Medicine Final Report Feb 2008

Table of Contents Executive Summary

1

The Changing Planning Environment

4

Accomplishments and Challenges

5

Integration: Making Integration Work: City-Wide Recruitment

7

Strategic Priorities Revised

10

Research

11

Education

12

Quality

13

Faculty

14

Funding & Infrastructure

15

Revised Short Term Goals

16

Looking Beyond Our Planning Horizon

18

Conclusion

19

Appendix 1: Strategic Planning Goals 2005–2010

20

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Executive Summary It has now been almost three years since the Department completed “Collaborating for Excellence”, the strategic plan for 2005–2010. At that time we articulated six overarching goals: achieving greater integration; enhancing research; enriching teaching programs; advancing quality and patient safety; attracting and supporting faculty members; and developing new sources of support for our academic activities. I am delighted with the outstanding progress of the Department. We have created a superb Website, implemented City-wide grand rounds, started Professors’ Day, implemented a Mentoring Program, and created new endowed Chairs. We have enhanced our support for the Eliot Phillipson Clinician Scientist/Clinician Educator Program allowing us to train future faculty members. The Department underwent a successful Royal College accreditation and we have implemented new rotations in the community for our residents. These are but a few examples. We should all feel proud of the remarkable progress made in this relatively short period of time. Now it is time to reflect on our strategic plan and modify or re-focus it where necessary. During the last three years both the internal and external environments have changed, new opportunities have appeared and new challenges have surfaced. In October 2007, the Department held a one-day planning retreat with 90 faculty members and external stakeholders. The goal of the retreat was to assess our progress to date in our strategic goals set out in 2005 and, in light of changes in the environment, to revisit and update those goals (Appendix 1). In addition, the retreat was designed to allow division heads to share successful strategies in their divisions so that these approaches could be disseminated across the Department. Dean Catharine Whiteside and Jeff Lozon, CEO at St. Michael’s Hospital, set the stage by describing some of the important changes in the environment and discussing their views of opportunities for the Department. One theme highlighted was the opportunity for enhanced collaboration across the Toronto Academic Health Science Network (TAHSN) supported by a cohesive voice on the local, provincial and national stage. For example, TASHN can advocate federally for enhanced support for CIHR or provincially for scientist career support. The emergence of the LHINs will also facilitate city-wide approaches to clinical care. Jeff Lozon concluded “our collective strength is in our individual best interest”– a theme consistent with our Department’s approach. The main foci of the retreat was city-wide recruitment. Many of the Department Division Directors (DDD) had identified challenges in recruitment; their goal is to make our Department successful in attracting the best faculty members to Toronto. We defined the principles that should guide recruitment: excellence of the candidates; alignment with strategic priorities of the division, hospitals, research institutes and DOM; clarity of job descriptions and the process for the candidate; fairness; and professionalism. We have identified specific actions to put this into practice. Overall, our collective view is that coordination of recruitment in a city-wide process will allow us to compete for the best faculty members and meet the strategic goals of our stakeholders. We all agreed that joint recruitment between the hospitals and common credentialing are important to our future. While we have focused on recruitment, the DOM recognizes the need to ensure retention of excellent existing faculty. This can be done through efforts to demonstrate that our faculty are valued and to provide support for rejuvenation and revitalization throughout their careers. Overall the retreat confirmed our commitment to the original goals articulated in our strategic plan “Collaborating for Excellence 2005-2010”. We are on the right track. Through the process of reflection, we have modified our goals or added new ones in each of our core themes.

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This report serves as a supplement to our original document which still describes accurately the Department of Medicine goals and strategic priorities. Effectively communicating our progress to faculty, students and staff, as well as our partners and alumni, is a very important piece of the strategic planning process and we will endeavour to improve our communication strategies to augment the Website, city-wide rounds and Department newsletter, Medinews. I am personally very proud of the progress we have made in the DOM over the last three years and I am excited about our plans for the future. We have benefited significantly from expert guidance from our external consultant, Helena Axler, throughout the planning cycle. Our keynote speakers are our partners; their contributions inform us, promote engagement and enhance communication and collaboration. I would also like to recognize the tremendous efforts of the Strategic Planning Management Team, particularly Charlie Chan, Kevin Imrie, Conrad Liles and Laurie Morrison, and members of their respective workgroups, who continue to work diligently advocating and promoting our planning goals while methodically overseeing their implementation through short-term and long-term planning phases. I am confident that the goals detailed in our strategic planning document, Collaborating for Excellence 2005-2010, together with the revised and new goals emerging from this process, will be accomplished under their stewardship. Wendy Levinson, Chair, Department of Medicine

Sir John and Lady Eaton Professor and Chair of Medicine Vision

Mission

International leadership in Through the discovery, health research, education and application and patient care. communication of knowledge we prepare future physician leaders, contribute to our communities and improve the health of individuals and populations locally and globally

• • • • •

Values

Innovation, critical inquiry and selfevaluation; Respect for diversity in culture and perspectives; Partnership and collaboration; A supportive and collegial environment; Accountability to our community of scholars and to the public.

