical researchers should be involved in the Innovation Center oversight and

governance– Clinical researchers should be involved in the Innovation Center project choice– The Innovation Center staff should support research activities such as collection of

preliminary data in preparation for proposal submission and in the preparation of

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budgets and contracting arrangements with UNCHCS. Budgets in proposal submissions should reflect the costs of research data collection and interventions.

3. Expand efforts and invest additional resources in key areas identified for basic and translational research.

This third initiative in the SP2 research strategic plan has multiple components that were identified as key priorities through the multiple prior components of the SOM strategic planning process. The SP2 group worked though several subgroups in order to flesh out and evaluate each of these components. While we do continue to view each of these components as very important to future research innovation and productivity in the SOM, we do propose some modification of the initiatives compared with the task force report. In some areas we have proposed budget reductions or change in emphasis, and in several areas we have identified areas that need additional planning prior to expenditure of substantial funds.

The SOM Dean of Research office and the TraCS infrastructure of PI-Extenders were identified as the units that should be charged with monitoring and implementation, in collaboration with other units of the SOM administration.

One theme that ran though several deliberations of our group was that the amount of funds to be invested in somewhat contingent on the future of the NIH CTSA initiative and UNC’s ability to get refunded in this highly competitive environment in which the RFA is still not issued by NIH as of 6/28/12. The need for many components of this research infrastructure will markedly increase if federal TraCS funding is not available, and this would require rebudgeting and some reprioritization.

Tactics to Achieve Initiatives: (list out specific tactics and steps needed to achieve targeted initiatives)

a. Biostatistics and Bioinformatics – Area of high need by faculty in many departments so continue significant SOM

investment, amount contingent on CTSA funding– Modify the distribution of skill sets, with increased emphasis on master’s level assistance,

assuming PhD level oversight– Increased emphasis on seed statistical support to help with proposals at early stages– Plan for ‘surge capacity’– Continue charge-back for statistical support for funded projects– Implement Executive, Strategic, and Technical committees that can coordinate

investment with the University at large, with the SOM strategic plan informatics group, and through the future SOM and UNCHCS informatics leadership. These initiatives have some overlap with the SOM strategic plan implementation group, Clinical SP 3, dealing specifically with informatics.

– Improve and centralize computational infrastructure.– Enhance existing expertise in Research Computing, Center for Bioinformatics, and

Lineberger Bioinformatics Core (latter to be coordinated with Lineberger but funded through their state funds)

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– Reach out to RENCI, the College, and other units on campus with expertiseo Identify and collaborate with expertise at RENCI in database management

and metadata tracking, computational biology and advanced programming

b. Comparative Effectiveness, Quality Improvement and Community-based research – Invest in purchase and linking of secondary databases, costs to be shared with other

Schools– Continue charge-back for programmer and statistical support of analysis of funded

projects– One faculty member to be recruited in year 3– Partially restore infrastructure support to the Sheps Center to support interdisciplinary

work– Ongoing infrastructure support for practice-based research network (PBRN)– Short term investment in extracting data from community based EMR’s– Investment in enhancing community-based research infrastructure, particularly those

already established, successful, and functional, with an eye toward expanding their focus and supporting their growth and future development, and linking and replicating established entities into different parts of the state

c. Continued Growth of animal models research platforms – Secure online database of mouse lines– Partial support of mouse cryopreservation/re-derivation– Develop transgenic rat capability– Participate in DLAM financial management to protect low per-diems– Increase commercial partnerships

d. Expand translational pathology and tissue procurement – Create a translational and pathology information technology (IT) team to design a web-

based system to track surgical pathology specimens and derivatives in the surgical pathology archives, the Translational Pathology Lab (TPL) and the Tissue Procurement Facility

o The web based system that will be developed to track surgical pathological specimens will be compatible with both the Translational Pathology Lab (TPL) and the Tissue Procurement Facility (TPF) and shall not be a standalone database. The management of the specimens should be incorporated or part of the already established larger data warehouse. Strong consideration to using IT specialists that are shared between TFP and TPL to ensure database compatibility is recommended.

– Hire a research pathology archives librarian to manage all tissue-related research requestso TPL/TPF will develop a specimen collection prioritization strategy. Initially

specimens collected under this program will be only for those paid for by investigators. The process will later be expanded to collection protocols for other groups and tissues.

o Procedures to query specimen availability and prioritization of requests for specimens will be developed.

– Hire an additional research specialist for the TPL

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o An additional research specialist for TPF and an additional research specialist for TPF are requested.

– Explore opportunities to expand TBL beyond its current limited spaceo The TPF freezers are currently at 70% capacity. Space will need to be identified

for x freezers. Freezers will need to be purchased prior to September 2014. Additional space requirements will need to be elaborated further. We acknowledge that this infrastructure will require complex and elaborate storage considerations. We recommend development of a storage business plan that addresses space and freezer needs after initiatives 1 and 2 are in place. Examination of budgeting for this space, including alternatives such as off-site storage, will be part of the planning process.

e. Develop a strategy of setting priorities for investment to enhance UNC Chapel Hill’s imaging capabilities.

Note: The Imaging Subcommittee reviewed the relevant material from Task Force 2, sought further input from Terry Magnuson and met with Weili Lin, Kathleen Caron and Jim Bear. The Committee is aware of the importance of imaging research and cognizant of breadth and complexity of imaging research at UNC, the large capital expenditures necessary to purchase equipment and the ongoing maintenance costs.

– Create an Imaging Research Advisory Committee (IRAC)New task force needed to establish planning process and governance for imaging investments, including external consultation. IRAC to consist of:

o Scientists engaged in ex vivo imaging research o Scientists engaged in vivo animal imaging research o Scientists engaged in vivo human imaging researcho Scientists engaged in translational team research other than imaging o Basic Science and Clinical department chairs with research expertiseo Appropriate representatives from administration with expertise in financial,

space, administrative and regulatory issues.– IRAC to survey and collate all imaging research at UNC, including community-based

studies outside of Chapel Hill, and, with the advice of outside experts, evaluate the current state of imaging research at UNC and recommend areas of strategic priorities for future investments, e.g. should all imaging research funding occur in Chapel Hill, or should BRIC resources also be employed in community-based research centers, consistent with its initial funding from the state?

– Ongoing, IRAC to serve as the body to evaluate all requests for support of imaging research from the Dean’s Office.

– There is a great perceived need for investment in the imagining infrastructurethe SOM should plan to invest $10M in research imaging over the next five years. These funds should not be specifically allocated until the completion of the planning, oversight and prioritization process in year 1 of the SOM strategic plan. The committee felt that there may be room for specific savings through potential joint purchasing with other UNC units, evaluated on a case-by-case basis.

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SOM Strategic Plan Implementation—Research SP 2: Timing and Sequence of Activities

What returns do we expect and when? (calendar of major actions required to execute tactics; include action timing and responsible party)

UNC Center for Health Care Innovation is established—recommend translational scientists to serve on oversight and governance committees; these researchers should be involved with Innovation Center project choices

Increased emphasis on interdisciplinary research at TraCS Biostatstatistics and bioinformatics (abbreviated as ‘biostats’): modify the distribution of skill

sets with increased emphasis on master’s level assistance, begin recruitment and organization to enhance master’s level support and support of seed statistical work to launch proposals

Bioinformatics: Implement Executive, Strategic, and Technical committees that can coordinate investment with the University at large through the office of the proposed SOM informatics leadership. Have committee assess strengths of bioinformatics units and resources on campus and begin outreach to College and RENCI. Coordinate with SOM strategic plan informatics group (Clinical SP 3).

Imaging: create an Imaging Research Advisory Committee (IRAC), a task force for developing plan and governance structure for imaging investments

DLAM: charge Joyce Tann with increasing commercial partnerships, begin planning for development of secure online database of mouse lines and participate in DLAM financial management

Pathology: o Sept. 2012-Dec. 2012 identify or hire 1 IT specialist to design a web-based system to

track pathological specimens (Responsibility—Bill Funkhouser); o Dec. 2012: Management and governance plan should be completed for oversight of

tracking system (Responsibility—Bill Funkhouser)

TraCS: Increased engagement between basic and clinical units on campus CER: invest in purchase and linking of secondary databases and support programmer DLAM: develop secure online database of mouse lines and participate in DLAM financial

management Pathology:

o Jan. 2013: create a translational pathology IT team to design a web-based system to track surgical pathology specimens that integrates TPL and TPF and begin creating storage/space business plan (Responsibility—Bill Funkhouser);

o Identification of space to house 2 freezers (Responsibility—Gene Bober)

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2012Dec.Aug.

ApriJan.

2013

Dec.Aug.

o Identification of space to house IT specialist/archive librarian and research support specialists (Responsibility—Bill Funkhouser);

Imaging: IRAC to survey and collate all imaging research at UNC (formal report to be posted online), consult with external experts regarding strategic priorities for future investments and create a governance plan that faculty will begin using for investment proposals.

Biostats: increase awareness of available resources and ways of streamlining support across departments

Bioinformatics: Identify units in need of support; recruit staff noted below, complete reorganization of current statistical support. .

Community-based research (CBR): provide community based infrastructure support

Comparative effectiveness research: recruit faculty member DLAM: Develop transgenic rat capacity, continued development of secure database of mouse

lines, continued participation in DLAM financial management and track increase in commercial portfolios

Pathology: management and governance plan should be completed for oversight of tracking system; Hire an additional IT FTE to maintain computer hardware. (Responsibility Bill Funkhouser)

o April 2014: Purchase (2) 80Freezers. (Responsibility—Todd Auman). Contingent on evaluation of storage needs and options

o Aug. 2014: TPL/TPF specimen collection protocol and prioritization strategy completed (Responsibility—Todd Auman/ Bill Funkhouser)

o Aug 2014: Hire a pathology archives librarian (Responsibility—Bill Funkhouser)o Complete development of a web tracking system that integrates TPL and TPF.

(Responsibility—Bill Funkhouser) o Sept 2014: Present a storage business plan that addresses space and freezer needs.

(Responsibility—Bill Funkhouser) Imaging: IRAC to evaluate and rank all incoming imaging requests and begin investing

strategically in equipment pursuant to imaging plan Biostats: continue to increase awareness of available resources, evaluate the modified support

structure through faculty survey and assessment of efficiency Bioinformatics: Technical Committee will identify key weaknesses in computational

infrastructure and areas of potential consolidation. Invest in improvements. Quality improvement research: development of mechanisms to securely extract data from

local practices engaged with PBRN’s Community based research: provide community based infrastructure support

Pathology: hire an additional research support specialist for TPF (Responsibility—Todd Auman/Bill Funkhouser)

Imaging: Ongoing strategic investments in equipment pursuant to imaging plan

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ApriJan.

2014

Dec.Aug.

ApriJan.

2015

Dec.Aug.

Comparative effectiveness research: After faculty member hired, continue to expand utilization of linked databases, expand capacity for pragmatic clinical trials, expand faculty utilizing resources in collaborative CER research.

Quality improvement research: reevaluate the amount needed for infrastructure support and type (will depend on status of TraCS)

Community-based research: provide community based infrastructure support DLAM: continue to track/manage databases, participate in DLAM financial management and

track commercial partnerships. Bioinformatics: Re-evaluate staffing patterns and types of support provided

Imaging: Ongoing strategic investments in equipment pursuant to imaging plan Quality improvement research: pilot support for QIR Community based research: provide community based infrastructure support DLAM: continue to track/manage databases, participate in DLAM financial management and

track commercial partnerships. Pathology: expand tissue collection procedures and protocols for other groups and tissues

(Responsibility—Bill Funkhouser) Biostats: respond to survey about modified support structure and tweak (hire additional

support or reallocate existing resources) as necessary

Imaging: Ongoing strategic investments in equipment pursuant to imaging plan; Evaluate investments made to date in equipment pursuant to imaging plan (tracking metrics)

Community based research: provide community based infrastructure support DLAM: continue to track/manage databases, participate in DLAM financial management and

track commercial partnerships. Bioinformatics: SOM leadership and TraCS will assess the effectiveness of informatics and

biostatistics initiatives.

SOM Strategic Plan Implementation—Research SP 2: Returns/Values/Metrics

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ApriJan.

2016

Dec.Aug.

ApriJan.

2017

Dec.Aug.

What returns/values do we expect and how will we measure? (Recommend both progress and outcome metrics; interim and overall metrics)

Initiative 1 (TraCS)– Continue the current TraCS study section structure– Continue emphasis on interdisciplinary team science, track greater involvement by UNC basic

science departments and centers.– Track new collaborations across departments and UNC-CH schools. – Track grant submissions derived from the pilot program, as well as external grants awarded

using knowledge gained from the pilot awards– Years 2-5 will demonstrate an increase in the number of pilots with basic science involvement,

and greater number of externally funded projects arising out of pilots

Initiative 2 (Innovations Center)– Year one- the IC will be established– Years 2-5- increasing numbers of external grant proposals utilize the IC infrastructure with

clinical and translational research taking place within the overall structure of UNCHCS. Will need to arrive at a base rate, then increase. ? Double?

– Years 3-5-increasing amounts of funded research. Research taking place at Rex, Triangle Physicians Network etc. Since the amount of this research conducted within UNCHCS is low, the amount should increase several fold.

Initiative 3 (includes Biostats, Bioinformatics, CER, QIR, CBR, DLAM, Pathology, Imaging)

Biostatistics and Bioinformatics– Increase the number of faculty receiving support from statisticians and bioinformatics staff– Increase the proportion of consultations provided by master’s level statisticians, with supervision

by doctoral level personnel– Increase faculty satisfaction with the services received, such as through TRACs and core services

surveys– Monitor the fraction of Bioinformatics staff salaries are placed on federal grants– Reports from the Executive, Strategic and Technical committees summarizing progress

and comparing UNC SOM/HCS to peer institutions in collaboration with SOM informatics strategic planning team

– Increase UNC faculty applications for bioinformatic grants (ABI, BIGDATA, etc).

Comparative effectiveness research– Increase the # of CER grant proposals submitted with SOM faculty as PI or co-investigator by

25%. Note: This will be partially dependent on the number of grant opportunities, such as the extent to which the new Patient-Centered Outcomes Research Institute (PCORI) is up and running. By year 3 the # of funded CER proposals should increase as well.

– Enhanced awareness of CER among SOM faculty, with more broad recognition of the issues and study designs involved. Evidence of this would be engagement of new SOM investigators either as PI’s or co-investigators. Enhanced training though T-32 and other awards

– Increased collaborative work with other UNC Schools on CER issues.

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Quality Improvement Research– Increased number of quality improvement/dissemination and implementation grant proposals

submitted for external funding in year 2. – Increased number of funded quality improvement/dissemination and implementation projects in

years 3-5. NOTE: The SOM will need to operationalize what ‘quality improvement/dissemination and implementation’ research is so it can be tracked. Once we arrive at a base rate, the goal should be at least a 25% increase in activity.

Community based research– Inventory community-based research on campus focusing on topics, diseases, issues covered,

funding sources and longevity, strength of community ties and support, and likelihood of continued UNC sustained presence in specific communities

– Increase in the number of non-Chapel Hill campus sites conducting clinical research . Consider priority for already established community-based research sites, and expanding their reach and activities. Special emphasis on difficult-to-recruit populations (rural, minority, etc)

– Increase in the # of projects conducted off site. Since the # of projects is small at present, this should be a substantial increase, probably doubling. As noted above , this would include and emphasize expanded activities at existing community-based sites, if they expand patient participation among difficult-to-recruit populations.

Growth of Animal models research platforms– Completion of the tasks outlined below by year 3 regarding infrastructure and service

enhancements– Establishment of the rat facility at The Farm– Success is partial cost return through charge-back mechanisms– Enhances investigator satisfaction with services

Expand translational pathology and tissue procurement– Creation of web-based system for tracking surgical pathology specimens– Management and governance plan for oversight tracking system completed by end of year 1. – Bill Funkhouser will be the liaison between the Department of Pathology and Laboratory Medicine and

the Committee. He will have responsibility for oversight of development of the tracking system and the translational pathology team and will be responsible for the development of a management/governance plan.

– Hiring of new staff:o Two IT specialistso Research Pathology Archives Librariano 2 additional Research Specialists – Purchase of two 80 freezers prior to September 2014.

– Development of a storage/space business when the tracking system goes online– Database compatibility (TPL and TPF) and linkageseventual incorporation with Carolina Data

Warehouse– Development of a specimen collection prioritization strategy– Develop procedures to query specimen availability and prioritization of requests for specimens– Adequate storage space, to be expanded once tracking software issues addressed

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Develop a strategy for setting priorities for investment to enhance UNC’s imaging capabilities– Completion of consultation and governance process by the beginning of year 2 of the SOM

strategic plan– Increased number of SOM and other investigators utilizing the BRIC and other imaging services

(year 2-3)– Increased number of grant submissions (years 2-3)– Increased number of grant awards (50% increase) years 3-5. – Increased collaboration and use with and by UNCHCS

SOM Strategic Plan Implementation—Research SP 2: Resources Required

What resources are required for implementation of the initiatives?

Initiative 1: (TraCS) *request depends on funding of our CTSA $ ? “modest compensation for study section members’ time is appropriate” discussed 5%? $1,000,000 ($200,000/year) (if TraCS is re-funded) for pilot award funds $3,750,000 ($750,000/year) (if TraCS is not re-funded) for pilot award funds

Initiative 2: (Center for Health Care Innovation) $0 (Direct support to come from Clinical Care SP2)

Initiative 3:

Biostats and Bioinformatics: *request depends on funding of our CTSA Expansion of biostatistical pool with greater emphasis on master’s level staff. The

level of funding needed is largely dependent on the renewal of the TraCS CTSA award.

Possible contractual arrangements with external statistical consulting firms, funds to be allocated if needed from budgeted allocation.

$300,000 for biostatistical support for grant preparation in CER (0.5 FTE at $60k/year)

Increasing bioinformatic and biostatistical support, including support for comparative effectiveness research (CER) will require significant investment in staff and equipment, some of which is contingent on our TraCS submission.

$850,000/ year Staff salaries range from $60,000-$100,000. If five new staff positions were created, that is ~$400,000/year. Computational hardware: ~$300,000 annual maintenance and upgrade with large ~$1,000,000+ investments every 3-5 years. This will involve negotiation with ITS as well as negotiation with other campus units utilizing these resources.

o Subtotal: $1,150,000

Comparative Effectiveness Research

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$300,000 for secondary data purchases $375,000 for programmer support $200,000 for server and security upgrades $80,000 for administrative support $200,000 for methods-oriented faculty hire in year 3 $750,000 for infrastructural funds to the Sheps Center, supporting multiple initiatives

o Subtotal: $1,905,000

Quality Improvement Research $200,000 for data collection ($100k/year for 2 years) $500,000 for infrastructure support for the UNC-affiliated PBRN’s $100,000 pilots for Quality Improvement Research

o Subtotal: $800,000

Community-Based Research $1,000,000 for community-based infrastructure support ($200k/year for 5 years),

focus on expansion of scope and reach of existing community sites if they can demonstrate ability to expand the range of patients enrolled and investigators engaged.

Animal Models in Research Platforms $200,000 for development of secure, searchable online database of mouse lines

($100k in year 1; $50k in years 2 and 3) $525,000 for mouse cryopreservation/re-derivation technology ($150k years 1-2;

$75k years 3-5; user fees to make up $75k remainder) $100,000 for development of rat space and equipment at the Farm

o Subtotal: $825,000

Pathology and Tissue Procurement $637,500 for IT personnel 12/2012 – 6/2017 $90,000 for archive librarian 8/2014 — 6/2017 $275,000 for research specialists 1/2015 — 6/2017 $30,000 for two freezers 4/2014 $? For additional space and freezers

o Subtotal: $1,032,500Imaging

$10,000,000 (over 5 years)

TOTAL: $17,712,500 (if TraCS is re-funded)$20,462,500 (if TraCS is not re-funded)

SOM Strategic Plan Implementation—Research SP 2: Resources Required (con’t.)

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What organizational structures, processes and management are necessary to enable implementation of each initiative? (Recommend additions or enhancements to leadership; identify who will have decision-making authority; who will monitor progress?)

Initiative 1: Leverage the success of NC TraCS and the SOM’s multidisciplinary research centers as primary homes for translational resources at UNC.

The composition of the study section should reflect the scope of submitted proposals. On a yearly basis, the study section composition should change as needed. Ad hoc reviewers can be added for additional content expertise as needed.

The study section has both a mentoring and an evaluative function. Modest compensation for members’ time is appropriate. We estimate 5%/year assuming they were engaged in mentoring as well as proposal review.

Applications are generally funded for 12 months, yet upon demonstration of significant progress, a no-cost extension for an additional 12 months may be requested. Each request is evaluated by the TraCS staff and PI Extenders.

Applicants must identify and delineate a significant outcome/impact of their research in the grant application; for example, the opportunity for federal or similar grant funding, a patentable product or the implementation of a sustainable community-wide health initiative. Basic science proposals must present a clear clinical or translational application of their research.

Proposals that seek to develop a team responding to a large federal grant such as a UO1 or PO1, or large clinical trial may request funding up to $100,000 and are limited to 12-18 months.

Interval review of the progress of funded applications requires interactions with Study Section members and the grantee. These reviews are essential and failure to participate in the process will result in termination of the research funding.

Matching funds may be obtained from a department or center, or split amongst various sources depending on the multidisciplinary nature of the proposal. The requirement of matching funds should not deter centers or departments who may not be able to generate those funds from permitting their faculty to apply for TraCS pilot grants. We envision the development of a fund, held by the Executive Dean and Vice-Dean for Research, that would be made available to those departments and fairly parsed between departments and centers based on application for these funds by the Department Chair or Center Director. Justification must include a definitive reason, signed by the chair or center director, why their department or center is not able to provide matching funds.

Currently, about $1.8M is awarded each year in pilot funds, a remarkable investment by the SOM and the university units. We recommend that this investment be continued in the future, since the experience of the past 4 years has been that, with appropriate selection and

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oversight of awards, this approach is a productive investment for the UNC SOM. If TraCS is refunded, an incremental investment of $200K/year from the SOM Strategic Plan would be helpful in reaching out to the basic science departments. If the TraCS application is not successful (or if NIH radically changes the CTSA program), then an investment of approximately $750K/year is advised.

Initiative 2: Innovation Center as platform for translational research

Governance: Clinical/translational researcher on the IC oversight committee.

Operations: Clinical/translational researcher as a standing member of the group that vets and prioritizes projects for the Innovation Center. We recognize that the majority of the impetus for the UNC HCS/SOM Innovation Center is coming from the desire to enhance clinical care processes and outcomes. The budget for the Innovation Center should be a single budget from that group, but to fully realize the potential of the Innovation Center clinical and translational research will need to be part of its operations.

Resources: A portion of the programming staff and the project administration staff will be needed to support research project/grant preparation for externally funded projects involving the Innovation Center. In the first two years of the IC (2012-13), the volume of such requests will likely be relatively low. 30% of a programmer and 30% of a business manager to assist with project preparation and budgets should be allocated to assisting with research start up activities in these first 2 years. At that time, consideration should be given to increasing this allocation to 50% of a programmer and 50% of a budget manager, depending on the volume of activity. Direct costs of supporting research (programmer, research assistant time) should be funded from external grant funding.

The IC oversight committee, as well as the SOM Dean for Research, will monitor progress and any increase in resources needed.

Initiative 3:

A. Integration of Biostatistics and Bioinformatics at the SOM, invest in necessary additional staff to address needs:

This is the component of the Strategic Plan that would change the most depending on the potential changes in the NIH CTSA structure (current under revision) and UNC’s success in the renewal. Currently, the amount of funds invested in statistical support is substantial, but the committee agrees with the prior strategic plan groups that reorganization in staffing models would increase the efficiency of the services delivered. The committee did not feel that primary reliance on graduate students (mentioned in the strategic plan document) would be optimal.

Expansion, to begin with, of the NC TraCS biostatistical pool engaged primarily in statistical support, as opposed to high level consultation from 2 to 4, with greater emphasis on master’s level staff, as opposed to doctorally trained statisticians. These individuals will do front end help for smaller and more junior projects, and in some cases, and where appropriate,

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investigators will be matched up with biostatisticians in SOPH prior to their grant being submitted. For any assistance provided, by this pool, that requires more than a few hours work, there will be a minimal hourly use fee.

The resources dedicated to pre-submission biostatistical support should remain constant, with perhaps a modest increment in master’s level staffing, we are here proposing mostly changes in emphasis and staffing

The SOPH, Department of Biostatistics Faculty, will continue to assist investigators with projects that require high level expertise, especially for federal grants.

. The committee was supportive of contractual arrangements with external statistical

consulting firms that could provide at-need ‘surge capacity’ when current resources were at maximum.

There is also still a need to increase investigator awareness of TRAC biostatistical resources.

Key bioinformatics challenges are to recruit the necessary expertise, ensure that that expertise is focused on projects in need of support, and to build a bioinformatic infrastructure capable of supporting both clinical and basic research projects.

Current units that are providing services to the SOM and HCS should be bolstered with additional staff and hardware

Outreach to local expertise in the College and RENCI can provide additional expertise; long term solution will require developing additional within the SOM and HCS, as well as more seamless collaboration with units in other schools on the UNC campus.

Identify facilitators who can connect those in need with those who have the ability.

Cost recovery should be emphasized, with TraCS and the SOM dean’s office working with the informatics and statistical units to ensure that costs are recovered once external funding is obtained.

B. Comparative effectiveness research :

Note: These budget estimates have been substantially reduced compared with the estimates from phase 2 of the strategic plan. This was accomplished in 2 ways: Assuming a cost-share of these activities among UNC schools and centers conducting Comparative Effectiveness Research (CER); reduction in support of for faculty hires given the multiple hires in the past year and faculty currently on K award. The need for some of this support will vary depending on success of the CTSA renewal.

Secondary Data purchases: Total need 120K per year, SOM to contribute 60K, the balance to be contributed by other schools and centers. The focus will be on databases that will benefit multiple investigators and at-risk populations. Especially important will be linked databases, such as linkages of registry data with claims databases, or electronic medical records with

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genomic data etc. While the funds to analyze the data should come from pilot and/or external grant awards, the data purchase will need to be internal. Governance regarding the types of data to be purchased will be under the purview of a committee of representative researchers from SOM (is Lineberger assumed to be the within SOM?), Medicine, Sheps, Pharmacy, SPH. This group can also assist with data use agreement format and governance for these databases. Can be expanded if additional schools/centers contribute to infrastructure. Total SOM budget over the 5 years= $300K, a 50% reduction from the phase 2 document.

Programmer support for infrastructure for secondary data and data linkages: 150K- SOM to contribute 75K/year in all years. Similar cost sharing to database purchases. Programmer support to conduct analyses for research once approved by the funder will need to be derived from the direct costs of the award. Total SOM budget over 5 years=$375K

Server and security upgrades: 40K/year (likely underestimated in the earlier versions, so will not decrease). This is a partial support for current server needs. Given the nature of these data, expectations are that these databases be situated on separate servers within the ITS physical space, so this is budgeted separately from other hardware purchases. Total funds over 5 years =$200K

Administrative support for management of and access to databases: 40K/year total, SOM support $20K/year, balance to come from other Schools and Centers. This is critical to assure that data use agreements are adhered to, and to assist faculty in accessing these resources. Total funds over 5 years = $80K

Biostatistical support for grant preparation in CER: 0.5 FTE $60K/year, but should be considered part of the entire statistics package, covered elsewhere in initiative 3.

Faculty hires. Several hires have taken place in the past months of 2012, including a faculty member in general medicine with expertise in systematic review, as well as an SOM hire with expertise in both informatics and CER. Recommend funding one additional methods-oriented hire in year 3 of the strategic plan. Startup of $200K x1. This is a substantial decrease from the prior strategic plan.

Infrastructural funds to the Sheps Center for enhanced communications, mentoring on CER and proposal development. $150K/year=$750K, decreased from the strategic plan.

C. Quality Improvement Research Support for data collection from multiple practice-based sites, including PBRN’s.

Development of mechanisms to securely extract information from external EMR’s: 100K/year x 2 years= $200K

Infrastructure support for the UNC-affiliated PBRN’s is currently on the order of 100-150K/year through TraCS. Amount will vary depending on the status of the TraCS renewal. Total over 5 years $500K. Recommend this be continued. Re-evaluation regarding amount and type 2 years into strategic plan.

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At least $100K in support for pilots for Quality improvement research specifically targeted toward obtaining preliminary data to support externally funded quality improvement/dissemination and implementation research. TraCS PIE’s to decide whether this would be stand-alone or used as a match. NOTE: Sheps Center has access to about $100K of trust funds that will be used toward dissemination and implementation research over the next 3 years. These are separate funds, so the total allocation would be greater than 100K.

D. Community-based research

250K per year for community based infrastructure support. The initial strategic plan text indicated that this would be for pilot work, but the committee felt that it would be better used for infrastructure support. We need to make community-based research more efficient so as to be competitive in the current funding environment. Implementation of these initiatives could be on a competitive basis, with the TraCS PIE structure vetting proposals with the guidance of the clinical research and community engagement cores. Total $1M. Timing will need to be negotiated, since some of the funds may need to be front or back-loaded. These funds could be considered incremental over and above current TraCS activities.

E. Strategically invest in continued growth of animal models in research platforms

Background: animal platforms are critical to the basic mechanistic work that is the foundation of translational medical research. In the last 5 years, fully a quarter of SOM funded grants involve animals, and these grants comprise 50% of research dollars awarded to SOM UNC. It is widely felt that UNC’s mouse facilities are among the top three in the nation. To promote research in the SOM, UNC needs to build on strength in this area.

Develop a secure searchable online database of mouse lines. This will be a joint effort between Genetics and DLAM.

$50K to pay programmer for specific needs (Matt Blanchard, re-format UCSF database), software/hardware x 1

Personnel to input, maintenance, curation of database for $50 K x 3 years before DLAM per diems can cover

$200K total 5 y investment :$ 100K year 1, $50 K year 2 and 3 Mouse cryopreservation/re-derivation technology (basement of Genetics). This should be a

joint effort between Genetics and DLAM. $150K x 2 years (experienced genetic technologist salary, equipment) then Yr. 3-5 at $75K

as users pick up 50% costs $525K total 5 y investment : $150K year 1 -2, $75 K year 3-5 (user fees to

make up $75K remainder) Develop rat transgenic capability at The Farm to allow projected rat use. $100K to develop space/equipment

$100K year 1 investment. Thereafter to be paid by user fees

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Participate in DLAM financial management to protect low per diems. Director of DLAM (current Craig Fletcher) should retain SOM Dean position to develop/manage interests of this critical SOM resource.

Increase commercial partnerships. We recommend that this general concept be added to current officer Joyce Tan’s portfolio. No cost.

The Strategic Plan calls for the following elements at a projected 5 y cost of $ 825K minimum:

F. Expand Translational Pathology and Tissue Procurement Create a translational pathology IT team to design a web-based system to track surgical

pathology specimens and derivatives in the surgical pathology archives, the Translational Pathology Lab (TPL) and the Tissue Procurement Facility. – Recommend that the web based system that will be developed to track surgical

pathological specimens be compatible with both the Translational Pathology Lab (TPL) and the Tissue Procurement Facility (TPF). This should not be a standalone database. With the exception of the request for IT specialist salary, other anticipated cost of development of this tracking system should be presented.

– Recommend that management of the specimens should be incorporated or part of the already established larger data warehouse.

– Recommend the determination of the level at which this shared program will be managed.

– Request clarification of the responsibility for oversight of the tracking system. This should be a joint discussion among the relevant departments, centers, and the SOM research dean’s office. This management and governance plan should be completed by the end of year 1.

– Two IT specialists have been requested. We recommend strong consideration to using IT specialists that are shared between TFP and TPL to ensure database compatibility.

