A Five-Year Look Back Selwyn M. Vickers, M.D., FACS Senior Vice President for Medicine and Dean JANUARY 30, 2019
In Memoriam
Harold J. Fallon, M.D. Former dean of the School of Medicine
Bill O’Byrne, M.D. Department of Anesthesiology and Perioperative Medicine
Gwen Claussen, M.D. Department of Neurology
Sabine Huke, Ph.D. Department of Medicine
Nass Cannon, M.D. Department of Medicine
Michael Miller, Ph.D. Department of Cell, Developmental and Integrative Biology
Lane Rutledge, M.D. Department of Genetics
Nancy Swift, BSN Nursing Supervisor in Surgery UAB Highlands
In Memoriam
Bongani Mayosi, BMedSci, MB ChB, FCP(SA), DPhil, OMS Dean of the Faculty of Health Sciences, University of Cape Town
LTC Thomas C. Smith III Director, Birmingham Veterans Affairs Medical Center
Thank You
Ray L. Watts, M.D. President
UAB Administration
Pam Benoit, Ph.D. G. Allen Bolton Jr., Senior VP, Academic MPH, MBA Affairs and Provost Senior VP, Finance, Administration
Paulette Patterson Dilworth, Ph.D. VP, Diversity, Equity and Inclusion
William Ferniany, Ph.D. CEO, UAB Health System
Tom Brannan VP, Advancement
Alesia Jones Chief Human Resources Officer
Christopher S. Brown, Ph.D. VP, Research
John Jones, Ph.D. VP, Student Affairs
Anne L. Buckley, APR Curtis A. Carver Jr., Ph.D. Chief Communications VP, Information Officer Technology and Chief Information Officer
Kathy Nugent, Ph.D. Executive Director, Harbert Institute for Innovation and Entrepreneurship
Selwyn Vickers, M.D., FACS Senior VP for Medicine and Dean of the School of Medicine
Building on Success UAB as the preferred academic medical center of the 21st Century ยง Top 10 in quality ยง Top 10% in patient satisfaction ยง Top 20 in NIH funding ยง Top destination for best talent
Selwyn M. Vickers, M.D., FACS Senior Vice President for Medicine Dean, School of Medicine
William Ferniany, Ph.D. CEO, UAB Health System
Physician Leadership Keith A. (Tony) Jones, M.D. President, UAHSF Chief Physician Executive, UAB Medicine Senior Associate Dean for Clinical Affairs, School of Medicine
FIVE-YEAR JOURNEY Moving from Information to Transformation
Vision for the Future The Preferred Academic Medical Center defined by culture, values, and investments in talent and resources that reflect a commitment to the highest levels of clinical care, scholarship and innovation, which includes discovery of knowledge, the education of medical leaders and the engagement of our community.
Collaborative Governance UA Board of Trustees
UAB Health System Board
UAHSF Board
Gathering Data to Create a Vision of Transformation CULTURE FINANCIAL INVESTMENT PROGRAMS PEOPLE INFRASTRUCTURE ORGANIZATIONAL STRUCTURE
CULTURE
Financial Investment
Programs
People
Infrastructure
Organizational Structure
Challenges Faced in 2013 AAMC audit of Dean’s Office senior leadership revealed staffing was short 18-20 full-time employees compared to competitors:
Dean’s Leadership Team in 2013 Equaled 3.5 FTE
CULTURE
Financial Investment
Programs
People
Infrastructure
Organizational Structure
Challenges Faced in 2013 25 20 15 R² = 0.947
Key principle of academic medical centers: Innovation and discovery drive great clinical care and reputation.
10 Bowman, M.A., Rubenstein, A.H., Levine, A.S. Clinical Revenue Investment in Biomedical Research, Lessons from Two Academic Medical Centers. 2007, JAMA, 207(22):10-13.