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Immediate Priorities: Core Themes Integration • • •

Implement our brand identity Develop a coordinated city-wide recruitment strategy Develop generic recruitment template to engage stakeholders and partners in strategic recruitment

Research • • •

Implement an internal grant review service for junior faculty members Review and refine the job description and support for “clinician investigators” Promote and assist the development of a “Clinical Research Centre” to support clinical research across the University of Toronto

Education • • •

Create a web resource for educators Create a budget to support educational scholarship Foster opportunities for interactions between educational scholars in the DOM

Quality • •

Develop benchmarks of academic productivity Formalize administrative leadership for the quality program

Faculty Development • • •

Evaluate the mentoring program. Promote training for mentors Create an Office of Faculty Development

Funding and Infrastructure • •

Attract two additional Endowed Chairs Begin building relationships with DOM alumni

Dedicated administrative support will be assigned to this area to formalize and enhance the staff support required for a professional and effective recruitment process.

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The Changing Planning Environment Faculty of Medicine Perspective:

Catharine I. Whiteside, Dean of Medicine Dean Whiteside provided the context of a changing planning environment. However, first she congratulated the Department on its many successes in the past three years in research funding, recruitment, leadership on quality improvement and fundraising. She commended the Department on its commitment to following through on its goals and the professionalism and leadership which it has demonstrated in driving forward its plan.

“I don’t think there has ever been a time when the Department has moved forward in so many directions and been so effective...this in not just the largest Department in our Faculty, it is clearly the most successful.”

The Dean shared the Faculty’s new strategic plan and focused on three key areas: Education, Research and Advocacy. The Faculty has championed, and provided leadership to advance, inter-professional team care, simulation and distributed medical education. There are still many Dean Catharine Whiteside challenges in education, including the integration of primary and community care with specialty care, an increased emphasis on ambulatory care; international and global heath, public health and health promotion. Health human resources expansion offers both a challenge and exciting opportunity for the Faculty. “Aggregate, Innovate and Translate” are the mantra for research in the Faculty. The Faculty’s leadership in graduate education is its competitive advantage. There is a tremendous opportunity for the clinical Departments to take leadership of translational and applied human research. Genetic epidemiology is a major focus that is integrative across the Faculty and a targeted area for national leadership. Facilitating the convergence of human subject research and commercialization infrastructure across TAHSN are challenges and priorities for the Faculty. There are opportunities for leadership in public health scholarship and educational scholarship, and growing needs for academic clinical leaders in international health and health policy. Increasingly, the University is enhancing its role as broker and facilitator for the aggregation of investigators across disciplines, sites and sectors. Advocacy is a key aspect of the Faculty’s strategic plan. This includes advocacy for increased salary support for investigators; increased funding at the CIHR level to balance operating funds with infrastructure and salary support and realistic indirect costs and federal and provincial grants. The Faculty has aligned with the Council of Academic Hospitals of Ontario to promote increased funding from all levels of government. In closing, the Dean noted that the future includes the alignment of education and research with clinical programs and greater integration and collaboration – key themes that have underpinned the Department’s strategic plan, Collaborating for Excellence.

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Academic Health Science Centre Perspective:

Jeff Lozon, President & CEO, St Michael’s Hospital In providing his perspectives of changes in the external environment, Jeff Lozon provided an overview of the changing academic health science centre environment over the past 10 years, the impact of a Local Integrated Health Network (LHIN) oriented environment and shared some key provincial and national trends. Academic health centres have shifted from primarily independent, highly competitive actors to a more networked and collaborative group. The Toronto Academic Health Science Network (TAHSN) provides a mature vehicle for collaborative planning and a cohesive voice on the local, provincial and national stage. Hospitals have made extensive investments in the academic enterprise at all levels and, in addition to their own research institutes, several have educational centres and institutes within their walls. Through the LHIN, the provincial government is now intensely invested in a local integrated services plan. Toronto Central LHIN has a mandate beyond TAHSN. It is not yet clear how the LHINs will evolve at this juncture, but they are community-oriented, a perspective that is reflected in their Boards, their focus and their areas of priority. Academia has been identified as a priority of the Toronto Central LHIN but its commitment and understanding of the interrelationship between teaching, research and patient care is still to be seen. Mr. Lozon noted increasing competition from traditional and emerging sources across Canada and beyond. He added that research initiatives are beginning to gel but face real constraints. A big challenge for Toronto is to compete on a national level; TAHSN’s highly distributed organization makes this more challenging that in other academic centres across the country. However, he concluded, “our collective strength is in our individual best interest” and that we need to continue to pursue and support collaboration.

Accomplishments and Challenges Dr. Levinson introduced the future planning for the Department by reflecting on the achievements of the first three years of the strategic plan, as well as the challenges and opportunities facing the Department in the years ahead. She noted the 2005 plan was ambitious, challenged by an overarching goal to collaborate across a diffuse, multiple partner Department and academic health centre. Despite the challenges, much has been accomplished and she provided a brief update on the progress against goals in the six areas of strategic priority.

“If we can envision big

opportunities, go after and win them by working together, it will set the stage for enhanced collaboration”. Dr. Wendy Levinson

Integration: City-wide grand rounds have been introduced and there is

now a functional website allowing faculty and resident communication. Starting efforts have been made in collaborative recruitment. A key priority, and indeed a major theme of this retreat, is to develop new ways to be more effective and more competitive in attracting excellent people to Toronto. Integration and collaboration remains a key priority for the Department; it’s success in this area will position the DOM strategically for success in the five other priority areas discussed below.

