Inside Duke Medicine

A Clear Vision—Part II

The second part of a three-part series in which we examine how Duke Medicine’s strategic plans guide success in challenging times.

Part I—Duke University Health System
Today: Part II—Duke University School of Medicine
In coming days, look for:
Part III—Duke University School of Nursing

Nurturing excellence

The Duke University School of Medicine, like medical schools across the nation, faced financial pressures long before the current global economic recession.

But progress in accomplishing goals set out in its 2005 strategic plan, and administrative initiatives in response to external funding declines, have put the School on a steady course through these trying times.

For example, those activities have put the School in a good position to capitalize on the funding opportunities of the American Recovery and Reinvestment Act of 2009 (ARRA), also known as the “stimulus bill.”

“All of our missions - education, research and clinical care - are severely stressed by external regulatory and funding pressures,” said Dean Nancy Andrews, M.D., Ph.D. “But we have a clear strategy that, together with our outstanding faculty and staff, will guide us in making the decisions and the critical investments we need to make to ensure our continuing success.”

The School has the advantages of a strong health system, a world-class faculty and a very balanced research portfolio, she said.

The School has been affected in three ways: Reduced distributions from endowments, lowered expectations for philanthropic support, and, most importantly, a flat NIH budget.

But, in reviewing the School’s strategic plan initiatives, said Dean Andrews, it is clear that, despite the economy, the School has continued to focus resources on its core objectives.

Examples of this progress include the strengthening of the Medical Scientist Training Program that supports M.D./Ph.D. students, and the School’s role in creating the University-wide Global Health Institute, Duke Translational Medicine Institute, Duke Institute for Brain Sciences and investment in core facilities.

“We’ve been very thoughtful and strategic around where our constrained resources are utilized,” said Andrews.
Indeed, much of the strategic plan and subsequent efforts of the school’s administration, said Andrews, have been student- and faculty-focused.

“We’re trying hard to be faculty friendly,” said Scott Gibson, executive vice dean for administration. “It’s a balance between investing in new programs in strategic areas of emphasis - which is important to our growth as a top tier school - and supporting the faculty and programs that got us here in the first place. We have to do both.”

Gibson points to numerous activities that grew out of the strategic plan, and continue even in these tight economic times. These include Dean’s Office bridge funding to promising investigators, improved assistance and mentoring for faculty who receive NIHK-Awards, improvements to research administration, and a forthcoming faculty work-life initiative led by Chancellor Victor J. Dzau, M.D.

Still, the School has had to make tough choices.

“We have had to make adjustments to our internal economy in response to the new economic situation, which actually started several 4-5 years ago when the budget for the National Institutes of Health flattened after a period of tremendous growth. These changes were essential to our ability to stabilize our financial picture,” said Gibson.

Earlier this year, the School implemented a number of expense management actions, followed by changes to its overhead allocation methodology, implementation of a gift assessment and a one-time balance assessment - structured as a loan - for discretionary funds greater than $500,000.

These measures were necessary for the School to shore up its budget over the next years.

The strategic plan has been enhanced by work to streamline research administration. The Research Administration Continuous Improvement (RACI), an initiative begun in 2007, involves University and School of Medicine senior leadership and faculty and staff advisors in ongoing efforts to make administrative functions as efficient as possible and investigator-friendly.

An example of this work is the streamlined process for account code creation, the reduction in budget requirements for modular grants and the soon-to-be-released research portal.

“This initiative was designed to help all researchers, and it has put us in very good condition to prepare for the ARRA economic stimulus,” said Gibson.

Meanwhile, students continue to be a primary focus of the School, which has embarked on a modernization of learning facilities. Last fall, a high-tech Gross Anatomy Lab and Fresh Tissues Lab were opened in the lower level of Davison Building.

And, the School is proceeding with plans to build a learning center, supported by a $35-million donation by The Duke Endowment last year.

However, because of the economic situation, the School has had to defer plans to build a state-of-the-art research building.

“With our top-notch faculty and a committed staff working together on our shared strategic vision, we will make progress despite the tough environment,” said Dean Andrews.