Strategic Plan Unveiled
Planning Committees Call for Greater Collaboration and Creation of New Centers of Excellence http://cpmcnet.columbia.edu/dept/fischbach/

AFTER MONTHS OF MEETINGS AND DELIBERATIONS, DRAFTING AND REFINING, THE strategic plan that represents the combined work of four large committees was unveiled on the Columbia Health Sciences web site. Review of the plan and feedback have begun and will continue throughout the refinement and implementation of the plan.

Dr. Gerald Fischbach, executive vice president and dean, initiated a strategic planning process in June 2001—shortly after becoming leader of the Health Sciences—to identify needs and opportunities for the division and to recommend plans of action. The four committees—education, research, patient care, and space and facilities—received recommendations and insight from hundreds of faculty, staff, students, and expert advisers.

“We certainly possess the intellect and the determination to address these needs and others yet undiscovered,” says Dr. Fischbach. “All of the recommendations require money, of course. But I believe that the Columbia family is equal to the task. We will succeed in proportion to the degree to which we engage the enthusiasm of faculty, students, staff, alumni, trustees, community leaders, and public and private patrons. We must now roll up our sleeves and implement them with care, wisdom, and speed.”

Mary Miers, assistant dean for planning in the dean’s office, says the plan “is meant to be a change agent. It is an ongoing, living process, not cast in stone. We set up the process to give rise to new initiatives, which we will evaluate in terms of merit and the resources required.” The study of needs and options for the physical plant occupied by Columbia Health Sciences and New York-Presbyterian Hospital was conducted jointly by the University and the hospital.

The other committees were chaired by Dr. Thomas Jessell, professor of biochemistry and molecular biophysics (research committee); Dr. Samuel Silverstein, the John C. Dalton Professor and Chairman of Physiology and Cellular Biophysics (education committee); and Dr. Eric Rose, Morris and Rose Milstein/Johnson & Johnson Professor and Chairman of Surgery (patient care committee).

Highlights of the plan are summarized below, but readers are encouraged to read the entire plan online. Anyone without access to the Internet may request a printed copy by calling (212) 305-7131.

Research

The research planning committee recommended maintaining research strength in neuroscience, biophysics and structural biology, and developmental biology and strengthening research in cancer, cardiology, cell biology, clinical research, geriatrics, health disparities, human genetics, immunology and inflammatory diseases, and infectious diseases.

Committee members noted that some research areas compare less favorably with similar efforts in other first-rate institutions. They cited cell biology, which has been severely depleted over the past decade; immunology, which lost ground with the departure of senior leadership in the early 1990s; and physiology, which has not kept pace with modern systems biology. The committee also expressed the need to improve the dialogue among Columbia scientists about genomic research and its role in the future of biomedicine.

Research committee members stressed the subject of collaboration, noting a lack of significant interactions among investigators working on related or complementary topics and links among basic, clinical, and translational research. Members proposed a review of the current structures of departments, centers, and institutes to ensure structures that do not impede the interdisciplinary and collaborative nature of contemporary science.

Committee members identified opportunities for additional fruitful collaborations with colleagues at the Morningside Heights campus, including biology, chemistry, computer science, engineering, physics, and earth science. The university and the hospital, committee members noted, must maintain their commitment to genuine partnership to address research questions and management decisions.

A critical issue that needs urgent consideration, committee members noted, is the growth of proteomics in close collaboration with computational science. Insight from other disciplines will likely be key, particularly from physics and engineering. In addition, further advances in understanding the molecular basis of human diseases will require interactions between chemists and clinical research teams.

Education

The education committee identified four major needs: tangible rewards for teaching; space for teaching, learning, and living; support mechanisms for teaching, assessment of teaching, assessment of student learning, and innovation; and the removal of barriers and creation of incentives for interactions and collaborations.

The committee reported that these shortcomings undermine the faculty’s efforts to develop innovative educational practice or keep pace with current advances, which places Columbia behind the national trends in health science education.

Teaching is seen as a low priority and not valued or adequately recognized, the committee reported. The committee noted the absence of Health Sciences policies to help faculty establish the level of their teaching commitments or to define their expectations of monetary or non-monetary support.

Education committee members expressed a need for more transparency and accountability in how education is financed. A budget, they proposed, would help clarify and establish priorities for maintenance and upgrading of teaching facilities, educational support systems, and administration and teaching.

In his response to the plan, Dr. Fischbach says the Health Sciences “cannot put off the need to provide tangible rewards for teaching.” Funds to support a cadre of talented and dedicated teachers will become a focus of fund-raising efforts. In addition, criteria for promotion and tenure will be reevaluated with teaching in mind.

