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The University of Arizona Health Sciences Center Strategic Plan

Transformation into the 21^st Century - 2000 Update

Introduction

The Arizona Health Sciences Center is one of the many assets of The University of Arizona.  The national and international reputation of the Arizona Health Sciences Center is well documented.  The College of Medicine and College of Pharmacy are Arizona's only colleges of medicine and pharmacy.  The College of Nursing offers the only doctoral program in nursing in Arizona.  The networks of the College of Medicine, Nursing and Pharmacy extend throughout our state.  The Arizona Board of Regents approved the College of Public Health in January 2000.  The University of Arizona Prevention Center in the College of Medicine and the Health Education Program in the School of Health Professions combined to become what is now the College of Public Health.  

The United States health care establishment created since the end of World War II has become the envy of the world. It has also become the most costly.  The wonders of biomedical research are disseminated far and wide.

Today, partially through the realization that many people lack economic access to basic health services, and partially through a societal decision to embrace competitive solutions to remedy economic and political concerns, we find the entire health sector in transition.  Transition embraces change.  The natural sequel of change in the health sector is transformation.  Science, technology, education, quality, cost and efficacy are among the many facets that nurture transformation.  The strategic plans of the Colleges of Medicine, Nursing and Pharmacy provide the guideposts through the process of transformation that have lead us into the 21st Century.

Mission Statement

The mission of the Arizona Health Sciences Center (AHSC) mirrors that of The University of Arizona, while giving special emphasis to the role of the AHSC in helping to educate and train the health care professionals for the State of Arizona.  The AHSC’s role in basic and applied research as it expands our ability to improve the health of the residents of the State is also recognized. Finally, the AHSC is also a provider of health services to residents of the State.  This not only provides residents with specialized services not obtainable elsewhere in the State, but also is a necessary requirement for the survival of the education and research functions of the AHSC.

The mission of the Arizona Health Sciences Center is:

·         To provide health sciences students with the knowledge and skills basic to the practice of their disciplines, inculcate them with the fundamental attitudes of professionalism, compassionate patient care and service to the community, and with a spirit and desire for life-long independent learning and scholarship;

·         To provide excellent clinical training programs for advanced level health professions trainees, including medical residents and clinical fellows, pharmacists, nurses, and provide continuing education programs for practicing health care professionals throughout Arizona;

·         To make nationally and internationally recognized contributions to scholarship, including basic and clinical research; provide excellent research training programs for graduate students and post-doctoral fellows in both basic and clinical sciences;

·         To enhance the quality of life of the people of Arizona through the provision of services which promote and model excellence, cost-effectiveness, and innovation in health care; lead research concerning public health and the delivery of health care;

·         To disseminate health information to the public.

Environmental Context

The University’s Strategic Plan identifies driving forces regarding higher education, demographic, economic and political/governmental trends.  The following specific driving forces in health care, which will have an impact on the Arizona Health Sciences Center, further amplify these trends.

Demographic Shifts

A more diverse, aging and growing population in Arizona, particularly among those over age 85, will create additional demands on the health care delivery system and on the education of health professionals.

Demands on Education

The demands of health care in the future will require professionals to work in interdisciplinary teams and engage in collaborative decision-making.

Adult learners of the future, including those in the health professions, will require self-directed learning and problem solving and critical thinking skills.

In order to respond to the health needs of society, the health sciences curricula will need to emphasize managed care, treating patients along a continuum of care, management of chronic illness, prevention and health education, epidemiology, and the health of populations.

Health professionals will need a thorough grounding in the principles and application of information management.

Health Care Reform and the Marketplace

With or without governmental health care reform, the delivery of health care will change dramatically in the coming decades.  The emphasis will be on cost-effective quality care, providing care within the most appropriate settings of care (more non-hospital care), and health outcomes.  Health care providers will be expected to be responsible for the health status of entire populations.

Managed competition is the dominant model of health care in Arizona and will remain so for the next several years.

Health care providers are aggregated into large integrated delivery systems consisting of hospitals, physician groups, other provider groups, and insurance payers.

Academic health centers (like the AHSC) are being severely challenged to compete on the basis of price with community providers.  Government reimbursement for education will continue to decline, and other payers are reluctant to subsidize the costs of teaching health professions students.

Academic health centers will continue to provide tertiary and quaternary care that combines research and teaching with patient care, but there will be increasing financial pressures from payers on these services as well.

As a result of market forces and/or health care reform pressures an undetermined number of academic health centers will close, or will merge with integrated delivery systems in their regions.