5 0 110 11 -2 21 0 -3 31 0 -4 41 0 -5 51 0 -6 61 0 -7 0
Average U.S. News & World Report Ranked‌
Innovation is correlated with clinical reputation:
2013 NIH SOM Rank
CULTURE
Financial Investment
Programs
People
Infrastructure
Organizational Structure
Challenges Faced in 2013 b)
25
20 13 (
25
20 12
22
20 11
22
20 10
19
20 09
20 06 (
17
20 08
20 05
18
20 07
20 04
a)
UAB SOM NIH ranking trend from 2004-2013:
28
29
31
0
10
20
30
R² = 0.9679 (a) Blue Ridge estimated ranking at 33 because JHS departments were not included in the total. The corrected rank is shown. (b) Estimated using NIH data and including Mayo. Identical to rank released by Blue Ridge more recently.
CULTURE
Financial Investment
Programs
People
Infrastructure
Organizational Structure
Challenges Faced in 2013 2013 U.S. News ranked adult specialties of affiliated hospitals compared to peers:
25
5
10
15
20
25
30
20 15 10
0
3 UCSF Hopkins Penn Stanford Yale Wash U Pitt U Wash Vandy Duke U Mich UCSD UCLA UNC Columbia Case… Emory Mt. Sinai Mayo Baylor Oregon NYU Northwe… Harvard Colorado Einstein Minnesota UT… U Chicago U… UAB U…
5
Culture
FINANCIAL INVESTMENT
Programs
People
Infrastructure
Organizational Structure
Challenges Faced in 2013 Institutional research growth requires investment; every NIH dollar needs $0.53 institutional dollars in support:
*Error bars represent 95% confidence intervals
Culture
FINANCIAL INVESTMENT
Programs
People
Infrastructure
Organizational Structure
Challenges Faced in 2013 § Only school in the top 35 without clinical revenue to support research mission (Dean’s tax) § UAB SOM had only one top 10 NIH department ranking (OB/GYN) § Clinical enterprise was contributing significantly less revenue to our broader academic mission compared to peers like Emory, North Carolina, and Vanderbilt
Culture
Financial Investment
PROGRAMS
People
Infrastructure
Challenges Faced in 2013 ยง CCTS renewal ยง CCC renewal ยง Renew Liaison Committee on Medical Education (LCME) accreditation renewal ยง Launch of new institutes, centers and departments ยง New regional medical campus
Organizational Structure
Culture
Financial Investment
Programs
PEOPLE
Infrastructure
Organizational Structure
Challenges Faced in 2013 Recruitment, reinvestment, and retention needed in key areas: ü Department (Chairs) § § § § § § § § § § § §
ü Department Reinvestments
Anesthesiology § Medicine Biochemistry and Molecular § Microbiology Genetics § Neurology Biomedical Engineering § Ophthalmology Cell, Developmental and Integrative ü New Leaders for Institutes and Biology (CDIB) Centers Dermatology • Informatics Institute ENT • UAB-HudsonAlpha Center for Family Medicine Genomic Medicine Pathology • Hugh Kaul Precision Medicine Pediatrics Institute Surgery • CCTS Neurobiology • Cystic Fibrosis Center Education • Institute for Cancer Outcomes and Survivorship • Comprehensive Cancer Center
Culture
Financial Investment
Programs
People
ORGANIZATIONAL STRUCUTURE
INFRASTRUCTURE
Challenges Faced in 2013 Creating effective collaborative governance: UAB Medicine as the Preferred AMC of the 21st Century ยง Top 10 in Quality ยง Top 10% in Patient Satisfaction ยง Top 20 in NIH Funding ยง Top destination for best talent
MOVING FROM INFORMATION TO TRANSFORMATION 2013-2018 RESULTS
CULTURE
Financial Investment
Programs
People
Infrastructure
Transformational Change Increased the size and capacity of the Dean’s Leadership Team:
Organizational Structure
CULTURE
Financial Investment
Programs
People
Leadership Support
Infrastructure
Organizational Structure
CULTURE
Financial Investment
Programs
People
Infrastructure
Organizational Structure
Transformational Change Growth in federally funded research dollars: NIH Funding $240,000,000
$232,996,499
$100M in growth in net new NIH dollars
$220,000,000 $200,000,000 $186,070,729 $180,000,000
