Re-engineering a crucial goal for U

By Leo

The opinion piece authored by Dr. Carol Wells (“Tenure revisions driven by administration,” April 18) regarding the re-engineering effort and the roles of the Academic Health Center administration, CSC Index and myself is so misinformed one can only wonder if the conclusions reached by Wells represent a self-serving, politically motivated “spin.” It is a time-honored process among our faculty that “if you don’t like the message, kill the messenger.” And, “if you can’t kill the messenger, kill the process.”
The facts behind and the reasons for the re-engineering process are clear: The world is changing dramatically around us, and we must change to meet this new reality. Nevertheless, it is equally clear to all of us voluntarily participating in the re-engineering process — now well over 100 members of the faculty and staff — that many of our faculty (and a few senior administrators) have some extraordinarily strong “beliefs” that absolutely cannot be supported by facts. We preach the merits of the scientific method, but we fail to use even the semblance of rigor in systematically reviewing the performance of our colleges and the Academic Health Center. No, it seems that it is far easier for many of us to keep our heads in the academic sand and ignore the changes occurring in the world that has supported us.
When new ideas are presented to improve our performance — ideas that are designed to enhance the experiences of our students and the career opportunities of our productive and relevant faculty members — our tendency is to jump to erroneous and self-satisfying conclusions. Where is the thoughtful questioning and consideration we so pride ourselves on as scientists and scholars? Unfortunately, as illustrated so well by Wells’ article (as well as some recent comments by a few other misinformed faculty members), the saying, “we are often wrong, but never, never in doubt,” could have been invented here.
Let’s review the facts. Wells states in her commentary, “Re-engineering is being imposed on the AHC by former Provost William Brody and the CSC Index consulting group.” Is this true?
It is certainly true that Brody, as the provost responsible for the health and well-being of the entire Academic Health Center, was acutely aware more than a year ago of the sweeping changes going on in the health care provider market, particularly here in Minnesota, and the threat these changes represented to the viability of the center. Also, he was well-informed about the growing national competition for federal research funding and the potential legislative threats to the future of such funding.
In response to these evident negative trends, he commissioned a diverse group of faculty — one representative of each of the seven Academic Health Center schools — to examine the implications of these negative trends on the center. He charged this group, known as the Quality, Re-engineering, and Technology Committee, to:
1) examine the AHC as representative of the entire organization, not the members’ particular discipline or school;
2) develop a fact-driven rationale for improving the performance of the faculty, staff and students and enhancing the center’s overall educational, research and clinical programs; and
3) propose solutions totally unencumbered by our current organization, policies or culture.
The committee faculty met, caucused with Brody, and determined how it wanted to work. The members considered “going it alone” without support of those more knowledgeable about organizational transformation. Committee members were also offered the option of using consultants to help guide the process. There was absolutely no pressure to “go it alone,” use consultants or use a given consulting firm. The committee faculty collectively agreed to use consultants. It met with and considered using at least three different consulting groups to help support the effort and decided to retain CSC Index.
The self-examination process the committee used was “fact-based.” Contrary to many “beliefs,” a substantial and determining database was developed. What was the extent of the fact-finding mission? More than 4,000 surveys were distributed to students in September and October, and approximately 1,000 surveys were distributed to faculty. In addition, more than 100 interviews were conducted using a standardized “guide” to elicit information. These interviews included:
1) academicians (such as university presidents, Academic Health Center heads, vice presidents, CEOs, and vice chancellors at institutions such as the universities of Washington, Wisconsin, Iowa, Michigan, Utah, Northwestern and California – San Francisco);
2) health care providers (such as executives at major Minnesota integrated service networks as well as single providers/practitioners);
3) corporate executives whose employees have health care delivered in the state;
4) health professions’ professional organization representatives;
5) members of the Board of Regents;
6) government and government agency representatives (such as members of the Legislature and the governor); and last,
7) executives and developers of major biopharmaceutical, medical/veterinary/dental products companies (such as 3M, Medtronic, Merck, Pfizer, Sandoz, and Boehringer Ingelheim).
Has any AHC faculty-sponsored initiative in the last 25 years undertaken such a comprehensive effort to find out how others — students, consumers, research customers, health care providers — think about what we are doing right, what we are doing wrong, what needs to be improved and how can we be more responsive? Frankly, we had no idea what we would find out. What we did find out, and what we reported to the faculty at large, should be alarming to all and serve as a fundamental “wake-up call,” even for those still buried in the academic sand.
Wells also makes certain assertions as to the alleged content of some alleged “CSC Index documents.” Although it is certainly true that Index provided extensive staff support to the committee and was extraordinarily helpful in facilitating the process of investigation, all documents produced during this effort were authored and extensively edited by each of the faculty members of the committee. While some early working drafts of these documents may bear Index identification, such identification simply results from the word-processing software templates associated with the Index staff computers, which were used interchangeably with the faculty computers, and, therefore, such drafts do not represent “Index documents.” Clearly, it is not the practice within any such University effort to circulate very preliminary draft documents beyond the working group.
In other words, this process of self-examination was and is faculty-driven. To assert that it was imposed by Brody and CSC Index is absolutely untrue. The administration, Brody and the consultants have facilitated a faculty-driven process of self-examination. While it may be comforting for some to believe that there was an insidious plot designed by the administration, this is wholesale rubbish. To my knowledge, Wells has done little to find out the truth and instead promulgates what appear to be unfounded and perhaps paranoid fears.