Mix and Distribution of Health Care Professions

In Arizona, there will continue to be a surplus of many physician specialties, with continuing shortages of other health care professionals.  Many rural and some urban areas will continue to be undeserved by health care professionals and services.

It is projected that in the future academic health centers will need to produce fewer physicians and fewer physician specialists overall, but given the need to provide more primary care for patients, more primary care providers will be required (including physicians assistants and nurse practitioners).

Resources

Fierce national competition for research dollars will continue.  Nationally, some research centers of excellence will downsize, or be eliminated entirely.

College of Medicine reliance on clinical income will not abate, and pressures on clinical income will continue under managed competition.  The core mission of education and research will be impacted by managed-competition revenue reduction.  Clinical research will bear the greatest pressures with ever-increasing reliance on faculty to provide patient care, leaving less time for research. Other health professional schools and programs will feel similar pressures, although to a lesser extent.

There will be further restraints on resources for education within academic health science centers.  Medicare (or other federal governmental) funding of graduate medical education (GME) for physicians will continue to decrease.  Federal funding of graduate nursing education is likely to continue decreasing as well.

Strategic Activities for Effecting Change

To cope with the environmental forces, the Arizona Health Sciences Center will focus on the following strategic activities for effecting change:

A.  Clinical Teaching Resources

Sources of patients are necessary to fulfill the educational and research missions of the health professions.  We are proceeding to weigh the need for participation in an Integrated Health System within our community and around the state in order to provide patient resources.  The participants may be physician groups and managed care contracts.  It will be critical for us to participate with those programs, facilities, and patients that ensure a quality educational experience for all of our student professionals.  It is a matter of concern that the Arizona Health Care Cost Containment System (AHCCCS) has decreased the patient population served at the Health Sciences Center.

B.  Faculty/Staff Size and Responsibilities

We are addressing with vigor and diligence the size of our faculties and staffs in the Arizona Health Sciences Center.  With the need to compete with the private sector in a changing marketplace, downsizing, restructuring and re-engineering of organizational elements have become critical.  Concurrently, we are amalgamating positions, and have been reviewing personnel systems and analyzing our curriculum.  Both University Physicians Incorporated (UPI) and UMC have begun to reduce staffing strategically, redirect professional activities, and probably will merge many of the functions of UPI and UMC.  Our ability to change rapidly, reassign professional personnel to duties not initially anticipated at the moment of hire, and the nature of contractual academic relationships pose unique problems.  The potential for diminished morale, and loss of our competitive edge is of concern.  Downsizing of our technical support services and redefinition in the work place is currently going on and it is likely to accelerate.

C.  Diversification of Research Funding

To maintain our stature as a Carnegie classification Doctoral/Research Extensive university, we need to diversify our revenue streams beyond the National Institutes of Health and other federal funding sources.  This requires each college to become involved in new partnerships and joint ventures with the private sector, including the pharmaceutical, bioengineering, and biogenetic industries.  We will look nationally and globally for new research partners.  These integrated arrangements require new thoughts and new approaches to indirect cost recovery, shared use of resources, ownership of patents, and product licensure.

D.  The 21st Century Curriculum Renewal Projects

All the colleges in the Health Sciences Center are nationally rated.  The colleges continue to recruit and retain outstanding faculty.  We are developing innovative teaching strategies for classroom and clinical settings, and continuing to invest in instructional resources such as computer assisted instruction, interactive videodisc programs, and multimedia instructional applications.  We have begun to develop structures to deal with society’s expectations for its physicians.  In the College of Medicine, the process of curriculum review and renewal as a second step of defining the physician is under way with statewide input.  We have encouraged wide and extensive participation from all interest groups around our State into this process.  Our Comprehensive Curriculum Analysis and Planning project, CCAP, which has been partially funded by Dr. Virginia Furrow and her generous gifts to the University, is leading the way to the new curricular structure for the 21st Century.  The Arizona Health Sciences Center is committed to expanding the entire Health Science Center student learning experiences into rural and other underserved areas in Arizona.  We anticipate the opportunity to coordinate appropriate rural and underserved clinical experiences and sites with multidisciplinary teams such as with pharmacy and medicine.  The College of Nursing is revising the nursing doctoral student recruitment plan and reviewing graduate curricula.

E.  Phoenix Expansion

The growth of the Phoenix Campus, with its capability that a third of our students can take their entire third and fourth year curriculum in Phoenix, along with the future developments of collaborative research facilities with both ASU and the private sector in Maricopa County, is part of our strategic plan to serve the entire state as the state’s only Health Sciences Center.

