1. 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

2. 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

3. 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?

4. 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

5. 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

6. What do you want?

7. What do you want?

8. 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

9. 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

10. 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

11. Panel Discussion

12. 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

13. 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

14. Discussion

15. Discussion

16. Discussion

17. Thank You