Hire a research pathology archives librarian to manage all tissue-related research requests – The request for the pathology archives librarian seems reasonable. (salary $30k per

year)– TPL/TPF should develop a specimen collection prioritization strategy. For example

will the specimens collected under this program be only those paid for by investigators? If other specimens are to be routinely collected what will be the strategy for selection of tissue? The SOM dean’s office will work with the TPL/TPF to develop appropriate recharge strategies.

– Procedures to query specimen availability and prioritization of requests for specimens need to be developed and should be consistent across the TPL and TPF.

Hire an additional research specialist for the TPL and TPF– Recommend that emphasis be placed on bioinformatics and linking of established

data warehouses. Consideration of placing programmer as part of the SOM/TraCS informatics group working with the clinical and research data warehouses. Strong consideration should be given to using IT specialists that are shared between TFP and TPL to ensure database compatibility.

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Explore opportunities to expand TPL beyond its current limited space

The TPF freezers are currently at 70% capacity. Space will need to be identified for two -80 freezers. Freezers will need to be purchased prior to September 2014. We acknowledge that this infrastructure will require complex and elaborate storage considerations. We recommend development of a storage business plan that addresses space and freezer needs after initiatives 1 and 2 are in place.

E. Develop a strategy for setting priorities for investment to enhance our imaging capabilities The SP2 subcommittee and full committee discussed the importance of a robust and cutting-

edge imaging capacity at UNC Chapel Hill in some detail. The committee views imaging capabilities as critical to maintaining and increasing UNC’s clinical research profile in a variety of translational areas. However, the committee was concerned that there was not in place a governance and prioritization framework to manage the planning process for purchase of new capacity and prioritize the sequence of purchases. To that end, the committee recommends that the SOM create an Imaging Research Advisory Committee (IRAC).

The IRAC is composed of:a. Scientists engaged in ex vivo imaging research b. Scientists engaged in vivo animal imaging research c. Scientists engaged in vivo human imaging researchd. Scientists engaged in translational team research other than imaging e. Basic Science and Clinical department chairs with research expertisef. Appropriate representatives from administration with expertise in financial, space,

administrative and regulatory issues.

Initially, the IRAC would:1. Survey and collate all imaging research at UNC. Create a formal report and post

the results on a web site2. With the advice of outside experts, evaluate the current state of imaging research

at UNC and recommend areas of strategic priorities for future investments. These areas may be areas of current excellence, important areas that need additional investment to flourish or new areas that are critically important to develop for future competiveness.

3. Present a budget for future investments to the Vice-Dean for Research

Ongoing, the IRAC will serve as the body to evaluate all requests for support of imaging research from the Dean’s Office.

1. Any faculty member or group of faculty members will submit a formal proposal to the IRAC. Proposals will specify initial and ongoing costs, users, governance, existing grants supported, new grants that could be written, return on investment in research productivity.

2. The Committee will evaluate and rank the proposals. The IRAC will set parameters to foster team research by giving higher rankings to multiple users grants crossing departments/center/disciplines and will give higher rankings to

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proposals that fit with the strategic priorities. Rankings and recommendations for funding will be reported to the Vice Dean for Research.

There is a great perceived need for investment in the imaging infrastructure, both in personnel and equipment, here at UNC. Given existing requests and the expense of these larger equipment items, The SOM should plan to invest $10M into research imaging over the next five years. We do not recommend specific allocation of funds until the planning process is complete. Whenever possible, these costs should be shared with other campus units that plan on utilizing these resources, which may well reduce the SOM investment below $10M.

The purchase and maintenance of imaging equipment will undoubtedly be critical to the future of imaging research at UNC. Although we recommend that the IRAC prioritize and allocate funding for specific purchases and upgrades, we estimate that a $10M investment over 5 years will promote the following:

o Purchase of novel imaging equipment to be shared amongst interdisciplinary research teams spanning both microscopic and organ-level imaging.

o upgrading existing equipment on campuso Upgrading infrastructure to house the novel imaging resources in a manner that

renders them conveniently accessible to the entire SOM imaging research community.

o Competitive pilot funds for supplies, personnel, data analysis and other start-up costs associated with using the newly purchased and existing imaging equipment on campus.

o Advertising imaging research at UNC to national and international research communities to increase recognition of UNC as a center of medical imaging research excellent and a source for medical imaging talent.

We feel that this $10M investment will result in the development of significant preliminary data that will substantially enhance the competitiveness of faculty in the SOM in terms of securing extramural funding, which will flow back to imaging resources at UNC.

We also feel that this $10M investment will help to enhance the national and international prestige of medical imaging research at UNC.

We feel that this $10M investment will be synergistic and strategically aligned with state funding already allocated to the BRIC, the cancer center, and other SOM centers and departments.

The committee recommends that major goals in the future is to expand the number of investigators working with these advanced imaging technologies, the number of external proposals submitted and funded using these technologies.

The committee also recommends development, by mid-year 2 of the strategic plan, an explicit plan to share technology and costs with UNCHS.

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SOM Strategic Plan Implementation—Research SP 2: Prioritization

What is most essential? What activities/expenses can be phased? (Recommendations prioritized within the SP group; individual recommendation elements prioritized where appropriate; recommendations prioritized as to short-term (>1 yr.), intermediate (2-3 yrs.) and long-term (4-5 yrs.)

The committee discussed these issues at some length. We have above designated areas that need to be implemented in year one, and others that can and should be deferred into years 2 and 3. The deferral of these activities does not lessen their importance, however. Most of the budget estimates in our report are substantially below those contained in the SOM strategic plan submitted several months ago. Prioritizing among the components in the initiatives proposed in the SOM strategic plan would require making determinations (for example) that enhancing our mouse line capacity is more (or less) of a priority than enhancing our tissue procurement and tracking capacity? Both these issues (and the others described above and in the strategic plan) are important to our future as a major research university for the next decade.

If budget reductions are mandated by the SOM oversight group, we can of course re-convene the committee and provide information back to the SOM oversight group regarding how reductions would affect the goals developed by faculty as part of both the strategic planning and implementation process.

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Strategic Priority 3: Streamline the organization and management of the research infrastructure to ensure it is best positioned to meet the future needs of SOM investigators


Team members and Departments:Bob Duronio, PhD Genetics and BiologyJohn Rawls, PhD Cell and Molecular PhysiologyGeorge Retsch-Bogart, MD PediatricsVirginia Miller, PhD Genetics and Microbiology and ImmunologyLeigh Thorne, MD Pathology and Laboratory MedicineKim Rathmell, MD, PhD MedicineMike Topal, PhD Pathology and Laboratory MedicineSteve Crews, PhD Biochemistry and BiophysicsCorbin Jones, PhD BiologyJim Bear, PhD Cell and Developmental BiologyAnnabelle Stein TraCSPat Brennwald, PhD Cell and Developmental BiologyJoan Taylor, PhD Pathology and Laboratory Medicine


Subgroups:SP3. Streamline the organization and management of the research infrastructure to ensure it is best

positioned to meet the future needs of SoM investigators.

SP3 consists of 4 initiatives, and the committee was broken up into 4 sub-committees that produced each of the 4 sections of this report.

Initiative 1: Michael Topal, Annabelle Stein, Jim Bear Develop a SoM-wide strategy for the organization and management of cores and platforms including the centralization of core/platform oversight and core consolidation, where appropriate.

Initiative 2: Joan Taylor, David Siderovski, Leigh ThorneInstitute a systematic, metric-driven evaluation of existing research platforms to ensure investments efficiently and effectively provide faculty with vital, high quality research resources.

Initiative 3: Corbin Jones, George Retsch-Bogart, John Rawls, Kim Rathmell, Steve CrewsInstitutionalize the process for evaluating new technologies, research areas and resource needs.

Initiative 4: Virginia Miller, Bob Duronio, Pat Brennwald Provide long term sustained funding for BBSP.

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Initiative 1: Develop a SoM-wide strategy for the organization and management of cores and platforms, including the centralization of core/platform oversight and core consolidation, where appropriate.

1. Plan design elements

A. Centralize recharge accounting and evaluation and oversight of cores in a new office for management of core facilities, under the Vice Dean of Research.

1) Develop a new office for core facilities: a) Office led by the Assistant Dean for Core Technologies, and under the auspices of the

Vice Dean for Research, focused on evaluation and oversight of core facilities to further strengthen basic and translational research.

b) The new Office will result from transfer of current staff from NC TraCS Office of Translational Technologies to the SOM Office of Research and rename (e.g. Office of Core Research Technologies - OCRT). Increased funds for the OoR will be needed to support these staff.

2) Centralize recharge-invoicing process: a) Support ongoing development and rollout by the Finance Office of automated

invoicing system for core facilities: additional centralized reporting features, further development of scheduling/calendaring, promote usage of the program to core directors and departmental accounting staff, with the goal of having a majority of core facilities using the program.

b) Establish monthly reporting to the new OCRT.

3) Centralize accounting and HR functions for core facilities in a single office:a) Benchmark with 2 to 3 other university models (or invite to UNC) for centralization

of management of core facilities (e.g. Vanderbilt, Cornell, Northwestern) to investigate and evaluate core centralization and consolidation in use by other institutions to determine the best approach for UNC.

b) Design processes for pulling financial management and HR management of the cores from Departments and Centers. This transfers financial responsibility for core facilities from Departments and Centers to the Dean’s Office. In return, the Dean’s Office gains, for the first time, significant oversight of core facilities and the ability to better quantify core facility success and failure.

c) Develop plan to fund cores if their department/center support is removed by centralization. Centers and departments should still contribute to core facilities, since they provide the research infrastructure used by all of the departments and centers. A usage agreement needs to be implemented with contributions clearly indicated and agreed to by all parties.

4) Improve communications between all parties involved with core facility management and usage:a) Expand Core Facilities Website to provide means for faculty to communicate with

OCRT about core facilities, educational seminars on core facilities, needs for new technologies, problems and general comments pertaining to core facilities.

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b) Develop a database to store relevant website- and survey-communications for planning on technology needs and help with evaluation of core facilities. See appendix.

c) Assistant Dean for Core Technologies will present short talks at faculty meetings to present Core Facility Website as a communications device for faculty and answer questions about core facilities.

d) Institute monthly meetings of the OCRT with major users of core facilities (as now done for core facility directors) to improve communication and gain insights into effectiveness of core facilities to serve the user.

5) Partial support for core director salariesa) As expectations and demands on our core directors grow, it is appropriate for the

Institution to recognize the importance of the infrastructure provided by our core facilities and assist with funding to support non-billable activities performed by our core directors including, serving on various advisory committees, educational activities, attending meetings and conferences, and development of new technologies and methodologies which may result in new services provided by our core facilities. The cost of these activities cannot be recovered through recharge.

6) Strengthen Core Facilities Advocacy Committee (CFAC): a) Develop evaluation metrics for CFAC members to facilitate their meeting and

communicating with core-facility directors and core-facility users to assess needs of core facilities. Work with CFAC members and OoR to develop expectations for representation of core facilities, meetings with core facility personnel and users, scope of responsibilities.

b) Increase number of CFAC committee members to ensure good representation of all core facilities. As CFAC’s responsibilities grow, and the amount of analytical data associated with each core facility increases, a larger CFAC committee will maintain effective representation of, and advocacy for, core facilities.

7) Require “Recruitment Impact Statements”: a) To better plan for equipment needs, funding, and platform development, establish a

policy requiring department chairs and center directors to analyze, in a statement to the Vice Dean for Research, the impact of recruitment of faculty on UNC SOM research resources. The impact statement will be reviewed by CFAC to advise the Vice Dean on the ramifications of the recruitment for research infrastructure at UNC. In some cases, this will require consultation with outside experts in the technology being brought to UNC (e.g. our experience with Biochemistry recruitment in area of molecular- or cryo-EM).

B. Consolidate core facilities (both physically, where appropriate, and to eliminate duplicative services). Opportunities for functional integration of resources within the SoM and the UNC-CH will be highly sought.

1) Information gathering for consolidation:a) Collect and analyze data on individual core facilities: financials, usage, staffing,

equipment, space. Sources should include financial reports, user surveys, annual planning surveys, recruitment impact statements, and discussions with all interested parties.

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b) Identify needs: Work with Vice Dean for Research and scientific committee to identify platforms and research focus areas slated for expansion or development.

c) Analysis of possible pockets of space to consolidate small groups of core facilities and of current and future (3-year) space needs of the cores, as available space is identified.

d) Determine the desirability and feasibility of consolidation versus sun-setting (e.g. financial and user evaluation data, technology life cycle, space availability, outsourcing, reduction of duplicative services). Each core will be considered for consolidation on an individual basis, based on conversations with CFAC, Vice Dean for Research, Basic Science Chairs, Center Directors, Core Directors and users to discuss the core facilities targeted for consolidation or sun-setting.

2) Consolidate small groups of core facilities. From information gathering small groups of like- or complementary cores (e.g. Histology Core Facilities, Mass Spec Core Facilities, Microscopy Core Facilities) will be targeted for consolidation or sun-setting after discussion with CFAC, Vice Dean for Research, Chairs and Center Directors.

3) Identify and pursue advantages of scale gained by consolidation:a) Cross-training.b) Vendor negotiations for better pricing on supplies, equipment and contracts.c) Educational advantages of having cores and core directors together in one place.

4) Transition Taylor Hall and Glaxo Building to house core facilities.a) Facilities planning for space renovations.b) Renovate space as it becomes available.c) Relocate SOM core facilities identified for consolidation to Taylor and Glaxo.

2. Timing and Sequence of Activities

A. Phase 1: Short-term, Year 1.

1) Develop a new office for core facilities. Within 3 months of issuance of the Strategic Plan the Office of Translational Technologies will be dissolved and the Office of Core Research Technologies will be in operation within the Office of Research. The Office will require a discretionary budget of $20,000 per year for travel, meetings, marketing materials, core-director’s retreat, CFAC retreat. The Office will also need 1 FTE Business Manager ($68,750), 1 FTE Director ($87,500), 0.5 FTE Assistant Dean ($87,500). Total = $263,750 yearly.

2) Strengthen Core Facilities Advocacy Committee (CFAC). Within 6 months of the Strategic Plan, the CFAC will expand from 5 members to 6 and to expand to 8 members by the end of Year 2. Funding is $10,000 per year per CFAC member = $60,000 per year.

3) Require “Recruitment Impact Statements.” Within 6 months of issuance of the Strategic Plan, a policy statement will be developed and presented to the Vice Dean for Research for discussion with the Chairs and Center Directors. No cost.

4) Improve communications between all parties involved with core facility management and usage. In Year 1, the Core Facilities Website will be expanded to better communicate with users of our core facilities and to capture information gained from these interactions

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and data from surveys in a searchable database. $100,000 will be needed for a programmer for one year to create the database.

5) Plan to centralize management of accounting and HR functions for core facilities. Begin investigating models at other universities and plan process. The cost to visit other universities is covered under the discretionary budget in section A1 above. Add 0.5 FTE for accounting tech in central office.

6) Partial support for core director salaries. The SoM will begin planning for a 15% coverage of the core director’s salary for 25 of our core facilities (or 10% salary for between 35 and 40 of our core facilities). In the first year the CFAC will collect metrics and information to determine which cores should be subsidized.

B. Phase 2: Medium-term, Years 2 to 5.

7) Partial support for core director salaries. The SoM will begin phasing in 15% coverage of the core director’s salary for 25 of our core facilities (or 10% salary for between 35 and 40 of our core facilities). The cost of this initiative is $337,500 per year.

8) Centralize recharge-invoicing process. Within two years of the Strategic Plan, the new recharge-invoicing system will have been rolled out to all of the core facilities and modifications in progress to meet the needs of individual cores. We expect the process to be complete and bug-free by year 3. No cost.

9) Strengthen Core Facilities Advocacy Committee (CFAC). By end of Year 2, metrics will be in place to better define evolving roles and responsibilities of CFAC members. No cost.

10) Information gathering for consolidation. By end of Year 2, information gathering on core facilities will be completed. No cost.

11) Consolidate small groups of core facilities. By end of Year 5, small groups of core facilities will have been consolidated in found space or in Taylor/Glaxo Buildings. Cost estimate: $1,080,000 to consolidate 30% or 18 cores (500 sq ft per core).

12) Identify and pursue advantages of scale gained by consolidation. This will be an ongoing process that should save 10% of recharge over time and facilitate translational and basic research at UNC. No cost.

C. Phase 3 (> 5 years)

13) Transition Taylor Hall and Glaxo Building to house core facilities. Years 6 and beyond, renovate space in Taylor and Glaxo and relocate SOM core facilities identified for

consolidation to Taylor and Glaxo. Costs are for renovation at $300 per sq ft.

3. Metrics

1) Our first metric for success with core facilities is the satisfaction of the SOM research base. Satisfaction will be measured from surveys of and meetings with users of the core facilities. The results will be captured in the newly developed core facilities database. We expect to see a substantial rise in the awareness of our core facilities, our core

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facilities website, and satisfaction with our core facility services over the five year period. The metrics will be measured and plotted over time to give a visual readout of progress.

2) We will measure the number of papers and grants contributed to by our core facilities as a measure of the effectiveness of our core facilities and thus the effectiveness of our core facility policies. These metrics will be measured as a result of our increased core facility information gathering and database collection and mining abilities.

3) Metrics for centralization of core facilities management will include stabilization of the finances of our core facilities. This will be measured from monthly financial reports. The level of detail in the financial reports will also indicate success, as a centralized management structure will enable better tracking of cash flow. Other metrics will include the number of core facilities using centralized invoicing and the number of cores using centralized financial services.

4) Consolidation of core facilities will be determined after meeting with stakeholders and CFAC. We expect a 30% reduction over 5 years when new core openings are considered. The metric is easily determined by counting the core facilities detailed on the up-to-date core facilities website. Progress will be lumpy as much time is spent in planning, gaining support, and renovations versus actual consolidation.

5) Merger or Sun-setting process CFAC identifies opportunities from annual reports, monthly surveys of financial

activity & bi-annual user-base satisfaction surveys of each SoM-invested Core Facility.

Proposal is assigned to one of six CFAC subcommittees (Animals, Biochemistry, Clinical, Computational, Genomics, Imaging) and discussed/reviewed with Core Director, faculty director/overseer of Core Facility, and director of complementary Core if merger is warranted.

Proposal should include strategies to recoup equipment and other costs, such as transfer of equipment to other cores or sale.

After information gathering, proposal comes before entire CFAC to decide if merger is warranted, if action plan for re-invigorating core is warranted, if equipment is being properly utilized or could benefit another core, or if sunsetting is indicated

6) The strength of our CFAC is more difficult to measure. Metrics will include number of funding decisions, advice to Dean’s Office, effectiveness of decisions as measured by Dean’s Office, Department Chairs and Center Directors. The effectiveness of CFAC is also measured by the success of our research infrastructure, ability to get grants, recruitments, publications – all dependent on effective infrastructure. More immediate measures are number of meetings with users, core directors, number of reviews, funding decisions, etc.

4. Resources Required (all numbers are in today’s dollars and should be inflation adjusted).

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A. Short-term (< 1 Year):

1) Funding for new Office of Core Research Technologiesa) Required personnel: 1 FTE Business Manager, 1 FTE Director, 0.5 FTE Assistant Dean ($68,750 Buss Mngr, 87,500 Dir, 87,500 Asst Dean): $243,750 annuallyb) Discretionary budget for Office: travel, meetings, marketing materials, core director retreat, CFAC retreat: $20,000 annually

2) Core Facilities Advocacy Committee: Increased supplement @ 10K per year for 6 CFAC members: $60,000 annually

3) Communications: Database development for centralized core facility data collection; See appendix.Programmer salary: 0.5 FTE for 1 year to build customized database: $50,000 one time

4) Support for core director salariesRecommended funding level to support approximately 25 core directors at 15% effort (see chart

below): $337,500 annually (another funding source could be F&A)

B. Medium-term (years 2 to 5)

1) Core Facilities Advocacy Committee: Add two new CFAC committee members: $20,000 annually

2) Central office 1 FTE accounting tech: $50,000 annually

3) Space renovations (funded years 1 - 5): Core moving w/o major renovations costs approx. $120 sq ft. Estimated cost to consolidate 18 cores (30% of 60 cores) @ 500 sq ft per core): $1,080,000: $216,000 annually

4) To facilitate merger/absorption <$20K per Core Faculty of funds [if required])

C. Long-term (>5 years):

1) Taylor Hall renovation, $300 per sq ft****** 2) Accounting FTE and HR FTE for centralized functions: $115,000 annually

Year 1: Total one-time expenses $50,000 Total annual expenses: $661,250Years 2 – 5: Total one-time expenses $10,000 Total annual expenses: $947,250Years >5: continue moving cores to Taylor Total annual expenses: $1,062,250

*****This does not account for costs for major renovations to Taylor and Glaxo Buildings.

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Core Directors Salary Support Chart (to support partial support of core director salaries)Average salary for directors of SOM cores is $70,000 per year, plus 19,600 for benefits (estimated at 28%), for a total personnel expense of $89,600, or round up to $90K to account for increases

# of cores supported % Support

5% 10% 15% 20% 25%

25

112,500.00

225,000.00

*337,500.00

450,000.00

562,500.00

30

135,000.00

270,000.00

405,000.00

540,000.00

675,000.00

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157,500.00

315,000.00

472,500.00

630,000.00

787,500.00

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180,000.00

360,000.00

540,000.00

720,000.00

900,000.00

*Recommended levelHourly breakdown of percent effort

5% 10% 15% 20% 25%annual 93 hrs/yr 187 hrs/ yr 280 hrs /yr 374 hrs/yr 468 hrs/ yrmonth 8 hrs/ mo 16 hrs/ mo 23 hrs/ mo 31 hrs/ mo 39 hrs/ mo

5. Prioritization

A. Short-term recommendations (less than 1 year)1) Open and convene Office of Core Research Technologies2) Fund Positions3) Expand CFAC by one member4) Implement new CFAC salary supplements5) Fund partial support for salaries of core directors6) Develop policy for Recruitment Impact Statement7) Expand Core Facilities Website and avenues of communication8) Create database to capture information from surveys and website

B. Medium-term recommendations (2 to 5 years)1) Centralize invoicing system and offer to all recharge centers.2) Expand CFAC to 8 members.3) Expand central office by 1 accounting tech as we centralize accounting function4) Gather information for consolidation and meet with stakeholders.5) Hold space that becomes available in Taylor and Glaxo Buildings.6) Alter space identified for consolidating core facilities.7) Consolidate 30% of core facilities by year 5.

C. Beyond 5 years

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1) Renovate space in Taylor and Glaxo for core facilities.2) Move cores to Taylor and Glaxo as space becomes available3) Hire core facilities accounting and HR staff for central office.

Initiative 2: Institute a systematic, metric-driven evaluation of existing research platforms to ensure investments efficiently and effectively provide faculty with vital, high quality research resources


– Institute a systematic, metric-driven evaluation of existing research platforms to ensure investments efficiently and effectively provide faculty with vital, high-quality research resources

2. Timing and sequence of activities

– The new programming hire (from initiative I) will develop a database to retrieve and store real-time user satisfaction feedback to aid in evaluation of core facilities (automatic requests, possibly through Sharepoint, will be sent at the time of delivery of goods/services). The programmer will meet with CFAC upon development of the database to provide expertise in the use of this system.

– Bi-annual financials will be obtained for all financial inputs (i.e. recharge account activities, Dept/Center grant/UCRF etc. capital & operating/salary payments outside of Recharge activities, as well as ‘free’ services provided in-kind to payers).

– Conduct bi-annual CFAC meetings (Sept & March) for formal review of survey feedback and financial data (as collected from above tactics), as well as other metrics, to determine the need for future investments in (or the sun-setting or merging of) particular cores and research platforms.

– Conduct annual meeting between SOM leadership and members of the CFAC to provide research vision/directives (to be held in September, before the bi-annual meeting listed above)

3. Metrics

– User feedback: assess user satisfaction with current management, goods& services; assess future needs of clientele that could be provided by core.

– Financial standing: is it in debt? Is the same service available outside at <2x price of UNC core? Is there an opportunity to expand the core (i.e. hire additional staff)?

– Timeliness/locale of service: Does going to outside vendor eliminate advantages to having core here?

– Vision of UNC SOM leadership: Is this a research direction for which the SOM is committed to providing sustained support?

– Practicality of elimination/merger: Does activity need a local core? [e.g., live cell microscopy needs to be near where cells are cultured; certain human samples cannot leave campus/hospital system; live animals are difficult and expensive to transport, etc.]).

– Compliance: If Cores do not comply with timely user survey requests and full financial reporting they will be considered non-compliant or “NC” cores. NC cores will not qualify for SOM/Office of Research Investments/emergency funding. Note that the NC designation simply reflects a lack of

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oversight by SOM (likely because the Core is funded by other mechanisms that warrant autonomy) and is not a reflection of performance.

4. Resources required– No resources are required for initiative 2 as the expenses for the planned hires are incurred in the plan

for initiative 1. – The existing CFAC, along with the new hires, will enable implementation of Initiative 2; the CFAC

will expand to six groups (with the addition of a Computational group chair) to accommodate this additional aspect of the research portfolio.

5. Prioritization

Short-term recommendations (within 6 months)– Immediately hire programmer and accountant to initiate collection of surveys and financials.– Meeting of CFAC members with new hires to establish groundwork and expectations regarding real-

time user survey system and financial reporting system– Initial meeting between SOM leadership and CFAC members to discuss research vision – Individual CFAC groups solicit all cores / research platforms to present user survey system and

financial reporting ideas – cores that do not wish to be subject to these new reporting systems will be considered for “Non-compliant” status

– Regular CFAC meeting will consider each core / research platform as being Compliant or Non-compliant

Intermediate-term recommendations (6 months to 2 yrs)– surveys and financials are provided to CFAC bi-annually– First official ‘bi-annual’ CFAC meeting in March 2013 will use financial information and real-time

user survey information as part of the metrics for core investment or sun-setting decisions– CFAC determines need for investment/merging/sun-setting in subsequent bi-annual meetings and

initiates implementation plan(s)

Long-term (2-5 years)– merging/sun-setting implementation plans completed

Initiative 3: Institutionalize process for evaluating new technologies and resource needs.


Building on the current framework that CFAC has established for evaluating technology requests, we propose an extension of this process to include four distinct streams of requests/investment decisions, as detailed below:Large Investments (Defined as >$500K; involves new faculty hiring and/or considerable space/renovation)

● Funded by SoM Dean’s Office of Research along with UCRF & other UNC/RTP stakeholders (NC TraCS, SoP, SoPH, College, NCSU, Duke, Hamner, inside/outside Triangle); at this level of investment, the idea originator(s) must seek involvement of Medical Foundation for philanthropy/benefactors.

● Annual RFA process (evaluations scheduled for late spring to coincide with recruitment-related requests); 90-day evaluation time.

● Originator can be SoM Dean’s Office, Dept. Chair/Center Director, or group of existing SoM faculty.

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● Formal 2-3 page proposal from idea originator needs initial CFAC approval before being considered at level of SoM Dean’s Office; this initial CFAC approval process will allow for checking whether proposal contains explicit mention of consideration of fit to SoM priorities/competitiveness enhancement. The applicant needs to consider the specific criteria to be evaluated considered by CFAC, including cost of outsourcing.

● Final proposal must include elements of a business plan (including any anticipated needs for subsequent major institutional investment, such as staff costs, service contracts, and informatics infrastructure), mechanisms to attract new users included in budget, description of investment partnerships, timeline for installation and operation, metrics for evaluating performance, potential pitfalls, and route to sustainability, including service contracts

● Proposal is assigned to one of six CFAC subcommittees (Animals, Biochemistry, Clinical, Computational, Genomics, Imaging) and discussed/reviewed with idea originator(s), current SoM faculty expert(s) in proposed technology/platform, outside expert(s) in proposed tech/platform (as required), and SoM Space Committee (as required); and graded using a standardized scale similar to NIH format (scores will be provided to Applicant).

● After information gathering, proposal comes before entire CFAC to evaluate the combination of following criteria:

● Tech/platform is required for UNC research competitiveness & meets UNC research priority● Tech/platform is required for maintaining existing productive faculty &/or

recruiting new faculty● If research can be outsourced to a commercial facility (if exists); cost of outsourcing should be

significantly greater than the cost of purchasing the tech/platform to recommend purchase● Costs for equipment/tech staff/space/faculty recruitment are defined & reasonable● Oversight plan and path to self-sustainability are defined & likely to succeed● Benefits to UNC are clear: Support letters from faculty, departments and centers declare buy-

in & predict high ROI● Opportunities exist for funding applications to NIH Shared Equipment RFAs, NCBC, NSF

Major Research Instrumentation Program, and/or Medical Foundation partnership

Small Investments (Defined as <$500K; might involve new faculty hiring and/or minor space/renovation needs)

● Funded by SoM Dean’s Office of Research along with UCRF & possibly other UNC stakeholders (NC TraCS, SoP, SoPH, College).

● Bi-annual RFA process (with one evaluation in late spring to coincide with recruitment-related requests); 60-day evaluation time.

● Originator can be Directors of existing Cores, Dept. Chair/Center Director, or group of existing SoM faculty.

● Formal 1-2 page proposal from idea originator needs initial CFAC approval before being considered at level of SoM Dean’s Office; this initial CFAC approval process will allow for checking whether proposal contains explicit mention of consideration of fit to SoM priorities/competitiveness enhancement and also outlines a business plan (including any anticipated needs for subsequent major institutional investment), timeline for installation and operation, metrics for evaluating performance, potential pitfalls, and route to sustainability, including incorporation of equipment capital & service costs, any new FTEs, and introduction of fee-for-usage/recharge structure. The applicant needs to consider the specific criteria to be evaluated considered by CFAC, including cost of outsourcing.

● Proposal is assigned to one of six CFAC subcommittees (Animals, Biochemistry, Clinical, Computational, Genomics, Imaging) and discussed/reviewed with idea originator(s) and SoM Space Committee (as required); and graded using a standardized scale similar to NIH format (scores will be provided to Applicant).

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● After information gathering, proposal comes before entire CFAC to evaluate the combination of following criteria:

● Tech/platform is required for UNC research competitiveness & meets UNC research priority

● Tech/platform is required for maintaining existing productive faculty &/orrecruiting new faculty

● If research can be outsourced to a commercial facility (if exists); cost of outsourcing should be significantly greater than the cost of purchasing the tech/platform to recommend purchase

● Costs for equipment/tech staff/space/faculty recruitment are defined & reasonable● Oversight plan and path to self-sustainability are defined & likely to succeed● Benefits to UNC are clear: Support letters from faculty, departments and centers declare buy-

in & predict high ROI● Opportunities exist for funding applications to NIH Shared Equipment RFAs, NCBC, NSF

Major Research Instrumentation Program, and/or Medical Foundation partnership● For core facility applications, proof of compliance with financial reporting and good standing

with OCRT

On-going Maintenance & Transition (Defined as <$50K per Core Facility)

● Funded by SoM Dean’s Office of Research.● Annual reporting from core directors to include: inventory of current equipment, employees funded

by the core, current users, annual financial report.● Monthly consideration of proposals from tech/platform directors; 30-day evaluation time with receipt

of final proposal; consideration requires record of compliance with annual reporting.● Platforms self-identify opportunities for evolution where new investment could reinvigorate an

underperforming Core; CFAC can also identify opportunities from monthly surveys of financial activity & bi-annual user-base satisfaction surveys of each SoM-invested Core Facility.

● Proposal is assigned to one of six CFAC subcommittees (Animals, Biochemistry, Clinical, Computational, Genomics, Imaging) and discussed/reviewed with Core Director and faculty director/overseer of Core Facility; and graded using a standardized scale similar to NIH format (scores will be provided to Applicant).

