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VOLUME 18 NO. 4
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inside.dukemediine.o
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Apil 2009
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ocus on strategic priorities andopportunities is keeping theDuke University School o Nursingon a steady but cautious course instormy economic times.Associate Dean or Finance andAdministration David Bowersoxsaid the downturn contains a “silverlining” or DUSON. In times o economic weakness, people pursueproessions such as nursing, or whichthere is robust market demand.Last year 50,000 qualiedapplicants were turned away nation-ally rom bachelor’s degree nursingprograms.As part o a long-term strategyto address the demand, DUSONadded a second cohort o more than50 accelerated bachelor o sciencein nursing program students to itsadmission plan or scal year 2010.The school, which already admits70-plus students each all, plans todouble enrollment within a ew years.DUSON’s master’s degreeprogram will see continued strong
Duke Univesiy Schoo o Nusing
On  cuious, bu sedy, couse
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he Duke University School o Medicine, like medical schoolsacross the nation, aced nancialpressures long beore the current globaleconomic recession.But progress in accomplishinggoals set out in its 2005 strategicplan, and administrative initiatives inresponse to external unding declines,have put the School on a steadycourse through these trying times.For example, those activities haveput the School in a good position tocapitalize on the unding opportuni-ties o the American Recovery andReinvestment Act o 2009 (ARRA),also known as the “stimulus bill.”“All o our missions – education,research and clinical care – are severely
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early ve years ago, Duke University HealthSystem articulated a strategic plan designed toserve as a roadmap to our long-term success.This plan made a health system-wide commitmentto optimizing services, improving the way entitieswork together and attracting the best aculty and sta.In implementing and executing the operationalactions associated with the strategic plan, DUHShas made signicant progress. But there have alsobeen challenges, particularly since the onset o theglobal economic downturn.At a time o such nancial and economicturbulence, it is important to understand that theorganization has had a successul strategic planwhich we continue to ollow today, and that we arenot simply reacting to the evolving pressures o achallenging environment.“The strategy has proven itsel, and we are con-dent we are moving in the right direction,” said MollyO’Neill, the health system’s chie strategic planningocer. “But current conditions require us to be evenmore careul stewards o our resources and to stayocused on making the proper strategic investments.”Competitive pressures, O’Neill added, “did notgo away with the addition o economic pressures.The building blocks o the strategy — each o thegoal areas — have proven appropriate or thechanging environment.”The ollowing is a review o our seven strategicpriorities and how we have executed them thus ar:
Opimize sevices in Duhm Couny
DUHS recently solidied its commitment to the peopleo Durham County with the completion o a long-termlease extension or Durham Regional Hospital.Also, a Master Facility Plan has linked DukeUniversity Hospital and Durham Regional inimportant ways through new specialty programs andtranser center enhancements to serve community
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Duke Univesiy Heh Sysem
Subsni pogess owd ong-em gos
Duke Univesiy Schoo o Medicine
Nuuing exceence
Duke Medicine segic pns guide success in chenging imes
Mch Dy bings se esidens o Duke …
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Inside Duke Medicine
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April 2009
INSIDE VOLUME 18, ISSUE 4
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CONtaCt USCmpus mi:
DUMC 104030
Deiveies:
2200 W. Main St.,Suite 910-B, Durham, NC 27705
Phone:
919.660.1318
E-mi:
editorinside@mc.duke.edu
CrEDItS
 
Coon:
Josh Taylor
Staff
 
Edio:
Anton Zuiker
Mnging Edio:
Mark Schreiner
Science Edio:
Kelly Malcom
Designe:
Vanessa DeJongh
Inside Onine Edios:
 Bill Stagg and Erin PrattCopyright © 2009Duke University Health SystemInside Duke Medicine, the employeenewspaper or the Duke University HealthSystem, is published monthly by DukeMedicine News & Communications.Your comments, story ideas and photocontributions are always welcome andappreciated. Deadline or submissionsis the 15th o each month.
needs and help manage patient fowsacross Duke Medicine. The creation o hospitalist and intensivist programs hasled to greater integration and improvedoutcomes at Durham Regional, andsignicant capital investments inradiation oncology, intensive care,inormation systems, and other serviceshave led to improved patient accessand quality o care.DUHS has also made importantcommitments to community healththrough a myriad o projects in Durham,including the Lincoln, Walltown, LyonPark and Holton clinics, and throughProject Access, in which specialistsdonate time and expertise.Duke Medicine has made signicantprogress in meeting the projected work-orce shortage in physicians, nurses, andphysician assistants through recruitmentand expansion o training programs.As always, all capital investmentsare subjected to a rigorous needs assess-ment. Planning continues or a majoraddition to Duke University Hospitaland the creation o a new AmbulatoryCancer Center, should that projectreceive Certicate o Need approvalrom the state this spring. Consideringcurrent capacity constraints andprojected teaching and health care needsin a dynamic and growing region, it isessential that Duke invest in its long-termuture o providing ecient and eectiveeducation, research, and patient care orthe citizens o North Carolina.
