Editor’s Note: Since June 1995, the Academic Health Center has been planning profound changes as it faces extreme financial pressures. During the past months, rumors and concerns about the restructuring process have been commonplace at the center.This two-part series represents a snapshot of views that people in the health center have recently expressed. This, the second story in the series, will examine the restructuring process so far in the Academic Health Center.
Faculty and administrators have been planning an overhaul of the Academic Health Center since last year, but many students and faculty members say they still don’t understand what’s going on.
Many in the health center, which includes seven health care schools and the University Hospital and Clinic, say the process has been secretive or fear it is imposing a corporate structure on the University.
Since June 1995, plans have been in the making for fundamental changes in the center ranging from alterations of tenure policies to a new organizational structure. Outlines of the restructuring plans are available on the World Wide Web and have been presented at health center forums. But for many, the information presented so far leaves questions unanswered.
“There’s so many really critical pieces of information that don’t seem to be out on the table at this point,” said epidemiology professor Harry Lando. He said he wants to see figures that illustrate the financial crisis in the health center, and wants to know more about how the plans he has seen will help remedy problems at the center.
Lando added that although he and many others are worried about the University’s restructuring process, they are also “extremely concerned” about the health center’s financial state and its ability to supply qualified health care professionals.
Provost Cerra said that in about two weeks he will officially announce comprehensive restructuring plans and provide information on the need for change. But Cerra declined to give a preview of his plans, saying he’d rather release the information only when he is done thinking it through.
Cerra took the office in April when the planning process for restructuring had already been going on for about 10 months. Many faculty believe that under Cerra’s leadership, the process has been more open than under the leadership of former Provost William Brody.
“I feel very strongly that what was happening under the former provost was of great concern in part because I felt that the process at that time was secretive,” professor Lando said. “I feel the new provost is much more open.”
When Cerra officially releases his plans, they will represent his first major stand on the issue. Right now he is in the process of getting feedback on those plans.
Former Provost Brody responded to criticism that the process was too secretive by saying that planners are still early in the restructuring process, and it is not surprising that people are raising objections at this point.
“Even very early, without putting any details on it … they’re going to say, ‘We didn’t like this process or you didn’t communicate with us,’ and that’s natural at this point.”
In June of last year, Brody began the restructuring process when he formed a group of seven faculty and administrators to begin addressing problems that face the Academic Health Center.
This group sent surveys to faculty and students at the center and conducted other research to gauge what kind of problems needed to be addressed by restructuring. They also hired the management consulting firm CSC Index to help plan a process of change at the center. CSC Index is being paid more than $2.6 million for its services.
Using information gathered by the group and the advice of the consulting firm, Brody developed a plan for change. The plan, which was presented to the public at a forum in January, included nonnegotiable terms that called for the creation of a three-track system of education, research and clinical service.
The ideas he presented were used as the starting point for a new phase of planning that began in March. During this phase, 70 to 80 faculty are working in nine different groups called Quality, Re-engineering, and Technology Committee teams. The teams are conducting further research and making more detailed plans for change. The four consultants from CSC Index on campus help facilitate meetings of QRTC teams.
Each team has a different focus. One, for example, is studying tenure and another is studying how each school in the health center handles its finances, and what kind of accounting system would work best in a reorganized center.
Implementing the plans that these groups are making will be the next step in the process and might start as soon as August.
Provost Cerra said major changes to the health center’s faculty structure will probably not appear before the end of summer. However, Cerra said support services like public relations and computer services might be changed before fall quarter.
The case for change
Many different factors are pressuring the health center to change, and planners present them on the Web as a “case for change.”
The health center, like other health care schools and hospitals across the country, is facing financial problems. State funding is dwindling and the hospital is losing revenue because it must compete with other hospitals and clinics that don’t have the extra costs of training health care students and conducting research. Health center officials also are less able to depend on Medicare funding for medical education as decision-makers in Washington plan spending cuts.
According to the “case for change,” competition for research dollars is increasing, and one way to keep getting funding is to do more multi-disciplinary research.