$171,945,411
$160,000,000
$168,394,834
$162,442,592
$140,000,000 $120,000,000
$195,053,174
$156,324,620 $158,476,912 $143,263,811 $149,533,584
$165,425,015
$132,915,974
$131,505,113
$100,000,000 2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
CULTURE
Financial Investment
Programs
People
Infrastructure
Organizational Structure
Transformational Change UAB SOM NIH ranking and trend: 2013
2014
2015
2016
2017
2018 0
5
10
15
21 23 26
31
25
20
23
25
30
35
CULTURE
Financial Investment
Programs
People
Infrastructure
Organizational Structure
Transformational Change UAB SOM public school NIH ranking trend since 2013: 2013
2014
2015
2016
2017
2018 0 2 4 6
8 10
13
10
8
8
8 10 12 14
UC San Francisco Pittsburgh Michigan UC San Diego UCLA- Geffen U Washington North Carolina UAB
CULTURE
Financial Investment
Programs
People
Infrastructure
Organizational Structure
Transformational Change Five-year growth of NIH grant >$100M (Elite 8): 50% 45%
42.8%
43.1%
40.4%
40.3%
40% 33.6%
35%
30.9% 28.5%
30%
23.8%
25% 20% 15% 10% 5%
co an cis Fr Sa n C -U
3
-S ta nf or
d
s St Lo ui
-P it t sb ur gh 6
1
-M 12
U
-C 7
-W as hi ng to n
ol um bi a
AB -U 21
ou nt Si na i-I ca hn
4
16
-N
or th w
es te rn -F ei nb er g
0%
CULTURE
Financial Investment
Programs
People
Infrastructure
Organizational Structure
Transformational Change Outstanding growth in department rankings: FY13 Department Anesthesiology Biochemistry & Molecular Genetics Biomedical Engineering Cell, Developmental & Integrative Biology Dermatology Emergency Medicine Genetics Medicine Microbiology Neurobiology Neurology Neurosurgery Ob/Gyn Ophthalmology Orthopaedic Surgery Otolaryngology Pathology Pediatrics Pharmacology PM&R Psychiatry Radiation Oncology/Radiology Surgery Urology
Ranking 16 46
Funding $ 2,192,070 $ 4,178,056
16 15 23 36 18 35 20 34
$ $ $ $ $ $ $ $
9,063,212 1,831,851 495,731 2,129,322 59,967,759 7,587,757 5,084,104 3,313,868
3 36
$ 7,990,042 $ 1,755,703
14 38 80 19 47 33 31 19
$ $ $ $ $ $ $ $
10,523,045 5,578,556 969,496 398,200 3,439,118 2,685,866 2,871,755 860,463
Ranking 9 52 6 10 1 21 13 16 28 25 17 22 9 6 37 12 17 72 23 36 43 21 12
FY 18 Funding $ 5,396,008 $ 3,576,080 $ 5,285,777 $ 13,873,267 $ 8,277,406 $ 689,469 $ 14,680,250 $ 86,607,537 $ 9,747,471 $ 6,246,385 $ 15,079,112 $ 2,100,868 $ 5,073,835 $ 9,309,000 $ $ $ $ $ $ $ $ $
366,513 14,909,839 15,805,526 1,291,353 129,200 6,341,436 1,076,840 5,535,649 1,597,678
Departments in top 10
1 6
CULTURE
Financial Investment
Programs
People
Infrastructure
Organizational Structure
Transformational Change Ranking trend from 2013-2018: US News Rankings
15 10 5
NIH Rankings 10
9
8
10
6
3
0 -5 -10 -15 -20 -25
24
22
22
21
25
-30 -35
31
More ranked programs than any AMC in the South except Duke (including Emory and Vanderbilt)
CULTURE
Financial Investment
Programs
People
Infrastructure
Organizational Structure
Transformational Change Overall clinical growth:
1000000
80000
$2,500,000
$2,000,000
$2,163,021 $2,035,744 $1,966,522 $1,824,677 $1,653,473 $1,584,379
1200000
100000
103202 100575 90986 86662 82206 79494
1400000
1492348 1424427 1358668 1290806 1178196 1143118
1600000
120000
$1,500,000
800000 49130 46507 45520 44754 43091 41297
60000
600000 400000
$1,000,000
40000
200000
$500,000
0 Outpatient Clinical Encounters
20000
2013 2014 2015
0
2016 2017 2018
$0 Net Patient Revenue Total Discharges 2013 2014 2015
Total Surgery Cases 2016 2017 2018
2013 2014 2015 2016 2017 2018
FINANCIAL INVESTMENT
Programs
People
Infrastructure
Organizational Structure
Transformational Change SOM Academic Enrichment Fund (a need for $0.53 for every new NIH dollar): $45 $40 $35 $30 $25 $20 $15 $10 $5 $0
VARIABLE 15 MILLION
Clinical Support
20 13 20 14 20 15 20 16 20 17 20 18
Culture