● After information gathering, proposal comes before entire CFAC to decide:● Costs for equipment/tech staff/space/faculty recruitment are defined & reasonable● Tech/platform is required for UNC research competitiveness &

meets UNC research priority● Tech/platform is required for maintaining existing productive faculty &/or

recruiting new faculty● If research can be outsourced to a commercial facility (if exists); cost of outsourcing should be

>2 times the cost of purchasing the tech/platform to recommend purchase● Oversight plan and path to self-sustainability are defined & likely to succeed● For core facility applications, proof of compliance with financial reporting and good standing

with OCRT

If any one of the previous questions is not answered “Yes”, then proceed to Merger or Sunsetting of Core facility as outlined in Initiative 1.

Strategic Investment

Group of technology oriented faculty and administrators separate from the CFAC but potentially including some CFAC members that would periodically evaluate the state of the institutional environment regarding technology. The goal would be to identify emerging technologies that have not been proposed but are worth investigating, to make sure that the institution is positioning itself advantageously, and ensuring that

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technologies brought to campus promote team, clinical, and translational research. The Committee may generate their own ideas as well as solicit and consider ideas from the SoM community. Allocation of $10-20K budget for travel and consultation.

Rationale for plan designi. Formalized “white paper” RFA response w/ discrete timing eliminates ad hoc & ‘private’ requests

being funded without appropriate prioritization/research of need.ii. On-going maintenance fund accounts for both emergencies to maintain function as well as renewal by

aging technical platforms into newer technologies for competitiveness.iii. Merger/wind-down decision needs to be formalized and revisited annually to avoid crises and serious

deficit-running; funding from the SoM Dean’s Office of Research not intended to cover debts but assist transitions.

Strategic improvements provided by our recommended plan designi. A formalized and transparent approach to new technology investments and research needs that is

based on metric-driven information.ii. Recommendations directly to the Vice Dean for Research for decision, which is made within the

larger context of the SOM Research Plan.

2. Timing and sequence of activitiesWithin 6 months of issuance of the Strategic Plan…

● The current CFAC will grow to a six-member / six-foci group (Animals, Biochemistry, Clinical, Computational, Genetics, Imaging, Genomics) chaired by the Assistant Dean of Core Technologies. Given their expanded and formalized duties as charged by the SoM Dean’s Office of Research, these six members will be compensated $10K per annum for their on-going service to the CFAC (e.g., monthly meetings, RFA issuance, proposal vetting, financial and user-survey analyses, etc.).

● New RFAs will be issued for all 5 funding mechanisms, and applications will be reviewed using new CFAC evaluation system as detailed above.

● Costs for operational aspects of above are currently covered through the Dean’s office and TRACs. Additional funding ($10K-20K/year) would be needed for hiring outside consultants to evaluate Large Investment proposals and to support site visits of peer institutions that have implemented proposed technologies. Additionally, support is needed for a database of Large and Small Investment proposals and potential technologies for proposals. This would allow constituencies that may have common technology interests to identify each other and reduce redundant proposals.

● Assistant Dean of Core Technologies and CFAC members, with full support from the SoM Dean’s Office of Research, will conclude numerous one-on-one consultations with all Department Chairs/Heads, Center Directors, and Core Directors to gauge feasibility for each existing core regarding centralization, relocation, and consolidation activities. Case-by-case decisions will be made for existing cores based on these consultations. Any new cores to be established after issuance of the Strategic Plan will have centralization and location considerations as key issues guided directly by the Dean’s Office of Research via the Assistant Dean of Core Technologies and CFAC involvement.

Within 3 years of issuance of the Strategic Plan…● Stand-alone cores will be reduced substantially from present-day numbers.

Within 5 years of issuance of the Strategic Plan…● Stand-alone cores will be reduced further as needed.

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3. Metricsi. Created core facility or platform nucleus will have its identity acknowledged in all publications

using its technology / resources (to be audited each year) – this requires development of regular, effective, web-based reporting systems for all Cores.

ii. Successful recruitment and retention of faculty tied to the existence of new tech/resources – reported by Chairs / Center Directors to the Dean’s Office of Research.

iii. Securing of competitive funding (NIH Shared Equipment, NCBC, individual R01s, Program grants (U-/P-series), etc.) – reported by faculty and core facility directors to Dean’s Office.

iv. Continued support and enthusiasm indicated in regular user satisfaction surveys (including methods to survey both faculty and staff/student users).

v. Financial reporting – no (or nearly no) deficit running in long-term post-investment (as an indicator of long-term sustainability, to be monitored formally and at least annually, but preferably monthly).

4. Resources required

All resources for Strategy 3 will be required immediately upon Strategic Plan implementation, and are not expected to change significantly within the next 5 years. Requested resources are listed below (total budget = $3.78M/annum) in addition to current CFAC budget resources. This requested funding level will allow CFAC to support approximately 70% of meritorious requests, whereas we are currently only able to fund 10-20% of meritorious requests.

● $60K per annum from Dean’s Office of Research for fractional salary support for six members of CFAC

● $10K-20K per annum for hiring outside consultants to evaluate Large Investment proposals and Strategic Investment Committee proposals, and to support site visits of peer institutions that have implemented proposed technologies.

● $2.5M per annum to fund Large and Strategic Investments (>$500k per award; 3-4 awards)

● $800K per annum to fund Small Investments (<$500k per award; 3-4 awards)

● $400K per annum to fund On-going Maintenance & Transition (<$50K per award; 8-10 awards)

● Note that the annual cost to support creation and maintenance of a database of Large and Small Investment proposals and potential technologies for proposals is included in Initiative 1.

What additional resources may be required, and where might they come from?F&A, NIH Shared Equipment grants, NSF Major Research Instrumentation grants, NCBC grants, Medical Foundation, targeted benefactors, contributions from other stakeholders and partners (e.g., Office of Provost/Chancellor, UNC Arts & Sciences, SoP, SoPH; Duke, NCSU, NCCU), and State legislature budget requests.

5. Prioritization

Short term recommendations (less than 1 year):

– Identify and convene Strategic Investment Committee

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– Implement new CFAC salary supplements

– Assemble and post a database of Large and Small Investment proposals and potential technologies for proposals. This will be aligned with the database proposed in Initiative 1.

– Issue new RFAs for all 5 mechanisms

– Institute scheduled review of submitted applications and make awards

Intermediate and long term recommendations (2-5 years):

– Regularly update database of Large and Small Investment proposals and potential technologies for proposals

– Issue new RFAs for all 5 mechanisms

– Complete review of submitted applications and make awards

Beyond 5 years:– Identify additional recurring funding sources to continue these RFA mechanisms and maintain

excellence

Initiative 4: Ensure the long-term financial stability and health of BBSPThe health and vigor of the graduate programs in biomedical sciences at UNC-CH is critical to the overall vitality of research in the School of Medicine. The reasons for this are clear: research driven by talented young PhD students is the lifeblood of many of the most successful laboratories on campus (particularly many junior investigators). The long-term success of the biomedical graduate programs depends on our ability to identify, recruit and develop the very best applicants to our program. In this regard the Biological and Biomedical Sciences Program (BBSP) has proven to be a great success. Each of the first four years of the program has attracted a larger and more talented and diverse pool of applicants, the competition for offers has become more and more selective, and the pool of students we recruit each year has improved significantly since the implementation of BBSP. For this initiative of Strategic Priority 3 we describe four goals that if achieved will sustain this early momentum and ensure the long-term success of BBSP and our graduate programs.


The primary objective of the four goals described below is to ensure the long-term financial health of our PhD programs by 1) developing an endowment to support BBSP and increasing the number of extramural training grants, and 2) eliminating the departmental/center BBSP “payback” with a fully centralized funding mechanism.Goal 1: Establish an endowment to support BBSP With the establishment of the Office of Graduate Education (OGE) the School of Medicine has developed the leadership and administrative capabilities to begin addressing this important goal in the following ways:

● The SoM needs to build a lasting, working relationship between the OGE and the Medical Foundation and UNC Development office in order to cultivate potential donors from 2 sources:

○ UNC alumni of our BBSP graduate programs.○ Individuals in the Research Triangle Area (or elsewhere) interested in science and in hearing

about the latest advances in biological and biomedical research. These could be people with or without formal scientific training in any discipline.

This effort requires a dedicated “OGE Development Officer (DO)” who will spend ½ time in OGE and ½ time working in the Medical Foundation and Development Office specifically on projects oriented towards this goal, such as:

o A monthly seminar series for public/potential donors

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o New faculty dinners with public/potential donorso A quarterly (2/semester) symposium event for public/potential donors

● The OGE DO will develop and maintain a BBSP alumni database, and interact with the student service managers of all the PhD programs for this purpose.

● LinkedIn and other types of social media will be used to find and stay in touch with BBSP alumni.

● The OGE DO will produce a periodic newsletter and other informational vehicles (e.g. appropriate OGE web page) with content obtained in conjunction with the PhD programs.

Goal 2: Increase our ability to obtain extramural support for graduate trainingThe SoM currently has 13 T32 training grants that in a typical year fund approximately 60-65 2nd year students from BBSP at the standard NIH stipend (which is ~$7,000 less than our current stipend). While this is excellent, important areas of training where Carolina has strength are not covered by T32 funds, including cell and molecular biology and developmental biology. New NIH T32 training grants would move us toward getting all of the first 2 years of graduate training covered by non-PI funds and thus increase the pool of potential “homes” for BBSP students, thereby making us more attractive to applicants. To do this we will:

● Provide seed money for planning and submitting new T32 applications as follows:○ Salary supplement for potential T32 PIs○ Funds for topical symposia to stimulate new T32 ideas

● Develop an RFA mechanism with a specific time during the year for people to apply to the OGE for T32 seed money.

● Plan for two such seed grants per year.

○ This includes resurrection of previous T32 applications (e.g. DB and CMB) that do not need major overhauls but have exhausted A1 submission.

Goal 3: Acquire a budget for summer rotations of entering BBSP students An ability to recruit the best students is necessary for the long-term success of BBSP and our graduate programs. With tightened research dollars, more faculty are reluctant to support summer rotation students. Summer rotations need to be a viable option for BBSP, because without them we are at a competitive disadvantage relative to our peer institutions for recruitment of the top students.

● Provide funds to cover up to 20 summer rotation students each year.

Goal 4: Eliminate the department payback for BBSP: As an umbrella program, BBSP provides funding for students during their first year prior to their matriculation into a particular lab and PhD program. As students join laboratories a combination of training grant (T32) and PI (R01) grant support is used to finance the students. A component of the BBSP budget (~30%) is currently funded by a “payback” by participating Schools, Departments, and Centers. The payback amount is calculated based on the average number of students that matriculate into each unit over a three-year period.

● Eliminate the payback because:○ It is a significant but variable burden on department and center budgets.

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○ The current payback mechanism is highly inefficient. Eliminating it would greatly reduce the time spent by OGE on the calculations of the fractional contributions from departments, and greatly reduced the time and effort spent trying to collect these contributions.

○ This effort could be redirected toward programmatic and fund raising efforts by the OGE.○ It will promote a positive relationship between BBSP and department chairs and center

directors when setting targets for BBSP admission and recruitment based on scientific and programmatic needs.

● Two possible mechanisms for eliminating the payback are:

○ “Wean” the departments from providing payback by gradually retaining a portion of departmental funds allocated by the Dean’s office over a 5-year period. During each of these years a portion of the reduced departmental budget will be covered by strategic plan funds. Each year the amount of offsetting SP funds will be reduced, as will the departmental BBSP payback, such that after 5 years the department will receive a reduced overall budget from the Dean’s office, but have no BBSP payback. In the end, the net change in cost to the SoM should be zero.

○ Use any new monies coming into the SoM to begin reducing the BBSP payback bill such that by 5 years the coverage of BBSP from the Dean’s office will increase from ~70% to 100% of the funds not contributed by other participating school’s share (i.e. College and SoP).

● In the absence of eliminating the payback it should be capped to reduce the budget uncertainty for departments and centers, and cost increases due to changes in the BBSP budget would be covered by the Dean’s office.

● Since other UNC-CH schools draw students from the BBSP pool, a goal of the SoM should be to work to obtain central campus funding proportional to the number of matriculating students in units other that the SoM.

2. Timing and sequence of activitiesGoal 1:

● Year 1: Hire and train a development and public relations staff member.

● Year 1: Host the 5 year BBSP alumni celebration of graduate research past and present to kick off our development campaign.

● Years 1-2: Develop a web site and other related database tools.

● Years 2-5: Host development program activities, and cultivate relationships.

Goal 2:● Years 1-2: Recruit 2-4 faculty to organize new T32 submissions.● Years 1-2: Host organizing symposia for new T32 topics.● Years 3-5: Submit and resubmit as necessary 3-5 new T32 applications.

Goal 3:● Establish the budget in year 1 and maintain for years 2-5.

Goal 4:● Years 1: Cap the payback amount and calculate weaning mechanism.

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● Years 2-5: Gradually acquire greater fraction of BBSP cost centrally.

3. MetricsGoal 1:

● Difficult to anticipate with any precision what kind of money would come in.

● After 2 years we hope to have established an engaged alumni database and have begun fundraising events like a topical symposium for alumni and a series of informal science evenings for patrons and alumni.

● Years 3-5 continue events and see fruits of relationship building in dollar returns; expand the network of donors, with help from the development office.

● By year 5 both the number and amount (total and per capita) should be increasing.

Goal 2:● By year 2 we should have submitted at least 2 new T32 applications.

● Years 3-5: at least 1 successfully funded new T32 for every 3 submitted using seed money.

● By year 5 we cover a greater fraction of all of our second year students. (Note: there will always be a fraction of students that are not eligible for T32 support either because they are foreign or because their area of research is not covered by one of the T32s.)

Goal 3:● Maintain or even improve the quality of students that we recruit as measured by:

○ GRE, GPA, research experience, undergrad institution○ our “reciprocal take rate” against specific rival institutions that have also admitted the student

Goal 4:By year 5 all SoM departments and centers will no longer have a BBSP bill and all of the first year PhD students will be funded centrally through the Dean’s office from Aug 15 matriculation to June 15 of the following year.

4. Resources required

Goal 1: $100K including one FTE:

Alumni database softwareSalary and FringeFunds for donor events

Goal 2:Salary supplement for potential T32 PIs at $5K/PIFunds for topical symposia to stimulate new T32 ideas: $10K/symposiumPlan for two such seed grants per year for a total cost of $30K/year.

Goal 3:$50,000/year would fund 20 summer rotation students.

Goal 4:

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The departments and centers provide approximately $1.5 million of the BBSP budget via the payback. Therefore we need $300K/year cumulative over 5 years to eliminate the payback.

The grand total for SP3 initiative 4 is $480,000 per year.

5. Prioritization

Priority 1 is setting up the Endowment Fund, Priority 2 is increasing T32s, Priority 3 is eliminating payback, Priority 4 is paying for summer rotations.

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Appendix (Research SP 3)

It is essential to obtain data to inform the direction that the SOM will move in coming years. This includes information about developing technologies that researchers are likely to desire in the future as well as new research avenues that are expected to be of increasing interest. This information is needed by the administration to appropriately plan for expected new needs but would also help our faculty identify new resources and collaborators which can strengthen their research programs. Traditionally this kind of information has been obtained through seminars, symposia, targeted work groups tasked to assess new directions and informal conversations in the hallway. However as the university grows in physical footprint as well as by increasing the size and diversity of faculty interests, the ability to obtain this information on a timely basis grows increasingly difficult.

We propose to create an electronic UNC research meeting place containing a searchable database of new technology and research avenues. The database will be developed in two phases. First, we will survey all UNC core directors to identify new technology that they feel could be of interest to UNC researchers. Since core directors are experts in their field, they should be conversant with the latest developments including breakthroughs that are not yet commercially available or widely publicized. Thus this survey will be expected to collect information about technology not currently accessible at UNC which may currently have low current but great incipient interest. The Office of Translational Technology in the SOM Office of Research conducts an annual survey of core facility operations. New, more forward looking questions will be added to this survey to encourage core directors to identify novel, groundbreaking technologies for future consideration.

Results from the core survey will be made available to all SOM faculty in searchable format by access through their ONYEN ID as a starting point for identifying new directions of interest to them. Next we will survey all research faculty for information about new technology that they are interested in accessing. Since we will be asking our faculty to disclose sensitive information about their thoughts for future directions, it will be essential that all information collected be treated as confidential. The combined results of these two surveys will be collated and cross referenced. This will, for the first time, give SOM detailed predictive information regarding expected trends in technology usage at UNC. By making this searchable and available on a confidential basis, this will also create a new mechanism for UNC faculty to identify other researchers with unsuspected similar interests in new, rapidly developing areas.

While this proposal is focused on the research interests of SOM faculty, it would be greatly strengthened by inclusion of research faculty from the other life sciences schools as well in order to increase the breadth and depth of the resulting resource.

Resources needed:

1. For a database developer, I would recommend a range of Applications Analyst Journey. The current pay range for that level is $61,668 to $75,797. Adding 21% benefits brings the range up to $74,618 to $91,714. This is likely to be either a part time position combined with a part time librarian position (below) or full time combining both positions depending on the individual.

2. OIS provides a secure database service that includes space on our Microsoft SQL Server that is behind a hardware firewall and is configured for Transparent Data Encryption (TDE). TDE automatically encrypts the entire database with no specific programming requirements. We charge $2400 per year for this service. As we move forward with the SOM IT Strategic Plan, I would expect those costs to decrease, assuming that systems are consolidated and centralized.

3. Librarian or data management professional to aid in accessing information for faculty. An entry level librarian position would be expected to start at ~$45,000 plus benefits would be ~$54,450 for a full time position. Thus maximum costs for this proposal should be ~$150K but are likely to be less than $100K.

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Education

Strategic Priority 1: Restructure the curriculum to prepare students to be leaders of 21st century medicine

Education Strategic Priority 1 Team Report


Julie Byerley, MD PediatricsMarcia Hobbs, PhD Medicine and Microbiology and ImmunologyCarol Otey, PhD Cell and Molecular PhysiologyAlice Chuang, MD Obstetrics and GynecologyTrisha White Family Medicine, CMCKurt Gilliland, PhD Cell and Developmental BiologyDeb Bynum, MD MedicineFrank Church, PhD Pathology and Laboratory MedicineNick Shaheen, MD MedicineAnthony Charles, MD, MPH SurgeryJeff Heck, MD Family Medicine, MAHECErin Malloy, MD PsychiatryLiz Dreesen, MD SurgeryLarry Marks, MD Radiation Oncology

Leeanne Walker, JD; Operations Committee representativeWarren Newton, MD; Oversight Committee leader

“Restructure the curriculum to prepare students to be leaders of 21st century medicine.”

Initiative 1: Enhance the students’ learning of the basic sciences and provide enhanced clinical learning opportunities for students cross the curriculum.

Initiative 2: Promote and develop additional active learning opportunities. Initiative 3: Introduce mechanisms that allow students to focus their educational experience

and meet personalized learning goals. Initiative 4: Add longitudinal elements in the clinical curriculum that shift more training

towards ambulatory care. Initiative 5: Establish a Medical Education Innovation Fund to seed innovative education

programs.

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SOM Strategic Plan Implementation—Education SP 1: Plan ElementsInitiatives:

1. Enhance students’ learning of the basic sciences and provide enhanced clinical learning opportunities for students across the curriculum.

Tactics to Achieve Initiatives: Restructure the basic science curriculum to allow earlier direct patient care experiences

(replace current first and second year with 18 month preclinical curriculum, followed by core clinical and advanced clinical curriculum)

o Organize 18 month preclinical curriculum by organ systems, combining normal physiology and abnormal pathology for each block

o Anatomy to run throughout (starting later), coordinating with block courseso Clinical skills course to coordinate and run concurrently with block courseso Combine CC1 and CC2 into one group that regularly meets and shares ideaso Visit schools that currently have this modelo We recognize that moving from 2 years to 18 months for the preclinical curriculum will

be challenging and difficult for faculty who are passionate about their area of teaching and expertise. In order to move forward quickly with this significant change to the curricular structure, we propose the appointment of a “Grand Master” or czar to oversee this process. This person would need to be familiar with the system, but ideally not biased or overly committed to any single aspect of the curriculum. We would anticipate 40% of this individual’s time being dedicated to this mission. In addition, there should be several “generals” who assist in the execution of decisions made.

o For the transition year, course directors will require either more salary support or an additional co-director.

o Centralize administration and scheduling for all block courses and clerkships

Enhance Step 1 performance through optional board review class and Step 1 –like NBME practice exams

o Initiate Step 1 practice examso Create optional board review class

Develop new educational programming on translational medicine required of all third and fourth year students

o Consider the development of online modules that would allow for more individualized curriculum focused around basic science integration

Provide opportunities for medical students to develop the ability to work in diverse teams to provide patient care by leveraging the diverse set of health professions on campus

2. Promote and develop additional active learning opportunities.

Tactics to Achieve Initiative: Development of interactive large-group instruction

o Techniques include, but are not limited to, the use of audience response system (ARS), case-method teaching, patient demonstrations, and interactive lecture techniques such as “buzz groups.” The School of Medicine must consider interactive large-group sessions

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as it considers active learning and should set a target that 25% of large groups should have an interactive component.

Development of modules for independent learning o Faculty often suggest that they do not have time to add interactive components to their

large-group sessions because they need all of the existing minutes for “lecture.” Therefore, faculty must consider moving mundane instruction out of their large-group sessions and into online modules so that students may focus on that material independently while spending their time in large groups in a more productive, interactive manner. Each course should strive to develop one set of modules that possibly encompass a particular theme.

Shift from large-group to small-group learningo This shift must happen somewhat organically on a course-by-course basis, although the

shift cannot happen without invested course leadership. In a new curriculum with new courses (with possibly different combinations of disciplines than are currently present), it is imperative that the “block leader” be experienced with respect to active forms of small-group learning.

Promoting active learning and consistency in MS2 small groupso Create a group of Clinical Teaching Champions to work collaboratively with the

established teaching champions provide consistency from course to course, implement new teaching techniques and coordinate experts who spend only limited time in course small groups

Enrich small groups by addition of team-based learning (TBL) Recognize that current small groups may become more active WITHOUT adding pure

team-based learning (TBL)o Small groups may become more active simply by having an advance reading assignment,

short quiz at the beginning of the session, and requirement that students work in pre-formed groups.

3. Introduce mechanisms that allow students to focus their educational experience and meet personalized learning goals.

Tactics to Achieve Initiatives: Develop voluntary tracks

o Establish four areas of focus for educational tracks – medical education, global health, rural/community medicine, clinician-scientist

o Create Executive Task Force/Oversight Committee for entire track programo Identify physician champion to oversee each tracko Develop/recruit individuals to serve on Educational Track (ET) task force/oversight

committee for each track For the tracking system, we expect that between a tenth and a quarter

FTE per mentor, with several mentors per track, would allow mentorship for students pursuing the track. This approach would remove some of the current burden of career counseling from our advisor system, allowing students to garner multiple opinions.

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o Identify existing curricular elements available to support each track While the curricular requirements of the tracks will initially be fulfilled by

utilizing courses that are already in existence, there will ultimately be a need to address potential curricular deficiencies and further develop additional curricular elements that may better support each track

Define requirements for application, acceptance, timeline, and successful completion of the track

o Develop method for review and evaluation of scholarly projectso Identify personnel who will be responsible for review and evaluation of projectso Recognize elective summative projects, and provide acknowledgement of that extra work

Mentor and reader evaluate projects Result in a differentiated “Graduation with Thesis” status at graduation

Provide administrative support After a 3-year trial period for both of these experiences, decide if tracking should be

required. This decision will be based on an objective assessment of student enrollment and performance, as well as subjective measures of student and faculty satisfaction.

4. Add longitudinal elements in the clinical curriculum that shift more training towards ambulatory care.

We recommend a pilot project in which 20 students would participate in a third year curriculum that would include Outpatient Medicine, Family Medicine, ambulatory components of Pediatrics, and exposure to undifferentiated acute care in the emergency department in a longitudinal form instead of block form. If successful, this could spread to whole class.

Tactics to Achieve Initiatives: Select and fund faculty, educator and administrative staff to engage in planning the

yearly calendar, curriculum, evaluation methods Recruit physicians/practices to host the pilot students Fund physician hosts for longitudinal sites Identify impact of changed calendar on the block clerkships and their capacity Identify impact on education of pilot students, the functioning of the host practices,

and the organization of blocks

5. Establish a Medical Education Innovation Fund to seed innovative education programs.

Tactics to Achieve Initiatives: Choose person(s) to meet with David Anderson at Medical Foundation to begin

discussion Work together with Medical Foundation personnel to develop a description of a Medical

Education Innovation Fundo Ideally would provide competitive seed funding to faculty to experience with new

approaches in medical education in line with the strategic plan

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o Housed in the Dean’s Office versus the Academy of Educatorso Available for SOM and/or GME projectso Awarded annuallyo Results widely shared

Medical Foundation develop philanthropic support of fund

SOM Strategic Plan Implementation—Education SP 1: Timing and Sequence of Activities


2012: Visit schools with 18 month pre-clinical scheduling system Beginning combining CC 1 and CC 2 into one pre-clinical curricular group, begin

discussions on integration of material Determine who to appoint as “Grand Master” and “generals” Plan for another customized Step 1-like NBME practice exam for 2012-2013 school year

(pilot of practice Step 1 in spring 2012 was very successful) Set target for interactive large-group instruction that 25% of large groups should have an

interactive component by 2013-14 Begin developing modules for independent learning—each course should strive to develop

one set of modules that possibly encompass a particular theme by 2013-14 Begin promoting active learning and consistency in MS2 small group Enrich small groups by addition of TBL Explore ways in which current small groups may become more active without adding TBL

(e.g., advanced reading assignments, short quiz at beginning of session; working in preformed groups)

Work on making curriculum more integrated with “feed forward” mechanisms with goal of categorized index by Fall 2013 (cases need to be cataloged, tracked and indexed with the “UNC 96 Diseases”)

Create executive task force/oversight committee for entire track program and begin developing voluntary tracks

Identify physician champion to oversee each of the four tracks Develop/recruit individuals to serve on Educational Track (ET) task force/oversight

committee for each track Identify existing curricular elements available to support each track Identify/hire faculty, administrative assistant and educator for longitudinal pilot Develop a student focus group to participate in development of longitudinal plan Longitudinal faculty planners to work with CC3-4 to identify impact of longitudinal

curriculum pilot on blocks; create capacity to replace capacity lost in blocks; (September-December 2012)

Longitudinal faculty to work with student focus group to address concerns re logistics (housing, transportation) as well as impact of longitudinal participation on students’ choice of block locations (September-December 2012)

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Educator and longitudinal faculty to create and beta test didactic material for longitudinal curriculum (September-December 2012)

Once CC3-4 approve plan, longitudinal faculty and administrative staff will publicize program to students and develop an application process and methods for selecting students (September-December 2012)

Longitudinal faculty and Dean and administrator develop recruitment plan for identification of host physician/practices (September-December 2012)

Strategic planning steering committee chooses person(s) to meet with David Anderson at Medical Foundation to begin discussion about teaching innovation fund

2013: Begin to plan for curricular and scheduling changes with grand master, generals, course

directors and oversight committee Begin centralization of administration and scheduling for block courses Administer Step 1-like NBME practice exam 25% of large groups should have an interactive component by 2013-14 Each course should have developed one set of modules for independent learning by 2013-14

Further plan for active learning and consistency in MS2 small groups—6 clinical teaching champions to be in place by Fall of 2014

Categorized index by Fall 2013 (cases that are used in small groups need to be cataloged, tracked and indexed with the “UNC 96 Diseases”)

Identification of faculty who are willing and able to serve as mentors to students involved in educational tracks

Identify an administrative support person for each of the tracks to manage and oversee all aspects of the program (March 2013)

Define requirements for application and acceptance into Tracks program (March 2013) January 2013: recruit students for the longitudinal pilot February-March 2013 decide on metrics for evaluation of program and evaluation tools April-June 2013 orientation for new preceptors and students July 2013 – students start longitudinal curriculum Medical Foundation explore philanthropic support of teaching innovation fund

2014: Initiate new curriculum and scheduling 6 clinical teaching champions in place by Fall of 2014 to aid in active learning and consistency Fall 2014 – evaluate longitudinal pilot Possible expansion of longitudinal component to entire medical student class, possibly in

conjunction with expanded 18 month clinical curriculum First Medical Education Innovation Grants awarded

2015: Consider multiple practice exams during course of first two years

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Address potential curricular deficiencies and further develop additional curricular elements that may better support each track—create additional courses and curricular activities that will make the track experience more robust for students (end of 2015)

2016: Evaluate curricular change Expand longitudinal opportunities

2017: Evaluate curricular change Expand longitudinal opportunities

SOM Strategic Plan Implementation—Education SP 1: Returns/Values/Metrics

What returns/values do we expect and how will we measure?

Initiative 1 (Restructuring the Curriculum)– Restructure the basic science curriculum to allow earlier direct patient care experiences

1. NBME/shelf exam scores2. Step 1 and 2 exam scores3. Residency match information4. Graduation survey5. Student satisfaction and feedback6. Faculty satisfaction and feedback

– Leverage new technologies to support efficient delivery of curricula1. Measure the presence of the modules2. Measure the large group time in face to face curriculum delivery

– Add components that integrate basic science concepts into the clinical curriculum and develop skills in translational research

1. Measure the presence of these opportunities– Develop new educational programming on translational medicine required of all third and

fourth year students1. Measure the presence of these opportunities

– Provide opportunities for medical students to develop the ability to work in diverse teams to provide patient care by leveraging the diverse set of health professions on campus

1. Measure the presence of these opportunities

Initiative 2 (Active Learning)– Faculty peer review of talented large-group leaders – Large group versus small group learning time– Faculty development opportunities, presented by AOE– Use of fewer lecturers in courses

Initiative 3 (Tracks)– Number (#) of students who apply to program

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– Number (#) of students who are enrolled in program– Proportion (%) of enrolled students who select each of the four tracks– Proportion (%) of enrolled students who opt to complete a thesis or scholarly project– Student track satisfaction: Proportion of students who are generally satisfied with overall

program experience (incorporate subjective and qualitative measures of student satisfaction)– Student Mentoring satisfaction: Proportion of students who are generally satisfied with

mentoring experience (incorporate subjective and qualitative measures of student satisfaction)– Faculty Mentoring satisfaction: Proportion of faculty who are generally satisfied with

mentoring experience– Monitor academic performance of students enrolled– Track percentage of enrolled students in top percentage of class (15% for MS2 year, 25% of

MS3 year, Junior AOA, Senior AOA, graduation with distinction, etc)

Initiative 4 (Longitudinal Elements)Metrics for this initiative are related to students, preceptors, clerkship faculty and overall patient care and patient satisfaction. Additionally, metrics for the longitudinal ambulatory curriculum should include those related to mastering skills and knowledge related to ambulatory care as well as those related to the other areas of their clinical education.

– For the pilot year 2013-14, metrics related to student progress would include NBME subtest scores not only in Family Medicine, Outpatient Medicine and Pediatrics, but in all the other clerkship areas as well. Performance could be compared with students in the traditional curriculum.

– Similarly, performance in content areas of the USMLE Step 2 CK exam as well as the USMLE Step 2 CS performance could be tracked and compared to the traditional curriculum.

– The student Clinical Logs based on the Core 96 and SOM Competencies would be an important way to track student clinical experiences.

– Student satisfaction could be assessed using the common clerkship evaluation form along with an addendum specific to the longitudinal outpatient week experiences and learning activities.

– Surveying the preceptors involved in the longitudinal ambulatory clerkship as to the primary goals of the experience—continuity of care, continuity of student, precepting issues, identification of appropriate longitudinal patients, etc.—will be useful. Comparison where applicable for precepting students in the traditional clerkship model is advised.

– All clerkship directors should be charged with gathering data in terms of feasibility, educational experience for the students when not at the outpatient sites, and comparison of experiences and clinical evaluations, other means of evaluating students (e.g. departmental exams, OSCE’s, oral exams) with those in the traditional clerkship.

– Lastly, it would be useful to include patient data: are patients following up with the student when the student returned to clinic? Patient satisfaction with student participation in care in this model compared to the traditional model is recommended.