Also according to the “case for change,” students are not satisfied with the education they receive at the health center. The market for health care workers is changing rapidly, according to restructuring planners, and many graduates have to be retrained once they enter the workplace
Surveys are called into question
Members of the group picked by Brody compiled surveys last September asking faculty and professional students to evaluate their expectations and experiences at the University. But some question the accuracy of those surveys.
Graduate students were excluded from the survey because restructuring planners found that survey questions didn’t apply well to them.
Generally, career tracks for graduate and professional students in the center are different. Some questions on the survey concerned clinical experience or developing professional identity. Those questions might not apply to graduate students, who usually pursue research careers at universities or in industry.
Terry Bock, an assistant to the health center provost, said survey results were used along with other pieces of data to focus restructuring plans for the center.
“They were an important factor, but they were one piece of a lot of data we were getting,” Bock said. The group also used surveys of health center graduates done by other organizations, as well as information about the health center’s enrollment and finances.
Professor of Lab Medicine and Pathology Carol Wells said she and other faculty question the way the surveys were constructed and the way the results were used.
For the money the health center is paying CSC Index, she said, the surveys should be something that can “stand up in an academic journal.”
Alexander Rothman, a social psychologist who teaches a class on research methodology, cautioned that every survey influences its response to some degree through the wording of questions and the options it offers.
“You have to be careful with surveys,” Rothman said. “They’re not mirrors that you hold up to people.”
The surveys sent by the planning groups to faculty and students don’t stand out as especially good or bad, Rothman said.
Many of the questions on student and faculty surveys were broad, Rothman said, and could be interpreted differently by different people. But he added that broad questions wouldn’t make the survey inaccurate if results take into account the possibility that people may understand the question differently.
Rothman pointed out a question that appeared in the faculty survey that reads, “Do you agree that fundamental change within the AHC is needed in order to fulfill its mission and achieve world class recognition?”
People probably have different views of what “fundamental change” is, Rothman said, and answers to that question would have to be evaluated with that in mind.
Dr. Leo Furcht, a health center vice provost, said surveys were used to give planners only a broad picture of what was happening at the health center.
“No one question is, in and of itself, incontrovertible evidence to go forward,” Furcht said. “I think (the survey) is just trying to get a snapshot.”
One figure that appears frequently in health center planning documents and speeches is that one in five students surveyed would not return to the University.
That figure came from a question in a student survey that asked, “If you had it to do all over again, would you make the same decision to attend the UM?” More than 20 percent of the students replied “no.”
Some have said the question is too broad because it doesn’t ask students to define why they wouldn’t return.
But Furcht said the statistic is a starting point for more investigation and believed it would be irresponsible for planners to dismiss it.
“It suggested to us that we need to look at the aggregate, or overall student educational experience, and determine the reasons for that.”
Rothman said the statistic would be most useful if it was compared with the same statistic for other universities.
“Although you aspire to have 100 percent satisfaction, it’s hard to imagine that’s ever going to be true,” Rothman said.
The vision of a new structure
Plans for a new faculty structure have raised concerns about what will happen to the seven schools that now make up the health center.
The nonnegotiable plans released in January call for dividing the health center into three organizations headed by vice provosts. The three new organizations would focus on research, education and clinical service.
The goal of this structure is to reduce the duplication of administrative activity. For example, each school now handles its own grant administration. That service might be centralized under one organization that deals with research.
Even though three new vice-provost positions would be created, Furcht said the health center would not be spending more money on the new jobs.
“We’re not going to have more money,” he said. “We’re likely going to have less money.”
Cerra suggested support staff may be the subject of cuts when he discussed the need for change Wednesday with the restructuring committees.
It isn’t clear yet exactly how sharply the three organizations in the health center will be divided. Clinical operations will get a distinct organization, Cerra said, but education and research may not be separated as distinctly.
Jeffrey McCullough, a professor of Lab Medicine and Pathology, said he thinks it is still possible to change the “nonnegotiable,” plan that would create three organizations.