Senghen ou pesencein Wke Couny
The investments made in WakeCounty have begun to demonstratethe wisdom o this strategy. DUHSacilities and clinical aculty havemade signicant inroads and havebecome an important part o ad-dressing the health care needs o thecounty’s rapidly growing population.Duke Raleigh Hospital has beenupgraded and renovated. The new DukeMedicine Plaza specialty physicianbuilding is ull, providing Wake Countypatients more convenient access to Dukeaculty physicians.Also, clinical programs led byDuke aculty, such as the new andgrowing neurosurgery program, aredrivingthe successo DukeRaleighHospital.Investmentsin cancer services, orthopaedics andcardiology, as well as state-o-the-artimaging technology, are improving theaccess to the latest in Medicare care inthe community.New acilities have opened inthe Brier Creek area, Knightdale,Morrisville and north Raleigh.
reoien muidiscipiny pogms
The new Duke Heart Center hasacilitated greater collaboration andeectiveness among the many specialtycare areas in the center, as well asamong its aculty. The changes haveimproved the patient experience andaligned the whole organization arounda single goal: patient-centered care.Plans or similar realignments thatbreak down organizational barriersand support patient-centered careare underway in other clinical areas,including cancer.
Enhnce pediic sevices
The $7 million, 13-bed, pediatriccardiology intensive care unit – therst in the state – opened at DukeUniversity Hospital in January.The Division o Pediatric Blood andMarrow Transplantation continues topioneer the use o umbilical cord bloodstem cells and extend this liesavingtherapy across the country.The Duke University Hospitalintensive care nursery is beingrecongured to increase capacity, andDuke University Hospital and DurhamRegional Hospital are collaborating onneonatal care.Duke Children's ConsultativeServices has expanded in Wake Countythrough new oces in Duke MedicinePlaza in Raleigh.
Buid  sucue o mbuoy ce
Substantial progress has been madein developing a distinct operatinginrastructure or ambulatory care thathas resulted in substantial improve-ments in patient satisaction, andtremendous success in the reporting o quality outcomes in outpatient services.The strength o our ambulatory careplatorm and services is now regardedas essential to the well being o thepatient and the organization.
ac, ein nd ewd enedcuy nd s
The health system’s clear vision startswith the patient, which we value mostabove all. We cannot provide thequality care they demand and deservewithout quality employees. To recruitand retain the very best, Duke oersexcellent benets and widely-recognizedprograms or proessional development.Last all,
Advance for Nurses
 magazine rated the health system as aworkplace that excels in opportunitiesor continuing education, tuitionreimbursement and rewards andrecognition.Also, the Employee TuitionAssistance Program benet increasedin January to $5,250 per year to helpemployees get the education needed toadvance their careers.Duke’s clinical aculty has grownsignicantly over the past ew yearsand urther expansion is plannedover the next several years. DukeUniversity Hospital and the DukeUniversity School o Medicine continueto be recognized as among the topten institutions in the country due tooutstanding work done every day byour aculty and sta.
Buiding upon hesengh o he Duke nme
Advertising, community outreach andmedia relations campaigns over thepast two years to build brand aware-ness or Duke Medicine, and its clinicalaculty, have been eective.Those eorts have contributed toDuke’s national reputation or excel-lence and ocused our organizationalstrength in support o our mission:“To transorm medicine and healthlocally and globally through innovativescientic research, rapid translation o breakthrough discoveries, educatinguture clinical and scientic leaders,advocating and practicing evidence-based medicine to improve communityhealth, and leading eorts to eliminatehealth inequalities.”
Summing up
We have a clear vision that guides ourwork toward uture success, even inthis ever-changing and challengingglobal economic environment.The successes show we are headedin the right direction, but now morethan ever the economic environmentmust be monitored or any signal thatwould require a course adjustment.We remain mindul that oursuccess today is built upon the excel-lent work done by our current andpast Duke Medicine employees; and itis that solid commitment to our idealsthat will guide Duke Medicine success-ully into the uture.
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We ave a lea vision a uides ou wokowad uue suess, even in is alleninlobal eonomi envionmen.
Duke University Hospital.