– As the program expands to all students, elimination of collection of comparison data would occur. However, further data collection could be compared with data that had been collected with the traditional model.

– Costs will need to be closely tracked; particularly in negotiating the value of the model of precepting compared to the traditional model.

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Initiative 5 (Medical Innovation Teaching Fund)– Establishment of fund– Goal $10,000 of annual award by 2014– Goal $50,000 of annual award, all supported by philanthropy, by 2020

SOM Strategic Plan Implementation—Education SP 1: Resources Required


Initiative 1:

Costs of site visits and/or videoconferencing: $10,000 New Block Directors: $1,225,120

o 3.8 FTE /year, 10% of 38 faculty teachers: estimated FTE cost of $ 130,000 per teacher, this amounts to $494,000 in direct salary support, with a fringe of 24% $612,560 per year for a total cost of $1,225,120

Administrative Costs: $ 150,000 Grand Master for oversight: $ 100,000

o 40% salary support Directors/Generals salary support: $ 100,000 Step 1-like NBME practice exam: $24,000

o $8,000 per testing entire class

Sub-total: $1,609,120.00

Initiative 2: Active Learning

Development of interactive large-group instruction: $0 (falls with AOE budget) Development of modules for independent learning: $10,000/year for 2 years (staff time of

Katie Smith) Promoting active learning by hiring 6 clinical teaching champions:

$204,000/year o Using the NIH salary cap of $170,000, the maximum total cost of this program per year

would be $204,000. Addition of team-based learning (TBL): $0 (falls within AOE budget)

Sub-total: $214,000.00

Initiative 3: Tracks

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Faculty mentors: $850,000o Cost 1 - Faculty sponsors of tracks – 0.25 FTE faculty in charge of each track to

develop requirements, potentially develop content, market tracks, mentor. Four tracks to start program, 0.25 FTE, so total of 1.0 FTE. Using the NIH salary cap of $170,000, the maximum total cost per year would be $170,000.

o Cost 2 - Faculty time (if believe need to compensate faculty mentors) – assumes 0.05 FTE required per student, assumes half of class tracks (so ~80 students), Using the NIH salary cap of $170,000, the maximum total cost per year would be $680,000.

Administrative support: $100,000o Assumes 0.5FTE administrative support per track. Four tracks to start program. $50K

average admin salary. Implies total cost of $100K annually.

Sub-total: $950,000.00

Initiative 4: Longitudinal Elements

Ambulatory Preceptors: $90,000o We recommend funding a pilot of 20 students. Preceptor costs per student are

$4500/student/year. A pilot of 20 students would be expected to cost $90,000 in preceptor costs. When compensation is based on decreased productivity or increased time spent, then a preceptor should be reimbursed $225,000 (estimated average general internist salary five years into practice)/5(they have a student 1/5 weeks) x10% (decrease in productivity) = $4500/student/year. However, some resources already flow through OME to support preceptors, so the incremental cost may be less (depending on how much current funding would be tasked to this program).

Curriculum Development: $170,000o 1.0 faculty FTE at $170,000, (that may be shared amongst course leaders in the

contributors to the course including Family Medicine, Internal Medicine, Pediatrics, and Emergency Medicine to #1, develop and implement the curricular content, #2, develop and implement an evaluation plan to study outcomes of the pilot students in both the longitudinal and traditional parts of the curriculum (as the traditional parts are now being fragmented) and compare outcomes with the traditional UNC students as well as the longitudinal students in Asheville and Charlotte, #3 recruit and develop the preceptors, #4 oversee the development of patient panels, #5 recruit, orient, and monitor the students, #6 increase awareness among all faculty to accommodate the longitudinal aspects which may occasionally disrupt the traditional clerkships, #7 develop the didactic curriculum to have a unique themes based on faculty’s interests and UNC SOM priorities, and #8 consider developing an evening or weekend element so students can have exposure to acute undifferentiated patients in the emergency department setting

Scheduling Coordinator: $47,200.00o This plan will require dedicated coordination beyond that currently available in SOM.

Published reports of successful longitudinal curriculum implementation consistently identify this as a critical area of need. We would propose a full FTE of a coordinator at approximately $40,000/yr, with 18% fringe, for a cost of $47,200.

0.2 FTE of PhD-level biostatistician: $21,960

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o Assessment of outcomes: Quantitative analysis of outcomes of this program is essential to understand its value and impact. We propose 0.2 FTE of a PhD level biostatistician, at $90,000 per FTE, and 22% fringe, for a total of $21,960.

Sub-total: $329,160.00

Initiative 5: Medical Education Innovation Fund

Falls within Medical Foundation budget assuming no strategic funds used prior to philanthropy

GRAND TOTAL: $3,102,280.00

SOM Strategic Plan Implementation—Education SP 1: Resources Required (con’t.)


Initiative 1: Updating Curriculum Faculty buy in and willingness to collaborate “Grand Master” to oversee this process “Generals” to assist in the execution of decisions Combining of CC1 and CC2 Centralization of administration and scheduling for all block courses

Initiative 2: Active Learning As above

Initiative 3: Tracks New branch of OME to monitor and provide oversight, as outlined in tactics

Initiative 4: Longitudinal Elements New branch of OME to monitor and provide oversight, as outlined in tactics

Initiative 5: Medical Education Innovation Fund No new structure required if AOE administers award New structure outside of AOE could be created

SOM Strategic Plan Implementation—Education SP 1: Prioritization

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What is most essential? What activities/expenses can be phased? (Recommendations prioritized within the SP group; individual recommendation elements prioritized where appropriate; recommendations prioritized as to short-term (>1 yr.), intermediate (2-3 yrs.) and long-term (4-5 yrs.))

1. Our group achieved consensus that most important is Initiative 1, adjusting the curriculum calendar and integrating the basic sciences. This is expensive upfront but will not be expensive forever.

2. We agreed that it makes sense to address the other initiatives concurrently – for example, active learning must be increased for the new curricular calendar to be effective ,and developing tracks is easily accomplished as the calendar is revised.

3. Initiative 5 (the medical education innovation fund) is perceived as low hanging fruit that is not costly, and therefore is a “just do it” item.

4. Implementing an additional longitudinal curriculum is maintained as crucial to becoming the nation’s leading public medical school. This was perceived as being the most challenging initiative in SP1, but nonetheless absolutely worthwhile. The pilot program proposed should be implemented as the clinical calendar is revised.

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Strategic Priority 2: Optimize student recruitment and admission practices and programs to provide physicians needed for North Carolina and the nation



Tom Bacon, DrPh AHECErin Fraher, PhD, MPP Surgery, Family Medicine, ShepsJohn Perry, MD Medicine, AHECSue Slatkoff, MD Family MedicineCedric Bright, MD MedicineWilliam Mills, MD, MPH PediatricsJack Naftel, MD PsychiatryJim McDeavitt, MD CMCKenya McNeal-Trice, MD PediatricsRuss Harris, MD, MPH MedicineWill Poe MS4Don Pathman Family Medicine, Sheps


“Optimize student recruitment and admission practices and programs to provide physicians needed for North Carolina and the nation.”

Initiative 1: Establish specific, measurable and achievable goals for training physicians to serve the needs of North Carolina, the US and beyond.

Initiative 2: Establish and support recruitment and admission practices and programs that support institutional goals.

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School of Medicine Strategic PlanStrategic Priority 2 Education

Strategic Priority 2: Optimize student recruitment and admission practices and programs to provide physicians needed for the state of North Carolina and national leaders, in order to meet our goal of being the nation’s leading public medical school.

Initiative 1: Establish specific measurable and achievable goals for training physicians to serve the needs of North Carolina, the US and beyond.

Plan Design Elements- Committee recommends developing a taxonomy of measures (see Appendix A), but first

needs to define process for coming up with how to establish specific measures; committee recommends pulling together group of key leaders, including graduates, to determine outcome measures to be used; need to compare with other medical schools in order to benchmark each of the measures.

- The ultimate goal is to track career choices of graduates and the extent to which those career choices benefit the health of the people of North Carolina and beyond, in terms of improved access to care, improved quality care, and research to benefit improved health care outcomes; as such the committee recommends establishing a more robust database on students from the time they are admitted to the medical school; this database would include not only demographic and career choice data, but also attitudinal data, such as student attitudes towards caring for the underserved; survey data are already collected through various school and national student surveys and can be part of the record on individual students; additional data will be tracked over time and surveys of graduates will be incorporated into the tracking system.

- Sources of date will include responses to surveys conducted by the SOM, the AAMC and others both during and after medical school, AMA master file data, North Carolina licensure data, and in-depth sample interviews taken on a selected number of graduates on a regular basis.

- A critical element of such a system is the infrastructure to manage a robust data system on students and graduates of the medical school; the basic infrastructure currently exists at the Sheps Center, and can be utilized, but would clearly need additional resources to manage a large and complex data system as proposed by the committee; this will require at least one more full time staff person to track state and national data, and faculty time to conduct analyses and prepare reports.

- Committee recommends two additional critical elements to achieve a greater impact of graduates on improved health for the people of NC and beyond; first is a review of admissions practices to assure that the students admitted are the right mix of intellect, interpersonal skills and commitment to service; the students admitted should have the characteristics as a group to most likely achieve the outcomes desired by the people of the state to improve the health of the people.

- Committee also recommends enhanced opportunities for students to be engaged in service to underserved populations in NC, to provide balance to the excellent global health options available to students; opportunities can include engagement in primary care service, population health projects, and research on the needs of the NC population; students need

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to be engaged in innovative initiatives in NC to gain experience with these populations and to appreciate the opportunities and rewards of service to the people of the state. Such a program could be housed in the UNC Program on Prevention, which also houses the MD/MPH Program, and which is already engaged in placing those students at sites in North Carolina for practicum experiences. It would require an additional FTE staff person, faculty leadership time, and travel funds.

Timing and Sequence of Activities- July – December 2012

o Convene Oversight Committee to develop proposed outcome measures for the school, in close collaboration with the Vice Dean for Education and the Executive Dean.

- January 1 – June 30, 2013 o Finalize measures and further define staffing needs for developing data system to track

graduates, including capacity to survey students and graduates on an occasional basis.o Oversee project through the Outcomes of Medical Education Project under the Vice

Dean for Education; contract with Sheps Center to develop data system.o Initiate planning for program on engaged service to underserved communities in North

Carolina.- July 1, 2013 – June 2014

o Employ staff and fully implement new career tracking data system on medical students and graduates.

o Implement plans for program on student engagement in service opportunities in North Carolina.

Metrics- Outcome measures for graduates will be developed as part of the process over the 2012-

2013 year. These will include, but are not limited to o Specialty choice and percentage entering highly needed specialties,o Location of practice, with an emphasis on remaining in NC and practicing in high

need areas and serving high need populations,o Leadership measures including filling leadership roles at community level, in

academia and at national levels, ando Success in research in terms of independent funding and number and percent of

graduates in principal investigator roles.- Process measures for progress on this project can include the production of annual reports

on location of graduates, and where available, changing attitudes of graduates; given current resources, annual reports on the location of graduates of selected classes or groups of classes can currently be produced with a modest increase in resources to cover some of the programming and analysis costs.

Resources Required- As noted above, two FTE professional staff level positions will be required;

1) One FTE staff ($75K plus benefits) with experience in workforce data management and analysis and in report writing, to work on data project.

2) One FTE staff ($75K plus benefits) for the program on engaging students in serving underserved communities in North Carolina.

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- Additional funding for non-personnel costs, including contracting for programming, IT, and space; estimated cost $50,000 per year.

- Travel of $25,000 per year for students engaged in service and for faculty oversight.- Faculty time for directing the data outcomes project and additional faculty time for the NC

student service project (.25 FTE for each initiative); annual cost = $80,000.- Total annual cost = $335,000 per year (plus time for oversight of the process by senior

leadership in the SOM).

Prioritization To be determined

Initiative 2: Establish and support recruitment and admission practices in programs that support institutional goals.

A. Expand the Medical Education Development (MED) program

Plan Design Elements

- SOM strategic plan recommends increasing MED from 80 students to 120 (50% increase) in order to expand the pool of underrepresented and disadvantaged students who are prepared to enter UNC Schools of Medicine and Dentistry and other health professions schools in North Carolina and beyond.

- Staff of MED, after careful consideration, and after reviewing current outcomes of MED, recommended changes in MED program to increase the likelihood that participating will succeed in medical school rather than increasing the numbers entering MED by 50%. Note: After initial review, the Strategic Plan Steering Committee has indicated its intent to both increase MED by 50% (per the Strategic Plan) and to consider recommended enhancements.

- Currently, up to half of the students entering MED arrive with significant deficits in preparation in the sciences and other fields, making it challenging for MED to prepare them for entry into medical or dental schools.

- MED staff recommends focusing on differentiating the current pool of entrants and creating three tracks of students in order to have greater success with the graduates of the program. These tracks include:

Track 1: approximately half of the students entering MED who will complete the normal MED curriculumTrack 2: approximately 25% of the students who would focus on strictly MCAT and DAT prep courseTrack 3: approximately 25% of the students who have most significant deficits in science preparation, who would take an intense organic chemistry curriculum as a preparatory course for entry into MED

- There are other enhancements that need to be made to MED in order to update its curriculum and strengthen its support for students prior to their entry into MED, during

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their participation in MED, and once they have matriculated into the School of Medicine; these include strengthening the curriculum in social and behavioral health and in population health issues, adding additional resources for recruitment, particularly of Latino and rural disadvantaged students, and then providing additional enhancements to the program, including ongoing support for students once they enter the School of Medicine; in addition, MED staff recommends additional pre-MED engagement with career counselors on the campuses of the primary feeder schools, both inside and outside North Carolina, in order to better advise students on the academic program requirements needed to succeed in MED and in medical or dental school. In addition, MED has relied on volunteer faculty for much of the teaching. The committee recommends providing resources to compensate all faculty teaching in the program.

- MED has always welcomed students from all racial and ethnic backgrounds, but has had some its greatest success with African American students; given the changing demographics in North Carolina, MED plans to continue a strong focus with African American students, but also add a focus with Latino students since Latinos are now approximately 8% of the NC population; given the rural nature of NC, MED will also give additional attention in the coming years in recruiting more disadvantaged rural students from NC.

- A critical financial issue is that MED is partially funded by a federal HRSA grant through the Health Careers Opportunities Program (HCOP). HCOP funding has been excluded from the Appropriations Bill currently working its way through Congress, and thus MED needs to be planning for a future funding model that does not count on HCOP funding as part of the mix.

Timing and Sequence of Activities- MED has piloted a track in the summer of 2012 for one group of students who are

enrolled in an organic chemistry curriculum.- Implementation of the full three tracks of MED can occur in the summer of 2013,

requiring planning for implementation of those tracks during the period of September 2012 - March 2013.

- The additional enhancements to MED including programs for career counselors on the university campuses, additional recruitment resources for Latino students and rural disadvantaged students, and additional resources to support students who have entered the School of Medicine, will occur during the 2013-2014 academic year.

- Planning for expansion to 120 students will begin in 2012-2013. Recruitment of a class of 100 students should occur in 2013, moving to 120 in 2014.

- Funds to replace the funds likely to be lost from the HCOP Program will need to be identified and in place prior to the start of the program in 2013.

Metrics- MED already tracks the progress of its students, both in terms of academic success in the

program, and in the success of students entering and completing medical or dental school.- Additional metrics will be developed to track the success of students who are

participating in the organic chemistry track and in the MCAT/DAT prep track in order to determine if this further differentiation results in greater success for those students who ultimately enter the full MED program.

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- These metrics include for Track 1, the percent of students completing the full MED program and who are admitted to medical dental school; the percent of students who graduate from medical dental school; and demographic and career information of the graduates of MED over the long term.

- For Track 2, MCAT/DAT prep, the metrics will be the percentage of these students who successfully complete MED and are admitted to medical or dental school.

- For Track 3, organic chemistry, the metrics will be the percentage of these students who are able to enter and successfully complete MED in a year following their participation in this track.

Resources Required- The full cost for operating MED in its current format is approximately $460,500.- MED staff estimates the cost for operating a fully functional enhanced MED program for

80 students, utilizing the three tracks as proposed, is $466,329 (see Appendix B for detailed budget); a program for 120 students will cost approximately $678,000.

- Beyond the operating expenses for the current and enhanced MED program, additional resources could be added to conduct pre-MED workshops for students, workshops with pre-health advisors, creating additional courses that could be offered at selected feeder schools in order to enhance the quality of science teaching at those schools, and additional resources for evaluation; the total for these enhancements is approximately $100,000 per year.

- As noted above, funds are needed to replace the loss of HCOP funding. Under the current program costing $460,000 per year, approximately $170,000 is provided through HCOP funding; as a result, these funds will need to be replaced with funding from the schools of medicine and dentistry, or other sources, in order for the program to continue at its current level.

Prioritization- The highest priority for MED is to replace the loss of HCOP funds in order for the

program to continue to serve 80 students each summer; thus, an immediate need of $170,000 - $200,000 is needed to replace the HCOP grant.

- Priority number two is to enhance the program through the development of the tracks, and to add additional pre and post activities to both strengthen the students entering MED and to have additional resources to support those students and evaluate the outcomes of the program post-MED. Approximate cost: $100,000.

- Expansion of MED to 120 students will require a substantial increase in funding to a total budget of approximately $678,000.

B. Develop a Loan Forgiveness Program, working in collaboration with the Office of Rural Health, for students who choose to practice in rural or other shortage areas and to specialties that are in short supply throughout North Carolina.

Plan Design Elements- Although the charge to the committee is to develop a loan forgiveness program to

incentivize graduates to practice in shortage specialties and shortage geographic areas in the state, the committee recommends a program with a broader focus since a combined scholarship and loan forgiveness program could enhance several priorities for the School of Medicine; these include:

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1. Increasing recruitment of students in various categories and offering them financial incentives to enroll at the school

2. Providing need-based aid which offers an option to students who do not wish to accumulate large educational debt - and might forego a medical career – who instead have loans they know up front can be forgiven through work in underserved communities and shortage specialties upon completion of training.

3. Programs to attract more students to enter certain high needs specialties, to remain in North Carolina to practice, and/or to settle in underserved areas of the state.

- The committee recommends an expanded financial aid program which is a combination of scholarship and a service option loan program; scholarship funds need to be expanded to allow admissions staff opportunities to attract students in high demand categories, including students to enhance the ethnic and geographic diversity of the school, high performing students, students from particular sections of the state, or students in other categories the school deems highly desirable for attraction to UNC.

- The service option loan would augment the scholarship funds, so that the entire costs of a Carolina medical degree can be met by all students. These loans are made with the upfront understanding that the loan must be repaid once the student has entered practice; or in lieu of financial payback can be paid off with clinical practice that meets the state’s high priority needs such as work in North Carolina, choosing a shortage specialty or choosing to practice in state or federally designated shortage areas.

Timing and Sequence of Activities- Funds must be raised to support the expanded scholarship and loan forgiveness program;

this could be a combination of funds raised as part of the new Carolina Campaign, set to kick off in 2013, foundation grants, state appropriated funds, and tuition funds.

- Once funds have been raised, the specifications for both the scholarship program and the service option loan program must be aligned; this must be done in close collaboration with the admissions committee. These funds can also be linked to the MED Program, making medical training at UNC more attractive to MED graduates.

Metrics- Process measures will include:

1. The amount of new funding available for scholarships and loans2. Percentage of students, and percentage of economically challenged students,

admitted to UNC who choose to matriculate here compared to the previous five years.

3. Percentage of high performing MED graduates who choose UNC compared to the previous five years.

- Outcome metrics included:1. Total average debt for graduates of the School of Medicine compared to previous

five years, once program is fully implemented.2. Percentage of graduates who have opted for the service option loan who choose to

remain to practice in North Carolina.3. Percentage of graduates who choose to practice in underserved communities.4. Percentage of graduates choosing high priority specialties.

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Resources Required- Primary resources required are a substantial increase in funding available for scholarships

and loans at the school; in order to sustain a program of this type with ongoing funding, approximately $1-2 million will need to be available each year; this will require new funds available for both scholarships and loans in the early years of the program; once the program is fully implemented a portion of these funds will continue to be replenished by students who have chosen to repay loans financially rather than paying them off through a service obligation.

- Additional resources required will include staff to manage such a program; it is estimated that two FTEs will be required, for a total of $150,000 per year.

Prioritization To be determined

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Table (Ini

Optimize student recruitment and admission practices and

programs to provide physicians needed for North

Carolina and the nation.

Strategy Activities

Convene expert panel to develop social accountability “scorecard” and “bandwidth”

Develop quantitative and qualitative data sources for

metrics Identify audience (institutional,

state and national level) and specific policies/resource

decisions data should influenceEnhance Infrastructure to

analyze and disseminate data publicly (publicly available on

Sheps website)Development of programs to influence physician choice of desired outcomes: service option loan program, MED,

community placements in NC (link SPH-SOM and build on existing MD/MPH program),

Carolina Covenant-type program etc.)

Identify mechanisms to increase med student

placements in underserved areas in North Carolina

Assumption: Implementation of strategies, activities and outputs will take place over next five years

Rich and robust sources of

Varied programs aimed at

needed for North Carolina

Problem/Issue

Develop taxonomy of social accountability measures (diversity, primary care, HPSAs,

community engagement)

Develop specific and measurable metrics for

desired educational and workforce

outcomesReport data in user-

friendly formats, peer reviewed literature,

websiteUse data to inform

resource allocation, for program evaluation and

policyIdentify programs to influence physician choice along career trajectory from pre-

matriculation to med school out into practice

Appendix A (SP 2)

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Resources/Inputs

Data: Quantitative and qualitative data

Human Capital: Data managers, data analysts, policy

analysts, cartographer, design/communication expertise, physicians,

researchers who can obtain, analyze and tell a “story” with

data

Budget: TBDBuild on existing AHEC and

Dean’s office money

Resources required: TBD for FTEs, IT, Space

Short Term

Institution-level agreement on social accountability

measures and commitment to using them

to shape resource allocation, program and

policy decisions (e.g. admissions, etc) to

graduate physicians who more accurately

represents the stateInstitutional commitment to transparency on Social

Accountability through public data dissemination

Agreement on state shortages and populations that need to be addressed

Creation of more opportunities for student

involvement in rural health/underserved areas

in NC

Intermediate

Social Accountability measures become used by Board of Governors and

legislature during budget deliberationsMeasurable progress

in producing graduates that meet desired educational

and workforce outcomes

Institution develops national

representation as leader in

development and implementation of

social accountability

OUTCOMES

Appendix B: MED Enrollment Expansion with 50% increaseDetailed Budget Justification

Personnel Expenses 1. MED faculty: 16 @ $500-$3,000/summer for a total of $29,800. Sixteen faculty will be paid a total of

$29,800 for teaching in the summer 2012 MED Program.

2. Teaching Assistants (19 @ $6,618.50=$125,751.50) (increase of $46,329.50). The teaching assistants are the main liaison between the program faculty and staff and program participants. They serve as tutors, advisors and mentors to the participants. They also assist the faculty in lab and conduct weekly review sessions in all courses. Each TA is assigned to two courses and serves as preceptor to 8-10 students. One TA is the test coordinator. TAs are selected from the first year medical school class.

Non-personnel Expenses1. Educational and office supplies: $24,000 (increase of $8,000). Educational supplies cover the cost of 12

cadavers; duplication expenses for program information, course syllabi, program manual; and text book replacement. Office supplies include general supplies, telephone service, postage and printing. Additionally, each student receives a UNC OneCard.

2. MCAT and DAT courses: $54,000 (increase of $18,000). Princeton Review will provide courses for MED students’ preparation.

3. Recruitment/Travel: In-State/Out-of-State: $13,876.50 (increase of $4,625.50). MED staff travels extensively during the academic year conducting educational seminars and recruitment sessions for groups of minority college students and their advisors. Staff presentations represent the broader agendas of the Medical School (e.g., the admissions office), as well as those of the program. Staff makes 55-60 trips per year, including 6-8 trips out-of-state. These funds are also used for trips to national and regional meetings of AAMC, NAMME, and HCOP technical meetings.

4. Special Programs Closing Program: $10,500 (increase of $3,500). The MED Program honors the participants of MED at the end of the summer with a breakfast and closing program. Food, materials, facility, and guest speaker travel are all part of the expenditures for the closing program.

5. Outreach and student development: $15,000 (increase of $5,000). The MED hosts the Larry D. Keith Area Health Professions Recruitment Seminar each year in June. Approximately 290 high school and college students attend seminars on career options, admissions process, and MCAT/DAT prep. The recruitment fair, with representatives from 50 schools conducts the seminar. Last year we hosted the seminar at the Friday Center.

Trainee Expenses1. Trainee Stipends: ($2,400 X 120 = $ 288,000) (increase of $96,000). These funds will be used for 120

MED students. The funds will be used in the following manner: payments of $2400/student for living expenses, food and printing costs during the program.

2. Housing ($107,100) ($892.50 x 120= $107,100) (increase of $35,700). Students are housed in Horton Dormitory for the summer. No meal plans, linens, or phone services are provided or included in the price of housing.

3. Parking ($9,576 *number depends on student requests. 2012 reflects 73 permits). Students are allowed to apply for parking on campus. The program pays the cost upfront and deducts the cost of the parking permit from the students’ final stipend.

TOTAL: $677,604 (TOTAL INCREASE OF $217,155)

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Strategic Priority 3: Develop and support infrastructure that will ensure our continued ability to train physicians within Chapel Hill and across the state



Cam Enarson, MD AnesthesiologyAlan Stiles, MD PediatricsRobyn Latessa, MD Family Medicine, MAHECMark Darrow, MD Medicine and Family MedicineEd Kernick, DPM Cell and Developmental BiologyRachel Hines MS4Kim Nichols, MD AnesthesiologyJoe Stavas, MD RadiologyAmy Shaheen, MD MedicineBarbara Welanetz SOM Planning OfficeKathleen Rao, PhD PediatricsBeat Steiner, MD, MPH Family Medicine


“Develop and support infrastructure that will ensure our continued ability to train physicians, both within Chapel Hill and across the state.”

Initiative 1: Proceed with full development of clinical campuses. Initiative 2: Develop plans for a new educational building on the Chapel Hill campus to

support planned class expansion and planned curricular innovations. Initiative 3: Promote and support the creation of teaching practices of excellence. Initiative 4: Leverage AHEC to improve clinical care and research across the entire state.

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SOM Strategic Plan Implementation—Education SP 3: Plan Elements

Initiative 1: Proceed with full development of clinical campuses

Tactics to Achieve Initiative 1:

A. Finalize Memorandum of Understanding between Charlotte Medical Center Campus and Mission Health-Asheville.

B. Complete final timeline to attain 50 additional longitudinal students, 40 at CMC and 10 at Asheville. (Currently there is a partial timeline for CMC and none for Mission)

C. Strategic mapping between UNC SOM and Charlotte – Asheville sites.D. Financial analysis for cost per student and cost per preceptor to included fixed versus incremental costs

and cost differential between traditional versus longitudinal students

Initiative 2: Develop plans for a new educational building on the Chapel Hill campus to supportplanned increase in class size and curricular innovations.

Working Assumptions and Goals for this Initiative:

Enhance current facilities short-term to support 3-year SP curriculum goal for TBL. Accommodate 180 students near-term, 230 with completion of new building program. Support curriculum development and innovation through facility design. Benchmarking research

suggests trends to consider for improved facilities, including: o creating more open and flexible spaceso incorporating more technology to support multiple teaching/learning modalitieso multi-campus and multi-site connectivityo increased use of active learning modes, simulation techniqueso enhancing Advisory College support through facilities redesigno enhanced collaboration with related Health Affairs schools and the diverse communities served

by medical professions, as feasible and appropriate Re-use Berryhill site, still considered best location for retaining SOM core campus proximity to

hospital, Health Affairs schools, UNC science and research communities. Assumptions above lead to recommendation to phase building development and continue current

distributed campus model. This can be an advantage, allowing for pilot programs and experimentation, incremental improvements beginning with existing facilities, and flexibility in fund-raising.

See attachments for benchmark data.


A. Confirm existing plan for relocation of large animal lab out of basement levels of Berryhill to Mary Ellen Jones within 5 years. If plan is no longer feasible, develop alternative plan. Facilitate decision to commit resources to this relocation project, working with UNC and SOM research administrations. Requires capital, collaboration with university leadership. Implementation = 2-4 years for design and construction, depending on site and final scope.

B. Develop short-term improvement plan for existing classrooms/labs and 3-phase capital building master plan for replacement /expansion that both supports curriculum innovation and eventually accommodates 230 incoming students. Plan should be informed by medical curriculum innovation and prioritization of Strategic Plan initiatives. Plan should be detailed enough to produce realistic cost estimates, build case for fund-raising and allocation of relocation sites for current occupants of Berryhill.

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o Update Building Master Plan: Scope of work to include: site and building systems upgrade feasibility testing, update of facility program components, cost estimates, sequence and schedule of required leadership decisions and resource allocations, concept design and renderings for fund-raising. Group recommends Balinger/BJAC team continue to work with SOM, managed by SOM Planning Office.

o Charge Education Committee to begin oversight of curriculum innovation decisions and timeline, and ensure coordination with building project team(s), fall 2012. Coordinate with Inter-Professional Education work group to encourage involvement/collaboration with other Health Affairs schools, OGE and basic science departments, etc, re: shared use of building resources. As appropriate, research existing and planned building resources of other schools and units within UNC that might be shared; survey existing business models, consider incentives for shared use.

o Short-term improvements: Recommend short-term enhancements to existing SOM classrooms and learning labs, for implementation within 3- 4 years. Support short-term goals for priority “seed” projects promoting more active learning, simulation, connectivity. Prioritize funding for equipment and furnishings that can be re-located. Plan a series of annual projects that will enhance the education program long before a new building is built. Project example: fit out 3 medium classrooms in Bondurant with multiple screens, control system and furnishings allowing for simultaneous presentations as well as break-out work in teams, to support a specific course revision.

C. Capital Building Phase 1: Recommend site and program for Anatomy and Microbiology learning labs, for implementation within 5 years. Confirm and update plan for Brinkhous Bullitt upper floors, still considered the most cost-effective relocation strategy available, taking advantage of the State Medical Examiner facilities about to be vacated. Lab relocation leads to vacating of Berryhill levels 2 and 6. Relocation must accommodate at least 180 students short-term; permanent site(s) must accommodate 230 students. As appropriate, explore collaborative resource planning through Inter-Professional Education work group recently set up by SOM, or other means. If for some reason the existing relocation plan is no longer feasible, develop alternate plan and budget. Once capital funding and site are secured, implementation = 2-3 years for design and construction.

D. Capital Building Phase 2: Recommend site(s) and program to replace remainder of classroom and support facilities now in Berryhill, for implementation within 5 years. Assumes continued use of distributed campus + some building/renovation for use outside of Berryhill site. Investigate feasibility of building 2 floors over Beach Café at Brinkhous Bullitt as a strategy for accomplishing this phase. Addition could eventually connect to new building on Berryhill site. Consider relocating TraCS on BB level 2 through completion of Phase 3, to minimize disruption to TraCS program and to co-locate as much of Med Ed program as possible. Completion leads to vacating of Berryhill levels 1, 4, 5, and full building demolition/replacement. Once capital funding and site are secured, implementation = 3-4 years for design and construction.

E. Capital Building Phase 3: Demolish Berryhill, and plan, design, build new building on same site, to increase SOM capacity to 230 incoming students and complete the capital building program. Build in flexibility for building program to evolve over next 3- 5 years with curriculum innovations. Collaborate with OGE, other Health Affairs schools to ensure best use of all resources. Expand Anatomy and Microbiology labs, or develop alternate plan to accommodate 230 students. Include greater College “homeroom” support for Year 1 and 2, workroom space for 3rd and 4th year residents rotating through clinical programs. Enrich classrooms with technology to support inter-campus communication, active learning educational formats. Develop and support strategy for both central and distributed simulation center learning and skills practice. Once site and capital funding are secured, implementation = 5-year completion phase for permitting, design, construction, occupancy.

