Collaborative Budgeting
Who would have guessed that a surgeon would blog on budgeting?
My interest began when a fellow surgeon, the current Chief Operating Officer of a Midwest hospital, wrote that budgeting can make collaboration more of a nicety than a necessity (Lambert M. 2004. “Improvement and Innovation in Hospital Operations: A Key to Organizational Health.” Frontiers of Health Serrvice Management. 20(4):39-45.).
I wondered if an alternative existed to the annual sharpening of the elbows. In Collaborative Gnosticism, I summarized teachings of my mentor, Lee Kaiser, who wrote that there are no political or economic solutions to the healthcare crisis, only spiritual solutions that arise from an abundance mentality. According to Lee, we have all the resources we need if we are willing to share them. In Collaborative Revolution, I paraphrased Peter Senge’s writing that innovators have learned to see the larger systems in which they live and work.
Howard Tepper, Associate Dean for Finance at Touro University College of Medicine, caught my attention with a systems innovation called mission-based budgeting. Touro is a new medical school, founded in 2007 by Dean Paul Wallach, an internist with a special interest in high blood pressure and lipid disorders.
The mission of Touro University College of Medicine is to:
- promote academic excellence
- expand knowledge through scholarship
- educate physicians and other healthcare professionals for the 21st century
- create an embracing and inclusive community
- build an environment dedicated to ethical behavior
- advance healthcare through science, compassion and caring in education, research, and practice
I will discuss two aspects in greater detail below:
- Mission-Based Department Structure
At Touro, the internal budget is aligned with the overall mission. The non-clinical faculty who were hired to teach (currently 23) are located in the Academy of Medical Educators rather than in individual departments. The budget is calculated by analyzing the curriculum course-by-course and week-by-week. This analysis is used to determine the faculty by specialty that are needed to teach the medical school curriculum. A Faculty Effort-Based Classification ensures that faculty who are hired to teach do not need to carve out time from research or clinical activities, as may happen at other medical schools. - 3-2-1 Tenure Replacement
To avoid the problems created by the current tenure system, but still make a commitment to its faculty, the chair of the academy and the Dean come to consensus on goals with each newly hired faculty member. These goals become the basis for a contract that both parties sign prior to hiring. At the end of the first year, a review evaluates progress toward achieving the contracted goals. Based on the results of the annual review, the chair of the academy and the Dean may award individual faculty members an additional contract year, so that top performers have a 3-year employment commitment from Touro. A new contract outlines the contract duration, revised goals, and new ways of achieving them.
At the end of the second year, a similar review takes place, in which the contract may be renewed for an additional year for those with 2 years left on their contracts, or an additional 2 years for those who did not get an additional year extension previously, but have made exceptional progress over the past year. Faculty who have not received contract extensions for the past 2 years have 1 year to locate a new position, which allows both parties to pursue options in a transparent fashion.
Touro is applying for accreditation for 2010. We look forward to learning how the current structure creates a cohesive and collaborative faculty by providing clarity of mission and direction and nurturing growth and development.
What do you think?
- What questions about mission-based budgeting come to your mind
- Does mission-based budgeting require a new organization, or can it be utilized in existing healthcare organizations
- What are the implications regarding mission-based budgeting where you work
As always, I welcome your input to improve healthcare collaboration.
Kenneth H. Cohn
© 2009, all rights reserved
Posted in Learning
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