Research: Our goal was to enhance the productivity and impact of our research. Annual research funding has

increased from $72 million to $105 million in just four years.

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Working together to attract matching funds, we have raised our endowment significantly to support the clinician scientist and clinician educator programs, which secure a strong pipeline to our future. Short term challenges include securing stable salary support for clinician-scientists, which requires joint advocacy and support from TAHSN and the University. A longer term challenge is to achieve collaborative research across our affiliated institutions.

Education: This has been an area of great accomplishments culminating in a successful accreditation earlier in the year. The Department has taught, championed and evaluated CanMEDS roles and provided leadership in the FOM in some of these efforts. DOM has developed a unified, common curriculum across all hospitals in education for our core trainees and the POWER system has helped us evaluate much more effectively across the entire educational endeavour. DOM has extended into the community to meet the needs for distributed education, building new relationships with our community affiliated partners. Notwithstanding the many successes, there are still educational challenges for the Department. A key challenge for the future is to enhance educational scholarship. Today, and in the months ahead, we must question: how can we really push forward and find leading edge ways to educate internists of the future? As a starting point, DOM has appointed a Director of Educational Scholarship and is in the process of recruiting a PhD Educational Researcher to focus greater attention on this important area. Quality: The Quality agenda was in its embryonic stages when it was identified as an opportunity and a strategic priority for DOM in 2005. We should all be proud of our accomplishments in this area. The Quality & Patient Safety Program, developed by the Department, with support from the CEOs of our affiliated institutions, has resulted in a very robust group of young and mid-career faculty working on quality improvement across the city, developing benchmarks and sharing experiences. The University plans to develop a Centre for Patient Safety Centre in collaboration with the TAHSN hospitals and there is opportunity for the Department to play a key leadership role in this new effort. While there has been significant progress in the Quality domain, there are still major challenges to address. There are big gaps in what we know and what we do in the hospitals and clinics. As leaders in the Department and in the hospitals, it is our responsibility to close that gap by looking at new and rigorous ways to study what we do and how we do it to move the fields of quality improvement and patient safety forward. To provide greater incentive for our faculty to pursue academic careers in this area, we must work on the promotion process to recognize and help advance the careers of people who invest their time in quality and patient safety.

Faculty: This strategic priority area includes recruitment as well as retaining, nurturing and supporting faculty.

Concerted efforts have been made to recognize and reward people, including the Professor’s Days, the Mentoring Program, Mentoring Awards and the Women Faculty Program, (designed to nurture the development of women faculty). Under this strategic priority the DOM has led the web-based CV initiative to facilitate building dossiers and preparing for the promotions process. Given that faculty is the Department’s most precious resource, we will continue to focus our efforts on enhancing faculty satisfaction and retention. Our challenge is to enhance our strategies for effective recruitment and this is the focus of our future work.

Funding and Infrastructure: Tremendous work has been done to reinforce our funding and infrastructure base. There is greater clarity about how the Department uses its financial resources. We have raised six endowed chairs and have enhanced the Clinician-Scientist Fund through a creative matching opportunity with the University. However, demands on our resources are great – as are our ambitions.

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We must build on our own resources while continuing to seek new revenues to enhance what we can offer, especially with respect to clinician-scientist support. A short term priority, and one that received attention at the retreat, was to agree on shared principles amongst the practice plans so that we can achieve equitable and secure support for all of our faculty. Dr. Levinson concluded her report by applauding the faculty for their contributions in driving forward the 2005 strategic plan. She acknowledged the tremendous progress in each of the strategic priorities, but also challenged the Department to tackle the outstanding issues and seize new opportunities which would maximize the impact and success of the Department and its faculty.

Integration: Making Integration Work – City-Wide Recruitment Bringing the best people to Toronto was one of the key themes of the planning retreat. In a survey which informed the planning retreat, Physicians-in-Chief and Department Divisions Directors specifically highlighted the need for a city-wide recruitment process that would bring together the four key stakeholders – University Department, Department Divisions, Hospitals and Research Institutes, to establish an integrated recruitment strategy in which all players would participate.

Keep the bar high, but if someone great comes along we need to grab them – but (the recruit) can’t just be smart; has to play well with others”

In the current situation, often recruitment is done independently by any Retreat Participant one of the four players, with little reference to the possible synergies with other Departments, divisions and TAHSN institutions. There is a growing belief that an integrated approach to recruitment would significantly increase the ability to attract the very best people to Toronto, and could be streamlined to accelerate the recruitment process. The recruitment session was informed by a panel presentation with Dr. Bob Hyland, Physician-in-Chief, St. Michael’s Hospital, (SMH), Drs. Chris Paige and Art Slutsky, VP Research UHN and SMH respectively, and Jeff Lozon, CEO, SMH. Drs. Hyland and Slutsky shared lessons learned from the recruitment strategies at SMH which allowed them to bring in 80 new recruits in 8 years. Key success factors included: Strong partnerships between the Hospital Department/Division, the Program, the Research Institute and Foundation as well as the University Department. In all cases, the recruit must be discussed and endorsed by the University Divisional Executive Committee before the Physician-in-Chief will get actively involved in the recruitment process. Drs. Charlie Chan and Conrad Liles provided stories of successful and unsuccessful recruitments to illustrate the challenges and complexity of recruiting in Toronto. Dr. Liles used multiple offer letters as a means of showcasing the lack of clarity around reporting relationships, the confusing university-hospital-research institute relationship; and loyalty/identity conflicts. Roundtable discussion followed the panel presentation with a dialogue around the principles which should guide recruitment and retention, these included:

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Principles for Recruitment Excellence •

Get the best people to Toronto

Alignment • • • •

Strategic plans; tied to broader vision Programmatic fit with division, institution, research foundation, DOM/U of T Resource planning- financial resources; space collaborations; incomes; reconciled with programmatic concerns and resources available Supportive environment that is ready and receptive to the new recruit

Clarity • • •

To the candidate – of the process Clear job descriptions and expectations aligned with the career goals of new recruits Efficiency of the recruitment – reduce complexity

Fairness • • • • • •

Transparency (e.g. in reporting hierarchy, partnership matrix and funding sources and levels) Best interest of the recruit Long-term commitment philosophy Financially appropriate on a national level Same considerations for Clinical Educators & Teachers as for Clinical Investigators & Researchers Consistent with business model for the division

Professionalism • • •

Adopt approaches of successful businesses Collaboration Communication: honest and courageous between stakeholders

Retention can be guided by many of the same principles, with a view to refreshing and revitalizing staff at various points in their career

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Mechanisms & Processes to Advance Recruitment Principles Simplify and Clarify the Recruitment Process • • • • • • • •

Unify and simplify the recruitment process Empower the DDD; discuss potential recruits at the Divisional Executive and put process in place for recruitment and/or career development of potential new recruits Establish agreement between expectations at the University, Hospital, program levels; avoid multiple reviews Bring together all of the stakeholders or partners in one room to go over the potential recruit background/CV to make decisions around the recruit Appoint a single leader/spokesperson for each recruit Strive for equity and security across practice plan; ensure that new recruits understand the details of the practice plan and hospital arrangements Simplify offers and appointments: consolidate details of offer and multiple appointments into one letter with standardized components Strengthen the identity of University of Toronto/DOM in the recruitment process

Provide a Supportive and Mentoring Environment • • • • •

Mentor residents and fellows for career choice that will fit the divisions/programs Develop entry/exit strategies that value the “professional” and the “personal” Demonstrate that recruits will be valued and supported Need to avoid unexpected, unpleasant surprises at 3-year review or promotion time Outline the process for junior faculty to promotion, e.g. start up, to grants to mid-career, outline what are the steps and deliverables; what are the sources of salary support, who can help?

Be Strategic – and, if you must be opportunistic, be “enlightened” in your opportunistic recruitment • • • • • • •

Be proactive and forward looking Identify the research needs of the future and recruit there Pay more attention to societal issues on recruitment (chronic care, ambulatory care, multicultural care, etc.) Use programmatic approaches as challenges to recruit; encourage cross appointments Support cross-division and cross-hospital appointments; consider logistics of cross appointments beyond dollars Establish an effective communication strategy to support recruitment Support with fundraising for endowment/chairs

Pay attention to retention • • • • •

Re-examine principles of clarity, alignment and fairness every three to five years Advance recognition and rewards Provide bridge funding for junior faculty, mid-career scientists as appropriate Establish chairs, endowments Provide support for rejuvenation and revitalization at various stages in faculty’s career

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Recommendations for a City-wide Recruitment Process •

All recruitment requests should first be presented to the Divisional Executive to achieve a cooperative, noncompetitive, approach and approval.

•

Once the recruitment proposal is endorsed, and potential key stakeholders have been identified and engaged, a “leader” will be nominated to facilitate frank and open communications between all stakeholders. In addition to functioning as the central point of contact for potential candidates, this individual will act as chief negotiator and broker between stakeholders and be the signatory for the letter of offer.

•

A generic recruitment template will be developed to ensure clarity, transparency, appropriate alignment of resources and expedient decision-making. The template will require stakeholders and interested partners to come together to achieve synergy between planning processes at the Divisions, Hospitals and Research Institutes and to enable an appropriate match of resources to the best interests of candidates.

•

A key piece of the template will be a letter of offer with standardized components that makes explicit who is in charge of the recruit’s academic progress, salary arrangements and research funds.

•

Dedicated administrative support will be assigned to this area to formalize and enhance the staff support required for a professional and effective recruitment process.

“To compete for top recruits, the process must be

comprehensive and inclusive; but you must also respect and adapt to the need for rigor and nimbleness.” “Recruitment is both buying and selling... reputation and collaborations are important in recruiting for academic excellence.” Colleen Keenan, Janet Wright & Associates

Strategic Priorities Revised – Core Themes Implementation theme leaders led breakout group sessions to update goals and to tackle specific issues and opportunities which could benefit from the collective wisdom of faculty. In the section which follows, theme leaders provide a brief update of progress against goals and new short term goals for their areas which were agreed upon by participants in the breakout group discussions. Collectively, the achievement of all of these goals will guide the strategic activity of the Department for the next two years. New goals are presented in

bold typeface.