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Initiative 3: Promote and Support Creation of Teaching Practices of Excellence

A commitment from the clinical leaders of the institution is needed to recruit Teaching Practices. UNC Health Care Systems has a large number of clinically highly effective affiliated primary care practices (TPN practices). Many of these practices are not currently engaged in medical student education. These UNC affiliated practices should be engaged and model effective teaching if the school is to recruit qualified practices outside of the UNC Health Care System. In order to recruit new practices, the commitment of the UNC health system will be necessary.

The Health System TPN, AHEC, UNC SOM, and need to partner to find strategies to effectively recruit qualified practices outside of the UNC Health Care System.

Recruitment and retention of qualified practices will be a major barrier to implementation of this part of the strategic plan. In addition to the above elements, the following may also help facilitate recruitment and retention:

Practices express greater satisfaction with teaching if they are working with a student over an extended period of time. To successfully implement a viable Teaching Practice model it may be necessary to move to a longitudinal model.


A. Practices exist in rich communities that offer many learning opportunities. Moving towards a model where students spend part of their time in the practice and part of the time learning in the broader community (including work with subspecialists and ancillary services) may also facilitate recruitment and retention while providing richer learning opportunities.

B. Selection criteria amended to add greater specificity and to assure that practices can sustain teaching efforts on a long term basis: Participating practices should provide high quality care to clinically diverse populations and have

sustained quality improvement efforts. Participating practices will commit to teaching students regularly, engaging all members of the practice

in teaching, maintaining familiarity with goals and assessment strategies of the curriculum, and participating in regular faculty development programs.

Commit to direct involvement in teaching including observing clinical skills of students regularly, providing specific formative feedback, and completing summative assessments in a timely manner

Fully integrate medical students into the practice, effectively teach the skills of primary care, and inspire students to practice primary care

Receive adequate compensation to provide the needed attention to teaching and mentoring. Compensation can include financial incentives, non financial incentives such as Category 1 CME, faculty development, and student contributions to clinical care and quality efforts in the practice.

Initiative 4: Leverage NC AHEC to improve clinical care and research across the state.


A. Better inform students of educational, research and service opportunities in AHECs, including residency opportunities. Tactics: Use opportunities in the 1st and 2nd year to expose students to AHEC faculty in educational settings. Specifically set aside a part of a day with the second year students to

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showcase AHEC, its functions, and opportunities to students and include written material, links to websites, and faculty bios. Intentionally include student option for location choices for AHEC sites and try to concentrate individual student time within single AHEC during training to optimize the development of faculty-student relationships. During the 3rd year provide written material on residency opportunities and web-links for AHEC based residencies.

B. Promote opportunities for translational research to occur in collaboration with full-time (added: or part-time) AHEC faculty in the community sites. Create more opportunities for interaction with faculty at AHECs to foster research collaboration (e.g., an annual research symposium focusing on community-based research and opportunities for greater collaborations). Tactics: Perform an annual inventory of community-based research sited in the AHECs including but not limited to AHEC based faculty, UNC sited faculty collaborators, funding sources and amounts, and specific opportunities for students to participate. Intentionally target AHEC sites as for development of community based research project hubs with support for infrastructure from SOM resources and the UNC CTSA. Likewise active collaboration with The Gillings School of Public Health, the Odum Center and other population research intense programs could be an asset for AHEC faculty and student participation. It may be worthwhile to also consider support mechanisms for AHEC and other faculty doing educational research as part of this initiative, again lending itself to opportunities for student research. A further recommendation is to set aside a part of AHEC Day annually to include a research presentation from a high profile community based investigator (perhaps initially invite speaker from outside, but evolving to an NC AHEC faculty member). Provide a forum during AHEC day for AHEC faculty research poster presentations to include highlighted AHEC faculty-student research projects. Consider a prize to the best AHEC faculty-student project with broad based recognition through AHEC and UNC and presentation during AHEC day. Intentionally utilize research opportunities via the CTSA or other UNC School of Medicine resources to target AHEC faculty with intentional support for student research opportunities included in resources. Consider also, students who are jointly seeking degrees in the School of Medicine and Schools of Public Health, Business, or other Masters or Doctoral program for intense recruitment and inclusion in AHEC based projects with AHEC faculty. There should also be consideration given to expanding the AHEC participation in the Eugene Mayer Community Service Program of the UNC School of Medicine incorporating greater elements of the scholarship in the AHEC sites.

C. Create opportunities for faculty and students to be more engaged with AHEC research on quality, using the extensive network of practices now served by AHEC’s Regional Extension Center and its quality improvement initiatives. Tactics: Specifically recruit faculty to projects taking advantage of the data collected through the AHEC Regional Extension Center as an approach to type II translational research. This could incorporate the work of the Department of Family Medicine’s student engagement in “Improving Health of Populations.” UNC based faculty and AHEC faculty collaborations should be encouraged. The inclusion of student participation in these projects should be encouraged. Consider establishing an elective for students using trainers from AHEC to teach principles of quality improvement for practice improvement. This might be offered early in the 4th year to be followed by rotations at a later point with participating practices targeting an experience in both clinical and QI engagement of the students. In addition, the Capstone Course training should include “Principles or Quality Improvement” as one segment and could draw on the AHEC expertise for this part of the Capstone program. These approaches would fit with competency for system-based learning and practice-based learning and promote student preparation for participation in residency and future practice.

D. Provide support for an AHEC strategic planning effort that will be synergistic with the UNC SOM strategic plan. AHEC currently has a strategic planning process underway and included within its planning is the goal of being in sync with the UNC SOM strategic plan (while being cautious in focusing on broad issues that cross institutional lines also). This plan is nearing completion and AHEC leadership will view the output of the AHEC planning in concert with the UNC SOM planning. It is helpful that Dr. Tom Bacon, Director of AHEC has been an active participant in both strategic planning processes and has focused effort

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on balancing the AHEC planning process with the statewide mission while maintaining balance with the UNC SOM planning process.

SOM Strategic Plan Implementation—Timing and Sequence of ActivitiesFY 2013

Initiative 1 (Asheville and Charlotte) Aug 2012: Finalize MOM between UNC SOM and CMC and Asheville sites 2012 Q4: Medical Student M2 match for regional sites 2012 Q4 Financial analysis completed Q1 2013: Preceptor site identification Q2 Preceptor site orientation Q2 Curriculum approval June 2013: Classes begin for M3 Regional Campuses

Initiative 2 (Med Education Building)Large Animal Group relocation

Confirm leadership support for current plans, or develop new process for planning and funding alternative site. Confirm commitment to seek capital funding, integrate with research strategic planning. Implementation by 2017 to be coordinated with university, DLAM.

Short-term improvements Begin short-term improvements plan fall 2012. Develop 3-4 year implementation plan and operating

budget commitment by spring 2013.

3-phase capital building master plan Retain consultant design team and form internal project team for master building plan update in fall 2012. Education Committee to begin oversight of curriculum innovation decisions and timeline, plan for

coordination with building project team(s) and other appropriate groups, fall 2012.

Initiative 3 (Teaching Practices) The UNC-SOM is currently piloting 5 Model Teaching Practices in the third year; use the lessons learned

to develop further practices. Increase the number of teaching practices integrating lessons learned from pilot year and assuring

adequate representation from Pediatrics, Internal Medicine, and Family Medicine in CSD/CSI course/ Outpatient Internal Medicine/Family Medicine and Pediatrics .

Convene working groups of clinical leadership within the UNC Health Care Systems to define strategies to recruit and retain TPN practices as Teaching Practices

Convene working group with AHEC to define strategic partnership between AHEC, UNC SOM, and the TPN to recruit qualified teaching practices

Define teaching expectations for TPN practices and its impact on other measures of success in the practice.

Define ultimate number of teaching practices needed to teach all UNC SOM students on outpatient experiences in Pediatrics, Internal Medicine and Family Medicine and explore whether there are insufficient currently existing practices engaged in teaching students that meet selection criteria. The majority of current practices do not meet selection criteria. Therefore, recruitment of new practices is needed as state above

Engage other disciplines to work on multidisciplinary education in the ambulatory arena Define adequate compensation and incentives (both financial and non financial) required to recruit

adequate number of practices. Hire educational consultants who work with practices to better integrate students (similar to QIC model

helping practices reengineer flow to improve clinical quality of care)

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Develop robust and realistic faculty development model for teaching practices that focus on feedback, curriculum and evaluation. And give appropriate continuing med ed credit with category 1 CME paid for by the SOM.

Begin work on practice retention Initiative 4 (AHEC) August 2012: Completion of AHEC strategic planning process Aug 2012-Dec 2012: Inclusion of expansion of Community Based Research site infrastructure funding

and AHEC faculty engagement in CTSA planning. This should also include practice network regionally or statewide via AHEC for community based studies. Provide seed funding for community based research programs for AHEC faculty as part of the CTSA renewal.

August 2012-Dec 2012: Plan for 4th year elective in QI principles as offer in 2013 elective offerings August 2012-Dec 2012: Plan AHEC student rotation shift to focus AHEC rotations in a single site to

enhance faculty student interactions and stimulate potential research interaction. October 2012-May 2013: Develop Capstone Program to include QI principles taught by AHEC QI

training faculty. August 2012-May 2013: Jointly plan research training program for AHEC faculty through the SOM,

focusing on community based research skills and compliance training to prepare faculty for participation and leadership of studies.

FY 2014 Complete master building plan for 3-phase capital building program, including strategy to for securing

funding program beginning in 2013. Develop major building program goals with Education Committee, based on curriculum development

work. Coordinate with University capital campaign, develop fund-raising strategy. Complete benchmark/best practice research to further inform SOM on new building development. Continue short-term improvements plan with SOM operating funds. Over 50% of practices teaching UNC SOM students meet selection criteria outlined above. Same issues

as above unless we can find new practices Implement faculty development efforts for all practices that wish to remain engaged in teaching medical

students, offering desirable incentives such as Category 1 CME and Part IV MOC Assure that all practices that wish to remain engaged in teaching UNC SOM students are actively engaged

in clinical quality improvement efforts and have defined opportunities for students to be involved in these efforts.

Engage members of practices to refine curriculum Identify learning opportunities in the broader community to enhance the Teaching Practice Experience. March 2013: Initiation of CTSA funding program for AHEC faculty (assuming renewal) March-May 2013: AHEC presentation to 2nd year students describing AHEC opportunities and providing

written materials/Website. March-May 2013: 3rd Student selection of AHEC rotation sites for 4th year electives (encouraging single

site selections to improve faculty engagement and research opportunities) April-June 2013: Inclusion of QI training in Capstone Course lead by AHEC faculty May 2013: Include research speaker in the AHEC day program and initiate poster session for AHEC

based research (to be an annual event). Aug 2013: initiate QI training elective for 4th year students lead by AHEC faculty of the Regional

Extension Center

2015 – 2017 Continue short-term building improvements annually as operating funds allow. Implement relocation of animal research labs. Set up project teams for Capital Building Program Phases 1,2,3 to advocate for securing sites and capital

funds. Once capital funds and site are secured, Phase 1 and 2 could be sequential in either order, or

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simultaneous. Phase 3, new building, will require 5 years minimum for planning, design, site preparation, construction, occupancy. For each phase:

o Define building program based on curriculum goals, benchmark researcho Work through design phases, with increasingly detailed program, design, estimates; do not

continue on to final design phases until funding and site is secured for that phase. Project team(s) to oversee final design documentation, construction, and manage budget for all services

including equipment procurement, commissioning, occupancy. 100% of practices teaching UNC SOM students on required outpatient experiences meet selection

criteria outlined above. Jan-Dec 2014: Continuation of student engagement/presentation for 2nd year class, 3rd and 4th year

class participation in training and participation in research, inventory update of research programs at AHECs

April-June: Capstone course participation May 2013 AHEC Day and research program continuation

SOM Strategic Plan Implementation—Education SP 3: Returns/Values/Metrics

Metrics—Initiative 1 (Asheville and Charlotte)

Metric Progress Outcome OverallMedical Student Satisfaction & personal goals

100% matched into regional campus programs by 2013

X % matched into regional campus of choice

100% student retention in regional campus program over two year experience

Medical Student academic progress

Establishment of longitudinal integrated clinical curriculum

Curriculum compliant with LCME guidelines

X % examination pass rate

Clinical preceptor experience

Operation and function of clinical preceptor sites

100% clinical sites compliant with LCME and UNC SOM guidelines

X % increase in clinical management exposure and variety of clinical cases

Clinical Faculty Satisfaction

Clinical sites and preceptors identified

Preceptor orientation about LIC program guidelines and expectations

X % Faculty retention

NC primary care impact to include rural clinical sites

X % selection of primary care residency by students in regional campus programs

% increases in rural health care practices and practice sites in North Carolina

Improved community health outcomes, access to health care, and cost of care in North Carolina

Patient care Didactic lectures established and clinical experience present for integrated care

X % improved patient satisfaction for newly established clinical sites

Economic Impact(Program Analysis)

Cost benefit analysis of program with development of program analysis

X % metrics have been met

X % increase in local and regional economic impact of newly established primary care sites.

Metrics—Initiative 2 (Med Education Building)

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Satisfactory completion of building program will be expressed in part through maintaining budget and schedule targets for planning, design, construction and occupancy phases. Peer design and construction awards, citations will further document professional quality of completed building phases.

Best available measures of building program success will be increased satisfaction levels of students, faculty and recruits, as demonstrated by before-after surveys. Existing survey programs include: annual student and graduate surveys, student self-study survey prior to LCME visit, recruit visit questionnaire, faculty job satisfaction surveys.

More focused before-after surveys can be planned to test efficacy of facility improvements during pilot program years; this may inform design of future building phases.

Metrics—Initiative 3 (Teaching Practices) A PhD in education would be helpful to establish meaningful outcomes. Current comparisons that

could be made. i.e. compare single practitioners who take <3 students/year and compare them to Teaching practices with over 20 students. Measures that would be useful include

Clinical Performance of students on subsequent clerkships? i.e. does being in a teaching practice improve subsequent performance?

Evaluation quality (i.e. do they do a better job at distinguishing among students?)We suggest looking at average scores and Standard deviation of evaluations on One45

Feedback quality (quality and themes of comments) Participation in Faculty development Student and faculty satisfaction Metrics to assess whether students learn more effectively from each other to define whether it is helpful

to have more than one student in a practice or measure interactions Clinical performance of practices (productivity and quality of care measures) Patient satisfaction (this has been a concern of the preceptors)

Metrics—Initiative 4 (AHEC)

Numbers of faculty participating in research; students engaged in AHEC based research; manuscripts, national presentations by AHEC faculty; grants awarded and funding level to AHEC faculty; student feedback on value of experiences in community based service, research; training indicators for student education in QI.

SOM Strategic Plan Implementation—Education SP 3: Resources Required


Initiative 1 (Asheville and Charlotte)

Various dollar amounts have been discussed that relate to the cost per student (inclusive) and the cost per preceptor site.

$5 million/year potential cost for the additional 50 students. This dollar amount likely represents the very maximum expected cost.

Initiative 2 (Med Education Building)

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Space, FTE, and $$ Resources:

No full-time FTEs are needed, except possibly for capital campaign fund-raising/marketing. Committee participation would be on an advisory level, while Planning Office and OME staff would be committed for project management as needed, supplemented by consultant staff.

$2.5M in SOM Strategic Plan funds are requested to update the master building plan for capital planning, and to provide an annual allowance for 3 to 4 years to significantly enhance existing classrooms and labs with additional AV technology, furnishings and simulation equipment.

A $ 90M, 3-phase capital building program is recommended, with renderings and detailed vision to be produced via building master plan.

See attached Excel worksheet for cash flow and details.

Initiative 3 (Teaching Practices)

Full time educational consultant to lead recruitment effort and partner with practices to integrate students into the practices. (90,000 per year)

Increased financial incentives ($1000-1500 per student month). Each student currently spends about 1 month in outpatient settings in the first 2 years and about 3 months on outpatient rotations during 3rd year. For 180 students this would ultimately cost about $750,000 - $1 million a year. Competition from the new osteopathic school may demand that increase reimbursement to equal theirs (unknown amount)

Additional resources: IT: WiFi availability, may need to help with some of the rural practices

Initiative 4 (AHEC)

$150,000/year 1, likely reduced to $50,000 year 2-5 (educational materials, website update, inventory of investigators, enhancements to AHEC Day, QI training for students, faculty travel and materials

$250,000/ year recurring x 5 years (seed grant program for AHEC faculty research, student participation costs with travel and lodging)

$65,000/year recurring x 5 years (Research Coordinator for AHEC) $25,000/year recurring x 5 years (Research Director salary (partial support))

*Minimal FTE changes anticipated, No new space needed on SOM Campus, May require additional space at regional AHEC sites.

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SOM Strategic Plan Implementation—Education SP 3: Resources Required (con’t.)

What organizational structures, processes and management are necessary to enable implementation of each initiative?

Initiative 1 (Asheville and Charlotte)

Each site has administrative staffs in place that will direct the expansion of the programs. There is no plan to change the organizational /reporting structure at this time.


Overall Governance and Participation in Building Master Plan Update The SOM Education Committee is the logical advisory body to guide progress, set priorities, and

advocate for resources through all phases of the building program. An executive building program committee of no more than 7 staff should guide the daily work of the

building program, with SOM leadership by Planning Office, reporting through Vice Dean, Finance and Administration and Education Committee. Exec group members should represent faculty and curriculum development, OME and OIS support, student reps, fund-raising/marketing. UNC Facilities Planning office would manage state-mandated processes for capital building project planning, design and construction. Project team members should make a multi-year commitment to serve on this work group, and consider this a major task for several years. Lead consultant team to be confirmed; group recommends that Balinger/BJAC team continue their work with SOM.

Representatives from OGE, other Health Sciences schools, UNC basic sciences, and other groups who may share building resources should participate in this process, through existing committees or perhaps as an informal work group that meets when input on building use and curriculum scheduling is needed.

Animal Lab Relocation Project A separate building project team would be formed for this project, led by UNC Facilities Planning and

including SOM Planning Office, key staff from DLAM and UNC/ SOM research administrations. This project can run on a parallel course with the Med Ed building program, but must be completed, or fully funded and committed to a schedule, before SOM capital building program phase 3 moves into detailed programming and design phases. Site and capital allocation will need to be secured before moving into final design and construction phases.

Short-Term Improvements and Capital Building Phase Work Groups: A project work group for each capital building phase should be led by UNC Facilities Planning and

SOM Planning Office project managers, guided by SOM curriculum faculty experts. Members would include staff specialists in simulation and classroom technology, plus representatives from student body, OME, OIS, and faculty involved in the curriculum supported by the particular building phase. Technical procurement, financial project management, system and equipment reviews and construction/permitting processes for all state-funded capital projects would be managed by UNC Facilities Planning, with management of all SOM users and leadership by the SOM Planning Office.

Initiative 3 (Teaching Practices) Key resource needed to implement this model is full commitment of clinical leadership of the UNC

Health Care System to demonstrate that Teaching Practices are a viable model and should become a key part of the negotiations with new practices

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Initiative 4 (AHEC) AHEC Director : oversee educational programs, direction of administrative needs for dissemination of

information to students Administrative staff in central AHEC office : coordination among AHECs of initiatives for research and

student rotations CTSA PI and Executive Dean : CTSA resource utilization in AHEC sites, research infrastructure

development, seed grant program Vice Dean for Education : Oversee educational program development for Capstone and electives,

coordination of rotations by students to AHEC sites, QI incorporation into Curriculum Individual AHEC site directors: Participation in inventory, administrative management of grants, travel,

student housing, data storage. QI faculty for current AHEC QI training institutes : training for students in QI methods and elective

management AHEC Research Director : New position or additional responsibility for current faculty member AHEC Research Coordinator : New position to be responsible for the annual inventory, administrative

coordination of research related tracking and metrics, notifications and coordination of students about opportunities and participation in research projects.

SOM Strategic Plan Implementation—Education SP 3: Prioritization


Initiative 1 (Asheville and Charollote)

1. MOM agreements2. Financial analysis and budgeting3. Preceptor and clinical site selection 4. Metrics (these will likely change based upon final MOM and preceptor sites)


Assuming priority for action should be based on importance for curriculum change, and what is physically feasible, the building phases match SP priorities.

1. Building improvements, enhancement to existing key classrooms and learning labs, can be implemented within 3 to 4 years, and can begin as soon as possible; new furnishings, technology and simulation equipment can be applied incrementally to begin supporting curriculum change with relatively little funding commitment.

2. Master building plan for remaining building phases is next most important, given the time it will take to secure resources, and the need to test phasing, technical feasibility, develop reliable cost estimates and marketing materials to make the case for a capital building program and communicate a vision to potential donors.

3. Capital Building Phase 1, relocation/redesign of Anatomy and Microbiology labs, and teaching of Basic Sciences curriculum in general, can be implemented within 2 – 4 years of securing site and capital.

4. Capital Building Phase 2, relocation of remaining educational and support space in Berryhill AND continuing to support curriculum change, can be implement within 3-4 years of securing site and capital.

5. Relocation of animal research labs only has value to educational curriculum as a tactic to help vacate Berryhill, which will allow for demolition of the old building and construction of a new SOM facility.

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6. Final Capital Building Phase 3, a new educational building to be constructed on Berryhill site, will finally allow for expansion to 230 student class size, and can be implemented within 5 years of completing all earlier phases, securing site and capital funds.

Initiative 3 (Teaching Practices)1. Highest priority is to get commitment of clinical leadership of the UNC Health Care System (TPN) to

recruit practices to develop a sustainable model of teaching practices.2. The Health System and the TPN will need to prioritize education as a measure of success in contract

negotiations, not just RVUs.

Initiative 4 (AHEC)1. Communication of AHEC role for medical students (short-term)2. AHEC Day recognition of Research—enculturation of research mission into AHEC (short-term)3. Research inventory of AHEC sites/faculty—Critical for development of metrics and communication for

opportunities to trainees (short-term)4. Seed funding of AHEC site Community Research Based projects—Growth of research is unlikely

without seed funding opportunity (intermediate to long-term)5. QI training for students—Could be done in an alternative fashion (Short to Intermediate-term)

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Clinical Care

Strategic Priority 1: Establish a UNC HCS-wide quality program, building on existing efforts, to ensure the greatest possible patient safety and highest quality care for all

Clinical Care Strategic Priority 1 Team Report

Team members and Departments:Bob Sandler, MD MedicineRobb Malone, PharmD MedicineSpencer Dorn, MD, MPH MedicineCarmen Lewis, MD, MPH MedicineRaj Pruthi, MD SurgerySam Weir, MD Family MedicineLarry Mandelkehr, MBA HCS Performance ImprovementAshley Howard Director of Patient AccessTina Willis, MD Pediatrics and AnesthesiologyJoanna Herath Division Administrator, GITony Lindsey, MD Psychiatry; Executive Associate Dean for Clinical Affairs; Chief of

Staff, UNC HospitalsDarren DeWalt, MD Medicine

Bruce Wicks, MHA; Operations Committee representativeAl Daugird, MD, MBA and Brian Goldstein, MD, MBA; Oversight Committee leaders

“Establish a UNC HCS-wide quality program, building on existing efforts, to ensure the greatest possible patient safety and highest quality care for all.”

Initiative 1: Design a comprehensive, system-wide quality initiative Initiative 2: Ensure successful implementation of the quality initiative via necessary

organizational change and investment

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SOM Strategic Plan Implementation—Clinical SP 1 (Quality):

Plan Elements

Create the UNC Institute for Quality that will establish UNC as the leading academic medical center in this field. Note: we aim to be the leading academic medical center, not the leading public medical center.

TACTIC 1. Obtain buy-in at the highest level.

Appoint William Roper as the Executive Director of the UNC Institute for Quality. This tactic takes advantage of Dr. Roper’s position as the Chair of the Board of Directors of the National Quality Forum and demonstrates the institutional commitment to the Institute.

TACTIC 2. Create an Institute with the following components.

Education. The UNC Quality Academy would develop a traineeship for third year medical students with formalized training, curriculum, evaluation and feedback. Partners with the academy would include UNC P&A’s Practice Quality and Innovation, UNC Hospitals’ Performance Improvement and Patient Safety, and UNC Hospitals’ Operational Efficiency. Academy faculty and student initiatives would be paired with current operational entities within the institution, ensuring a relevant learning experience that is current, strategic, and supported within the institution. The goal would be to transform projects from what have traditionally been learning exercises into projects that directly impact patients or translate into operational benefit or efficiency. A program of this sort could lead to national recognition.

Faculty development and research. The Institute would contribute to faculty development in two ways. First, the Institute would provide educational resources, opportunities for mini-sabbaticals, and capital to conduct quality research pilots. Second, the Institute would provide support for mandated quality improvement projects for maintenance of certification. A coordinated approach for maintenance of certification could benefit both faculty and the institution, targeting meaningful and strategic projects that are also educational and rewarding. Quality scholars would lead groups through processes and projects.

Outreach. During the initial phases of outreach initiatives, the Institute would use a CME model to develop and deliver day-long courses to internal and external medical professionals. These programs would make UNC improvement content available to practices, extend lessons learned to UNCPN, Rex and Chatham Hospital, and promote faculty expertise. In later phases, the institute would develop workshop or longitudinal learning opportunities as well as ‘learning collaboratives’ to support development of advanced improvement skills among external medical professionals or practices.

The Institute would have an advisory role for Clinical Care.

Clinical care. This would include top level leadership and grassroots efforts. Although the Institute would be located in the School of Medicine, the Director of the Institute would work closely with the UNC Hospitals Chief Quality Officer to create an organizational structure for current initiatives (Meaningful Use, Performance Improvement and Patient Safety, Operational Efficiency, Commitment to Caring, Practice Quality and Innovation, Ambulatory Care Operations, etc).

Within the realm of clinical care, the Institute can also develop into a source of internal communications to all clinicians and staff regarding HCS improvement activities.

The Institute should also partner with UNC Hospitals and UNC P&A in ongoing efforts to change the culture in our clinical settings, in ways that promote patient safety, improved care, and greater patient and family involvement in care.

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The UNC Institute for Quality will partner as much as possible with several entities in and out of UNC to ensure success of all components.

UNC Kenan-Flagler Business School UNC School of Public Health The North Carolina Translational and Clinical Sciences Institute and the Carolina Data Warehouse NC State University Agency for Healthcare Research and Quality North Carolina Hospitals Association and the North Carolina Quality Center NC Area Health Education Centers UNC Health Care’s “Learning and Organizational Development” Division within the Department of

Human Resources UNC School of Medicine Office of Continuing Medical Education UNC School of Medicine curriculum development committees UNC HCS IT Department UNC Hospitals Office of Graduate Medical Education

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http://www.ncahec.net/

http://www.ncqualitycenter.org/

https://www.ncha.org/

http://www.ahrq.gov/

http://www.ncsu.edu/

http://tracs.unc.edu/perform-research/data-access-informatics.html

http://tracs.unc.edu/

http://www.sph.unc.edu/

http://www.kenan-flagler.unc.edu/


Timing and Sequence of Activities

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Announcement of Institute(Roper)Search for Director(Roper)Appointment of Asst DirectorsHire Program AdministratorHire other program staffQuality Academy Development

Resident/ACGME programMedical Student Program

Faculty Development Program Launch

MOC compliments SOM/HCS QIGrants/QI scholar components

Clinical CareOutreach/Spread Start JAN 2014

The activities, budget, deliverables will ultimately be determined by the Institute Director with approval by the Executive Committee. The pace and scope depend on the vision of the directors, the budget and the buy-in by stake holders, particularly the Hospital.

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Returns/Values/Metrics


Initiative 1. Create the UNC Institute for Quality– Tactic 1. Obtain buy-in at the highest level– Tactic 2. Create an institute for education, faculty development, outreach and clinical care

Tactic 1Obtain buy-in at the highest level

Metric: name Roper as Executive DirectorReturn: signal to the broader community that UNC is committed to quality at the highest level and across the boardValue: if UNC aspires to be the leading public academic medical center our program in quality could lead. The institute will signal to our patients and payers that UNC is serious about quality and value.

Tactic 2Establish the UNC Quality Academy

Develop traineeship for third year medical students:Metrics: number of Academy faculty identified and active and number of students enrolled, evaluation by students and facultyReturn: we could measure gains in efficiencies and economic benefit of projects developed by Academy members. A curriculum would distinguish UNC from other schools

Faculty development and researchProvide educational resources and opportunities

Metrics: pilot grant program, number of faculty engaged in research, number of faculty with mini-sabbaticals, maintenance of certification program in place, publications, and presentations by faculty at national and regional meetingsReturn: pilot programs could lead to funded grants (dollars returned) or more efficient programs at UNC (dollars saved); Value: faculty research could lead to national prestige and reputation.

OutreachProvide CME courses; develop programs for Rex and Chatham and medical professionals throughout the region.

Metrics: number of courses each year, number of programs at affiliated hospitalsReturn: income from CME programValue: an active menu of programs would build our brand in quality and increase visibility for our programs.

Clinical careDevelop comprehensive quality program that would include every provider and every staff member

Metrics: number of clinical areas with quality programs, number of clinical programs that meet their metricsReturn: Applying ‘Lean’ principles more broadly would increase efficiency and lower cost (amount to be determined); quality programs could lead to more lucrative contracts with payers, attract more patients, shorten hospital stay, decrease complications, decrease hospital acquired infections, improve throughput.Value: we can’t afford not to do this.


Resources Required


Director – The Director of the UNC Institute for Quality position will be filled by a physician with extensive training and experience in quality improvement with a history of leading successful multidisciplinary healthcare improvement initiatives. The position will equal a 0.6 FTE.

Co-Directors – The Co-Directors of the UNC Institute for Quality will be physicians with quality improvement training and a history of championing healthcare improvement initiatives. Each co-director position will equal a 0.4 FTE.

Proposed Expense Budget for UNC Institute for Quality FY 2013- 2015

Role/Item Project Effort FY13 FY14 FY15 3 year Total

Director 1.00 0.60 0.60 161,130 165,964 179,420 506,514Administrator 1.00 1.00 1.00 $111,247 $114,584.41 $118,021.94 $343,853 Co Directors

Education 40% MD 1.00 0.40 0.40 $107,420 $110,642.60 $113,961.88 $332,024 Outreach 40% MD 1.00 0.40 0.40 $110,642.60 $113,961.88 $224,604 Research 40% MD 1.00 0.40 0.40 $107,420 $110,642.60 $113,961.88 $332,024

Administrative Asst 1.00 1.00 1.00 55,000 56,650 58,350 $170,000 2 Quality Analyst Staff 2.00 2.00 2.00 156,544 161,240 166,078 $483,862 2 Quality Leader Staff 2.00 2.00 2.00 180,954 186,383 191,974 $559,311 1 Quality Analyst Staff (YR 2-3) 1.00 1.00 1.00 80,620 83,039 $163,659 1 Quality Leader Staff (YR 2-3) 1.00 1.00 1.00 93,191 95,987 $189,178

Total Personnel Expenses 879,715 1,190,561 1,234,755 $3,305,030

Mini sabbaticals, fellowships (faculty development) $100,000 $103,000.00 $106,090.00 $309,090 Pilot Grants $500,000 $515,000.00 $530,450.00 $1,545,450 Recertification $25,000 25,750 26,523 $77,273

Total Non Personnel Expenses $625,000 $643,750 $663,063 $1,931,813

UNC Appt FTE

Full-Time Equivilent

Effort

Quality Leaders – A Quality Leader (Quality and Organizational Excellence Leader) is a position recognized and used by UNC Hospitals with requirements of a Bachelors degree and at least 5 years experience in quality improvement or relevant advanced degree or healthcare licensure and functioning at an equivalent performance level. The leader also has experience leading advanced process improvement and quality initiatives. The Quality Leader will provide Project Management (timelines, organization, and improvement team management) for initiatives in the area of focus (Quality Academy, Faculty Development and Research, Outreach) as well as assistance leading small groups, coaching teams, and teaching improvement methods. In the first year of funding, 2 Quality Leader positions will equal an effort of 2 FTE. In year two, this will increase to 3 Quality Leader positions at a total of 3 FTE.