Goal is to achieve $55 million Budgeted at $20 million (UAB B) $34 million received in 2015 (UAB V/B) Variable at approximately $15 million
Viva
HSF
Hospital
Culture
FINANCIAL INVESTMENT
Programs
People
Infrastructure
Organizational Structure
Transformational Change AEF Investments:
$112M Chair Packages and Department Reinvestments Anesthesiology; Biochemistry; Bioengineering; Cell, Developmental and Integrative Biology; Dermatology; Family Medicine; Huntsville; Medicine; Microbiology; Neurobiology; Neurology; Ophthalmology; Otolaryngology; Pathology; Pediatrics; Surgery; Radiology
$59.1M
$56.4M
Institutes and Centers
Other
Comprehensive Cancer Center
Chair/Leader Recruitments in Progress
Center for Clinical and Translational Science UAB HudsonAlpha Center for Genomic Medicine Informatics Institute Hugh Kaul Precision Medicine Institute Cystic Fibrosis Center
Faculty Recruitment and Retention Inflammation, Infection and Immunity (I3) Outcomes and Population Health Joint Health Sciences Staff Appreciation Payments
Culture
FINANCIAL INVESTMENT
Programs
People
Infrastructure
Organizational Structure
Transformational Change O’Neal Comprehensive Cancer Center at UAB: O’Neal Industries, Inc. and its shareholders gave the single largest gift in UAB history to the Comprehensive Cancer Center.
$30M
Culture
FINANCIAL INVESTMENT
Programs
People
Infrastructure
Organizational Structure
Transformational Change The Campaign for UAB: With the help of the O’Neal gift, UAB surpassed its $1 billion fundraising goal with $1,002,957,673 raised.
$1B+ 67% total funds raised
percent of funds donated to School of Medicine
Culture
FINANCIAL INVESTMENT
Programs
People
Infrastructure
Organizational Structure
Transformational Change Created the Board of Visitors:
Total contributions to date: $46M
Culture
Financial Investment
PROGRAMS
People
Infrastructure
Organizational Structure
Transformational Change Medical Education § LCME accreditation: Last site visit occurred in 2014 and is good for 7 years. Next site visit will take place 2021-2022. § Created Learning Communities § Created Montgomery Regional Medical Campus § Underrepresented in mediucine (URiM) figure never reached >8% for 49 years in a state that’s 24% URiM. § Entering class of 2017: 15% § Entering class of 2018: 16.1%
Culture
Financial Investment
PROGRAMS
People
Infrastructure
Organizational Structure
Transformational Change Challenges overcome:
•CCTS renewal: top three in U.S. •CCC renewal: funded continuously since 1974 •Renewed set of core research science goals to direct growth
Culture
Financial Investment
PROGRAMS
People
Infrastructure
Organizational Structure
Transformational Change Creation of research priority areas:
Precision Medicine Informatics Basic Science Discovery I3: Inflammation, Infection and Immunity Population Health, Health Disparities and Outcomes Effectiveness Research
Culture
Financial Investment
PROGRAMS
People
Infrastructure
Organizational Structure
Transformational Change Creation of key programs:
ยง Established institutes, centers and new departments ยง Collaborated with HudsonAlpha ยง Worked on Global Health, UCT collaboration, Gates Grand Challenge ยง Created funding opportunities and awards to recognize research success (Blue Sky, Multi-PI awards, Second RO1s)
Culture
Financial Investment
PROGRAMS
People
Infrastructure
Organizational Structure
Transformational Change Created Pittman Scholars Announcing 2019 recipients:
Matt Alexander, Ph.D. Pediatrics
Aaron Fobian, Alexa Mattheyses, Ph.D. Ph.D. Psychiatry CDIB
Pankaj Arora, M.D. Medicine
Kyle Wood, M.D. Urology
Culture
Financial Investment
Programs
PEOPLE
Infrastructure
Organizational Structure
Transformational Change Bridging and retaining SOM Faculty: 25 Professors
20 Assistant Professors
8 Associate Professors
49 Bridge Funding Recipients
Total: 102
Culture
Financial Investment