McCullough, leader of the planning team that deals with patients and clinics, said if the teams find new information that doesn’t fit into the plans made in January, then decision makers will take that into account. Final decisions on large changes will be made by the University’s Board of Regents. Cerra can make some small changes without the board’s approval.
As of now, the health center is still moving toward the three-organization system. Provost Cerra said that in August or September, he would begin hiring vice provosts to lead the three new organizations.
Some plans state that every faculty member in the health center would belong to a research organization called a “focus group.” According to planning documents, each group would have between five and 40 members, and could be composed of faculty from several different schools.
For example, faculty from the schools of pharmacy, medicine and nursing, might work together in a “geriatrics group” or a “pain research group”.
This new organization is designed to foster more inter-disciplinary research. But it also raises concerns.
Under the plans, the formation of each research group would have to be approved by the provost of research. But some faculty fear that if the provost had to approve faculty research projects, academic freedom would suffer.
Professor of Physiology Richard Purple said one rumor in the health center is that the provost could make large contracts with corporations or government organizations and assign research duties for those contracts to professors.
But Vice Provost Furcht explained that provost approval would only prevent the duplication of research.
Even if that’s the case, Purple said, he doesn’t like the idea. “No matter how you slice it, it comes up as control over who’s going to do what research.”
Now, a research project might have to be approved by groups such as the department it’s being conducted in, the dean’s office and an animal-care committee.
Deans make sure that technical details of research projects are taken care of, Purple said. They don’t decide whether the researcher can study a certain topic. Having a provost make such a decision violates academic freedom, he said.
The established system for research approval is “true and trusted,” Purple said. He doesn’t trust the new system because of those who recommended it, he said. Former Provost Brody and the consulting firm CSC Index do not have the University’s best interests in mind, he said.
Although restructuring may add a new research group structure, Cerra said it will not abolish departments or schools, and schools will still be led by deans. But when the new vice-provost positions are created, the role of the deans will change, Cerra said.
Many people were disturbed by a rumor that, in late April, former health center Provost Brody asked the deans of the Academic Health Center to resign their positions.
“I have never asked the deans to resign,” Brody said. “I’ve asked the deans to begin living the vision, which is that we would have three organizations.”
Cerra said that Brody mentioned during a speech that the deans might consider resigning to show their support for restructuring.
“He wasn’t actually provost when he mentioned it, and it wasn’t in any way a request,” Cerra said. “It was said in the way of ‘Well, you might consider it.'”
None of the deans have resigned because of the remark. Marilyn Speedie, dean of the College of Pharmacy, was one of the deans who was at the meeting and heard the comment.
“I think it has been blown out of proportion from how I understand it was intended,” Speedie said.
Ronald Franks, dean of the medical school in Duluth, was also at the meeting. He said the deans later joked with Brody about the comment, asking him if they’d be able to get a job at John Hopkins, where Brody will be president next year.
A Secretive Process?
Members of planning groups say they have been trying to include as many people as they can in the process, but some faculty believe they’ve been kept in the dark about the groups’ plans.
Concern about secrecy came to a head in April when faculty believed some deans were being restricted in how much they could say about restructuring.
Professor Lando said that during an April meeting in the School of Public Health, the school’s dean showed slides of re-engineering plans, but couldn’t oblige when she was asked for copies of the slide.
“Our dean told us this information was confidential. We could not have copies of it,” Lando said. The slides are labeled “Confidential. Do not copy.”
He added that after Cerra became provost in late April, the slides were made public and the process has seemed less secretive, but he said important information is still missing.
Franks, who heads the team that deals with curriculum, said the intentions of the restructuring teams have been misinterpreted. He said members of planning groups try to save time by organizing ideas before presenting them to faculty.
The motivation of the teams, Franks said, is “let’s try to be efficient as possible. Let’s let us get some of our ideas together and then present them to you.”
He added that in his group, which is putting together guidelines for creating a curriculum, faculty input is necessary.
“Their input will be critical because we want to get the best model possible,” Franks said.
