1. Conflict, Collaboration, and Resolution
Jeannette E. South-Paul, MD
Presidential Address, STFM
May 1, 2005, New Orleans
University of Pittsburgh
Andrew W. Mathieson
Endowed Professor and Chair
Family Medicine

2. Life is a Journey 1941 Citizen Kane premieres
1963 An American tops Mt. Everest
1972 North Vietnamese troops capture Quang Tri

3. Life is a Journey This year in history
60th anniversary of the liberation of Auschwitz
60th anniversary of the suicide of Adolf Hitler
30 th anniversary of the fall of Saigon

4. Life is a Journey
Rwanda and Benin – conflict between ethnic groups…neighbors
Somalia – guerrilla groups vs the Somali Bantu minority
Sudan – anatomy of a crisis
Two visions of the future – the minority Islamic government vs the traditional non-Arab southern Sudanese

5. Life is a Journey
……For which we are rarely given the roadmap in advance…

6. Conflict, Collaboration, and Resolution
Liberals vs Conservatives
Values discussion
Life issues
Stem cell use and research
Politics

7. Conflict, Collaboration, and Resolution
X vs Y
Harvard President Summers’ Controversy

8. Conflict, Collaboration, and Resolution
Federal vs States’ Rights
PA deciding between funding Public Transit vs Medicaid and Behavioral Health vs Secondary Education
Who pays for health care – locally vs national health insurance

10. Conflict, Collaboration, and Resolution
Town vs Gown
Who is the patient’s best advocate?
Quality of care?
Most important voice in legislative issues?

11. Conflict, Collaboration, and Resolution
Recognizing the impact of diversity

15. Kaiser Family Foundation
People of color more likely than whites to live in neighborhoods that lack adequate health care resources
28% of Latinos and 22% of African Americans report having little or no choice in where they seek care as compared to 15% of whites experiencing this difficulty
Kaiser Family Foundation, March 2005 Policy Brief

16. Conflict, Collaboration, and Resolution
USMGs vs IMGs
US born and bred vs outsourcing

17. Conflict, Collaboration, and Resolution
Osteopaths vs allopaths
Clinical practice variations
Traditional western clinicians vs Integrative medical practitioners

18. Conflict, Collaboration, and Resolution
Rural vs Urban
Educating our trainees regarding these differences
Appropriately resourcing quality services

19. Conflict, Collaboration, and Resolution
Clinicians vs Researchers
Building the knowledge base
Requirements for success
Complementing each other

20. Importance of involving the community to find solutions to health and social issues
Community Oriented
Primary Care Model
(COPC)

21. Core of NIH Roadmap Vision
At core of this vision is the need to develop new research partnerships with organized patient communities, community-based health care providers, and academic researchers.

22. Conflict, Collaboration, and Resolution
Generational Differences -
Silent Generation (1925 – 1944
Boomers (1945 – 1962
Generation X (1963 – 1981)
Millennials ( )

23. Conflict, Collaboration, and Resolution
Silent Generation (1925 – 1944
Boomers (1945 – 1962
Work hard out of loyalty
Expect long term job
Pay dues
Self-sacrifice is a virtue
Respect authority
Generation X (1963 – 1981)
Millennials ( )

24. Conflict, Collaboration, and Resolution
Boomers (1945 – 1962
Generation X (1963 – 1981)
Work hard if balance is allowed
Expect many job searches
Paying dues is not relevant
Self-sacrifice may have to be endured, occasionally
Question authority
Millennials ( )

25. Conflict, Collaboration, and Resolution
Handling Generational Issues
Improving mentoring
Redefine the ideal worker
Enhance faculty career and leadership development
Bickel J, Brown AJ. Generation X:Implications for faculty recruitment and development in AHCs. Acad Med 1005;80:

26. Economic Aspects of Our Community
Extended families living under one roof
High unemployment
High health care costs

27. National Healthcare Disparities Report - 2004
NHDR uses the IOM dimensions of quality to examine racial/ethnic differences in patterns of care – whether services are safe, effective, patient – centered, timely and equitable

28. National Healthcare Disparities Report - 2004
Hospitalized Hispanic and non-Hispanic black Medicare beneficiaries obtained lower quality care for pneumonia than white beneficiaries – eg time of receipt of initial antibiotic dose once admitted

29. How to Get There from Here?

30. Working Together
So how do we manage conflict in the academic environment to collaborate effectively and achieve our mission and vision?

31. Leadership Need for strong, innovative leaders
Experience outside of academic medicine and awareness of context of modern medicine in light of current scientific, economic and political demands
Moses H, Their SO, Matheson DHM. JAMA 2005;293(12):

32. Changes Needed in AHCs Moses et al …
Strengthen ties between academicians and private practitioners
Simplify AHCs organizational labyrinth
JESP additions ….
Analyze and emphasize the position of primary care in AHCs – educational, clinical, research
Cultivate and prioritize community relationships

33. IOM – Unequal Treatment
Raise public/.provider awareness of racial/ethnic disparities in health care;
Expanding health insurance coverage;
Improving the number and capacity of providers in underserved communities;
Improving the quality of care; and
Improving the knowledge base on causes and interventions to reduce disparities

34. The Institutional Climate
Education with Harmony

35. The Tribal Wisdom of the Dakota Indians, passed on from one generation to the next, says that when you discover that you are riding a dead horse, the best strategy is to dismount.

36. :
But in modern business including educational institutions, and government, because heavy investment factors are taken into consideration, other strategies are often tried with dead horses, such as the following

37. 1. Buying a stronger whip. 2. Changing riders. 3
1. Buying a stronger whip. 2. Changing riders. 3. Threatening the horse with termination

38. 4. Appointing a committee to study the horse. 5
4. Appointing a committee to study the horse. 5. Arranging to visit other sites to see how they ride dead horses. 6. Lowering the standards so that dead horses can be included.

39. 7. Reclassifying the dead horse as "living-impaired. " 8
7. Reclassifying the dead horse as "living-impaired." 8. Hiring outside contractors to ride the dead horse. 9. Harnessing several dead horses together to increase speed.

40. 10. Providing additional funding and/or training to increase the dead horse's performance Doing a productivity study to see if lighter riders would improve the dead horse's performance.

41. 12. Declaring that the dead horse carries lower overhead and therefore contributes more to the bottom line then some other horses Rewriting the expected performance requirements for all horses.

42. And, as a final strategy: 14
And, as a final strategy: 14. Promoting the dead horse to a supervisory position.
Quoted from:

43. “Effective participation by members of all racial and ethnic groups in the civic life of our Nation is essential if the dream of one Nation, indivisible, is to be realized.”
—Justice O’Connor in Grutter v. Bollinger