Last year, Dean Fischbach accepted a recommendation from the Patient Care Strategic Planning committee to create a new position in the administration to represent the entire clinical faculty. The new senior associate dean for clinical affairs is responsible for improving patient care at Columbia Presbyterian, dealing with concerns of the faculty, and leading the effort to enact the other priorities of the patient care committee. Dr. Joseph Tenenbaum, the Edgar Leifer Professor of Clinical Medicine, was selected in January to fill the position and began serving as senior associate dean in March. He spoke with In Vivo about his goals.
Why was this position created?
The strategic planning group for clinical activities has several initiatives for improving performance, including developing a faculty-wide program for error reduction and increasing patient satisfaction. The planning group recommended the clinical affairs dean position to ensure there was a full-time focus on clinical activities in the dean's office and to carry out new initiatives.
Why were you interested in taking on these responsibilites?
I had developed a broad perspective of clinical leadership by serving as president of the Faculty Practice Organization, as interim chair of the Department of Medicine, and as a still-practicing clinician at Columbia. I see this as a wonderful opportunity to continue these interests.
What are your initial plans?
I'm going to meet with the chairs and leadership of each of the clinical departments of the hospital and affiliated institutions in order to understand the direction and goals to which they are committed.
In addition, I'm going to further the program that Columbia's Faculty Practice Organization has already initiated to develop faculty training in patient satisfaction. This involves training all Columbia employees and faculty in the most current practices of customer attentiveness, responsiveness, and service excellence and then surveying patients to determine actual performance. Last year in Columbia's Faculty Practice Organization, in a survey led by Dr. David Kahn, professor of clinical psychiatry, we found that when an unknown patient called a practice's office they received a satisfactory result only about half the time. Getting a satisfactory result is influenced first by the office's secretaries answering the phone reliably and then by providing meaningful referral information. There may be an office that's superb at taking care of its own patients but not as adept in handling calls from other providers or their secretaries or patients.
Finally, I plan to undertake a program to reduce errors and improve patient safety. Clinical medicine has long prided itself on a commitment to safe practice, but the Institute of Medicine report on medical errors shows that the existing error levels in medicine remain unacceptable. The Faculty Practice Organization, Columbia Presbyterian Physician Network, and NewYork-Presbyterian have already begun to find new means to measure and ensure safety. We will seek working plans from the faculty to reduce system issues that lead to errors in the care of patients in both the hospital and the office.
So far, you've talked about initiatives that focus on the patient's experience. What about the faculty's experience?
I'll continue to contribute to a project that stems from the Faculty Practice Organization that establishes a method to deal with grievances from faculty. Most of the grievances relate to practice arrangements, access to office space, and rewards and incentives for research performed by doctors.
Also, we'll explore new models for academic clinical employment to meet the needs of the institution and faculty. The current system is based on a clinician being a full-time member of a practice plan with variations in incentives for research activities.
The strategic plan calls for the new dean to focus on culture change. Describe the culture of this institution and how you are going to change it.
Culture change is not one of my first goals, but it's inherent in the projects we're undertaking. The standard model of the medical school as a collection of departments is giving way to an integration of department activities and goals. That can be enhanced by a clinical dean who tries to foster collaborations. NewYork-Presbyterian has tried to do this by organizing "service lines" which support clinical activities, bringing together departments with comparable interests. For example, the cardiovascular service line brings cardiologists and surgeons together.
We're also making sure there's a healthy collaboration between clinical and research areas, which is particularly germane in this era when we talk about translational research and taking research findings from the lab directly to the patients.