Quality Analysts – A Quality Analyst (Quality and Organizational Excellence Analyst) is a position recognized and used by UNC Hospitals with requirements of a Bachelors degree and 2-5 years experience

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in quality improvement or relevant advanced degree or health care licensure. The analyst also has experience facilitating/coordinating process improvement and quality initiatives. The Quality Analyst will provide assistance with coordination, data collection and performance improvement tool development, data collection, and data entry for the initiatives in the area of focus (Quality Academy, Faculty Development and Research, Outreach). In the first year of funding 2 Quality Analyst positions will equal an effort of 2 FTE. In year two this will increase to 3 Quality Analyst positions at a total of 3 FTE.


Resources Required


Initiative 1: Create a UNC Institute for Quality

Creation of the Institute will require the active participation of the dean as the Institute Executive Director, the President of the Hospital as facilitator and the entire faculty and staff as implementers.

While no fundamental changes in the organizational structure of the School of Hospital are required, the Institute, as a bridge between entities, could provide a model for future new organizational structures that would break down some of the existing walls between the School and the Hospital. The Director would be a member of appropriate Hospital and Health Care System governance structures that relate to quality.

Decision making authority ultimately falls to the Dean. Progress could be monitored by an executive committee appointed by the Dean. Oversight will be provided by the Board of Directors.

Appoint an executive committee: Members might include - Performance Improvement And Patient Safety (Mandelkehr), Operational Efficiency (Spivak), Practice Quality and Innovation (Malone), Ambulatory Care Operations (Spencer) and 4 at-large members appointed by the Dean.


Prioritization


There is only one initiative and it should receive high priority.

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Strategic Priority 2 : Establish a mechanism for innovation and entrepreneurship in clinical care delivery and financing


Team members and Departments:David Rubinow, MD PsychiatrySeth Glickman, MD, MBA Emergency MedicineCam Patterson, MD, MBA MedicineDave Gerber, MD SurgeryRich Davis, MD OphthalmologyKeith Kocis, MD Anesthesiology and PediatricsBrent Lamm NC TraCS InstituteKate Menard, MD, MPH Obstetrics and GynecologyBryant Murphy, MD Anesthesiology Tammie Stanton Post Acute ServicesCarol Lewis, MBA Psychiatry


“Establish a mechanism for innovation and entrepreneurship in clinical care delivery and financing.”

Initiative 1: Establish a Center for Health Care Innovation.

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SOM Strategic Plan Implementation—Clinical SP 2: Plan Elements

1. Establish a mechanism for innovation and entrepreneurship in clinical care delivery and financing

1.1 Introduction

The framework of health care delivery is shifting rapidly across the US. The systems that will thrive will focus on cost efficiency, quality of care, innovative health care delivery, and alignment of incentives with payers and other participants in the health care equation. Attributes not normally associated with academic institutions—nimble and agile adaptation, collaborative approaches, and public-private partnerships—will be required to outperform. Conversely, systems that lack these attributes will be left behind. The UNC Health Care System and School of Medicine must formalize its strategies to foster innovation and entrepreneurial approaches to our health care practice in order to thrive in this challenging and changing environment. The creation of a Center for Innovation will provide the staff, structure and supporting processes needed to promote innovation across the UNC HCS and SOM.

1.2 Role of the Center for Innovation

Provide a locus to serve the development of patient-centered innovations across UNC HCS and SOM• rapid assessment• coordinated facilitation • partnership development • funding

Support and showcase existing innovations and promulgate the experience/skills already obtained

Demonstrate commitment of UNC HCS and SOM to branding around innovative quality: improved outcomes, patient satisfaction, and decreased costs

1.3 Mission

To initiate, evaluate and support adoption of disruptive innovations in the delivery and financing of health care that are patient centered, improve health outcomes, and lower costs.

Our success will be interdependent with that of our partners from outside organizations, other University entities, and the State of North Carolina.

1.4 Scope

1.4.1 Initial Scope

Experiments in:• Business model innovations• Clinical process redesign• Innovative care delivery models and pathways• Continuum of care expansions • New technology deployments

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• Other clinical delivery or financing innovations

Select experiments of Translational Research including:• Studies of post-lab, human-ready, actionable scientific discoveries• Pre-clinical translational studies• Clinical trials• Comparative Effectiveness Research• Community-Based Research

1.4.2 Potential Future Scope

• Provide additional support for commercialization of successful innovations with promising business plans in coordination with existing infrastructure at NCTraCs, Rex and other areas of the UNC HCS / SOM

• Scale successful innovation – manage rollout / adoption within UNC HCS

1.5 Generation and Selection of Innovations

1.5.1 Role of Think Tank / Academy of Innovators

One of the critical roles of the Center is the generation and selection of innovative ideas with the greatest promise for achieving the Mission of the Center. An Academy of Innovators from a variety of disciplines will be created within the Center’s “Think Tank” and tasked with developing a continuous cycle for idea generation. Selection of individuals to this group will be critical to the success of the Center for Innovation (see additional discussion in Section 5.4). The Academy of Innovators will be tasked with the:• Continuous generation of new innovative ideas in collaboration with internal and external

innovators through forums, challenges, discussions and other interactive venues• Fostering of relationships with members of the Center’s External Advisory Board(s) and

other external partners to create a broad and rich network of resources for generating and vetting ideas

• Development of processes to formalize activities around idea generation, selection and project portfolio management

1.5.2 Support from Center’s core staff

The Center’s core staff will provide analytical and administrative support for the Think Tank as follows:• Feasibility assessment of new ideas• Support for formal selection process• Single point of entry for innovators (internal and external) to approach the UNC HCS and

SOM when seeking opportunities for partnership and/or requesting resources and support for the development of new ideaso Research projects will be coordinated with NCTraCS

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o Projects that have potential for commercialization will be coordinated with the Associate Dean for Medical Entrepreneurship and appropriate areas of NCTraCS

o Projects/ideas suitable for other existing departments of the UNC HCS (e.g., hospital QI, Strategic Planning / Business Development) will be referred rather than pursued

1.5.3 Criteria to be considered in the selection of innovation initiatives for project support from Center:• Alignment with Center Mission and Scope• Potential to be transformative • Ability to strengthen or create new partnership opportunities• Potential to address an unmet customer need• Scalability• Availability of external funding• HCS/SOM ability to support the pilot implementation effort (i.e. ease of implementation and

acceptable demand on HCS/SOM resources)• If Translational Research, NCTraCS review and support for project

1.6 Examples of Innovation Projects

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2. SOM Strategic Plan Implementation—Clinical SP 2: Timing and Sequence of Activities

2.1 Timing and Sequence of Activities for 2012

2.2 Timing and Sequence of Activities for 2013

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2.3 Timing and Sequence of Activities for 2014 and beyond

The Center for Innovation will continue to forge new partnerships and generate innovative initiatives. Once established and in a position to meet its primary objectives related to the promotion of innovation across the UNC HCS and SOM, the focus of the Center’s resources may be expanded to include additional areas of interest and benefit to UNC HCS and SOM. Some examples may include:

1. State and national policy development to enable further innovation2. Industry-wide education and training through innovative forums3. Transfer of knowledge to other external innovators through consultation relationships4. Potential investment in clinical space for use in prototyping and running trials for new ideas

and concepts (dependent upon successful fund raising)

3. SOM Strategic Plan Implementation—Clinical SP 2: Returns/Values/Metrics

3.1 Metrics

Metric TargetYear to Initiate Metric

Innovation Portfolio Management Number of large scale business model

innovations supportedAt least 1-2 / year FY13

Number of small scale innovations supported At least 3-4 / year FY13 Number of translational science innovations

supportedAt least 1 / year FY13

Project-specific metrics established and tracked for each project

100% FY13

Number of successes / failures TBD FY14 Number of projects considered / selected TBD FY14

Partnerships / Fundraising Number of new partnerships forged 2-3 / year FY13 Project-specific funds raised TBD FY13 General funds raised TBD FY14

Establishment of Center Staff hired 3 additional staff in FY13 FY13 Governance groups formed and established All in FY13 FY13 Processes documented All in FY13 FY13

Change Management Satisfaction of Think Tank members TBD FY14 Employee feedback on innovation culture

(survey)TBD FY13

(baseline)

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4. SOM Strategic Plan Implementation—Clinical SP 2: Resources Required

4.1 Organizational Structure – Staffing

The Center will add three additional staff members during FY13 (see below) to reach full staff of 5.7 FTEs.

Fully staffed the Center for Innovation will be 5.7 FTEs requiring 1,500 square feet of space. A request for space has been submitted to current HCS/SOM space planning processes for either Hedrick or MacNider

4.2 Projected Costs – Administrative

Below are projected costs for establishing the Center for Innovation during FY13 and continuing to operate over the five year strategic planning period. Included in the budget are salary and benefit costs for the Center employees, costs to establish and maintain the Think Tank (i.e. Academy of Innovators and the external Advisory Board(s)), as well as overhead for the department (e.g. space, telecom, office supplies). A small amount of funding has been reserved to support unknown project-specific costs but is not intended to provide full funding for anticipated innovation initiatives. Additional funding will be secured for each project initiated by the Center on an as needed basis (see below).

Because the Innovation Center serves both the HCS and SOM, a 50%/50% cost sharing arrangement has been agreed upon by the CFOs and leadership team to fund the administrative costs of the Center. UNC HCS has already committed 50 % ($700,000) in its FY13 budget for the Center for Innovation with the expectation of a continuing annual commitment. Therefore, the support needed from the SOM is the remaining 50%, $700,000/year, a total of $3.5 M over the five year strategic planning period.

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4.3 Project-Specific Costs and Funding

Funding for costs associated with implementation of initiatives will be sought through partnerships for specific projects (through financial support and in-kind donations), grants and additional internal funding where appropriate (e.g. a department may choose to fund a project or portion of its costs). One of the major activities of the Center will be to develop new partnerships and strengthen existing relationships with outside organizations. To date, most innovation projects have been funded through partner support, and a number of external organizations have expressed interest in funding future projects.

4.4 General Funding

Discussions are underway with the Medical Foundation and Kenan-Flagler School of Business to seek contributions and donations from foundations, private and corporate donors, venture capital investors and other sources of funding. Healthcare innovation is a high priority across the nation, and the Center for Innovation will be well positioned to capitalize on resulting funding opportunities.

5. SOM Strategic Plan Implementation—Clinical SP 2: Resources Required (con’t.)

5.1 High Level Structure

The Center for Innovation contemplates a Governance Group and a Collaboratory. The key components include the following:

• A small, nimble HCS-level governance team to build culture of innovation and manage portfolio of initiatives

• A Think Tank comprised of external advisory board(s) and an experienced Academy of Innovators charged with generating, vetting and prioritizing innovative ideas

• Implementation team to manage experiments and support Think Tank efforts• Education and consultative staff to support and promote innovation throughout the HCS

and SOM

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5.2 Detailed Structure

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5.3 Proposed Innovation Leadership Group

Members• David Rubinow Chief Innovation Officer, Chair• Gary Park President, UNCH• Al Daugird President, P&A and TPN• David Strong President, Rex Healthcare• John Lewis CFO, UNC HCS• Terry Magnuson Vice Dean for Research, SOM• Marschall Runge Director, NCTraCS • Ron Falk Chief, Nephrology and Hypertension• Cam Patterson Assc. Dean, Health Care Entrepreneurship

Key Responsibilities• Prioritize and recommend system-wide initiatives to Wednesday Leadership Group• Oversee portfolio; monitor and learn from successes and failures• Oversee Center funding and resource allocations• Promote culture of innovation• Monitor overall success in innovation based on select metrics• Eliminate barriers to success

Meeting Frequency• Quarterly

5.4 Think Tank / Academy of Innovators

The Academy of Innovators will be a small group of individuals selected based on their creativity, action orientation, interest in promoting innovation as part of their daily tasks, and ability to provide critical analysis and solution development for health care industry challenges. Diversity within the Academy will be important, and an effort will be made to build a multi-disciplinary team.

Members• David Rubinow, Chief Innovation Officer, Chair• Carol Lewis, Associate Director, Innovation• Others TBD (some recommendations for internal members to date include Tammie Stanton,

Robb Malone, Seth Glickman, David Gerber, Gregg Tracton, and Brian Goldstein)

Key Responsibilities• Continuously generate new innovative ideas• Identify disruptive and transformative innovations• Collaborate with external advisory boards and partners• Vet and prioritize ideas

o Recommend large-scale business model innovations to Innovation Leadership Groupo Select small-scale innovations and allocate Center resources accordingly

Meeting Frequency• As needed but not less than monthly; members expected to work independently to promote

the genesis of new ideas

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5.5 Think Tank / External Advisory Board(s)

Members• David Rubinow, Chief Innovation Officer, Chair• Carol Lewis, Associate Director, Innovation• 5-7 external innovators volunteering time

Key Responsibilities• Collaborate with Academy of Innovators• Generate and recommend innovative ideas• Identify partnership opportunities• Advise Center on vetting and selecting innovations, mission, objectives and approach

Meeting Frequency• Quarterly

5.6 Collaboratory Staff Responsibilities

Vetting and Selection• Create and manage formal process for submission and review of ideas• Provide analytical support to the Think Tank for vetting innovations

Design, Implementation and Evaluation• Design, develop and launch selected initiatives• Coordinate with operational and support areas• Monitor and measure results of initiatives• Secure outside funding • Engage partners in development and launch• Provide analysis and informatics

Consultation / Education• Promulgate lessons learned• Identify processes that can be streamlined• Guide potential innovators in early project development

Fundraising and External Relationships• Engage partners via a single point of entry• Seek external funding (e.g. grants, donations, partnerships) • Leverage experience of others in process development and culture change

6. SOM Strategic Plan Implementation—Clinical SP 2: Prioritization

As part of the UNC HCS strategic planning process, the budget and scope of the Center for Innovation were discussed and revised to retain those items deemed as highest priority. The proposal presented in this document retains only the most critical components of the Center required to be successful.

The following elements were eliminated from the original proposal and budget for the Center reviewed by the UNC HCS Strategy Steering Committee (SSC) in February, 2012. Although important, in the context of budget limitations these items were deemed to be lower priority than those retained in the current proposal described above.

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Components Removed from Center for InnovationDuring UNC HCS Strategy Development Process

Annual Amount

Five Year Amount

6 Collaboratory staff positions 2 fund raisers 2 education and consultation positions 3 project support positions

$440,000 $2.2 M

Project-specific funding $850,000 $4.3 MTOTAL COSTS CUT FROM ORIGINAL PROPOSAL $1,290,000 $6.5 MOriginal Proposed Budget $2,690,000 $13.5 MCurrent Proposed Budget $1,400,000 $7.0 MSOM 50% Share $700,000 $3.5 M

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Strategic Priority 3 : Institute a SOM-HCS informatics strategy to enable highest quality care and innovation


Team members and Departments:Brent Lamm NC TraCS InstituteMike Pignone, MD MedicineTracey Parham ISDDon Spencer, MD, MBA Family MedicineShelley Earp, MD MedicineSai Balu LCCC BioinformaticsLarry Klein, MD Medicine and RadiologyMatt Ewend, MD NeurosurgeryCarolyn Viall Donohue NursingChuck Esther, MD, PhD PediatricsTim Carey, MD, MPH Medicine and Social MedicineJim Evans, MD, PhD Genetics and MedicineCarol Lewis, MBA PsychiatryDennis Schmidt SOM Office of Information SystemsStan Ahalt RENCIPeter Leese Performance Improvement and Patient Safety Plan (PIPS)Ramon Padilla ITS


“Institute a cross SOM-HCS informatics strategy.”

Initiative 1: Identify the organizational structures, policies and practices that will be needed to facilitate and enable functional integration of clinical informatics.

Initiative 2: Make necessary investments to realize the vision for the Carolina Data Warehouse.

Initiative 3: Support proposal for a program in medical informatics. Initiative 4: Enable better communication between faculty and IT staff.

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SOM Strategic Plan Implementation—Clinical SP 3:“Institute a cross SOM-HCS informatics strategy”

Motivation for investment in Informatics

1.1 Dramatic changes in academic health care are impacting all key stakeholders

Administratorso Shift the organization from “volume” (fee for service) to “value” based care modelso Drive integration of the entity-components of the health care systemo Manage / contain expanding costs of delivering care and training the next generationo Offer value-added services and access to innovation for patients with increasing choices

Clinicianso Evaluate and maintain compliance with emerging and expanding quality targetso Utilize expanding sources of data to continuously improve patient careo Update practices to incorporate evidence-based and patient-centered care models

Researcherso Leverage expanding sources of data to compete for flat and/or declining federal funding, make

research more efficient in the future constrained environmento Explore emerging opportunities in comparative effective research and genomics

1.2. Innovative Informatics solutions will be required to solve these complex challengesData Integration

o Virtually all of these future challenges will require integrating disparate types of data (clinical, administrative, genomic, patient reported, etc.)

o Leveraging centralized capabilities to perform system-wide data integration offers potential economies of scale and helps avoid “reinventing the wheel” scenarios

Self-service Data Access & Analysiso Balancing access to data with information security will require creation of centrally managed self-

service applications (e.g., research data portal) that offer users flexibility and agility while ensuring compliance with regulations and prevention of data loss

Population Health / Evidence-based Decision Supporto The ability to leverage aggregate, population-level data will be required to support new value-based

compensation models and quality improvement initiativeso Metric-driven compliance with expanding guidelines and clinical documentation requirements will

require computer-aided feedback and automation for clinicians

Genomics / Personalized Medicineo “Big Data” solutions will be required to enable incorporation of genomics and personalized medicine

techniques for clinical utility and new research opportunities

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1.3. Successful implementation of the SOM Strategic Plan will require many Informatics capabilities

Researcho Integration of genomics and clinical datao Clinical “laboratories” for new clinical decision support modelso Support for growth in industry sponsored clinical trials recruitmento Hypothesis-driven patient registries

Quality Improvemento Ability to identify and analyze patient populationso Metric-driven evaluation of quality programso Enhanced technologies for high-quality data capture at point of care

Innovation Centero Data-driven evaluation of practice redesign effortso Integration of new data sources (e.g., predictive modeling)

Faculty Development & Educationo Informatics training for next generation of MDs and developing effective interface between

clinician researchers and Informaticianso Metric-driven performance improvement and assessment

1.4. SOM Strategic Plan is a critical opportunity to prevent (and revert) further “data islands”

• Current landscape includes dozens of department and investigator level databases and registries– Poses potential information security risks– Burdens investigators and research staff with having to maintain IT skills within their teams

and spending time addressing IT issues– Inhibits sharing of data across studies, projects, and efforts

• Opportunity to provide centralized services at lower overall cost & retaining agility and flexibility– We have seen early success with LCCC and TraCS initiatives (e.g., data warehouse and

research study data management services)

• Our objective is to build on these models for broader quality, secure data management offerings– Metric-driven service offerings (e.g., response times, cost targets)

• (i.e., make it easy and cost effective)

1.5. Current barriers need to be addressed to ensure Informatics needs can be met

• Informatics faculty to guide initiatives based on latest evidence• Clear prioritization of informatics efforts and resource utilization

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• Sufficient informatics staff to service growing needs• Lack of effective interface between those with informatics expertise and those positioned to pursue

research and clinical work• Development of new Health IT professionals to meet demand• Effective and efficient access to health care system-wide data:

– Comprehensive patient record across all system entities– Financial / cost data for comparative effectiveness research– Patient reported outcomes– Department-specific clinical systems that are currently isolated– Silos of patient registries – lack of cross-organization data sharing

2. Scope of Clinical Informatics & SOM IT Uses / Applications of Informatics:

o Research / academic requirements that impact or relate to information systems used for patient care, clinical research, basic science, and teaching missions.

HCS Entitieso The long-term goal is to include all entities of the UNC HCS; however, a phased approach will be

required. Alignment with HCS operational integration initiatives (e.g., Heart & Vascular and Oncology functional integration efforts) is recommended.

User Groupso The aligned SOM-HCS Informatics initiatives that span clinical quality improvement, research,

and education will potentially have implications for all key user groups across the organization. For example:

Clinicians Researchers and staff Educators Centers and Institutes (e.g., LCCC, NC TraCS, RENCI, Sheps, etc.)

Clinical Informatics Systems:o Electronic Medical Record Systems

Prompts, reminders, and decision aids for quality improvement Integration of clinical decision support models

o Ancillary and specialty clinical information systems Evaluation and procurement of new specialized software Use of text-mining (e.g., colonoscopy follow-ups per guidelines)

o Financial information systems (billing, cost accounting) Comparative Effectiveness Research

o Carolina Data Warehouse & Patient Registries (local & national) Evidence-based population health Predictive modeling research State-wide population registries Quality improvement / patient safety analysis

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SOM IT Systems:o Information systems used for administrative, academic and research missionso Systems and example areas of potential requirements include:

Centralized Servers Supporting file and print sharing, databases, and classrooms

Centralized Storage Tiered architecture to meet various needs Enterprise encryption solution for data at rest

Physical Network Infrastructure Network switches and routers Centrally managed physical firewall(s) Tipping Point Intrusion Prevention and other protective devices

3. Plan Design Elements

3.1. Initiative 1: Identify what organizational structure, policies and practices will be needed to facilitate and enable functional integration of clinical informatics

3.1.1. Key Objectives SOM-HCS Clinical Informatics

o Create a model that will ensure alignment of the clinical informatics goals for the School of Medicine and Health Care System to reduce inefficiencies, improve data security, and foster collaboration across the missions of clinical quality, research, and education

SOM IT Strategyo Establish a centralized set of IT services that will reduce overall IT costs, increase the quality and

responsiveness of IT capabilities, and improve end-to-end information security across the SOM

3.1.2. Plan Design Elements: SOM-HCS Clinical Informatics

Unify SOM-HCS Informatics governance under newly formed Information Services Oversight Committee (ISOC) structure chaired by HCS CIOo This will avoid creating redundant governance structures and will facilitate alignment of goals

and objectives via a common forum

Charge ISOC “Clinical Sub-committee” with research and academic missions, and augment with 3-5 additional research and academic championso Additional membership will help ensure research and academic Informatics needs have an equal

voice to inform prioritization of clinical informatics strategy, direction, and initiatives

Establish small, time-limited, faculty-led Task Force to discuss and provide formal recommendations to the ISOC to address SOM Informatics governance objectives, including (but not limited to):o How are research and academic driven requirements impacting clinical (and other) information

systems prioritized and formally requested?

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o Should informatics staff remain distributed across SOM departments, or should a central organization exist? If so, should this reside within SOM or HCS?

o What policies will be used to determine deployment of limited informatics staff and resources with competing priorities?

o What incentive models should be recommended to promote the use of centralized IT (server and storage) services for cost efficiency and security?

o Should internal information security audits be conducted routinely for central and department / investigator level IT systems storing sensitive (PHI) information?

o What IT governance relationships exist between HCS, SOM, and ITS?o What evaluation and review processes should exist for SOM departments seeking to obtain and

implement information systems used in clinical setting?o How will data (clinical, billing, etc.) from non-Chapel Hill entities of the HCS system (e.g., Rex,

Chatham, TPN) be made available to research? Will there be any limitation on the research use of these data?

Establish formal process, through the ISOC, to track prioritization and implementation of research and academic informatics requirementso Quantifying the volume and progress of Informatics-related requirements will serve as a key set

of metrics for evaluating successful implementation. A well-defined process will be required to ensure data are captured for analysis.

3.1.3. Plan Design Elements: SOM IT Strategy

Include SOM IT in HCS Information Services governance structure through the ISOC “Administrative Sub-committee” – Director of SOM Office of Information Systems

o Currently no SOM IT-wide governance structure; utilize newly established ISOC initiative and structure as the vehicle to align with HCS governance

Request ITS, HCS, and SOM IT leaders / administration to evaluate and recommend organizational reporting structure for SOM IT

o We view this linkage as critical given the current gaps between HCS and SOM information systems for clinical faculty (e.g., disparate user accounts)

o A key goal is to establish a clearly defined processes for how research-initiated Informatics / IT solutions that have potential clinical utility can develop in a research-friendly setting and migrate to production operations

Perform comprehensive inventory of existing SOM-wide IT systems, database, and human resources

o Many isolated, disparate systems and resources exist throughout departments

Conduct comprehensive SOM-wide information security risk assessment and action any findings

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Establish central service offerings for server, database, and storage capabilities, with fully transparent Service Level Agreements (SLAs) – utilizing virtualization (cloud) technologies for flexibility and agility

o Incentivize departments and faculty to use central IT services vs. purchasing, installing, and supporting isolated systems

o Create simple, cost-effective recharge models $X / server image per month $Y / Gigabyte of secure, network storage per month $Z / secure database structure per month

o Use Service Level Agreements (metrics) to gain acceptance of services Setup of new server within X days Setup new secure database structure within Y days

3.2. Initiative 2: Make necessary investments to realize the vision of the Carolina Data Warehouse for Health (CDW-H)

3.2.1. Key Objectives

Provide the necessary infrastructure, support, and process capabilities needed to enable faculty and staff to fully utilize aggregated clinical, business operations, and research data for quality improvement and data-intensive, emerging research opportunities

Establish the CDW-H as the robust clinical and administrative data repository required to attract top-notch Informatics faculty and support large-scale improvement in patient care

3.2.2. Plan Design Elements

Identify, prioritize, and implement automated data integration of additional data sources into the CDW-H that are needed to expand use across research and education

o This includes additional data sources within the Chapel Hill-based entities, as well as clinical and business operations data from the other system entities, as well as data for population health and care management

o Note: This aligns directly with HCS strategic plans established in early 2012

Expand Data Governance from Chapel Hill-only to HCS-wide structureo Legal, data-use, and compliance issues will need to be identified and addressed; a

comprehensive data governance approach is required to ensure successo Note: This aligns directly with HCS strategic plans established in early 2012

Enhance the current CDW-H Research Portal to include “app store” like self-service capabilities and leverage expanded data sources

o The current Research Portal solution offers basic “cohort discovery” capabilities; additional applications need to be developed by CDW-H Analyst/Programming staff to offer common data analysis capabilities to faculty and staff

E.g., Quality improvement reporting and dashboards

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o This effort also needs to include creation of online training guides and informational communications to drive awareness and utilization

Establish centralized registry platform and service with integration to CDW-Ho Leverage data management service offering via NC TraCS as a model and create

integration with clinical operations data from the CDW-H E.g., automated population of clinically captured data into registry

Implement a readily usable online, self-service data exploration tool to enable users to explore and evaluate data available within the CDW-H environment

o One of the major feedback points from faculty and users has been lack of visibility of available data and data linkages within the CDW-H

Formally link input from clinical ambassadors to CDW-H Operations Governanceo Align this effort with Medical Informatics faculty hires

Create single, streamlined request process between clinical care, operations, and research under CDW-H Governance structure

o Currently, there is confusion over when to utilize Informatics resources from ISD, OIS, and other centers/institutes such as NC TraCS and LCCC

o A single request in-take process will enable Informatics teams to coordinate

3.3. Initiative 3: Support proposal for Program in Medical Informatics


Recruit and retain faculty with expertise in medical informatics research, and establish an Informatics program that will enable UNC to keep pace with the rapidly expanding needs for Informatics capabilities

Enable an academic program that will help train the next generation of physicians who will have an ever-increasing need for Informatics skills


Hire 3 initial medical Informatics faculty via NC TraCSo Note: This effort is currently underway with non-strategic plan fundso 1 senior-level and 2 junior-level faculty position have been created and candidates are in

the process of being evaluated by a formal search committeeo In addition, 1 GRA position has already been established and filled within the NC TraCS

Biomedical Informatics core

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Secure additional funding through SOM Strategic Plan for 3 additional facultyo A total of 6 new Informatics faculty hires through the SOM, coupled with existing faculty

from across the Health Affairs, Information & Library Sciences, and the College schools will provide the critical-mass needed to formalize an academic program

Establish formal “Biomedical & Health Informatics” (BHMI) academic programo Work with the Provost’s office and Deans from across the campus to formalize an

academic program that spans Biomedical & Health Informatics Biomedical: Clinical and Medical Informatics Health: Population and Public Health Informatics

Identify existing faculty from across the campus that can be appointed to the Biomedical & Health Informatics program to help create the critical mass needed

o Target is 12-14 total faculty (new, dedicated Informatics hires plus existing faculty with joint appointments)

3.4. Initiative 4: Enable better communication between faculty and IT staff


Establish a model of bi-directional communication between faculty and IT / Informatics staff that will enable generation and implementation of new ideas for improved Informatics capabilities and clinical transformation

Provide an organizational framework to enable evaluation and implementation of changes in care delivery based on research performed by the Biomedical and Health Informatics (BMHI) program


Appoint 5-10 “clinical ambassadors” who will devote a portion of their time to serving as liaisons between ISD and the user community within the SOM

o The aspect of the role will include negotiating between Informatics faculty (potential ideas), clinical faculty (what is feasible in a patient care setting), and IT (what is technical / operationally possible)

o Faculty physicians who are “informatics aware” and are highly motivated to see improved Informatics capabilities, as well as the ability to communicate new initiatives

o A challenging role, but if established could serve as a major selling point to attract Informatics faculty

o The rationale is that faculty physicians will most likely be able to relate complex Informatics concepts to their peers better than Informatics staff members

o Also, faculty physicians will be more likely to help Informatics staff understand and action the clinical workflow and environmental nuances to inform solutions

o Requires funding for percent efforts from our IT savvy clinical ambassadors (10% effort for each)

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Hire a dedicated masters-level communications coordinator to tie together the work of the clinical ambassadors and to support ISD-SOM communication

o A common complaint from faculty is not understanding the strategy and direction of Informatics throughout the organization

Program a feedback tab in EMR system that would allow point of service feedback; assign communications coordinator to review feedback and organize it for consideration by the ambassadors and ISD staff

Explore the use of small-scale grant programs – potentially with the Innovation Center and/or Quality Improvement initiatives – for clinical entities that wish to improve clinical data quality

Explore the utilization of Meaningful Use Practice Coaches currently deployed throughout clinical departments to serve as additional Informatics liaisons with staff

4. SOM Strategic Plan Implementation—Clinical SP 3: Timing & Sequence of Activities

What returns do we expect and when?

Initiative 1: SOM-HCS Informatics

Aug 2012: Update Information Services Oversight Committee (ISCO) “Clinical Sub-committee” with additional research and academic charges and member champions

Aug 2012 – Apr 2013: Task Force charged with creating specific recommendations to address SOM Informatics / IT governance issues

May 2013: Task Force produces formal SOM Informatics / IT governance recommendations to ISOC for review and consideration (detailed list of key questions listed above)

Jan 2013 – Aug 2013: Develop and implement process for tracking prioritization and implementation of research and academic informatics requirements, and transparent reporting (i.e., internal website with published progress reports)

Initiative 1: SOM IT Strategy

Aug 2012: Add SOM IT leadership to ISOC “Administrative Sub-committee” Jun 2013 – Jun 2014: Implement SOM IT governance recommendations coming out of Task

Force focused on key governance and organizational questions Aug 2012 – Dec 2012: Perform SOM-wide inventory of IT systems and resources Jan 2013 – May 2013: Conduct SOM-wide information security risk assessment May 2013 – Aug 2013: ITS, HCS, and SOM IT business leaders evaluate and recommend any

potential changes to SOM IT organizational reporting structures Sep 2013 – Dec 2013: Implement any recommended organizational reporting structures Aug 2012 – Apr 2013: Establish (initial) centralized server / database / storage virtualized

(“private cloud”) infrastructure, service level agreements, and monthly recharge processes

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Initiative 2: CDW-H Aug 2012 – Aug 2013: Hire 3 additional CDW-H Research Analyst staff Aug 2012 – Dec 2012: Establish single, streamlined, and online request process for CDW-H

across clinical care, operations, research, and academic needs Aug 2012 – Aug 2013: Establish online, self-service data exploration and terminology tool

(IBM Business Glossary; software costs covered by HCS) Aug 2012 – Ongoing: Periodic (e.g., monthly) meetings with Clinical Ambassadors and CDW-H

Analysts to discuss and identify data model and terminology efforts and issues Aug 2012 – Ongoing: Using the ISOC “Data & Analytics Sub-committee” governance body,

continuously identify, prioritize, and implement data integration of SOM and HCS wide additional data sources into the CDW-H (e.g., Rex, TPN, P&A, cost accounting, genomics databases, etc.)

