When Paul Taheri, M.D., says most doctors don’t know much about business he isn’t making a criticism. “They know biochemistry,” he says. “That’s what they’re supposed to know.” That’s not enough anymore, he adds, with health care relying more on business-based models and doctors moving into administrative positions that require the ability to apply fundamental business principles to the delivery of health care.
“How we pick our leaders in health care and academia doesn’t make a lot of sense,” says Taheri, professor of surgery and president of the University of Vermont Medical Group at Fletcher Allen. “It’s based on clinical or professional credibility and achievement and has nothing to do with the ability to manage, or lead for that matter. Today, docs need some business knowledge in their toolkit to be successful. You have to know how to make a business case or you will be in jeopardy of losing your funding. The question becomes ‘how do you get the system to work for you to leverage it to deliver better care.’”
With these new realities in mind, Taheri and William Cats-Baril, associate professor in business, designed a pilot program in Spring 2009 based in part on courses Taheri took at the University of Michigan, where he earned his MBA, and at the Wharton School at the University of Pennsylvania and Kellogg School of Management at Northwestern. Cats-Baril developed the curriculum of the program, helped recruited UVM faculty members to join him in teaching courses on marketing, finance, operations, organizational behavior and strategy to doctors, nurses, residents, physician assistants and other health care professionals Fletcher Allen.
“Rocki-Lee DeWitt (dean of the business school at the time) had been trying to establish a relationship with FAHC for some time and we found in Paul the first real partner interested in a meaningful long-term relationship,” says Cats-Baril. “Paul and I had worked on some projects together and we both saw the need to bring more professional management to the medical group. We thought that by helping physicians better understand business principles inherent to their practice, they would be more engaged and accountable for their performance.”
In addition to Cats-Baril, business faculty Susan Hughes,Tom Noordewier, Larry Shirland, Mark Youndt, David Jones and DeWitt, have taught courses in the program.
“The relationship between the business school and the Center for Health Care Management has really benefited our faculty and students,” says Shirland, professor and interim dean of the business school. “We try to tailor the courses so they’re applicable to health care and provide information and strategies participants can use. In turn, they’ve provided our students with the opportunity to complete research and work on projects with health care professionals.”
Students get first-hand experience studying and working in health care
Program participants receive a certificate or “mini-MBA” from the Center for Health Care Management, originally designed by Taheri and Cats-Baril to address an education gap in administrative best practices for clinic management. The center expanded its scope to include innovation and research, which includes student-led improvement projects with guidance from faculty members and health care professionals. Projects have focused on maximizing efficiency at an infusion center; improving patient satisfaction; building an online onboarding presence; and helping incoming physicians become more productive team members, among others.
Justin Carswell ’10 produced a case study titled “The Infusion Project: A Study of Infusion Services at Fletcher Allen” as part of his senior project for his Engineering Management course. He was tasked with evaluating the current state of infusion serves at Fletcher Allen and proposing an optimal delivery plan to minimize costs while improving or maintaining current patient service levels. After becoming familiar with the locations and services at the hospital’s five infusion sites at the Vermont Cancer Center, Children’s Specialty Center, Rheumatology, Walk-in Care Center, and Neurology, Carswell conducted data analysis focusing on patient volume, drug volume, cost and other financial data.
Carswell’s recommendations included the pre-ordering of all infusion drugs at each center, resulting in a potential net benefit of $3 million and 28,000 minutes of time saved; standardizing basic patient accommodations for every site; and using the Cancer Center’s “Ticket to Treatment” program at each site as an effective patient-practice interaction tool that benefits both parties.
“It was a valuable learning experience for me on a number of levels,” says Carswell, who presented his findings to the Patient Safety and Operations committee at Fletcher Allen. “I’ve done other case studies, but this was my first glimpse of problem solving that affected real people. These were gravely ill patients, so it had some real weight to it and made you think about what these people were going through. It was very personal.”
Abigail Trutor, program director for the Center for Health Care Management, says that some of the project findings by students may appear minor but can have major impacts on health care delivery and patient care. A group of MBA students assisted a women’s clinic at Fletcher Allen, for example, where the goal is to answer the phone within one minute 80 percent of the time instead of the 60 percent at which it was operating. The students’ recommendation: move the fax machine closer to the phone so employees didn’t have to walk into the next room to transfer or receive patient records.
“We’re not asking for big leaps and bounds or any epiphanies,” she says. “For students, it’s an opportunity to step into the shoe of health care and see how it really operates. Not only is it great for us, but it’s great for them because they have the opportunity to interact with people they would normally not have access to. We’re only 15 steps away from the business school, and this is an opportunity for them to complete an internship that can beef up their resume and give them something they can speak about while out job hunting.”
‘The perfect triad’
Taheri, who says health care accounts for about 17 percent of America’s gross domestic product, credits the program’s success with its ability to attract multiple health care players, including what he calls “the perfect triad” consisting of a doctor, nurse and administrator. “That’s the ideal scenario,” he says. “When you have a physician and a nurse in the room together they are having different conversations than if you only had physicians, which is why this program was built to be cohesive. Change occurs when they go back to their floor and the three of them walk around and talk and reinforce the issues and the learning that transpired in the class.”
David Adams, M.D, an anesthesiologist and associate dean for graduate medical education responsible for all residency training programs, says the old model of “hanging up a shingle and going to work isn’t the way it works anymore.” He found the courses helpful from an administrative perspective and thinks they are especially useful for younger residents who are coming of age professionally during a time when health care is being increasingly run based on business models.
“The Marcus Welby model no longer works,” says Adams, adding that the courses really helped him from an administrative perspective. “We know now that doctors have to interact with systems and understand certain business concepts to be successful. These areas have traditionally not been part of med school. This program addresses these issues with professors who are truly engaging and thought provoking.”