fIlE PHOtO
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enrollment, and the new Doctor o Nursing Practice Program has twoqualied applicants or every avail-able seat.“We’re meeting societal needs anddoing our part to strengthen DukeMedicine,” Bowersox said o DUSON,where tuition creates over 80 percento revenue.The School continues to execute itslong-term strategic plan, he said, andhas a clear vision or uture success.“We have excellent coordinationamong orward-thinking administra-tive and aculty leaders, as well as acommitted sta, who are driving ourcontinued success,” Bowersox said.Within those long-term goals,DUSON plans to pursue eight to 10strategic aculty hires in the comingyear to help support planned growth.Two new positions refect the strategicplan’s call or incorporating technologyinnovations into academic programs.A director o educational excellenceand an educational technologist willhelp aculty with the latest Web-basedteaching technologies.“Using technology to strengthenour distance-based and onlineprograms is at the core o what wedo and dierentiates us rom our peerschools,” Bowersox says. “We are seennationally as a technology leader.”Another goal calls or translatingnursing research into improved nursingcare delivery, through creation o theDuke Nursing Translation Institute.The institute, in Duke South, plans toadd proessionals dedicated to improv-ing models o care based upon thelatest nursing research.A concern moving orward isstudent nancial support. Whilescholarships rom DUSON’s endow-ment are cushioned rom the economyin the very short term — with payoutspegged to a three-year average return— 60 percent o ABSN students rely onprivate loans.DUSON’s proposed scal year2010 budget is balanced and conserva-tive, refecting almost no investmentearnings income or operations.Meanwhile, non-essential spending ison hold and the 2010 budget keepsmost non-salary expenses at 2009levels, aiming to avoid impactingstudents, research or clinical practice.Bowersox sees DUSON aswell-positioned. Leadership is closelymonitoring its nancial status, andthe national and global economies, tokeep expenses in line and to ully meetthe needs o those who would like aDUSON education.“The dean and ve associatedeans o our school agreed as a teamsoon ater the economic downturnbegan what we valued most. Werearmed our strong commitment toocus on two goals — balancing thebudget and prioritizing resources tothe areas o most signicant strategicimportance, with students at the topo the list,” he said.
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April 2009
Inside Duke Medicine
“We've been vey ouul and saeiaound wee ou onsained esouesae uilized.“
— Dean Nany Andews, M.D., P.D.
stressed by external regulatory andunding pressures,” said Dean NancyAndrews, M.D., Ph.D. “But we havea clear strategy that, together with ouroutstanding aculty and sta, will guideus in making the decisions and thecritical investments we need to make toensure our continuing success.”The School has the advantages o a strong health system, a world-classaculty and a very balanced researchportolio, she said.The School has been aected inthree ways: Reduced distributions romendowments, lowered expectationsor philanthropic support, and, mostimportantly, a fat NIH budget.But, in reviewing the School’sstrategic plan initiatives, said DeanAndrews, it is clear that, despite theeconomy, the School has continued toocus resources on its core objectives.Examples o this progress includethe strengthening o the MedicalScientist Training Program thatsupports M.D./Ph.D. students, and theSchool’s role in creating the University-wide Global Health Institute, DukeTranslational Medicine Institute,Duke Institute or Brain Sciences andinvestment in core acilities.“We’ve been very thoughtul andstrategic around where our constrainedresources are utilized,” said Andrews.Indeed, much o the strategic planand subsequent eorts o the school’sadministration, said Andrews, havebeen student- and aculty-ocused.“We’re trying hard to be acultyriendly,” said Scott Gibson, executivevice dean or administration. “It’s a bal-ance between investing in new programsin strategic areas o emphasis – whichis important to our growth as a top tierschool – and supporting the aculty andprograms that got us here in the rstplace. We have to do both.”Gibson points to numerousactivities that grew out o the strategicplan, and continue even in these tighteconomic times. These include Dean’sOce bridge unding to promisinginvestigators,improved assistanceand mentoring oraculty who receiveNIHK-Awards,improvements toresearch administration, and a orth-coming aculty work-lie initiative ledby Chancellor Victor J. Dzau, M.D.Still, the School has had to maketough choices.“We have had to make adjust-ments to our internal economyin response to the new economicsituation, which actually startedseveral 4-5 years ago when the budgetor the National Institutes o Healthfattened ater a period o tremendousgrowth. These changes were essentialto our ability to stabilize our nancialpicture,” said Gibson.Earlier this year, the Schoolimplemented a number o expense man-agement actions, ollowed by changesto its overhead allocation methodology,implementation o a git assessmentand a one-time balance assessment —structured as a loan — or discretionaryunds greater than $500,000.These measures were necessary orthe School to shore up its budget overthe next years.The strategic plan has been en-hanced by work to streamline researchadministration. The Research Adminis-tration Continuous Improvement(RACI), an initiative begun in 2007,involves University and School o Medicine senior leadership and acultyand sta advisors in ongoing eorts tomake administrative unctions asecient as possible and investigator-riendly. An example o this work is thestreamlined process or account codecreation, the reduction in budgetrequirements or modular grants and thesoon-to-be-released research portal.“This initiative was designed to helpall researchers, and it has put us in verygood condition to prepare or the ARRAeconomic stimulus,” said Gibson.Meanwhile, students continueto be a primary ocus o the School,which has embarked on a moderniza-tion o learning acilities. Last all, ahigh-tech Gross Anatomy Lab andFresh Tissues Lab were opened in thelower level o Davison Building.And, the School is proceedingwith plans to build a learning center,supported by a $35-million donationby The Duke Endowment last year.However, because o the economicsituation, the School has had to deerplans to build a state-o-the-artresearch building.“With our top-notch aculty anda committed sta working togetheron our shared strategic vision, wewill make progress despite the toughenvironment,” said Dean Andrews.
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