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Research The research portfolio has undergone significant leadership change since the original strategic planning goals were developed. A new Vice Chair, Research has been appointed and a new Department Research Committee has been struck. In spite of a period of necessary reflection and adjustment, progress has been made against the original goals and in February 2007, the short term goals were extensively revised. Recruitment and retention are key issues for the research portfolio and recognition of this is reflected throughout the revised short term goals and immediate priorities. An optional Internal Grant Review Service is needed to support young investigators (those at the Assistant Professor level within the first five years of appointment). This functional service will be designed to improve grants for those individuals who want to have their work reviewed while avoiding the pitfall of placing too onerous a task on senior faculty. The service will be administered via DDD offices. To allow sufficient review time grants will be submitted six weeks in advance. Grants that would be eligible are those over $50,000 per year. Two reviewers per grant are recommended and reviewers should be selected by the PI and DDD in consultation with each other. It may be possible to link this review to consideration of bridge or seed funding in the future. Career support for junior and senior investigators is having an adverse impact on the retention of Clinician-Scientists. Many of the career support awards from the CIHR have evaporated and no career awards are routinely available from CIHR beyond the level of young investigator. Alternative strategies, including advancement activity to secure Endowed Research Chairs, will be aggressively pursued. A high priority is the re-definition of the job description of the ClinicianInvestigator. Being neither a Clinician-Educator nor a Clinician-Scientist, these individuals are not eligible for many career support awards. There is an urgent need to define, consider career support mechanisms and set concrete goals, expectations and milestones for these individuals so they know exactly what is necessary for their career development and success. A longer term priority is the development of a UT Clinical Research Centre to support clinical trials as well as infrastructure support for large scale population studies. The Centre would facilitate clinical trial development, clinical trial support in terms of data collection, management and storage as well as the creation of repository systems for clinical specimens. The Centre will be both physical and virtual with beds that can be staffed to accommodate overnight stay for patients enrolled in trials. A UT Clinical Research Centre provides a unique advancement opportunity for the Department and this will be aggressively pursued. To actively foster mechanisms for city-wide collaboration, we will seek support of extra-Department units as a key way to achieve this goal. Seminars and workshops can bring like-minded investigators together; from diverse disciplines, divisions and institutions. Empowering DDDs to serve as facilitators or sources of information to foster collaboration is also a strategy we will pursue.

–Conrad Liles, Vice Chair, Research

Short term goals to enhance attractiveness, productivity and impact of research • • • • • • •

Develop guidelines for appointment and support of PhDs Re-structure the Clinical Sciences Division at MSB Facilitate development of new teams of collaborators for submission of innovative Team Grants Develop stable funding for Clinician-Scientists Develop optional Internal Grant Review Service for Junior Faculty Review and re-define the position of Clinician-Investigator Advocate, facilitate and develop UT Clinical Research Centre

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Education We have accomplished a great deal in education over the past two years. Through our strategic planning process, we identified advancing educational scholarship as a major priority for the next two years and this was the focus of discussion for the education break-out group at the retreat. We have already begun laying the foundation for this work. This past year we introduced a position of Director of Educational Scholarship and currently are in the process of recruiting a PhD Educational Researcher. While involvement in teaching and program administration is essential for the delivery of education, the work is not of itself inherently scholarly. The challenge is to turn such work into scholarly activity. We have identified three areas of scholarship: Scholarship in Teaching, Scholarship in Administration, and Educational Research. Scholarship in Teaching involves turning what we do day-to-day into work that will impact others. A key measure of impact of such activities is dissemination, which could include presentations at meetings and posting material on teaching repositories such as the MedEd portal, a central repository created by the AAMC. This site allows people to submit and access material centrally thereby facilitating meaningful dissemination. In addition, through the act of downloading materials, they are required to provide feedback and thereby achieve peerreview. The DOM will advocate for increased use of this tool, or similar tools, and generally promote engagement amongst its members. Scholarship in Administration presents a different challenge. Our programs are constantly innovating, introducing new curriculum or restructuring to better teach or evaluate; however, these initiatives are often not planned and conducted in a “scholarly” way. There are several reasons for this including the DOM size and sheer volume of work administering programs, unfamiliarity with how to search the medical education literature to identify work that has been done before and the overall lack of comfort with educational research methods. A small but growing number of individuals in the Department are engaged in a systematic program of enquiry in education. This path requires advanced training and significant commitments of time as well as engagement and support from agencies such as the Wilson Centre. Such individuals are critical to advancing scholarship within our Department and need to be supported. They are an important resource for other educators and need to be engaged in our evolving community of educators. Short term goals to enhance educational scholarship include developing a central list of information on funding opportunities for educational research and increasing the visibility of faculty development opportunities to further enhance skills, including the Teaching Scholars Program and the Clinician-Educator Program. To further promote this platform, consideration will be given to amending educational administrator job descriptions to include a requirement to make the program scholarly; implying dissemination and peer-review. This would increase the prominence of the individual who is the program administrator, advertise the program and enhance the image of the Department that supports the program. A final and essential requirement to advancing scholarship is financial support. This needs to be enhanced in two ways. Firstly, support for the Educational Development Fund (EDF) needs to be continued and enhanced. The EDF, run by the Education Deans at the Faculty of Medicine, provides modest funding to support scholarly projects. These funds need to be matched by the Department. The process of approving applications at the Departmental level needs to be enhanced to further improve the quality of applications.

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A second important type of funding is stipend support for individuals engaging in the full spectrum of scholarly work to protect time for them to conduct these activities. A budget will be provided to the Director of Educational Scholarship for both types of support. Our new short term goals are specifically related to advancing Educational Scholarship in the Department.