F.  Allied Health Education

The health needs of the State require training not only physicians but other health professionals as well.  Some services that traditionally were provided by physicians can be delivered more efficiently and economically by these health professionals.  Training of the changing work force requires us to participate in new ways with both ASU and NAU, along with the community colleges in the State.  Efficiency of education can be realized with a full-service, integrated telecommunication network that links campuses throughout the state in a single orchestrated program for training health professionals.  Our first strategic activity has been the tri-campus Public Health Program, which has exceeded our most hopeful wishes.  The new College of Public Health will enhance the collaborative efforts to train other health professionals.

G.  Telecommunication:  Telemedicine/Teleconferencing

An increasingly advanced telecommunications capability will facilitate the Arizona Health Sciences Center in achieving its statewide, regional, and national outreach goals.

The Arizona Telemedicine Program, a multidisciplinary clinical program of The University of Arizona Health Sciences Center, has been of critical importance in establishing statewide leadership in this area.  The program was created in 1996 at the initiation of the Arizona legislature to establish pilot projects demonstrating the efficacy of telemedicine in delivering better health care to Arizona's medically underserved rural areas. Telemedicine is defined as the use of computers, video imaging, fiber optics and telecommunications for diagnosis and treatment of persons in rural, geographically isolated communities and state institutions.  Initially, the Arizona legislature funded an eight site Arizona Rural Telemedicine Network as a general appropriation to The University of Arizona Health Sciences Center's operating budget.

The initial eight sites in this project are Cottonwood, Ganado, Holbrook, Payson, Sierra Vista/Douglas, Springerville, Tuba City, and a Department of Corrections site in Yuma.  An additional project that provides teleradiology services to the Cobre Valley Community Hospital in Claypool (Miami-Globe) is supported through the Arizona Department of Health Services utilizing the state's Tobacco Use and Health Care fund.  Late in 1996 the U.S. Department of Agriculture, Rural Utilities Service announced a grant to The University of Arizona to extend the Arizona Telemedicine Program to the Mariposa Community Health Center in Nogales, Arizona.  Additionally, the Department of Corrections is funding additional telemedicine sites at their facilities in St. Johns and Douglas, as well as at their Division of Health Services headquarters in Phoenix.  By end of FY 1999, Arizona Health Sciences Center was the central hub for an eighteen-site statewide telemedicine network.

In addition to the provision of telemedicine clinical services, this network has a teleconferencing capability, thereby creating a vehicle for extending educational and administrative functions to these rural sites.  The combine telemedicine-educational-administrative functions provide vital support for Arizona Health Sciences Center students on rural rotations, and present continuing education activities for rural health care practitioners and preceptors. 

The telemedicine network is fully compatible and integrated with Arizona Health Sciences Center’s existing and growing teleconferencing capability.  In January 1996, with Flinn Foundation support, phase one of the Arizona Health Sciences Interactive Video Educational Network established a dedicated teleconference circuit between the Arizona Health Sciences Center in Tucson and the Arizona Health Sciences Center - Phoenix Programs.  This circuit allows medical students in Phoenix to attend core lectures and clerkship courses delivered by Tucson faculty and facilitates participation by Phoenix area faculty in the programs of the Arizona Health Sciences Center.

The Phoenix circuit complements an existing teleconference capability to deliver educational events to all Tucson area hospitals and to statewide educational sites through a shared network operated by Northern Arizona University.  Together these networking capabilities have allowed the Arizona Graduate Program in Public Health (AzGPPH) to flourish as a truly statewide academic effort.  In mid 1996 the Arizona Health Sciences Center pursued phase two of the Arizona Health Sciences Interactive Video Educational Network, which expanded the dedicated teleconference circuits to the health sciences academic programs at Northern Arizona University and Arizona State University, as well as the Arizona Department of Health Services. 

The current teleconference network architecture also allows for uplinking Arizona Health Sciences Center educational activities to satellite transponders for distribution to a national and potentially international audience.  Future satellite-distributed programs similar to the 1996 Update on Antithrombotic Therapy, originated here and received by eighty sites across the U.S. and Canada, will allow health sciences faculty to exert leadership in the national health sciences academic arena.