Aug 2012 – Aug 2013: Hire 2 additional Data Integration staff Aug 2012 – Aug 2013: Perform legal, compliance, and cost related assessment of adding non-

Chapel Hill entity data into the CDW-H (e.g., Rex, TPN, Chatham, etc.) Aug 2012 – Feb 2013: Hire Research Portal programmer staff May 2013 – Dec 2014: Develop and launch enhanced CDW-H Research Portal with initial set of

self-service applications (e.g., expanded cohort discovery, quality improvement dashboards, physician-specific metrics and data points for credentialing needs, etc.)

Jan 2015 – Mar 2015: Develop and implement online training model and initial modules for self-service CDW-H Research Portal capabilities

Jan 2015 – Ongoing: Continuous development of additional CDW-H Research Portal capabilities based on requirements governed through ISOC Data & Analytics Sub-committee and Biomedical Informatics Faculty grants & projects

Apr 2014 – Ongoing: Develop additional online training modules as new capabilities are developed

May 2013 – May 2015: Establish centralized registry platform and service with integration to CDW-H (i.e., NC TraCS REDCap service with web-services linkage to CDW-H for automated population of approved patient data)

Initiative 3: Informatics Academic Program Pre-Aug 2012: Complete and submit intent-to-plan proposal to Provost’s office Pre-Aug 2012 – Dec 2012: Identify collection of existing faculty from across the campus that

can be appointed to the BMHI program Dec 2103: Formally link new Informatics hires (potentially 3), currently being explored by the

College of Arts and Sciences, to the BMHI program proposal Aug 2012: Finalize and submit Biomedical and Health Informatics (BMHI) Program proposal to

Provost’s office (Complete): Hire initial 2 (TraCS-funded) Informatics faculty positions Aug 2012 – Dec 2012: Hire 3rd (TraCS-funded) Informatics faculty position Aug 2012 – Jun 2014: Hire 3 additional (SOM Strategic Plan funded) Informatics faculty

positions• Present – Dec 2012: Develop and submit Master’s degree proposal to GA• Aug 2013: First cohort of BMHI Master’s students start in Fall 2013 term

Initiative 4: Increased Communication between Faculty and IT

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Aug 2012 – Dec 2012: Identify prospective clinical faculty for “Clinical Ambassador” positions Jan 2013: Appoint initial 2-3 Clinical Ambassadors and establish organizational structure (e.g.,

reporting to CMIO) Jan 2013 – May 2013: Clinical Ambassadors develop and establish work-practices for the team

to perform bi-directional communication between clinical departments and IT Jan 2013: Hire Master’s level communication coordinator position Jan 2014: Appoint additional 2-3 Clinical Ambassadors Jan 2015: Appoint additional 2-3 Clinical Ambassadors

5. SOM Strategic Plan Implementation—Clinical SP 3: Returns/Values/Metrics


Initiative 1– SOM-HCS Informatics

1. Y1: Task Force policy and governance recommendations completed.2. Y1: Complete faculty informatics satisfaction survey as baseline.3. Y2-5: Complete annual faculty informatics satisfaction surveys.4. Track quantify of research / academic requirement submissions, evaluations, and

implementations.

– SOM IT Strategy1. Total IT spending within SOM2. Aggregate SOM IT costs as ratio of research funding3. Number of servers consolidated from individual departments4. Formal, published reporting (monthly) of results against SLA’s

1. Initial response time, time-to-resolution, customer satisfaction surveys5. Measure our increase in level of security:

1. Percent compliance with risk assessment2. Number of incidents3. Patch levels

Initiative 2– Quantified usage of Research Portal (unique users, usage growth over time)– Number and content of new data sources integrated into the CDW-H– Continued measurement of research grant funding utilizing this resource– Number of registries utilizing centralized, integrated service offering– Turnaround time of data requests

Initiative 3– Baseline: 31 certificates awarded to date through CHIP program– First GRA started with CDW-H / TraCS May 2012– Informatics-related research funding growth (via RAMSeS grant funding data)

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– Track graduates from program (certificates and masters degree)

Initiative 4– Quantitative and qualitative analysis of EMR system feedback– Annual Informatics satisfaction survey results from clinical faculty

7. SOM Strategic Plan Implementation—Clinical SP 3: Resources Required


Initiative 1: Total = $1.997M over 5 years

SOM-HCS Informatics:

$150k for administrative support staff to facilitate Task Force and committee activities, and collect and report on progress metrics (Note: assume no budgeted costs for faculty and staff membership time)

SOM IT Strategy

Assume no budgeted costs for Governance committee activities Assume no budgeted costs for SOM-wide IT inventory activities $1.0M ($100k / year x 2 FTE x 5 years) required to maintain expanded infrastructure (Note: Could

be pulled from existing departmental IT staff) $300k for external vendor to perform SOM-wide information security risk assessment $315k initial investment to establish central server, database, and storage infrastructure to support 100

servers.o Alignment with SOM-commissioned Dell Reporto $51,000 - 3 Dell R810 quad processor servers o $5,000 - 1 Dell VCenter Server to control Virtual infrastructureo $24,000 - 12 VMWare licenses (1 per cpu) o $60,000 - 2 Netapp Storage arrays (1 primary and 1 for replicated backup)o $100,000 - SafeNet encryption appliance to encrypt data at resto $25,000 - Virtual Machine Training for Administratorso $50,000 – Orchestration and Management Tools

$232k second year investment to expand central server and storage infrastructure to support an additional 100 servers.

o $34,000 - 2 Dell R810 quad processor servers (Up to 100 Virtual Servers )o $28,000 - 8 VMWare licenses (1 per cpu) + License renewal from year 1o $60,000 - 2 Netapp Storage arrays (1 primary and 1 for replicated backup)o $100,000 - SafeNet encryption appliance to encrypt data at rest


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Note: Propose potential sharing of funding for CDW-H Informatics resources with HCS strategic planning efforts

$250k for hardware and software infrastructure to support self-service (e.g., Research Portal and “app store” like tools) capabilities

$450k (2 FTE x 2 years) for contract Data Integration specialists to establish data integration with additional data sources, including non-Chapel Hill HCS entities (Note: should explore potential cost-sharing with HCS for these positions)

$800k (2 FTE x 4 years) for Programmer to develop self-service tools based on requirements from clinical ambassadors and Informatics faculty

$2.0M (4 FTE x 4 years) for additional CDW-H Analyst staff $200k for new online education and training modules


$525k ($175k x 3 years) for 1 senior Informatics faculty hire $300k one-time startup package for senior faculty hire $840k ($140k x 2 hires x 3 years) for 2 assistant professor level faculty hires $250k ($125k x 2 hires) one-time startup package for assistant level faculty hires


$500k (10 ambassadors x 0.1 FTE / year x 5 years) for clinical ambassadors $400k (1 FTE x 5 years) for masters-level communications coordinator $500k ($100k / year x 5 years) for data quality focused pilot grant program $20k for programming of feedback feature in EMR system

TOTAL: $8.632M over 5 years

7. SOM Strategic Plan Implementation—Clinical SP 3: Resources Required (con’t.)


Initiative 1:

Updates to Information Services Oversight Committee and Sub-committees as outlined above in the plan details section

(This initiative is really designed to try and address the overall Informatics structures.)

Initiative 2:

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Alignment with Data & Analytics components of HCS Strategic plan

Initiative 3:

Informatics new faculty hires will require support and discussion from target Department Chairs Informatics program will need to be established both as a unit (tenure granting home) as well as

programmatically (curricular home). Both of these issues need to be addressed at both the SOM and University level

Initiative 4:

Clinical Ambassador appointments will require support and discussion from target Department Chairs, and assessments of impacts on clinical time

Establish process that allows us to track and report Ambassador engagements in order to assess efficacy and outcomes

8. SOM Strategic Plan Implementation—Clinical SP 3: Prioritization


Overall Prioritization of Initiatives

1. Initiatives 2 & 3 (The committee feels these are of equal priority for establishing a strong and leading Informatics program at UNC)

2. Initiative 13. Initiative 4

Sequencing of Initiatives

Short-term Academic program in Biomedical & Health Informatics (Initiative 3) 3 faculty hires above/beyond NC TraCS-funded hires (Initiative 3) Additional CDW-H staffing (Initiative 2) ISOC-related SOM Informatics / IT Governance (Initiative 1) Task Force to evaluate key governance questions and provide recommendations to ISOC Initial centralized server/database/storage environment for SOM IT (Initiative 1) Perform SOM-wide IT systems and resources inventory and information security risk

assessment Provide self-service CDW-H data exploration and terminology toolset Create single, streamlined request process for CDW-H across HCS-SOM missions Appoint initial cohort of clinical ambassadors Provide initial set of data quality focused pilot grants

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Intermediate / Long-term Evaluation of prioritization and implementation of research and academic focused

Informatics requirements within clinical information systems environment Expand centralized server/database/storage infrastructure pending evaluation of adoption rate

and financial sustainability of the recharge service model Ongoing data integration of new SOM-prioritized data sources into the CDW-H Implementation of enhanced CDW-H Research Portal and “app store” like capabilities Establish centralized registry platform with integration to the CDW-H Appoint additional clinical ambassadors pending evaluation of the program’s results, and

potential make percent effort changes if needed to ensure success Program feedback capability in EMR system Increase number of data quality focused pilot grants pending evaluation of initial awards

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Faculty Development

Strategic Priority 1: Enable data-driven management by defining and systematically tracking performance at both the institutional and individual levels

Faculty Development Strategic Priority 1 Team Report


Cam Enarson, MD, MBA Anesthesiology Wayne Price, MD PediatricsHunter Wagstaff UNC Physicians & AssociatesJill Cunnup Endocrinology and MetabolismShannon Carson, MD MedicineLeslie Parise, PhD Biochemistry and BiophysicsMatt Mauro, MD RadiologyBobby Wunnava, MD AnesthesiologyNancy Fisher, PhD Microbiology and ImmunologyRenae Stafford, MD, MPH SurgerySpencer Smith, PhD Cell and Molecular PhysiologyPatsy Oliver Finance and Business Operations

Cam Enarson; Operations Committee representativeCam Enarson; Oversight Committee leader

“Enable data-driven management by defining and systematically tracking performance at both the institutional and individual level.”

Initiative 1: Define, track and disseminate institutional HR performance metrics. Initiative 2: Define faculty performance metrics for clinical service, research and

teaching.

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SOM Strategic Plan Implementation—Faculty SP 1: Plan Elements

Initiatives:

1. Enhance data collection and HR processes to better understand recruitment and retention, including key drivers of attrition overall and within subgroups.

Tactics to Achieve Initiatives: 1) Enact a formal Exit Interview process for all basic science and clinical UNC SOM faculty. This

process should include an interview with the Department Chair and a separate interview with a representative in the UNC Medical School Human Resources Office (UNC SOM HR). A templated form should be used for the interviews. All data collected as a result of the interview should be kept in a database by UNC SOM HR. Examples of templates can be found at the following sites:

a.) http://hsc.unm.edu/som/academicaffairs/ExitInterview.shtmlb.) http://medicine .missouri.edu/business/.../ Exit %20 Interview %202%20(SW) c.) http://www.medschool.lsuhsc.edu/faculty_affairs/docs/exitinterview.pdfd.) http://www.med.miami.edu/hr/exit.asp

2) Baseline data is already collected as part of the retention process when a faculty member is offered a position outside the institution and should continue to be collected. Data should also be collected on why a faculty member chose to stay at UNC after being recruited by another institution.

3) Identify “Best Practices” for retention, recruitment, and diversity initiatives from comparator institutions such as Duke, Wake Forest and University of Michigan.

4) Use metrics from the AAMC GDI (Group on Diversity and Inclusion) and compare these metrics to the make up of the Medical School Faculty.

a.) https://www.aamc.org/data/facultyroster/reports/272016/usmsf11.htmlb.) https://www.aamc.org/data/c.) https://www.aamc.org/members/gdi/priorities/

5) Internal benchmarking: Compare School of Medicine metrics to metrics from a similarly composed UNC professional school, such as the School of Public Health, Dentistry and/or nursing.

6) Obtain resident and subspecialty metrics from UNC GME office that they are required to collect for ACGME to compare to metrics of the Medical School faculty. Query the current residents and subspecialty residents about factors that would influence them to select an academic appointment at a School of Medicine such as UNC.

7) Incorporate information gleaned by querying the residents with any relevant data obtained from the AAMC’s Resident GME Survey.

8) Align diversity collection efforts between the GME Office and the SOM

9) Faculty Forward Survey from the AAMC – Results of the recent report should be tabulated, specifically with regards to retention, recruitment, attrition, and diversity.

10) Publicize “Opening Doors” and any other faculty development initiatives that improve awareness and institutional climate in concert with the office of Faculty Affairs and Faculty Development.

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https://www.aamc.org/members/gdi/priorities/

https://www.aamc.org/data/

https://www.aamc.org/data/facultyroster/reports/272016/usmsf11.html

http://www.med.miami.edu/hr/exit.asp

http://www.medschool.lsuhsc.edu/faculty_affairs/docs/exitinterview.pdf

http://medicine.missouri.edu/business/.../Exit%20Interview%202%20(SW)

http://hsc.unm.edu/som/academicaffairs/ExitInterview.shtml

11) Make inroads and capture any data from the “Back to Carolina” programs in the Medical School that are aimed at recruiting back former students and resident trainees from UNC

12) Query the Assistant Dean for Medical Education for input on diversity ideas and any relevant metrics that individual uses in their position.

13) Meet with the new Associate Provost in charge of Diversity and Multicultural Affairs to discuss alignment of goals and explicit metrics and explore mechanisms for feedback of data from that office to the UNC SOM and Healthcare System stakeholders.

14) Perform Entry Interviews to gather incoming Faculty’s perceptions and reasons for choosing UNC SOM as a place to work.

15) UNC SOM HR should do more “academic detailing” to the faculty about its resources and its function separate from the University HR department.

16) All data that is collected needs to be aligned so that it satisfies the minimum requirements for reporting to UNC-CH, LCME, AAMC and in addition, encompasses all other data identified by faculty and administration as being important to collect such as the entry and exit interview data.

17) Given recent strategic plan developments for SOM and the UNC healthcare system and their alignment, consider producing a single UNC Healthcare System Report that includes data for the entire system grouped by “service lines” – healthcare schools, hospital, GME, etc.

2. Report data on a regular basis to School of medicine leadership, Department chairs, center directors and the faculty at large.

Tactics to Achieve Initiatives: 1) Email Communication or other Electronic communication such as an E-newsletter like Vital Signs.

However, this should be an explicit communication separate from Vital Signs. Engage a consultant from UNC SOM Public Affairs and Marketing to design a communication strategy for this internal “academic detailing” program.

2) A representative from the SOM HR Office should annually attend each individual Department Faculty Meetings

3) SOM leadership should include an update on diversity initiatives, progress, and metrics at SOM Faculty Meetings.

4) Annual reports should be publicly available and potential faculty, resident and student recruits should be supplied with the annual report.

3. Produce and disseminate an annual SOM diversity report.

Tactics to Achieve Initiatives: 1) Enhance the current Diversity Report supplied to the University or other supervising bodies by

commissioning an individual in the SOM HR Office to collect the metrics and conduct the queries identified in # 1-16 above. This individual would then heavily assist the SOM HR Director and other similarly placed individuals in compiling the Diversity Report.

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2) Given recent strategic plan developments for SOM and the UNC healthcare system and their alignment, consider producing a single UNC Healthcare System Report that includes data for the entire system grouped by “service lines” – healthcare schools, hospital, GME, etc.

SP1 – Initiative 1

SOM Strategic Plan Implementation—Faculty SP 1: Timing and Sequence of Activities


2012: July/Aug 2012: Compile Exit Interview questionnaire for departing faculty, entry interview for

new faculty and enhance collection of retention data. Sept 2012: Post job listing to hire a new member of the SOM HR department who will work on

this initiative or assign the tasks to an existing member of the SOM HR department Nov 2012: The newly hired individual will prioritize the tasks and actionable items above and

begin working on them

2013: Jan 2013: Begin communicating the compounded data to SOM leadership Feb 2013: Expand communication of findings and data to the Department Chairs March 2013: Disseminate information to SOM Faculty and begin Diversity Report May 2013: Continuous work on the Diversity Report June 2013: Finalize the Diversity Report and work on next year’s metrics and items Etc.

SOM Strategic Plan Implementation—Faculty SP 1: Returns/Values/Metrics


Initiative 1– Development and completion of exit interview templates– Development and completion of entry interview templates– Review of retention data and development of formal questionnaire for those faculty who choose to

stay at UNC– Development of policy at administrative level to codify process for faculty entry, retention and exit

interview process– Report on “best practices” at comparator institutions– Development of matrix that includes all diversity data required by stakeholders with a mandate for

reporting: UNC CH, AAMC, ACGME and LCME to ensure alignment and adequate data collection– Develop working group between hospital GME, SOM and other healthcare schools such as nursing,

dentistry to explore diversity across the spectrum of healthcare at UNC.

Initiative 2– Consultation with UNC SOM Public Affairs and Marketing.– Design internal academic detailing communication instrument/s around diversity, retention and

recruitment

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– Delivery of data to faculty, leadership, department chairs and center directors by internal academic detailing campaign

– Delivery of data to faculty, leadership, department chairs and center directors by UNC SOM HR representatives

– Delivery of data to faculty, leadership, department chairs and center directors by SOM leadership at biannual faculty meetings

– Annual reports posted on SOM website and included in recruitment materials for faculty, students and residents

Initiative 3– New hire in UNC SOM HR– Develop plan for diversity reporting across the institution– Dissemination of report.

SOM Strategic Plan Implementation—Faculty SP 1: Resources Required


Initiative 1:

$50,000 (salary for one FTE) $1,000 (IT)

TOTAL (Initiative 1): $51,000

SOM Strategic Plan Implementation—Faculty SP 1: Resources Required (con’t.)


Initiative 1: No additions or enhancements to leadership, but enabling the hiring for a Direct Report to SOM leadership such as SOM Director of HR and/or UNC SOM Vice Dean for Faculty Development and Faculty Affairs. The SOM Director of HR and/or UNC SOM Vice Dean for Faculty Development and Faculty Affairs would have decision making authority and will monitor the progress of the Direct Report. It is possible that this Direct Report may have additional duties tasked to them as outlined by other subgroups of the Strategic Planning Committee.

SOM Strategic Plan Implementation—Faculty SP 1: Prioritization


According to the timeline created earlier in this report, all of the measures outlined can conceivably be prioritized as short-term (within one year) and can be worked on simultaneously as the metrics and data required to compound the Diversity Report must be collected from different sources.

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Initiative 1:a.) The first priority is establishing a mechanism for Exit, Entry and Retention Interviews at the

Department Chair level. This is critical in order to obtain data to prepare reports. b.) Simultaneously, current data collection around diversity needs to be aligned and placed into a matrix

to ensure that all data that is available and important is being collected for appropriate stakeholders.

Initiative 2:a.) Internal marketing and academic detailing discussion should occur early. This will allow for rapid

dissemination after data has been collected and reports prepared. All other priorities can be considered on equal footing and still short-term.

Initiative 3:a.) New hire is priority as other initiatives will ultimately be dependent upon this hire in some

fashion.b.) We encourage the SOM to be forward thinking and put together a diversity working group across

the UNC healthcare system. This group can define and enhance the environment where students, faculty, resident trainees, nurses and other allied health personnel and healthcare system employees interact.

SP1 - Initiative 2SOM Strategic Plan Implementation—Faculty SP 1: Plan Elements

Initiatives:

Define research productivity metrics for use in faculty performance evaluations, including post-tenure review.


The committee has created a list of productivity metrics (See Appendix 4).

A. Circulate statement of guiding principles and metrics to the following groups:a. Chairsb. Division Chiefsc. Center Directors

B. Synthesize a final document. Any controversial aspects should be assigned to a task force of including interested parties from all sides.

Establish SOM guidelines regarding the use of performance metrics in determining the flexible component of faculty salary.


The committee has concluded that the Clinical and Basic Science Compensation Plans are the appropriate vehicle for such a policy.

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A. The Clinical and Basic Science Compensation Plans, including the Department-level implementations, should be revisited and, where appropriate, revised to take advantage of the performance metrics tracked by this Strategic Initiative.

B. The metrics laid out by this committee should be employed to more fairly and completely judge faculty productivity. While the metrics should add a large degree of transparency to determining the flexible component of faculty salary, Chairs, Center Directors, and Division Chiefs should retain a degree of flexibility in order to appropriately incentivize aspects of faculty performance not measured by the metrics presented here.

Establish teaching metrics relevant to the restructured curriculum.

Tactics to Achieve Initiatives: The committee has created a list of teaching metrics (See Appendix).

A. Refer the statement of guiding principles and list of teaching metrics to the Academy of Educators for comment.

B. Integrate the suggestions from the Academy of Educators, and circulate statement of guiding principles and list of teaching metrics to the following groups:

a. Chairsb. Division Chiefsc. Center Directors

C. Integrate the suggestions and circulate statement of guiding principles and list of teaching metrics to teaching faculty for comment.

D. Synthesize a final document. Any controversial aspects should be assigned to a task force of including interested parties from all sides.

Establish common measures of clinical performance and clinical FTE across the clinical departments.

Tactics to Achieve Initiatives:

Clinical Performance and Service / cFTE: A. Create a task force with broad representation to review and comment on the a) statement of guiding

principles and b) list of metrics (see Appendix 2 and 3). The task force should represent the major Departments within the SOM and consideration should be given to representation from the following groups:

a. Chairsb. Division Chiefsc. Departmental administrators

B. Create a task force to assess the feasibility of developing a system to report clinician-specific patient (and/or referring physician) satisfaction.

C. Task forces will report to faculty for commentD. The Task Force will present a final report to the Chairs group

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Develop an SOM policy regarding cost-sharing of faculty salary support not covered by grants.


After discussion by the committee it was determined that we feel this policy needs to be addressed above the expertise of this group. The recommendation from the committee is that a Task force be developed within the SOM. The task force should ideally be a mixture of senior investigators, dean level administration, department chair and administrative support. We feel these key players are essential in representing the different sides of this issue. While we did not feel comfortable addressing the overall policy we did discuss key areas that the taskforce will need to take into account. Ideally the task force would be in place by December of 2012 with an agreed upon new policy to go into effect July 1 2013

A. Decreasing state funds: State funds are one of the most frequently used sources of funds to cover cost shares. We have seen an historic and consistent trend of these funds being cut at the state level. If state funds are intended to be prioritized in a manner that would directly support our teaching mission, the growing needs for cost shares threatens the teaching mission.

B. Decreasing NIH salary cap: This latest reduction from the NIH of $20,000 will impact the School significantly and will put pressure on all the other sources of cost share funding.

C. Limited and inconsistent use of trust funds and endowments: Many senior faculty have significant funds of various kinds that could be used to support their cost share, but these funds are not consistently used as faculty are very reluctant to use them if they don’t have to.

D. Cross-subsidization from clinical funds: Clinical funds are the other most frequently used funds for covering cost shares. This has been done regularly for many years and is an example of one significant mission supporting another. As the institution moves more toward both incentivized compensation and to potentially dually employing faculty with the Health Care System, the current convenience and flexibility that we enjoy will be significantly reduced.

E. Clinical Faculty productivity is heavily based on the profit and loss of the individual faculty member. When a senior faculty is awarded a grant it should be looked at as a productive incentive for the faculty, however, with the current method of cost sharing is handled, it is instead looked at as a costly venture for the department/division and reduces the amount of “profit” allocated to the faculty. The strategic plan proposes expanding research in areas where research has not been as strong; several of the specific examples involve highly compensated specialties where the cost share implications for doing so will be large.

F. A task force including Department Chairs and Administration should be charged with this. The Task Force should be assembled and charged by July 16, and generate a policy for review by all Chairs and Center Directors by August 16.

G. The Task Force should take great care to avoid dis-incentivizing research activity. H. The final policy should leave Department Chairs some degree of flexibility, and yet ensure

transparency for personnel.I. The policy should be adaptable to cope with both surpluses and deficits of overhead funds. This is

to be avoided as the committee recognizes that it could otherwise lead to a negative feedback loop of decreasing research activity. To this end, the policy may include a mechanism by which the Deans office would ensure that deficient departmental funds would not result in dis-incentivizing research activity.

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What returns do we expect and when?

Clinical Performance and Service

Aug 2012: Creation of Task Forces CPSF: Clinical Performance, Service and cFTEQM: Quality Metrics Task Force

Task Force on cost-sharing should report back Sep 2012:Should hear back from Academy of Educators Oct 2012: OIS should have a final plan for IT end of database implementation Nov 2012: CPSF: Report to faculty for comment

Jan 2013: CPSF: Task Force Report to Chairs Feb 2013: CPSF: Final version available for incorporation into

Departmental Compensation Plans Apr 2013: CPSF: Departmental Compensation Plans reviewed and approved Oct 2013: OIS should have a fully functional metrics database in place Nov 2013: QM: Report to faculty for comment Jan 2014: QM: Task Force Report to Chairs Feb 2014: QM: Final version available for incorporation into

Departmental Compensation Plans Apr 2014: CPSF: Departmental Compensation Plans reviewed and approved




Initiative 2– Establish teaching metrics

Progress Metrics1. Adherence to timeline

Outcome Metrics1. Each Department will have clear metrics in place to reward teaching excellence.2. Membership in the AOE will increase3. Teaching evaluation scores will not decrease over time

– Research metricsProgress Metrics

1. Higher average faculty compensation (measured against AAAP benchmarks) will increase

Outcome metrics1. Improved retention and mid-career faculty2. Higher ranking on NIH research dollars, compared to peer institutions

– Common measures of clinical performance

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Progress metrics1. Adherence to timeline

Outcome metrics - Increased clarity and transparency in clinical metrics will advance the Department’s mission and increase clinical income for Departments or Divisions that have the potential for profitability. 1. Each Department will have clear metrics in place to reward clinical productivity

and outstanding service.2. Average faculty compensation (measured against AAAP benchmarks) will

increase 3. The number of faculty with salaries below the AAAP 20th percentile by rank and

specialty will decrease. 4. Average productivity as measured by Departmental standards will increase.



What resources are required for implementation of the initiatives? (total dollar figure; FTEs, IT, space; budgeting support available from Operations Committee and Office of Finance and Business Operations)

Initiative 2:

$100,000 (Established for enhancements to Curvita, and Faculty Productivity database)

TOTAL (for Initiative 2): $100,000


SOM Strategic Plan Implementation—Faculty SP 1: Resources Required (con’t.)


Initiative 2:Common measures of clinical performance

1. Adequate administrative support, processes and reporting mechanisms must be in place to assure each faculty member has access to accurate information (at least quarterly) in order to assess their own progress in achieving goals based on the clinical metrics within their Department’s compensation plan.

2. IT support to organize, store, analyze, process, and backup metrics data. This will require some software engineering. Ideally, portions of the metrics can be automatically pulled from existing systems such as RAMSeS.


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1. Task Force to create a cost sharing plan (< 2 months)2. Department chair review of metrics (<6 months)3. IT implementation of a metrics-tracking system (<12 months)

Appendix 1 (Faculty SP 1):Guiding Principles for Teaching Metrics

1. Transparency and clarity a. It should be clear to participants how various teaching activities will affect their

compensation (both guaranteed annual salary and incentive payments). b. The reward for exceeding expectations and penalties for not meeting expectations must

be clearly stated in the compensation plan. 2. Reductions in the cFTE used to determine relative RVU/cFTE within a Department (or other

administrative unit) should be considered for specific teaching or educational roles that are uncompensated but that require an exceptional time commitment and are vital to the Department’s educational mission.

3. Each faculty member should has access to accurate information (at least quarterly) in order to assess their own progress in achieving goals based on the teaching metrics within their Department’s compensation plan.

4. Educational metrics should reflect the mission priorities of the Department or other unit.

POTENTIAL TEACHING METRICSMajor Minor

Number of contact hours Grand rounds (time)Number of classes and number of lectures Prep timeCourse director, evaluations Amount of participation in residency trainingNew curriculum or approach to teaching Teaching time outside of SOMNumber of students in class and lab AdvisorsSmall group vs. lecture (time required) Books and publications (Clinical and Basic)GME Program Director (if no reduction in cFTE)

Appendix 2 (Faculty SP 2): Guiding Principles for Clinical Performance Metrics

1. Transparency and clarity a. It should be clear to participants how various clinical activities will affect their


be clearly stated. c. Each faculty member should has access to accurate information (at least quarterly) in

order to assess their own progress in achieving goals based on the clinical metrics within their Department’s compensation plan.

2. Fairness

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a. Metrics for RVU production may be adjusted to assure that faculty doing ‘mission-critical’ but low-RVU producing activities are not penalized. Such adjustment must be clearly outlined in the Compensation Plan.

b. Metrics for RVU production may be adjusted to even out high and low-RVU producing Divisions or units. Such adjustment must be clearly outlined in the Compensation Plan.

c. Metrics for RVU production may be adjusted to account for nurse practitioners, physician assistants or other personnel that may increase productivity for an individual clinician. Such adjustment must be clearly outlined in the Compensation Plan.

3. Other considerationsa. Consideration may be given for excessive night, weekend or holiday on-call time if not

compensated separately.b. Consideration may be given for ‘shift-workers’ (Emergency room, ICU physicians, etc)

or other situation where patient volume cannot be controlled. In such cases, Departments should outline substitute metrics (i.e. number of shifts or weeks of service per FTE according to established benchmarks, wRVUs/hr, patients/hour, etc).

4. Clinical metrics should reflect the mission priorities of the Department or other unit. 5. The amount set aside for clinical productivity incentive payments should be large enough to

motivate behavior.6. Clinical FTE

a. For SOM purposes, cFTE will be defined as:1.0 minus [%funded research + %funded administration+ %funded education]

b. Reductions in the cFTE used to determine relative RVU/cFTE within a Department (or other administrative unit) should be considered for specific roles that are uncompensated but that require an exceptional time commitment and are vital to the Department’s mission.

POTENTIAL CLINICAL METRICSMajor Minor

RVU’s per cFTE (based on national benchmarks) Access (number of visits; new versus follow-up appointments, etc.)

Quality (patient satisfaction – may be major if adequate measure can be developed)

Actual charges and receipts compared to salary+fringe +/- overhead costs (may be major or minor at the Department’s discretion). This measure could be problematic where payor mix is unfavorable for a unit within a Department or for a Department as a whole.

Appendix 3 (Faculty SP 1):Guiding Principles for Service Metrics

1. Transparency and clarity a. It should be clear to participants how various service/administrative activities will affect

their compensation (both guaranteed annual salary and incentive payments). b. The reward for exceeding expectations and penalties for not meeting expectations must

be clearly stated. 2. Reductions in the cFTE used to determine relative RVU/cFTE within a Department (or other

administrative unit) should be considered for specific roles that are uncompensated but that require an exceptional time commitment and are vital to the Department’s mission.