–Kevin Imrie, Vice Chair, Education

Short term goals to transform and enrich teaching programs • • • • • • •

Double resident-months in community Double educational scholarship (presentations and publications) Partner to develop faculty development to build education capacity in community Double stipends for educational roles Develop a community of educational scholars in the Department Create a web resource for educators Create budget to support educational scholarly work

Quality & Patient Safety The Quality and Patient Safety Program, that has been initiated with seed funding from the Department Chair and the CEOs of our affiliated partners, has been a great success and has been instrumental in seeding the quality agenda in our Department. A funding program was established to support University-wide efforts to improve quality of care. Teams meet on a monthly basis for educational sessions. To take the quality agenda to the next academic level, it is important to identify champions within each division, create and promote leadership training programs and nurture academic careers and scholarship in this area. Having successfully demonstrated that city-wide collaboration is possible in this area, the time is ripe to facilitate the broader achievement of this strategic priority across the Department and with its TAHSN partners. Energy, wisdom, and advocacy will need to be invested to develop an academically viable career path to attract and engage faculty in quality and patient safety. The creation of job descriptions, leadership positions and promotion pathways will all be pursued as will a quality improvement and patient safety toolkit to disseminate best practices and guide people to appropriate resources. Quality project presentations by residents, as well as awards at research day events will continue in order to promote the quality agenda and to support evolving career paths in this area. There are new opportunities for the Department in this area. The Faculty of Medicine is planning to establish a Centre for Patient Safety in a model similar to the Centre for Faculty Development at St. Michael’s Hospital. The Department is posed to take a leadership role in this new Centre. In addition, the LHINs will provide a platform for collaborative efforts in Quality and Safety and the Ministry of Health is presently sponsoring educational efforts in this area. Our faculty play a leadership role in the MOH efforts.

–Drs. Chaim Bell and Ed Etchells

Short term goals to advance quality care and develop performance measures in this area • • • • •

Continue and grow the Quality & Patient Safety Program Formalize administrative leadership for the DOM quality program Advocate, facilitate and develop an academically viable career path in quality Develop benchmarks of academic productivity Develop educational program for residents

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Faculty Mentorship is the key priority in faculty development. For the past two years we have focused on recognizing and valuing mentorship through a new awards program. Our priority for the next three years is to formalize the structure of mentorship and ultimately recognize scholarship in mentorship in and of itself. Good mentorship must be valued in the same way as good teaching; it must become a requirement to achieve promotion under any of the three platforms. As a start, a new web-based mentorship program, supported by the WebCV and generic across all institutions, has been developed to capture the hours and quality of mentorship and co-mentorship provided at every level. The program stimulates interactive dialogue between faculty members and their Hospital DDD, University DDD, mentor and co-mentors through the use of annual activity reports and academic planning documents. We decided an evaluation form was needed to make the process a bit more rigorous and evaluate the quality of mentoring. While we acknowledge that evaluation may have mixed reviews by faculty, and will require further consideration, if mentorship is to be valued and included in the criteria for promotion under all three platforms, then there must be a way to evaluate it. A faculty development program, comprising a formal training program and workshop series, is needed to help DOM faculty understand the mentoring process through a variety of delivery methods and at different stages of a faculty member’s career. It will provide training for mentors and also teach them how to separate from mentees when the relationship is not working well. We need a shepherding capacity to inform faculty of available faculty development resources. The website provides an introduction to Department resources but the information provided is not sufficient to achieve a comprehensive understanding. A formalized Office of Faculty Development, with dedicated leadership and administrative support, is required to promote and advocate for mentorship at local and national levels and to increase visibility of the full range of faculty development opportunities. The Office of Faculty Development could also provide a gateway to much needed financial and retirement planning services through liaison with Human Resources Departments at the hospitals and the University and formal linkage with the Centre for Faculty Development to heighten both the profile and opportunities for faculty development in a number of areas which are of interest to our faculty.

–Dr. Laurie Morrison

Short term goals to retain, attract and nurture faculty • • • • • • • •

Develop tracking & evaluation systems for mentoring Develop faculty awards in mentorship Develop recognition strategy for emerging leaders Improve communication for appointment and 3 year review Formalize and evaluate the mentorship program Enhance scholarship in mentoring Promote training opportunities for mentors Create an office of faculty development with dedicated leadership and administrative support

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Funding & Infrastructure During the last three years the DOM finance committee has made major changes to the DOM budget. This has included clarifying the stipends associated with positions and increasing the stipends for educational leadership positions. We have made the use of funds transparent to the Executive Committee which includes representation from each of the hospitals. The budget now has a five year projection and a contingency fund. In terms of fundraising, the DOM has been successful raising endowed chairs and supporting the ClinicianScientist/Clinician Educator fund. Many of these efforts have taken advantage of local opportunities. Now we need to advance our efforts by articulating major goals and developing partnerships beyond our local ones. To accomplish this, we will begin to build relationships with DOM alumni and develop strategic, department-wide, fundraising goals. The potential overlap between Department, Faculty, University and our home-base hospital foundations, will be addressed by developing overall guiding principles and policies to guide us on where to channel resources and how to target donors to avoid competition and, hopefully, to find more opportunities to collaborate with our partners in joint fundraising initiatives. The practice plans of our fully affiliated hospitals fulfill the newly implemented Clinical Faculty Agreement for conforming practice plan principles. One of our other major goals relates to harmonization of the practice plans in an effort to support faculty members in an equitable fashion across the city. Open dialogue between the practice plans on the Finance Committee facilitates this. We have the opportunity to share best practices across the practice plans. An analysis is needed to determine how the different practice plans have performed based on academic support provided over the last 10 years. We will also need to develop shared principles to guide the different practice plans across the Department.