Programs
PEOPLE
Infrastructure
Organizational Structure
Transformational Change
2013-2018 recruited leaders (talent acquisition 17/22 out of state): 1. Dr. Mitch Cohen Chair, Department of Pediatrics
12. Dr. Christina Grabowski Associate Dean, Admissions
2. Dr. Herb Chen Chair, Department of Surgery
13. Dr. Ronald Lazar Evelyn F. McKnight Endowed Chair in Memory and Learning
3. Dr. George Netto Chair, Department of Pathology
14. Dr. Bill Carroll Chair, Department of Otolaryngology
4. Dr. Roger Smalligan Regional Dean, Huntsville Campus
15. Dr. Bradley Yoder Chair, Department of Cell, Developmental and Integrative Biology
5. Dr. Boni Elewski Chair, Department of Dermatology
16. Dr. David Bedwell Chair, Department of Biochemistry and Molecular Genetics
6. Dr. Jim Cimino Director, Informatics Institute
17. Dr. Matthew Might Director, Hugh Kaul Precision Medicine Institute
7. Drs. David and Jennifer Pollock Professors, Department of Medicine
18. Dr. Michael Birrer Director, Comprehensive Cancer Center
8. Dr. Smita Bhatia Director, Institute for Cancer Outcomes and Survivorship
19. Dr. Craig Powell Chair, Department of Neurobiology
9. Dr. Ravi Bhatia Division Director, Hematology/Oncology, Department of Medicine
20. Dr. Irfan Asif Chair, Department of Family and Community Medicine
10. Dr. Jay Zhang Chair, Department of Biomedical Engineering
21. Dr. Dan Berkowitz Chair, Department of Anesthesiology and Perioperative Medicine
11. Drs. Joseph Tector and David Cooper Co-Directors, Xenotransplantation Program
22. Dr. Steven Theiss Chair, Department of Orthopaedic Surgery
Culture
Financial Investment
Programs
PEOPLE
Infrastructure
Organizational Structure
Transformational Change Growth in the number of PIs: 0
50
100
150
2018
323
2017
303
2016
2015
296
267
2014
259
2013
259
200
250
300
350
Culture
Financial Investment
Programs
PEOPLE
Infrastructure
Organizational Structure
Transformational Change Investing in wellness: § UAB Medicine has launched the Wellness website to consolidate information and resources § Well-Being Index participants: § Faculty – 576 § Trainees – 266 § APPs – 152
§ Will continue to roll out to other groups in SOM and UAB Medicine
Culture
Financial Investment
Programs
People
ORGANIZATIONAL STRUCUTURE
Transformational Change Space optimization success: ยง Wallace Tumor Institute ยง 7,500 ASF of recruitment space identified
ยง Shelby ยง 13,845 ASF of recruitment space identified
ยง Renovated McCallum will create space for ~32-40 new recruits
INFRASTRUCTURE
Culture
Financial Investment
Programs
ORGANIZATIONAL STRUCUTURE
People
INFRASTRUCTURE
Transformational Change Organizing for success:
• Alignment of HS, HSF, and SOM • President of HSF full-time position
UA Trustees HSF Board
UAB Medicine Board
-
Board Committees: Executive Finance Medical Leadership Compensation Audit & Compliance
Chair: Dean of SOM
Future State-Chair: Dean of SOM when President chairs a system board
UAB Medicine JOL Council
Executive Policy Council Senior Leaders Forum Operating Committees
THE NEXT FIVE YEARS: CHALLENGES AND OPPORTUNITIES
Challenges § Providing competitive pay and doing our very best to recognize hard work and effort from faculty and staff § Finding $0.53 to support every NIH dollar § Reaching the AEF $55 million threshold to keep the status quo § Needing ~$115 million to support our current research base § Producing an operating margin >3% in U.S. with worst Medicare Wage Index (MWI) § Maintaining and developing a culture of cost reductions with improved quality § Developing local statewide and national partnerships for UAH and VIVA § Recruiting and retaining our best faculty § Needing new or designated rehab and cancer homes § Aging clinical plan and insatiable need for capital expenditures