With completion of the network supporting the Arizona Telemedicine Program and phase two of the Arizona Health Sciences Interactive Video Educational Network, the Arizona Health Sciences Center has a fully integrated high speed rural, urban, and national telecommunications network.  This state-of-the-art capability greatly enhances the ability of faculty, staff and students to achieve the diverse set of goals that accompany our responsibilities, as Arizona’s only academic health sciences center.

H.  Primary Health Care Education

Strategic planning for expansion of primary health care education currently is being reevaluated.  The legislature has required new mandates for primary care education.  Concurrently, the infrastructure to support Rural Health Education through the Arizona Health Education Centers (AHEC) was defunded by the legislature in the 1995 session.  AHEC infrastructure has been the basis for College of Medicine primary care initiatives and minority recruitment.  A new plan is being developed.

I.  Environment and Culture

To enable persons to maximize their potential as contributing members of the college, University, and community, we will continue to support development and training opportunities for all staff and faculty.  We will encourage their participation on college, AHSC, and University committees.  The College of Nursing has initiated and implemented a faculty governance model and new administrative structure supporting a climate and environmental culture that emphasizes communication, participation, and shared decision-making.

J.  Outreach

The linking of collaborative educational, research and service activities to health needs is a requirement of a land grant university.  This is related to the demand for increased collaboration between the Health Sciences Center and other health care partners.  We anticipate offering educational programs, participating in interdisciplinary research grants, authoring publications and co-teaching courses with partners throughout the state.  Our colleges continue to explore partnerships and collaborative relationships with community health groups.  We will continue to recruit adjunct faculty and professional preceptors for our students.  We will utilize the expertise of our community colleagues and encourage their input into the educational process.

Goals, Objectives, Strategies, and Indicators

The strategic plan for the Arizona Health Sciences Center will guide our course and steady the helm in turbulent times.

Goal I: To educate a health workforce that meets the needs of the State of Arizona.

Objective 1: Support students, graduates, and practitioners in their professional education and in the provision of health services to the people of Arizona.

Strategies:

·         Redefine our size and responsibilities.

·         Re-engineer our curricula.

·         Re-address the primary care needs of our citizens.

·         Advance the Colleges of Nursing and Pharmacy as statewide, regionally and nationally recognized centers for excellence in clinical practice and research.

·         In the College of Nursing, implement undergraduate and graduate curricula focused in selected programmatic areas that incorporate up-to-date knowledge or nursing science and health care delivery models.

·         In the College of Pharmacy, review and implement professional and graduate curriculum that will prepare students to provide rational, safe and cost-effective drug therapy as well as conducting research leading to new discoveries in the pharmaceutical sciences.

Objective 2: Recruit and admit the most qualified professional and graduate students to the Arizona Health Sciences Center including an appropriate representation of minorities as reflected in the State population.

Strategies:

·         Maintain and expand the number of student learning experiences in rural and other underserved areas of the State of Arizona.

·         Recruit, admit and retain the most qualified undergraduate and graduate students including individuals from under-represented populations.

·         Implement an advising and guidance process that focuses on retention, progression, and graduation of competent and confident practitioners and scholars.

·         Create a statewide database of minority students in K-12 who could be encouraged to pursue education in one of the health professions.

·         Expand and improve recruitment activities currently in place.

·         Create educational partnerships with Arizona schools (K-12), universities, and community colleges.

·         Improve early outreach.

Objective 3: Expand the geographic sites at which education in the Life Sciences occurs to ensure adequate patient populations for all students in the health professions.

Strategies:

·         Decentralize the sites for professional education.

·         Expand the Arizona Health Sciences Center Phoenix Programs.

·         Expand the interactive Arizona Telecommunication Network.

·         Integrate and expand all continuing professional education programs.

·         Explore vigorously new relationships and partnerships.

Measures:

1.  Number of College of Medicine graduates entering primary care residency programs.

2.  In the College of Nursing, percent of undergraduate and graduate students having a rural or underserved clinical nursing experience.

3. In the College of Nursing, percent of BSN graduates pass the NCLEX-RN examination.

4.  Number of students in the first year class in the College of Pharmacy.

Goal II: To plan statewide for the allied health professions in Arizona.

Objective 1: Integrate allied health educational training across the State.

Strategies:

·         Create the Arizona Consortium for Allied Health Professions Education.

·         Complete and expand Public Health training at UA, ASU, and NAU.

·         Integrate the School of Health Professions with existing health professions education programs at university and community college levels.

·         Consider adding other health related professions programs into the School of Health Professions.

