The Decision to Redesign: The beginnings of our P4 adventure Dan Burke, Frank deGruy, David Graham, Deborah Seymour and John Nagle University of Colorado Family Medicine Residency STFM Annual Meeting 2008 Baltimore

Overview Share some of our hopes and objectives Find out yours Tell our story of deciding to re-vamp our curriculum Review an organizational change tool Small group discussion of your individual situations and issues Share some of these issues

Themes and Questions Incremental vs. Transformative change Miter saw vs. Sledge Hammer (or even a back-hoe) Change Dysphoria, Change Euphoria Change is messy Which projects should we do? The FFM list is long Do we have capacity for this? Who’s not looking for faculty Will we crash our program or enhance it? Strengthen a weak program or divert energy in a strong program Is it worth the effort? Is it worth the risk?

We Hope That We stimulate others to articulate the pros and cons of transformative change in their programs Our experience makes it easier for you Sharing our story is therapeutic for us

Objectives Identify leadership and management themes common to residencies contemplating or involved in transformative change Evaluate your program’s ability to the implement the “Eight-Stage Process of Creating Major Change” as described by Kotter, 1996

What do you want?

What do you want?

The Setting – Pre 8/06 A Fairly Troubled Residency Accreditation issues 2 tracks Faculty (and PD) turnover Resident turnover Match/Scramble Hospitalist service In a Fairly Favorable Environment Innovative clinics Supportive Dean Departmental Expertise New Clinic Site New Hospital and University Campus

Residency Pre-8/06 Started 1994 with split form Rose Residency Multiple Tracks:Clinica Campesina track came and went, DH track came and stayed 2001: Site visit – provisional Accreditation with many citations 03-04: Budget cuts and layoffs, new hospitalist service, PD Change, EMR started, OB Fellowship crashes 04-05: Rebuilding, AAMC-CCC, Site Visit, Accreditation, Faculty searches 05-8/06: Planning for new clinic, faculty turnover, faculty searches, P4 Possibilities

8/06: To P4 or Not to P4 The Eager: -Chair The Tired and Fearful: -Vice Chair -Medical Director -Behavioral Science Director The Tired and Fearful: -Program Director -Associate PD #1 -Associate PD #2

Panel Discussion

Kotter’s 8 Step Plan From John P Kotter’s 8 Step Plan From John P. Kotter, Leading Change 1996 Harvard Business School Press 1. Establish a Sense of Urgency 2. Creating the Guiding Coalition 3. Developing a Vision and a Strategy 4. Communicating the Change Vision

Kotter’s 8 Step Plan 5. Empowering Broad Based Action 6. Generating Short Term Wins 7. Consolidating Gains and Making more Changes 8. Anchoring New Approaches in the Culture

Discussion

Discussion

Discussion

Thank You