–Charlie Chan, Vice Chair, Finance

Short term goals to reinforce the funding and infrastructure base • • • • • •

Adopt the new budget model of the Faculty of Medicine Allocate financial support to each division based on strategic plan Implement standardized salary support for educator roles Attract two additional Endowed Chairs Begin building relationships with DOM alumni Develop strategic, department-wide, fundraising goals

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Revised Short Term Goals Listed below are the revised short term goals and implementation priorities for 2008. The DOM Implementation Committee will continue with its oversight responsibility. Designated leads for each area, with strong support from their committees or faculty throughout the Department, will continue to be responsible for achieving the goals identified for their respective areas. Attention will also be paid to greater clarity around the expected outcomes for each goal and establishing effective indicators so that we can measure progress against these goals. Strategic Priorities 2005-2010 1. Achieve greater integration across the Department and beyond traditional disciplinary boundaries

2. Enhance attractiveness, productivity and impact of research

3. Transform and enrich teaching programs

Revised Short Term Goals

Implementation Priorities 2008

1-1 Implement our “brand identity” 1-2 Implement the Web CV program in all hospital sites 1-3 Develop annual report to showcase Division & Department success 1-4 Develop a coordinated city-wide recruitment strategy 1-5 Develop a generic recruitment template to engage stakeholders and partners in strategic recruitment 1-6 Develop a letter of offer with standardized components 1-7 Create dedicated administrative support and develop expertise 2-1 Develop guidelines for appointment and support of PhDs 2-2 Re-structure the Clinical Sciences Division at MSB 2-3 Facilitate development of new teams of collaborators for submission of innovative Team Grants 2-4 Develop internal bridge-funding solutions and advocate for intervention at the Faculty of Medicine 2-5 Develop optional Internal Grant Review service for Junior Faculty 2-6 Review and re-define the position of Clinician-Investigator 2-7 Advocate, facilitate and develop UT Clinical Research Centre 3-1 Double resident-months in community 3-2 Double educational scholarship 3-3 Partner to develop faculty development to build education capacity in community 3-4 Double stipends for educational roles 3-5 Develop community of educational scholars 3-6 Create a web resource for educators 3-7 Create budget to support educational scholarly work

1-1 Implement our “brand identity” 1-4 Develop a coordinated city-wide recruitment strategy 1-5 Develop generic recruitment template to engage stakeholders and partners in strategic recruitment

2-5 Develop optional Internal Grant Review service for Junior Faculty 2-6 Review and re-define the position of Clinician-Investigator 2-7 Advocate, facilitate and develop UT Clinical Research Centre

3-6 Create a web resource for education 3-7 Create budget to support educational scholarly work

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Strategic Priorities 2005-2010 4. Advance quality care and develop performance measures in this area

5. Retain, attract and nurture faculty

6. Reinforce the funding and infrastructure base

Revised Short Term Goals 4-1 Continue and grow the Quality & Patient Safety Program 4-2 Formalize administrative leadership for the DOM quality program 4-3 Develop benchmarks of academic productivity 4-4 Advocate, facilitate and develop an academically viable career path in quality 4-5 Develop educational program for residents 5-1 Develop tracking & evaluation systems for mentoring 5-2 Develop faculty awards in mentorship 5-3 Develop recognition strategy for emerging leaders 5-4 Improve communication for appointment and 3 year review 5-5 Formalize and evaluate the mentorship program 5-6 Enhance scholarship in mentoring 5-7 Promote training opportunities for mentors 5-8 Create an office of faculty development with dedicated leadership and administrative support 6-1 Adopt the new budget model of the Faculty of Medicine 6-2 Allocate financial support to each division based on strategic plan 6-3 Implement standardized salary support for educator roles 6-4 Attract two additional Endowed Chairs 6-5 Begin building relationships with DOM alumni 6-6 Develop strategic, department-wide, fundraising goals

Implementation Priorities 2008 4-2 Formalize administrative leadership for the DOM quality program 4-3 Develop benchmarks of academic productivity

5-5 Formalize and evaluate the mentorship program 5-7 Promote training opportunities for mentors 5-8 Create an office of faculty development with dedicated leadership and administrative support

6-4 Attract two additional Endowed Chairs 6-5 Begin building relationships with DOM alumni

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Looking Beyond Our Planning Horizon The Department is well on its planning path and the strategic framework developed in Collaborating for Excellence has served, and should continue to serve, it well for the next two to three years. However, at the retreat we challenged a small group of faculty to look “outside the box” and see if there were some significant, future-oriented issues that we should be identifying today which may have an impact in five to ten years down the road. The faculty answered our question – with more questions!

“How do we take our strength, stature and reputation to make a greater impact on issues of social importance?”

How should we provide care in the future? Do we continue to operate as single

Retreat Participant providers to single individuals or should we shift towards a more systematic approach? Some specialties have started to work in different models of care integrating allied health professionals, looking at screening access to care and looking at screening in the community to identify early diseases. Ontario has a chronic disease management strategy for diabetics. Can we learn from that? Should we be looking at a Department-wide strategy for care of the elderly? How will we address the strong tide of the “silver tsunami”?