The committee recommended development of a “one-stop shopping” system to support teaching, and Dr. Fischbach pledged to develop an entity that will transform teaching and learning, beginning with consolidation of systems that provide scheduling and related logistical support. He also agreed to consolidate or improve coordination of resources now available to help faculty with curriculum design, presentation skills, and teaching approaches. The committee’s proposal for a clinical skills assessment facility will be highlighted in fund-raising efforts.

Patient Care

Patient care committee members, while drawn mostly from the clinical faculty, developed a vision for patient care at Columbia that would include active involvement of the entire health care team. The committee developed a vision statement:

We, the health-care team at Columbia-Presbyterian Medical Center, are dedicated to continuing our tradition of providing the highest quality medical care, focused on the needs of our patients and their families. We will realize our vision through responsible innovation to create tomorrow’s medicine in a welcoming environment, supported by state-of-the-art technology and systems. We will be valued for, and defined by, our creativity, compassion, and commitment to ever-improving excellence in patient care. We can achieve this vision only if certain key characteristics or elements can be fostered in the patient care environment. In short, we must transform our institution.

The committee identified as key elements to the vision the development of the highest quality medicine, creation of a culture of caring, identification of the best people at every level of the organization, development of an infrastructure to provide optimal support, and creation of an organizational structure that enables and actively facilitates work toward the realization of the patient care vision.

The committee recommended the school hire a dean for clinical affairs, a position that was created in September in response to the recommendation. Recruitment is under way.

In addressing space concerns, the committee called for a comprehensive review of space utilization, beginning with outpatient space. Assessment of current utilization and needs, they concluded, must be a joint hospital-university undertaking with specific priorities to guide decisions and creative approaches to solving space allocation problems.

Space

The need for more space and better space, along with the need to create critical adjacencies, was evident before the planning began, Dr. Fischbach says. “The academic planning process has made the needs more evident and more specific. We must develop a long-range plan, but we simply cannot put off the first steps. Significant delays will lead to loss of faculty and paralysis of recruitment of faculty and students.”

Dr. Fischbach says space will be assigned based on a thorough evaluation of current utilization. This, coupled with ongoing reviews of departments and centers, will “help with difficult decisions.” At the same time, he added, the administration will continue to develop plans for new space expected to come online in the next one to two years. This is in the context of a long-range vision that will transform the campus over the period of 20 to 25 years.

The quality and location of the space, planners agree, are as important as the amount, and critical adjacencies must be established. Building design should link basic scientists, clinicians, patients, and students.

As part of the strategic planning process, Columbia and the hospital initiated a comprehensive review of existing facilities and an assessment of available or potential sites for expansion. A multidisciplinary team of engineers, architects, urban planners, experts in medical center design, and others, working closely with university and hospital officials, prepared a comprehensive Campus Planning and Development Survey. The survey calls for a new ambulatory care building on the 165th Street parking lot, which would include a heart institute, ambulatory surgery, and areas dedicated to clinical neuroscience and other medical and surgical programs.

The survey also includes a concept for a contiguous building that will bring together in one location research and clinical disciplines in the study and treatment of disorders of the brain and nervous system. The group conducted a detailed assessment of the condition and potential future uses of all existing campus buildings and developed a comprehensive inventory and analysis of sites in the community that might be acquired for campus use.

In addition to these long-range plans, Columbia is taking steps to improve the quality of campus life now. These include beautification of 168th Street, the upgrading of space for study and interaction, and improved signage to assist the 15,000 to 20,000 people who pass through the center each day.

What’s Next

In his introduction and response to the planning reports, Dr. Fischbach described the flexibility of the strategic planning efforts. “Neither the academic plan nor the space plan provides a rigid blueprint for action. Rather, the reports evaluate what exists and provide various options for the future. I offer them as the opening statement in what I hope will be an ongoing dialogue. They represent, in my mind, a summing up of a wonderful beginning.”

He said the goals set by the process can be achieved “if we remain focused on our priorities and if we can marshal the human and financial resources required. There is a danger in raising unrealistic expectations, but as we move ahead, we welcome the challenge of a bold plan.

“The economic and political climate in which we now operate is very different from the atmosphere of optimism that characterized the late 1990s. It would be too easy to retrench, ride out the storm, and hope for the best. No one is in favor of that option. As we approach Columbia’s 250th anniversary and CPMC’s 75th, we must exploit all of the strengths offered by this great university.”