“The concern has been that we’re over here designing someone’s curriculum and we’re going to roll it out in a month or so” Franks said. “Actually we’ve been doing the opposite. We’ve been meeting with as many people as we can.”
Commonalities with corporations
The presentation of nonnegotiable terms in January made some at the health center nervous because it was seen as a move away from the University’s democratic decision making process and toward the top-down decision making process of a corporation.
“(The restructuring process) has all the earmarks of a management coup and appears to totally misunderstand the nature of U governance,” said Professor Purple, adding that administrators should be supporting faculty in their decisions, not telling them what to do.
Representative Tony Kinkel DFL-Park Rapids, chairman of the state House of Representatives’ Higher Education Finance Division Committee, said the University may not have had time to go through with its usual decision making process because it was facing economic pressures from the market.
“Higher education has been described as organized anarchy, that is, where there is a lot of autonomy and collaboration in decision making,” Kinkel said. “One of the things that has made this difficult is that the force of change is coming from the market place. … That’s not coming from administrators. That’s not coming from regents. That’s not coming from legislators. That’s just the hard reality.”
Planning documents that refer to students as customers increased suspicion that the restructuring process is an attempt to make a more corporate culture at the University.
Head of the Epidemiology Department Russell Luepker acknowledged the University could probably learn from businesses, but worried that the restructuring process would take it too far.
“There are things worth taking if they can help us do our work better,” Luepker said. But, “I worry taking lock, stock and barrel is not the best way to do this.”
Planning documents state that the University serves three separate types of customers: students, patients and the people who pay for medical research.
Each set of customers needs something different from the “product” they receive, the documents state. Students need “value,” a quality education at a good price. Patients need tailored care and custom solutions. Research funders need the best “product.”
Ami Claxton, president-elect of the School of Public Health Student Senate, said she wasn’t sure she agreed with the documents that spelled out what kind of “product” each set of customers really wanted.
“For me, best value means a pretty good product at a very low price,” Claxton said. “I want a very good product.”
But Claxton said that being seen as customers puts students in a unique position.
“We’re customers and they have to listen to us,” Claxton said.
Franks said that documents referred to students and other people as “customers” to help remind planners that faculty and staff are there to serve the different groups of people.
“The purpose was not to simplify or trivialize that relationship, but rather we reminded ourselves as faculty that the students are here to learn from us and the University’s primary purpose is to benefit the students.”
Some faculty were also concerned to hear that people on the planning teams were asked to take the perspective of CEOs to make decisions about the center.
Franks said asking people to think like they were CEOs was just one of many techniques used to get people to open their minds and come to the table with fresh perspectives.
“It was one of the examples that were used, but I think it got misinterpreted as an attempt to overthrow the academic enterprise,” Franks said.
Group members were also asked to imagine other things such as a blank sheet of paper or building a new health center from scratch to help them get new ideas.
“The effect was to sort of set aside your biases and prejudices and start fresh,” Franks said.
An anticipated reaction
Planners of the re-engineering process say some objection to change is predictable.
In fact, charts produced by the consulting firm CSC Index predict that resistance will increase as the amount of changes increases. Another chart predicts specific types of resistance, like rumors circulating in the “work force” and the resistance of “middle managers” as it comes time to roll out the plans.
Rumors circulated this spring at the Academic Health Center. There was the rumor that the deans had been asked to resign. There were also rumors that the dental school had been excluded from the planning process because its faculty had been outspoken against reorganization. There are, in fact, members of the dental school on the planning commission.
But rumors thrive when people don’t feel like they’re getting enough straight information, and wonder if a decision making process that was set up to give them a voice in matters is being replaced by a system that involves little more than taking orders.
In about two weeks, Cerra will publicly release information on why the Academic Health Center needs to change and what changes have been planned. Cerra joked that when that document is released, people will have “more information than they want.”
Professor Luepker repeated what many other faculty have said when he said he wants Cerra to succeed in leading the Academic Health Center through a time of rapid change.
“At the very least,” Luepker said, “he has sat down and listened to people.”