What is our competitive intelligence? Should we develop a niche, a competitive advantage, to make us more attractive to students and faculty? Should we seek outside advice and look at ourselves from a different lens?

How can we exploit cross-disciplinary opportunities? We train in silos, but science is evolving across disciplines. What should we be doing to take advantage of these opportunities?

How can we balance deferred retirement with new recruitment? A university-wide issue that is not being

systematically addressed is that of academics continuing to work over 65 years. We have very talented people over 65 years who continue to enrich our human resource pool, but that in turn limits the financial resource pool needed to recruit young faculty and promote succession planning. How can we achieve balance?

How can we be more engaged internationally? Toronto is named by UNESCO as an international multi-racial

society and it is important to reflect this in the face of our faculty. The opportunity exists; we have large numbers of foreign medical graduates and faculty recruited from all over the world but we need to overcome barriers to integration and take advantage of our international partners, locally and abroad. Increasingly, universities around the world are forging significant links with other universities and academic Departments overseas and this is something we too should explore. Should DOM we be establishing targeted international partnerships?

How do we take our strength, stature and reputation to make a greater impact on issues of social importance?

Should DOM be tackling some of the tougher questions around public vs. private health care, health care inequities, relationships with Pharma? Should we be holding forums, stimulating debate and coming up with positions on issues that require open debate and discussion? These and other important issues will need to be discussed as the Department looks ahead beyond the current planning time horizon and prepares itself for new issues and opportunities in years to come.

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Conclusion Collaborating for Excellence has provided the Department with an effective framework to achieve its vision and

mission. We are on a purposeful path, having achieved many of our short term goals and making good progress in each of our six areas of strategic priority. This mid-course planning retreat has enabled us to pause and reflect on our achievements and to fine tune our broader goals, with new short term goals that will provide sharper focus for the next two to three years.

Collaborating for Solutions has demonstrated the strong commitment of our faculty, TAHSN hospital partners and other key stakeholders to work collectively and collaboratively to achieve our vision of “international leadership in health research, education and patient care”.

Strategic Planning Management Team Charlie Chan, Funding & Infrastructure Shannon Coull, Advancement Allison Hardisty, Strategic Planning Kevin Imrie, Education Conrad Liles, Research Laurie Morrison, Faculty Maureen Todd, Business & Administration

Keynote Speakers Catharine I. Whiteside Dean, Faculty of Medicine

The Changing Planning EnvironmentUniversity of Toronto/Faculty of Medicine Perspective Jeff Lozon President & CEO, St Michael’s Hospital

The Changing Planning Environment - Academic Health Science Perspective & Making Integration Work – City-Wide Recruitment Bob Hyland Physician in Chief, St Michael’s Hospital

Making Integration Work – City-Wide Recruitment Chris Paige Vice President, Research, University Health Network

Making Integration Work – City-Wide Recruitment Art Slutsky Vice President, St Michael’s Research Institute

Making Integration Work – City-Wide Recruitment

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Appendix I Strategic Priorities 2005–2010

Five Year Goals

1. Achieve greater integration across the Department and beyond traditional disciplinary boundaries

1-1 Facilitate greater collaboration across divisions, Departments and among affiliated hospitals. 1-2 Promote and support integration of information technology and health information management systems across affiliated hospitals 1-3 Achieve equitable and secure payments for all faculty members across all divisions and hospitals. 1-4 Promote and enhance the profile of a unified Department 2-1 Enhance partnerships and interdisciplinary opportunities with hospital-based Research Institutes and other University of Toronto Departments 2-2 Increase research funding and infrastructure support for scientists and a high impact research agenda 2-3 Promote, support and expand the Clinician Scientist program 2-4 Support translational research as a research priority of the Department 3-1 Strengthen partnerships with and among fully affiliated teaching hospitals to collaborate for excellence 3-2 Formalize relationships with network of community hospitals to enhance teaching experience and placements 3-3 Increase exposure to ambulatory medicine 3-4 Operationalize CanMEDS attributes for all levels of training 3-5 Leverage new teaching modalities and technologies 3-6 Promote faculty development and educational scholarship 3-7 Enhance benchmarking and performance measurement in education. 4-1 Champion the "quality agenda" within the Department and promote leadership in this endeavour 4-2 Explore opportunities to collaborate with affiliated hospitals on quality 4-3 Develop internal expertise for performance measures (including benchmarking and health informatics) 4-4 Ensure the "quality agenda" is central to clinical training 4-5 Innovate, test and assess new models of clinical care and new technologies 5-1 Recognize and reward the contributions of all faculty 5-2 Strengthen mentorship and career path development for all faculty at various stages of their career 5-3 Intensify efforts for strategic recruitment of top calibre faculty 6-1 Develop and implement a diverse set of strategies to stabilize and grow the Department's resource base 6-2 Identify and pursue local and global partnerships that will facilitate achievement of the Department strategic agenda 6-3 Establish a dialogue and develop guidelines for managing ethical issues with industry and government partnerships

2 . Enhance attractiveness, productivity and impact of research

3. Transform and enrich teaching programs

4. Advance quality care and develop performance measures in this area

5. Retain, attract and nurture faculty

6. Reinforce the funding and infrastructure base

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