What med ed and organizational change have in common

Contributing Writer
AMA Wire
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The AMA’s Accelerating Change in Medical Education Consortium, which includes 32 medical schools, is working to create the medical school of the future by developing and spreading innovative ideas and practices. But making major curriculum revisions is no easy feat. Learn how the ideas of leading thinkers on business innovation can be applied by medical schools embarking on radical change.

Honest self-assessment

Rajesh Mangrulkar, MD, associate dean for medical student education at the University of Michigan Medical School, recently spoke at the AMA’s ChangeMedEd 2015 conference about his institution’s journey in transforming its med school curriculum as a founding member of the AMA’s Accelerating Change in Medical Education Consortium.

“What we envisioned needing our curriculum structure and project to go through was big and very different than what we had had at Michigan,” Dr. Mangrulkar said. “Honestly, when I would give ... presentations on what we were envisioning, some people said this is the biggest change at Michigan in 50 years. Some people said 100 years.”

A recent attempt at curricular innovation did not inspire confidence that such an ambitious project could succeed. In 2008, Dr. Mangrulkar led a project to create a more competency-based and time-independent curriculum. That ended in a “public, fiery death,” he told the audience comprised primarily of academic physicians.

This time around, he and his colleagues turned to the business literature for ideas on how to achieve a different outcome. Specifically, they needed to rally enough support for the curriculum change to win over a majority of the medical school faculty, who vote on any major structural change.

The Disruptive Innovation model created by Harvard Business School’s Clayton Christensen provided a useful framework for how the transformation project could be structured within the University of Michigan Medical School’s existing organization.

Dr. Mangrulkar and his team began with a self-assessment.

“We needed to understand what our own processes were and [what] our own values were, and so we did an honest, authentic assessment of Michigan’s culture of innovation, our processes and procedures for curricular management, and who we had on the team,” he said.

The existing values of the main power brokers at the University of Michigan Medical School—the department heads—were good advocates for education but not strongly aligned with major, transformational change, they determined. In addition, the analysis revealed that the school had strong processes rooted in good deliberative governance and that the leaders who would spearhead the innovation efforts were skilled but still weary and affected by the failed effort in 2008.

Based on these findings, they decided to embed the project within the existing governance structure—a different plan than in 2008, when a separate think tank had been established, akin to the “crazy people in the garage” doing innovative things, Dr. Mangrulkar said.This time, he and his colleagues adopted what in the parlance of Disruptive Innovation was a “heavyweight team within the organization.”

A steering committee and operational committee, with several work groups and teams, were established for the curriculum strategic planning process. But they all would report to the school’s existing curriculum policy committee, which directly reported to the executive committee representing the faculty and chaired by the dean.

8 steps for success

An eight-step process for leading change from another Harvard Business School professor, John Kotter, formed the backbone of the efforts to facilitate the more recent curricular transformation. In particular, the first six steps propelled the project from its earliest stages through the necessary faculty vote, taking a full two and one-half years of groundwork.

  • Establish a sense of urgency. This is crucial so that stakeholders understand why such sweeping changes are needed, even when immediate results in the form of graduation and residency matching rates are good. The dean needed to own this message, which ultimately took the form of five talking points developed from stakeholder surveys, dialogues and similar efforts. The fifth was broad: “Society needs us to change.” But the others all were focused internally and were understandable within the context of the school.
  • Establish a powerful guiding coalition. Those leading the innovation project enlisted the support of a wide variety of stakeholders, including from the health system owned by the University of Michigan. The steering committee included the hospital CEO and representatives from the Veterans Affairs hospital. Dr. Mangrulkar also emphasized that “getting the AMA to support our ideas was very powerful.”
  • Create a vision. The curriculum structure itself was not the vision, but rather it was how that curriculum would result in a new type of graduate who would posess additional skills and abilities. The vision that was developed during a three-hour retreat centered around the idea that every Michigan graduate must be able to lead change in health, health care and health care science.
  • Communicate that vision. Inspired by other schools in the AMA’s Accelerating Change in Medical Education Consortium, Michigan hired an outside marketing and branding firm—the same one that worked with the school’s athletic department. The firm developed the “Michigan Medicine: Transforming, Creating, Leading” branding, with messaging that resonated with students, faculty and staff.
  • Empower others to act on the vision. Student involvement was a key part of this step. The student body was engaged from the beginning of the process, taking part in the operations and steering committees, the work groups, and a new student advisory committee for the curriculum transformation. This “powerful group” has included upward of 100 students, which is a “stunning” proportion of the school’s total 780-student enrollment, Dr. Mangrulkar said.
  • Planning for and creating short-term wins. About 300 people led the charge for the curriculum overhaul. They developed pilots and experiments and disseminated their work through multiple venues, including retreats and conferences with poster presentations. An important aspect here was to share information not only about successes but also about the results that were not positive to convey that the team genuinely was interested in the nuances that would go toward enacting a successful transformation and that the model would always continue to evolve based on experience.

When the faculty vote occurred in June, they approved the curricular innovation by a 4:1 margin, with a record turnout of nearly 800 medical school faculty.

Steps seven and eight of Kotter’s process call for institutionalizing the changes that have begun. This will be a new and challenging endeavor, but Dr. Mangrulkar is fully optimistic and hopes that this process has helped establish a culture at Michigan that is more nimble and able to embrace and work through large-scale transformations going forward.

“We’ve had a successful vote, but change is a process that is never over,” he said.

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