Measures:

1.  Number of memoranda of understanding between the College of Medicine and community colleges for cooperative training of allied health personnel by the end of calendar year

2.  Number of students, including full-time and part-time working students, in Arizona Graduate Program in Public Health.

3.  Total number of medical technologists’ graduated/year from the School of Health Professions.

Goal III: To maintain the leadership role of the Arizona Health Sciences Center in biomedical research.

Strategies:

·         Diversification of researches funding from private, public, and global sources.

·         Complete infrastructure development to include the Sarver Heart Center.

·         Continue planning and fund raising for expansion of research space for all AHSC colleges.

Measures:

1.  Extramural funding per year (in millions) in the College of Medicine

2.  State-of-the-art research space, occupied and utilized in the College of Medicine

3.  Percent of tenure-track faculty who have funded programs of research within the College of Nursing’s identified research emphasis areas, which reflect the health care needs within Arizona.

4.  Number of faculty in prestigious national associations:

In the College of Medicine, the number of faculty listed among best doctors in U.S.

In the College of Pharmacy, the number of faculty inducted into Fellowship in the American Society of Health System Pharmacists, American College of Clinical Pharmacy, or American Academy of Clinical Toxicologists

Goal IV: To achieve an environment and culture that support all members of the University community.

Objective 1: Ensure an environment and culture that empower all persons in the Arizona Health Sciences Center to maximize their potential as contributing members in the education of students, in research and other scholarly activities, and in service to the community.

Strategies:

·         Provide services that support the growth and development of employees in expanded knowledge, self-confidence, and motivation.

·         Increase opportunities for staff development.

·         Implement faculty development plans.

·         Establish mentoring systems.

·         Maximize individual effectiveness.

·         Support a climate for effective decision-making that is caring, challenging, and respectful of creativity and critical thinking.

·         Where appropriate by college, continue implementation of faculty governance and further define administrative structures.

·         As appropriate by college, establish communication processes to promote shared decision-making.

·         Maintain responsiveness and sensitivity to consumer needs.

·         Encourage student participation on AHSC committees.

·         Support student activities and organizations.

·         Solicit input from local and regional health care providers regarding program planning and curricula development.

·         Foster an atmosphere of trust and respect that promotes and enhances growth, rewards, spirit, and leadership.

·         Establish guidelines for accountability.

·         Encourage collegial behaviors of honesty, openness, inclusion, fairness, objectivity, and patience.                    

·         Develop resources and support that ensure an optimal physical environment and facility to meet the educational, research, and service missions of the AHSC.

·         Increase faculty and staff support and involvement in development efforts.

·         Develop a worksite health promotion program for faculty, staff and students in conjunction with AHSC disease prevention and health promotion programs.

Measures:     

1.  In the AHSC, percent of classified staff participating in courses/workshops for professional development

2.  In the AHSC, number of harassment incidents (requiring formal investigation)

3.  In the AHSC, number of staff in classification career progression

Resource Assumptions

Resource assumptions for this strategic planning period are modest.  Marginal new appropriated revenues requested through the legislative process approximate 2.7 percent for fiscal 1999-00 excluding the employee salary request.  Employee salary data and the University’s portion of the System’s request will be submitted by the Board of Regents to the Department of Administration for inclusion in their recommendations for all State employees, therefore this planning document does not include assumptions regarding those issues.  Marginal new non-appropriated revenues (Auxiliary, Designated, and Restricted funds) are expected to continue their modest aggregate growth rates in the 2 to 3 percent range.

Resource assumptions suggest only modest incremental funding will be available for the planning period.  The University depends upon funding from a variety of sources to accomplish its mission.  The advent of biennial budgeting for the universities has established the appropriated funding level for the 1999-2001 period.  Marginal new revenues approved for 2000-01 have been set at approximately 3.1 percent and include provision for an annualized salary adjustment pool of 2%, which will be effective April 1, 2001.  Adjustments in revenue resulting from tuition are similarly modest.  Marginal new non-appropriated revenues in the Designated, Auxiliary and Restricted funds will vary but are expected to be in the range of 2.5% to 3.5 % for the year.  The University is embarking on an expanded fundraising program.  However, the results of that activity are longer term in nature and not expected to have a significant influence on expenditures in the 2002-2003 biennium.  

For health care centers, changes resulting from national health care reform and the marketplace will play a vital role in the resource assumptions.  Issues related to these factors make funding levels less predictable due to the economic impacts resulting from external policy considerations, the effects of managed care, and other economic factors which will present both opportunities and challenges for future strategic planning.