3. Service metrics should reflect the mission priorities of the Department or other unit.

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POTENTIAL SERVICE METRICSMajor Minor

Committees: Hospital, University, Departmental, SOM, national/international (time, role, prominence)

Comprehensive exams (oral and written)

Mentoring faculty and students Fund raisingMember of thesis committee Quality improvement (Clinical)

Appendix 4 (Faculty SP 1)Guiding Principles for Research Performance Metrics

1. Transparency and clarity a. It should be clear to participants how various teaching activities will affect their


be clearly stated. 2. Reduction in cFTE should be considered for specific research leadership roles that require an

exceptional time commitment3. Research metrics should reflect the mission priorities of the Department or other unit.

RESEARCHMajor Minor

% FTE funded (internal or external External researchAward $$ (total, direct/indirect – 3 year average)

Funding agency – NIH vs. Foundation

Submission # of proposals scored PI and co-PI dollars awarded (better way to capture team science

Peer review papers published (impact, first and last author)

Number of collaborations (grants and papers) and translationalPatents and licensing (could become major)Type of award (clinical trials, RO1, T32, U, etc.)Total submission # of proposals scoredTotal number of publicationsBooks and publications (Clinical and Basic)Selected abstract (invited to present at prominent meetings/committees)

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Strategic Priority 2: Align faculty performance expectations, evaluations and reward systems


Team members and Departments:Paul Godley, MD, PhD MedicineMagee Leigh, MD PediatricsPeggy McNaull, MD Anesthesiology and PediatricsAndrew Dudley, PhD Cell and Molecular PhysiologyScott Hultman, MD, MBA SurgeryDon Budenz, MD, MPH OphthalmologyBecky White, MD, MPH MedicineJean Cook, PhD BiochemistryDonna Culton, MD, PhD DermatologySusan Fiscus, PhD Microbiology and Immunology

Cam Enarson, MD, MBA; Operations Committee representativeCam Enarson, MD, MBA; Oversight Committee leader

“Align faculty performance expectations, evaluations and rewards systems.”

Initiative 1: Expand career tracks for faculty in non-traditional roles. Initiative 2: Align faculty rewards with performance.

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SOM Strategic Plan Implementation—Faculty SP 2-2 Plan Elements

Preamble: The subgroup assigned this initiative identified several key points central to the development of tactics and prioritization of those tactics that are summarized below:

The number of faculty in non-traditional roles and their contribution to the school of medicine is not known and/or not well defined.

Faculty in non-traditional roles may not have an obvious path for career development and advancement.

The school of medicine should ensure that all faculty regardless of their role have performance-based metrics for promotion and are periodically evaluated by their departmental leadership.

SOM Strategic Plan Implementation—Faculty SP 2-1 Plan ElementsDon Budenz, Scott Hultman, Becky White

Initiatives:

Expand the use of rolling contracts for fixed term faculty upon promotion to Associate Professor.

1. Tactics to Achieve Initiatives : To improve the recruitment, retention, and support of our faculty, with the goal of achieving excellence and leadership in the interrelated areas of patient care, education, and research, a previous Fixed Term Faculty Task Force recommended, in December 2008, that the School of Medicine “establish an additional uniform set of guidelines for appointment and contract renewal and non-renewal that is commensurate with the duration and quality of service.” Toward that end, the task force proposed a series of fixed-duration and rolling contracts for FTF, based upon individual rank and focus (clinical versus research). Specific details of this plan were left to the discretion of departmental chairs.

The current SP 2-1 task force (Hultman, Budenz, White) reviewed this report and agreed that rolling contracts for FTF should be further investigated. Informal focus groups from the Departments of Anesthesia, Surgery, Ophthalmology, and Medicine (Infectious Disease) provided considerably diverse opinions about this topic.

Therefore, the SP 2-1 task force suggests the following tactics to further study and generate recommendations regarding the concept of rolling contracts for FTF:

Form a study group to include clinicians, educators, and researchers, with representatives from both tenured/tenure-track and fixed term faculty.

Obtain stakeholder input from the Dean’s office, Departmental Chairs, Center Directors, and Division Chiefs

Survey FTF to determine what factors are important in recruitment and retention, asking the questions,” how important are rolling contracts, and if important, what components would be most attractive?”

Specific items that the study group will need to investigate include differential fixed versus rolling contracts, specific length of contracts, severability, reasons for non-renewal, process of non-renewal, automatic versus initiated renewals

The study group may want to begin with a model and modify the details, based upon input from the stakeholdersThe model for FTF rolling contracts could be as follows:

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Year Rank Length Type of Contract Year 1 Assistant Professor 1 year differential fixed lengthYear 2 Assistant Professor 1 year differential fixed lengthYears 3-4 Assistant Professor 2 years differential fixed lengthYears 4-7 Assistant Professor 3 years differential fixed lengthYears 8-11 Associate Professor 3 years differential rolling contractYears 12 and beyond Associate Professor 3-5 years differential rolling contract

2. What returns do we expect and when? (calendar of major actions required to execute tactics; include action timing and responsible party)

2012 Aug 2012: Form study group Sept 2012: Obtain stakeholder input (questionnaire, survey monkey, interviews) Oct 2012: Meet with focus groups (clinicians, researchers, educators; tenure/tenure-track, FTF) Nov 2012: Discuss results Dec 2012: Generate recommendations Jan 2013: Write up final draft Feb 2013: Present findings to Drs. Enarson and Godley

2013-2017 Not applicable.

3. What returns/values do we expect and how will we measure? (Recommend both progress and outcome metrics; interim and overall metrics)

We would like to receive responses from greater than 50% of the Departmental Chairs, Division Chiefs, Center Directors.

We would like to meet with several focus groups, consisting of a diverse group of representatives from across the School of Medicine.

4. What resources are required for implementation of the initiatives? (total dollar figure; FTEs, IT, space; budgeting support available from Operations Committee and Office of Finance and Business Operations)

$___Not applicable__TOTAL: $____0_____________

5. What organizational structures, processes and management are necessary to enable implementation of each initiative? (Recommend additions or enhancements to leadership; identify who will have decision-making authority; who will monitor progress?)

Dr .Cam Enarson will have decision making authority and will monitor progress of this Initiative and the specific tactics.

Initiative 1:

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Most important (short term, <1year) – Email survey sent to Department Chairs, Division Chiefs, and Center Directors, with a response rate of > 50%, as well as focus groups to include adequate diversity of faculty. Appropriate review of the responses performed and final decision made by committee of Dr. Enarson’s choosing.

Initiatives:

Initiative 1: Create SOM policies regarding expectations for research funding of individual faculty.

Tactics to Achieve Initiatives: (list out specific tactics and steps needed to achieve targeted initiatives) Define expectations in terms of percentage of salary. For faculty participating in patient care, this

definition will be limited to the percentage of time devoted to research efforts. Base expectations for research funding on individual faculty level of appointment and track. Determine the current written (and unwritten) expectations among both basic science and clinical

departments/chairs via email survey.


2012 Aug 2012: Dr. Cam Enarson will send an email to all Department Chairs requesting current

written (and unwritten) expectations for research funding of faculty members based on level of appointment and track with a deadline of September 1, 2012.

Sept 2012: Department Chair responses will be received and reviewed by a committee of Dr. Cam Enarson’s choosing. Final recommendations on expectation for research funding will be made by this committee.

Oct 2012: Final recommendations will be reviewed and incorporated into a formal document by Dr. Cam Enarson.



Initiative 1: We expect to receive responses from greater than 75% of the Departmental Chairs. Once the responses have been received, there are no additional metrics.

What resources are required for implementation of the initiatives? $___Not applicable__

TOTAL: $_______0__________


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Dr .Cam Enarson will have decision making authority and will monitor progress of this Initiative and the specific tactics.

Initiative 1:


Most important (short term, <1year) – Email survey sent to Department Chairs and responses received. Appropriate review of the responses performed and final decision made by committee of Dr. Enarson’s choosing.

Initiative 2. Have chair reviews include the research productivity of departmental faculty as a key component of their individual and departmental evaluation.

Tactics to Achieve Initiatives: (list out specific tactics and steps needed to achieve targeted initiatives) Revise the letter that is sent to the Chairs prior to the chair review (titled “Statement of General

Criteria for Evaluation of Department Chairs”). The letter will be revised to request inclusion in the Chair’s portfolio of metrics that assess “research productivity of the departmental faculty” (currently included as part of Item 3 in the letter to the Chair).

Such metrics will be based on the AAMC metrics recently defined by the Data and Benchmarking Committee as “Selected Metrics – Fiscal Year 2011”. These metrics allow for determination of grants/funding not only as a fixed dollar amount within a given time frame, but allow for assessment of grants/funding coming down the pipeline.


2012 Aug 2012: Dr. Paul Godley will revise the letter sent out to the chair prior to their review. Sept 2012: It is expected that this revised letter will begin being sent out in September 2012. Oct 2012: All subsequent chair reviews will begin to include this information as part of the review

process.



Initiative 2 We expect all chair reviews from October 2012 forward to include review of these new data.


Initiative 2:

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$______Not applicable__________TOTAL: $ 0


Process changes are outlined in the “Tactics to Achieve Initiative”. Dr. Paul Godley will monitor progress.


Most important (short term, <1year) – Revise letter sent to chairs prior to their review. Review all chair review portfolios to make sure the new metrics are being reported.

Initiative 3. Revise the SOM basic science and clinical science compensation plans to reward excellence in research and teaching, consistent with the goals articulated in this strategic plan.

Tactics to Achieve Initiatives: (list out specific tactics and steps needed to achieve targeted initiatives) Develop a task force whose purpose will be to revise the SOM basic science compensation plan to

reward excellence in research and teaching (last updated 2009). Provide this task force with the recently revised (pending approval) SOM Clinical faculty

compensation plan to ensure attempt at uniformity within the SOM.


2012 Aug 2012: Dr. Cam Enarson to assign a task force for revision of the SOM basic science

compensation plan to reward excellence in research and teaching. Sept 2012: Task force will have their first meeting. Feb 2013: Revision will be complete by Feb 2013.

2013-2017 New compensation plan approved by fiscal year start 2013. New compensation plan to be implemented by fiscal year start 2014.

What returns/values do we expect and how will we measure? None

What resources are required for implementation of the initiatives? Initiative 3:

$______Not applicable__________TOTAL: $_____0____________


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Assignment of a task force under the direction and leadership of Dr. Cam Enarson, who will monitor progress.


Assignment of the task force to be completed as a priority with a short term deadline (<1 year) for completion by 2013 and implementation in 2014.

Initiatives:

Revise the policy for instructor and lecturer appointments to allow a one year initial appointment and no more than one reappointment year.

Tactics to Achieve Initiatives: (list out specific tactics and steps needed to achieve targeted initiatives)a. Revise the policy for instructors and lecturer appointments to require all fixed term faculty

(FTF) with instructor or lecturer appointments be formally evaluated at a minimum of every 2 years by their departmental leadership. (An informal review should be completed yearly at a minimum.)

i. Each instructor or lecturer should be provided performance-based metrics from which reappointment and/or promotion will be determined.

ii. FTF with an instructor or lecturer appointment should have the opportunity to determine the rate of their professional advancement. (The policy as stated above for instructor and lecturer appointments implies that an individual cannot remain in an instructor or lecturer appointment for more than 2 years.)

iii. Reappointment and/or promotion will be considered by departmental leadership based upon defined performance-based metrics at a minimum of every 2 years if not earlier depending upon individual performance and productivity.

b. SOM leadership should clarify prior to revision of the policy if proposed changes would be in direct conflict with an overarching university policy about instructor and/or lecturer appointments.


o Fall 2012 - Following clarification of the overarching university policy, each department will be notified of the change in policy.

o Spring 2013 – Individual departments will be required to evaluate current instructors and lecturers based upon mutually agreed upon performance-based metrics. Documentation of evaluations and resultant reappointments and/or promotions must be documented internally within each department.

o 2013-2017 – Develop a systematic data collection system within the SOM for yearly standardized reporting from each department regarding FTF especially those with instructor or lecturer appointments.


o Fall 2013 - Faculty survey that demonstrates the following:o Improvement of faculty satisfaction ratings, especially among FTF.o Improvement of faculty understanding of their individual performance-based metrics.o Fewer instructors and lecturers who feel they are in a “dead-end” position.

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o Personnel and resources required to disseminate policy changes and monitor implemented changes.

o Personnel and resources required to develop and to maintain a database regarding the SOM FTF.

$____Not applicable____________TOTAL: $_______0__________


o As aboveo SOM FTF Committee charged with implementation of above

Initiative 1:


Highest Priority: All FACULTY regardless of their role deserve an annual review with a formal discussion about career paths at a minimum of every 2 years.

Phased implementation of systematic data collection system within the SOM for yearly standardized reporting from each department regarding FTF

Develop expanded career paths and tracks that reflect the different roles that exist within the school.

Tactics to Achieve Initiatives: (list out specific tactics and steps needed to achieve targeted initiatives)a. Agree with Educator and Administrator tracks for FTF as proposed within the Task Force 7 report. b. Data collection in order to identify all those faculty within the SOM in non-traditional roles:

i. Require all departments within the SOM to provide a list of all faculty in non-traditional roles. The list from each department should include the faculty member’s role, review process and criteria for reappointment and/or promotion, highest achieved degree/training, length of service, academic level, and years at current academic level.

ii. Poll sister institutions on their policies and tactics regarding FTF in non-traditional roles.iii. Poll identified FTF in non-traditional roles regarding issues pertinent to their career growth

and development.iv. Following completion of data collection, reconvene a smaller group or charge SOM FTF

Committee to re-evaluate potential expanded career paths for FTF in non-traditional roles.c. Require all departments with faculty in non-traditional roles provide these faculty performance-

based metrics from which their reappointments and/or promotions will be based. d. Require all departments designate an appropriate individual who will be responsible for the

evaluation of each FTF in a non-traditional role. Furthermore, the identified individual should also be encouraged to develop an expanded career path with the non-traditional FTF.

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i. In some cases, additional training, certification, and/or education may be required of the FTF in a non-traditional role for promotion.

ii. It will be challenging to identify appropriate individuals to evaluate/mentor FTF in non-traditional roles. (Who evaluates/mentors nurse practitioners with in the Department of Medicine?)


August-December 2012 – Poll individual departments, sister institutions, and FTF in non-traditional roles (detailed above).

Spring 2013 – Reevaluate FTF non-traditional roles based upon data collection through a reconvened smaller group or through the SOM FTF Committee. Documentation of evaluations and resultant reappointments and/or promotions must be maintained internally within each department at least for FTF at the instructor or lecturer level.

2013-2017 – Develop a systematic data collection system within the SOM for yearly standardized reporting from each department regarding FTF especially those with instructor or lecturer appointments.


Spring 2013 - Data returned as requested above Fall 2013 - Faculty survey that demonstrates the following:

o Improvement of faculty satisfaction ratings, especially among FTF.o Improvement of faculty understanding of their individual performance-based metrics.o Improvement of faculty understanding of their career path, especially as it relates to

promotion and advancemento Fewer instructors and lecturers who feel they are in a “dead-end” position.


Personnel and resources required to complete data collection as requested above. $__Staff time for data gathering as noted above TOTAL: $_________________


Detailed above


Highest Priority: All FACULTY regardless of their role deserve an annual review with a formal discussion about career paths at a minimum of every 2 years.

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Strategic Priority 3: Establish the conditions to help faculty succeed, both generally and for specific sub-groups.


Team members and Departments:Amelia Drake, MD Otolaryngology/Head and Neck Surgery Stuart Gold, MD PediatricsAndrea Azcarate-Peril, PhD Cell and Molecular PhysiologyRupa Redding-Lallinger, MD Pediatrics Eric Wallen, MD SurgeryHy Muss, MD MedicineAna Felix, MBBCh NeurologyBenny Joyner, MD, MPH Anesthesiology and PediatricsHarvey Lineberry, PhD HRSteve Tilley, MD MedicineAnn Bailey, MD Anesthesiology and PediatricsChanning Der, PhD PharmacologyRita Tamayo, PhD Microbiology and Immunology Jeff Spang, MD Orthopaedics

Cam Enarson, MD, MBA; Operations Committee representativeCam Enarson, MD, MBA; Oversight Committee leader

“Establish programs and practices to promote and facilitate faculty success, both generally and for specific sub-groups.”

Initiative 1: Enhance faculty benefits that help attract and retain top performers and enable faculty to be most productive.

Initiative 2: Foster an institutional climate in which a diverse faculty thrives through programs that recruit, retain and promote under-represented minorities.

Initiative 3: Provide opportunities to revitalize and give incentives for intellectual vibrancy among clinical faculty.

Initiative 4: Optimize involvement, responsibilities and evaluation of fixed term faculty (FTF) within the SOM.

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SOM Strategic Plan Implementation—Faculty SP 3: Plan Elements

Initiatives:

1. Enhance faculty benefits that help attract and retain top performers and enable faculty to be most productive.

Tactics to Achieve Initiative:

o Regularly review faculty salaries and systematically resolve inequities.o Determine feasibility and legality of obtaining spousal benefits for same sex spouses.o Evaluate parking; especially re-evaluate parking based on seniority.

2. Foster an institutional climate in which a diverse faculty thrives through programs that recruit, retain and promote under-represented minorities.


o Creation of two new pipeline programs to retain the best under-represented minority (URM) medical students, match them into UNC residency programs, and to recruit our best URM post-graduate trainees as junior faculty. These pipeline programs will be housed in the Office of Special Programs (OSP).

Pipeline Program 1 : Recruiting URM UNC medical students into UNC residency programs. The following activities should be sponsored by the OSP to help recruit and retain URM medical students:

1. Small group programs for URMs to prepare them for residency2. Small group programs to encourage URMs to consider graduate level

training at UNC3. Recruiting events to allow interaction between current residents with

current URM students4. Interactions between staff of this pipeline program with residency

program directors to assist with recruiting efforts5. Development of 1 on 1 mentoring programs between URM faculty and

URM students6. Representatives from this pipeline program will attend national

meetings (e.g. SNMA) to recruit URM applicants to UNC for GME training.

7. Additional programs to attract current URM medical students at other universities to enroll in UNC GME programs (e.g. housing provided during recruitment visits)

Pipeline Program 2 : Recruiting URM residents to faculty positions. The following activities should be sponsored by the OSP to help recruit and retain these residents:

1. The faculty leader and staff will interact with URM residents and fellows to cultivate their interest in establishing a faculty career at UNC.

2. Faculty leader will meet with Department chairs and Departments to create faculty opportunities.

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3. Development of 1 on 1 mentoring programs will be developed between URM faculty and URM residents.

4. Leadership development programs for residents should be developed. URM residents should be encouraged to attend by the faculty leader and residency program directors.

o Develop a “Back to Carolina” program to maintain ties with former URM MD and PhD trainees when they leave UNC with the goal of bringing some back after they gain experience elsewhere.

A special branch of the Medical Alumni Office should be created to track and connect with URM graduates of the UNC SOM.

A special branch of the GME office should be created to track and connect with URM graduates of UNC GME programs.

The faculty leader recruited to develop pipelines 1 and 2 will work with the Medical Alumni Office and GME office to develop the “Back to Carolina” program.

A yearly “Back to Carolina” weekend as part of reunion weekends should be developed for graduates of UNC SOM and UNC GME programs.

o Actively recruit and groom existing URM faculty to leadership positions across the SOM.

Develop a focused program of leadership development for junior/midcareer minority faculty members. Initial proposal was to have day-long retreats monthly (for 10 people) for 8 months. This program would be developed out of the Faculty Affairs office.

Choose selected URMs with leadership potential to participate in the Carolina Leadership Academy in Academic Medicine (CLAIM) program.

Educate Department chairs and Division chiefs on the SOM Strategic Plan initiative to foster an institutional climate in which a diverse faculty thrives through programs that recruit, retain and promote under-represented minorities, and why it is important for them to be in leadership positions.

o Explore opportunities to expand the Simmons Scholars program (SSP) to enable desired breadth and depth of support. It was felt by the committee, some of whom are Simmons Scholars, that the duration of funding is too long. Re-organization of the Simmons Scholars program will likely need to be dealt with by the SSP Advisory Committee (Luiz Diaz, Chair).

o Model Department: The Department of Surgery under the leadership of Dr. Anthony Meyer has successfully recruited a large number or URMs to its faculty. The following is a list of suggestions was provided by Dr. Meyer:

Recruiting your own is KEY A diverse faculty already present helps significantly for future

recruiting When interviewing candidates for faculty or resident positions, think

“what about people not like me.” Get people you know both here and at other institutions to give them

a “push” in UNC’s direction Recruit people with an interest in the institution, e.g. alumni of UNC,

UNC SOM, UNC GME

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Create faculty development programs for ALL faculty (not just URM faculty), but encourage URM faculty to participate in them. (both research development and clinical development).

Involve successful URMs in the process of developing this strategic plan initiative.

Involve URM faculty in leadership positions. Some successful URM faculty in the Department of Surgery:

1. Keith Amos- Surgical oncology2. Ben Haithcock- Chief, section of Thoracic Surgery3. Anthony Charles- Clerkship Director for MSIII4. Sam Jones- Associate Director UNC Jaycee Burn Center

Provide opportunities to revitalize and give incentives for intellectual vibrancy among clinical faculty.


o Establish competitive endowed clinical scholar awards that offer extended release time for selected faculty who have demonstrated research ability.

o Institutionalize the nomination of faculty for external recognition and awards.o Increase discretionary funding for faculty to travel to meetings.o Establish an intramural academic clinical faculty sabbatical program.

Optimize involvement, responsibilities and evaluation of Fixed Term Faculty (FTF) within the SOM.

Preface: The vast majority of our faculty is fixed-term, and recent trends suggest that numbers of FTF will continue to grow and soon will represent 80% of the SOM faculty. FTF have an essential role in research, teaching, providing medical care, and sustainability of the health care system as a whole. It is critical that we provide additional opportunities for FTF engagement within the SOM and continually examine the scope of responsibilities and evaluation of FTF in new and evolving roles. This will require ongoing effort that demonstrates a commitment to the FTF as essential members of the SOM community. The role of FTF in the maintenance of research, education and clinical excellence differentiates the SOM from other elements of UNC and requires a different approach.

Tactics to Achieve Initiative:a. Development of SOM guidelines regarding FTF involvement with and

engagement in departmental affairs. STRATEGY: Creation of a policy that will eliminate all discrimination based on

whether the faculty is FT or TT. All faculty should be eligible for participation in every committee and funding opportunity at the SOM, regardless of whether they are FTF or TTF. This new guidelines will guide departments and departmental leaders towards complete transparency regarding the importance of full participation of FTF across all leadership opportunities. Specifically, this policy will establish that all faculty should be able to participate in departmental and

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SOM committees with decision capacities on responsibilities and evaluation of peers.

b. Establishment of a statement of mutual expectations (SME) at time of hiring. STRATEGY: Responsibilities of newly appointed FTF should be clearly stated in

SME documents signed by the appointee and the appropriate department chair. Standardized language is suggested for clear understanding of expectations.

c. Clear and standardized guidelines should be set to ensure transparency in FTF reappointment and promotion. This is particularly relevant in the absence of a department chair or when support from the chair is lacking. STRATEGY:

i. The school of medicine must harmonize guidelines for notice of reappointment or removal for all faculty. This should include standardized language for all letters of reappointment. Appointment should be no less than every 3 years. Reappointment should be clearly outlined no less than one half of the length of the appointments. As example, an assistant professor with a 3 year contract should know within 18 months of every appointment whether they are likely to be reappointment or not. In extraordinary circumstances (which should be clearly listed to avoid loopholes), a one-year appointment may be reasonable and should be clearly outlined.

ii. New guidelines for the movement of faculty from the FTF to the tenure track that are transparent and clearly communicated across all departments. This process of promotion and/or retention should be harmonized throughout the SOM to reduce the possible impact of unfairness within a Department.

iii. Clear guidelines for promotion of FTF should established by an ad hoc committee. These guidelines should be then reinforced across the SOM to assure that all FTF is not only informed but encouraged to apply for promotion in a timely manner. Rules should be standard and clear avoiding broad and inexplicit language.

d. Establish a standing SOM FTF committee with the charge of periodically assessing FTF needs and communicating needs and other FTF issues to SOM administration. Membership should be broad and include representation from assistant, associate and full professor levels, across both clinical and basic science departments and representation from education, clinical and research missions.


Initiative 1: Sept/Oct 2012 :

Present data from recent salary review to Departments and to the faculty at the faculty meeting. Determine a plan to resolve concerns regarding accuracy of the data.

Nov/Dec. 2012 :

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2012

Present same-sex partner benefits to the UNC P&A as an option to be included in benefit package. Discuss legality and cost and proceed.

Initiative 2: July 2012 :

A faculty leader will need to be recruited to develop and maintain this pipeline program.

A faculty leader will need to be recruited to develop and maintain this 2nd pipeline program. Search should begin July 2012 (same person as for pipeline # 1).

Sept 2012 : First cohort of scholars to begin the ACCLAIM program, to last 1 academic year.

Nov/Dec 2012 : Review Simmons Scholars program to see if the breadth and depth are adequate. Consider reducing the “term” from 6 years to 4 or 5 years, to enhance the numbers benefitted.

Initiative 3: Sept-Dec 2012 :

Begin the work of establishing a “Dean’s Fund” to award startup funds for faculty interested in research. As NIH funds go primarily to established labs, this is felt to be a pivotal support mechanism for junior faculty or unfunded faculty to get started.

Initiative 4: Aug/Sep 2012 :

Drafting guidelines assigned to responsible parties Nominate members and chair of standing SOM FTF committee

Nov/Dec 2012 : First draft of SOM guidelines regarding FTF involvement First draft of Statement of Mutual Expectations (SME) First draft of standardized guidelines on transparency in FTF reappointment and

promotion First meeting of SOM FTF committee

Initiative 1: Mar 2013 :

Evaluate Parking as new deck gets completed and offer options other than seniority to faculty.

June/July 2013 Review responses to 2012 salary inequities, and see if adjustments can be made prior

to the next academic year, with justification.

Initiative 2: Jan 2013 :

Start the selection process for the second cohort of ACCLAIM scholars

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2013

A faculty leader will need to be recruited to develop and maintain this pipeline program. Search should begin January 2013.

Mentoring opportunities for URM residents should be initiated January 2013. The faculty leader should begin meeting Department chairs January 2013.

Mar/Apr 2013 : Roll out “Back to Carolina” and contact grads of the SOM who may wish to return. Begin offering Leadership Development Programs in the 2013-2014 academic year for

junior/midcareer faculty, and encourage URM faculty to attend (vs. only for URMs). July 2013 :

o Small group programs and mentoring opportunities should be initiated July 2013.o National meeting should be attended by the faculty leader in 2013.o The faculty leader should begin meeting residency Program Directors in 2013.o A list of webpages of existing programs to support and recruit URM faculty

should be developed by SOM Human Resources and made available to Chairs and convened search committees.

o The faculty leader should meet with Medical Alumni Office staff and GME staff in 2013 to begin developing the above design elements.


Explore the utility of a “travel fund” for research faculty who cannot otherwise present their data



Initiative 2: Back to Carolina weekends should begin in 2014. Begin offering Leadership Development Programs in the 2013-2014 academic year for

junior/midcareer faculty, and encourage URM faculty to attend (vs. only for URMs).

Initiative 1: Jan/Mar 2015 :

Review updated faculty salary data, either from the SOM or from AAMC data to see trends.

Initiative 2: Jan/Mar 2015 :

Have a distinct presence at the SNMA meeting, with handouts re. Carolina programs.

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2015

2014

Initiative 3: Jan/Jun 2015 :

Continue nomination of superior faculty for external awards. Standardize the award nomination process for start-up “Dean’s Fund” awards. Review data of awardees, as to success in obtaining extramural funding.

Initiative 4: Aug/Sept 2015 :

Administer a follow-up questionnaire as to the involvement and perception of FTT in SOM activities.


Evaluate Parking as new deck gets completed and offer options other than seniority to

Initiative 4: Aug 2012 :


Sept 2012 : First draft of SOM guidelines regarding FTF involvement First draft of Statement of Mutual Expectations (SME) First draft of standardized guidelines on transparency in FTF reappointment and




Initiative 4: Aug 2012 :


Sept 2012 : First draft of SOM guidelines regarding FTF involvement First draft of Statement of Mutual Expectations (SME) First draft of standardized guidelines on transparency in FTF reappointment and


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2016

2017


Initiative 1– Tactic One :

o Value: Enhanced transparency regarding participation of FTF across all leadership opportunities.

o Metric: Reduced FTF turnover, grievances and heightened FTF participation levels across departmental leadership opportunities

– Tactic Two :o Value: Enhanced transparency regarding participation of FTF across all leadership

opportunities.o Metric: Reduced FTF turnover, grievances and heightened FTF participation levels

across departmental leadership opportunitieso AAMC survey assessment data should be utilized to track markers of institutional climate

and faculty satisfaction by markers of diversity. OSP and Human Resources should produce an annual Diversity Report for the SOM, modeled after the University Diversity Plan Report. This report should include specific information about efforts and outcomes at the SOM level and within each Department.

o The jobs taken by URM UNC residents should be tracked.o Reasons why URM UNC residents stay at UNC for faculty positions, and reasons that they

choose to leave should be solicited. o List all leadership positions across the SOM and track the number of URMs who hold

these.

Initiative 2– Tactic One :o Value: Enhanced transparency regarding participation of FTF across all leadership

opportunities.o Metric:o AAMC survey assessment data should be utilized to track markers of institutional climate

and faculty satisfaction by markers of diversity. OSP and Human Resources should produce an annual Diversity Report for the SOM, modeled after the University Diversity Plan Report. This report should include specific information about efforts and outcomes at the SOM level and within each Department.

o The jobs taken by URM UNC residents should be tracked.o Reasons why URM UNC residents stay at UNC for faculty positions, and reasons that they

choose to leave should be solicited.

– Tactic Two :o Metric: The same metrics for tactic # 1 will be useful for assessing the efficacy of the

design elements of this tactic.

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– Tactic Three :o Metric: List all leadership positions across the SOM and track the number of URMs who

hold these.


opportunities.o Metric: Reduced FTF turnover, grievances and heightened FTF participation levels across

departmental leadership opportunities











Initiative 1:

$________________

Initiative 2:

Salary support for:o the faculty leader housed in the OSP (20% effort) o 0.5 FTE for administrative support for the faculty leader o $100,000 is the projected cost for salary and benefits for the personnel above.

Travel of faculty leader to 1 national meeting yearly- $2,000 Food fund for small group programs- $5,000/year Leadership development programs for all residents- $10,000

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o Quarterly? Funding clinical and research faculty positions specifically for URMs

o via grants from various groups such as NAACPo Endowed professorships by prominent URM community leaders

Back to Carolina Weekend- $ 10,000 Leadership development programs for faculty- $20,000 Funding for the CLAIM program- ??

Initiative 3:

$_______________

Initiative 4: .5 FTE (administrative support to maintain minutes, provide support to the

committee and schedule/support meetings etc.) $18,000 / year

SOM Strategic Plan Implementation—Faculty SP 3: Resources Required (cont.)

Initiative 1: Faculty participation, ideally led through an appointed individual or committee, to

regularly review faculty salaries and benefits.

Initiative 2:ACCLAIM Program: buy-out of 4-5 clinicians’ salaries (50,000 x 4) for each cohortSimmons Scholars: funded“Back to Carolina”: administrative support

Initiative 3: Dean’s Fund: 200,000 per year to establish start-up funds for 5 faculty per year x

3 years

Initiative 4: Short term Administrative support is required to contribute to establish a committee

that will develop these guidelines, regularly inform the membership of the updates, subsequently inform all departments and ensure enforcement.

Data : additional data requested at this time include the demographic distribution of the fixed term faculty at UNC and at 2 peer institutions.

o These data should be reviewed no less than every 3-5 years to ensure that the FTF needs are being met.

Personnel: Administrative support to maintain minutes, provide support to the committee and schedule/support meetings.


Initiative 1:

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Administrative Support: Priority Rank : 1

Initiative 2: Administrative Support:

Priority Rank : 1


Priority Rank : 1


Priority Rank : 1

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