Core Needs § High-end imaging capabilities for research and clinical purposes § Single-cell analysis capabilities § Cryo-electron microscopy acquisition § Bioinformatics support services to assist investigators with experimental design and data interpretation § Expansion of microbiome analysis capabilities § Optogenetics and behavioral assessment capabilities
Space Goals: ยง Creating/optimizing space for ~60-90 net new researchers ยง Creating wet lab and dry lab spaces that are modern, attractive, safe, reliable, manageable, and sustainable ยง Provide a governance strategy and space policies that are transparent, equitable, and competitive with our peers
Total Net New PIs Experimental Current Initiatives
Dry
~70-80
~52-62
~18
LHRB as Genomics
~19
0
~19
Total New Recruits
~89-99
~52-62
~37
OPPORTUNITIES
Advancing Wellness § Stress Management and Resilience Training (SMART) § Eight members of the UAB Medicine community will train to lead group-level versions of the intervention
§ EMR streamlining (Scribble) § Engaging with the provider community to identify features of the EMR that could be modified to decrease unnecessary work
§ Reducing administrative burden § Engaging with faculty in early 2019 to identify the source of their burdens, so we know where to work to reduce them
AGHI and All of Us § Alabama Genomic Health Initiative participants have been recruited in 65 of Alabama’s 67 counties § All of Us is rapidly expanding the number of institutions where people can enroll in the research program § A top priority for both programs is achieving a diverse participant community, especially by including those who are underrepresented in biomedical research
21st Century Cures Act Funding for NIH Innovation Projects under the Cures Act ($4.79B): Fiscal Year
Precision Medicine Initiative
2017
BRAIN
Cancer Moonshot
Regenerative Medicine
$40,000,000
$10,000,000
$300,000,000
$2,000,000
2018
$100,000,000
$86,000,000
$300,000,000
$10,000,000
2019
$186,000,000
$115,000,000
$400,000,000
$10,000,000
2020
$149,000,000
$140,000,000
$195,000,000
$8,000,000
2021
$109,000,000
$100,000,000
$195,000,000
2022
$150,000,000
$152,000,000
$194,000,000
2023
$419,000,000
$450,000,000
$216,000,000
2024
$235,000,000
$172,000,000
2025
$36,000,000
$91,000,000
2026
$31,000,000
$195,000,000
TOTAL
$1,455,000,000
$1,511,000,000
$1,800,000,000
$30,000,000
Designed to help accelerate medical product development and bring new innovations and advances to patients who need them faster and more efficiently. In addition to this, more than 2.3 billion is available for Alzheimer’s and dementia related research and 3.8 billion for neurosciences.
Regional and National Impact § Filling gap in the “Stroke Belt” as one of 25 institutions to join the National Institutes of Health StrokeNet § One of nine NIH Udall Centers for Excellence in Parkinson’s Disease Research § Hugh Kaul Precision Medicine Institute became a partner coordinating center with Harvard for the Undiagnosed Diseases Network’s 11 clinical sites
What is our WHY? Impacting the future of medicine in the United States by transforming Alabama and the Deep South Alabama • 1st worst state for stroke • 3rd worst state for diabetes • 3rd worst state for kidney disease • 4th worst state for heart disease • 6th worst survival rate for chronic lower respiratory disease
Impact • Continue to provide clinical care and make translational research strides to treat the burden of diseases in our region • Utilize programs like All of Us and the Alabama Genomic Health Initiative to continue reaching out to those who have traditionally lacked representation in medical research • Maintain dedication to health disparities and outcomes effectiveness research
Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try. Atul Gawande, M.D., MPH
A Five-Year Look Back
Questions?