Let me next turn to the issue of tenure and the conspiratorial assertions made by Wells. As only one facet of the need for change within the Academic Health Center, the committee raised the issue of tenure and associated aspects of faculty governance. It was one of many issues the committee faced, but in my judgment as a committee member, it was not the most important aspect of improving the performance of the AHC. However, given the prospects for stable funding (at best) from the state, increased competition for extramural research dollars and declining clinical financial support, we were left with the obvious conclusion that lifetime, full-salary guarantees for tenured faculty was going to be a problem.
It is also very apparent that many faculty feel fundamental changes in the tenure code are necessary. In the data collection process, the committee designed a questionnaire for faculty. The questionnaire asked faculty members’ views of many things, including: a common merit review across the AHC, a productivity-based compensation system, post-tenure review, whether tenure should be redefined while guaranteeing academic freedom without necessarily guaranteeing salary/compensation and establishing a new governance structure to deal with unproductive faculty.
The results of the faculty survey have been made public. More and more, my colleagues have expressed to me that they want to see change in the tenure code. While there may be a few vocal opponents to addressing such obvious needs as responsible work performance reviews of faculty, is this position responsive to the institution? Is this posture responsive to the citizens of the state? Literally hundreds of faculty responding to the surveys thought we should have post-tenure reviews, revise tenure requirements, have productivity-based compensation and revised tenure governance procedures.
If we fail to address the issue of lifetime, full-salary guarantee for tenured faculty, the consequences are predictable: low to no salary merit increases for all employees across the AHC, since it’s improbable that increased resources will be forthcoming; programmatic retrenchments imposed or needed to provide even a cost-of-living salary increase for faculty and staff; and a decrease in the number of faculty and staff — leading to decreased research and development activity in aggregate and individual departments, as well as schools. So we can deal with the obvious problem now or keep our heads in the sand and slide into mediocrity. The problem won’t go away. If we are going to deal with it, the time is now.
Wells also asserts that on Nov. 13 of last year, I made a specific comment with respect to tenure that alarmed her. Besides the fact that this alleged comment was made in a meeting on a faculty tenure track promotion wherein all comments are understood to be strictly confidential, she misquoted me. What I did say was in the context of encouraging a highly productive, tenure-track assistant professor to go up for promotion in the fifth year. I said, “I’m worried that tenure as we know it will not exist in the same form. …” I have held the same view for a number of years and have expressed it to numerous people. As a department head seeing firsthand the pressure on all financial resources, it would be simply irresponsible for me to mislead a faculty member and have him or her assume that we can continue to incur the same financial obligations indefinitely.
It should also be noted that the regents were fully aware of the problem well before the committee recognized that the prospects for successful organizational change were tied to revisions in the tenure code. The regents, as it is their prerogative, launched an analysis of tenure last October. The members of the AHC/Quality, Re-engineering, and Technology Committee team read about the regents’ action in the newspaper. This step antedated any position taken by the committee.
Furthermore, a synopsis of regents’ discussions on tenure and tenure reform was recently sent to members of the University Faculty Senate. This synopsis begins with comments by Regent Jean Keffeler at a May 15, l995, meeting and cites numerous additional times that these issues were discussed during the summer of l995 — well before the committee had even considered a faculty survey on this issue. Therefore, it is highly misleading for Wells to assert that tenure reform is a committee- or consultant-driven issue.
It is also important to note that there is a strong conviction on the part of some legislators — particularly those who deal with the University budget — that lifetime, full-salary guarantee for tenured faculty must be changed. I am aware of legislators who have for a number of years discussed the need for some responsible review and modification of the lifetime job and increasing compensation associated with tenure. While discussion of this may be new to some, it’s not at all new to many. It is clear that both the Legislature and the governor want the University to be far more accountable for use of the funds we receive. Therefore, although the committee Phase I faculty team members can take credit for many things, we cannot take responsibility for initiating any tenure reform process. Others — the regents and state legislators who care deeply for the University and its success — can.
So, while faculty members can cast aspersions on the administration, consultants and other individual faculty members, they are wrong. The positions set forth in this vital process of Academic Health Center self-examination, which have been fully described in presentations and publications (and are available to all on the committee’s World Wide Web site: http://pro.med.umn.edu/qrtc/qrtc.html), were faculty-determined. If faculty members such as Wells would adopt the scholarly standard that they so adamantly defend under academic freedom — one that is inhospitable to inaccurate and unfounded statements that promote self-serving political positions — the AHC, as an organization, might have the opportunity to achieve excellence and gain the recognition and support from the citizens of the state of Minnesota that we require.
In summary, I believe that the faculty members of the committee, Brody and the consultants who assisted us should be given great credit by the faculty, the regents, the Legislature and the governor for dealing head on with the overwhelming challenges facing the AHC. I am convinced that the re-engineering effort must and will go forward under Frank Cerra’s leadership. The faculty who worked on the Phase I committee effort deserve to be recognized for initiating a process that now represents the most comprehensive and aggressive change plan of any AHC in the United States. They cannot be accused of a lack of personal courage and conviction. They were given a job to do and they did it very, very well.
In an all-AHC town meeting on April 26, Cerra talked about the importance of sharing common values and urged us all to “walk the talk.” Two fundamental center values proposed by the committee are teamwork and mutual respect. Clearly, some of us need to learn to work together, treat each other with more respect and share our differences openly and honestly. It is time to lower the rhetoric, get back to the facts and start working together to realize our vision for the Academic Health Center.
Professor Leo T. Furcht is head of the Department of Laboratory Medicine and Pathology.