Roosevelt/Welfare Island History
The president of the Roosevelt Island Historical Society is trying to locate physicians who worked on the island as students, interns, and residents. The island was known as Welfare Island until 1973.

The hospitals on the island: City Hospital, Metropolitan Hospital, Cancer Institute, Neurological Institute, Goldwater Memorial Hospital, and Bird S. Coler Hospital.

“We are interested in talking to these persons and learning about their experiences there,” says Judith Berdy, president of the association. “If they have any photos, writing, or memorabilia, we would love to see it. We have an archive and collect island history and stories.”

Judith Berdy can be contacted at 575 Main Street, Roosevelt Island, NY 10044, or (212) 688-4836. She can be contacted at jbird134@aol.com by e-mail.

Virginia Apgar’s Legacy Celebrated 50 Years after the Apgar Score

AT A SEPTEMBER 2002 ALL-DAY SYMPOSIUM HONORING THE life and work of Virginia Apgar, Dr. Selma Calmes, chair of anesthesiology at the Olive View-UCLA Medical Center and a biographer of Dr. Apgar, told the story about the Apgar score’s beginnings: At a breakfast meeting at P&S in 1949, a medical student observed that a method to evaluate newborn health was sorely needed in the delivery room. Dr. Virginia Apgar said: “That’s easy,” jotted down five signs of health, and rushed off to test it.

Three years later, on Sept. 21, 1952, Dr. Apgar first presented the scoring system that would ultimately save many babies’ lives. The Apgar score that measures a baby’s heart rate, respiratory effort, muscle tone, reflex irritability, and color at one and five minutes after birth is now used throughout the world. In February 2001, the New England Journal of Medicine reported the Apgar score still to be the best predictor of infant health in the first month of life. Dr. Apgar, a 1933 graduate of P&S, died in 1974.

Dr. Calmes gave the capstone address at the scientific symposium to honor Dr. Apgar’s work on the 50th anniversary of the Apgar score. She said Dr. Apgar’s “prepared mind” helped her create the score. While the score was a key achievement in her life, Dr. Apgar’s professional activities also influenced the development of anesthesiology, obstetrics, and perinatology, and raised awareness of birth defects.

Born in 1909, Dr. Apgar graduated fourth in her class at P&S, one of four women that year. After two successful years in a surgical residency program at Presbyterian Hospital, she was told women surgeons would not succeed and was encouraged to consider the new subspecialty of anesthesiology. After a year of anesthesia training at the University of Wisconsin and New York University, Dr. Apgar returned to P&S in 1938 as director of Columbia-Presbyterian’s fledgling anesthesiology division in the Department of Surgery.

When the anesthesiology division under Dr. Apgar matured into a department 11 years later, Dr. Emanuel Papper, who had more research experience than Dr. Apgar, was named chairman. Despite the disappointment, Dr. Apgar became the first female full professor at P&S and focused on obstetrical anesthesia for the next decade.

Dr. Apgar’s score and her other efforts led doctors to pay greater attention to the newborn in the delivery room instead of only attending to the mother, a point emphasized by many speakers at the September event, including Dr. Mary Ellen Avery, president-elect of the American Association for the Advancement of Science and keynote speaker, and Dr. Allen Hyman, professor of anesthesiology at P&S and one of the symposium’s co-chairs.

At age 50, Dr. Apgar earned a master’s degree in public health from Johns Hopkins University and became director of research and development at the March of Dimes, where she fostered national discussion about the previously taboo topics of birth defects and prematurity.

Other participants at the symposium were Dr. Richard Polin, professor of pediatrics; Dr. Richard Smiley, associate professor of clinical anesthesiology; Dr. Nancy Green, medical director of the March of Dimes; Dr. Mary D’Alton, interim chairwoman of obstetrics and gynecology; Dr. Thomas Jessell, professor of biochemistry and biophysics; Dr. Ruth Fischbach, professor of bioethics; and Dr. Marion Hunt, special consultant to the dean and member of the conference planning committee. Dr. Hunt authored a perennial date book dedicated to Dr. Apgar.

The symposium closed with a concert organized by Dr. Nicholas Cunningham, professor emeritus of clinical pediatrics and public health, that featured a quartet of P&S students (Jeremy Hwang’06, Alin Severance’06, Lauren Wiebe’04, and Lissa Baird’03) playing the string instruments made by Virginia Apgar.

Dr. Ruth Fischbach, director of Columbia’s Center for Bioethics, co-chaired the symposium.


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