Volume 24xxNo. 1xJanuary 2000

Bauer appointed to reconfigured vice president's post;
dean sought

Doctors can help spur health legislation,
says Eshoo

Facilities upgrade planned for medical school facilities

2000, a new century, a new start!

byx LA W R EN C Ex M.x S H U E R

Hopefully, you made it through the New Year celebrations without problems and by now are enjoying life with fresh opportunities and a perspective inspired by the magic - or at least the omnipresence - of the new millennium spirit.

I think it is useful to look for transitions and milestones if for no other reason than they help us put our lives in perspective. On that note, I think it's safe to observe that we are immersed in the information, or Internet, age.

Professionally - at Stanford and elsewhere, as well - we find ourselves leaving an older era, the merger age, and that has raised a question I hear regularly: "Why didn't it work?"

I think we have some answers to that question, but I think there are more constructive questions: "What did we learn and what can we do about it?"

The two-year UCSF Stanford "experiment" was well intentioned, but fatally flawed. First, the cultures of UCSF and our institution were just too different to allow for the type of trust and collaboration the merger required to achieve promised economic benefits. At the end of the day, we found no champions for continuing the merger: Administrators were frustrated with efforts to put together a single, powerful health care system. The faculty - who as a group were convinced that the only potential benefits of the merger were economic - eventually perceived that even potential financial benefits were not balanced and equitable between two medical centers 40 miles apart. Had the faculty felt that there was a good academic reason to continue, we might have seen another attempt to continue. But they didn't.

We can learn from our merger experience by recalling that UCSF Stanford Health Care was born three years into another structural experiment - Stanford Health Services. This was the integration of the faculty practice and the hospital as an attempt to align the two so that each would be better positioned to survive. Before SHS was launched, our hospital, Packard Children's Hospital and the medical school appeared not to be in the same book, let alone on the same page in regard to our goals or aspirations. While SHS and its next iteration, UCSF Stanford Health Care, fell short of achieving hoped-for integration, the experiment nevertheless helped us see new ways of doing business and relating to our environment. If we didn't achieve integration in some crucial respect, at least most of us came to understand and often practice innovative new relationships with our colleagues (at least locally) and with our health care system. To cite just one example, everyone of us now is either fully immersed in managed care or else consciously aware that we are anomalies.

Our job now is to synthesize the best of what we have and to reshape ourselves to creatively manage the realities of modern academic health care and modern economics.

We are starting to do that with positive results here at Stanford. I am encouraged by physician participation in our Operations Improvement cost-saving program, which this year has achieved greater physician involvement. I am optimistic after seeing the early cost savings and physician acceptance of our new restricted inpatient formulary. At a recent operating room committee meeting, I was delighted to observe a collective perspective that the hospital was likely to realize more cost savings from greater physician efficiency - our behavior - than from reducing products and supplies.

We have plenty of good reasons beyond our own practice needs to support our institution's core missions - care, research and education. The medical school has just received concept approval of a project that will replace all of the lecture and classroom facilities and medical school offices as part of an effort to revamp the curriculum and improve how medical students are trained. The Edwards Building is going to be leveled as part of this plan and a new structure will be built on its footprint.

The university has received a gift from Silicon Valley entrepreneur John Clark to help spur the development of "Bio X." The gift will fund a building that symbolically will reside between the medical school campus and the undergraduate university. Here collaborations between engineering and the medical school will be fostered.

The cancer building will eventually be constructed once it clears all of the political hurdles. This will allow our specialists who treat cancer to come together in a modern facility to treat patients more effectively and efficiently.

All of us must be equally innovative and aggressive in our pursuit to become more efficient. We need to look at things from different perspectives if we are to be successful, and now more than ever, we must display a willingness to listen to and perhaps try new approaches. We also need to consider different organizational units or personnel alliances to aid us in this endeavor and to channel our creativity into re-engineering how we do business - learning from both the recent and the distant past. We cannot simply say that the merger was not successful, we must evaluate its components. We must discard what doesn't work, embrace things that do, and re-engineer a future that allows us to achieve those practical economic and logistic objectives that will help us meet our strategic educational, research and clinical goals.

larshuer@leland.stanford. edu.

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