Thank you for attending this session. Thank you to my colleagues here up on the dais as well. I'm going to be talking a little bit about building and integrating academic programs in CCOs. I have no financial relationships to disclose. And as a professional educator, I'd be remiss without giving learning objectives. So we're going to be listing some of the academic missions of critical care organizations and explaining the rationale for that integration. We'll also describe some of the initial steps of integration and list some of the integration goals for each of the academic missions. Okay. So we're off to a great start. This not only describes me because my colleagues have expertly set me up with some of the things they've already talked about, but it also describes perhaps you and your critical care organization because by the time that you are thinking and starting to integrate some of the academic missions, a lot of stuff has probably already happened. There's been integration steps that have already taken place and specifically the clinical operations have likely been integrated. The financial operations have also likely been integrated. They should be. They should be the first things to be integrated for a critical care organization. Certainly the academic missions that we're going to be talking about in a few minutes are dependent upon the structural, the organizational, and the financial operations that are already in place. So there's probably already a high level of collaboration between leaders within your institution. This includes between hospitals or between departments or divisions or ICUs or whichever the contributing groups are at your institution. And my job in the next few minutes is to convince you that you're not done yet. There are still areas to integrate, and these are the academic missions. And I'm going to list them here. So patient safety, quality improvement, education, research, professional development. And at first glance, they may not necessarily seem like academic missions, but they all have a degree of scholarship and academic rigor, and that's why they're included in this list. Okay, so we've seen this figure before, and I'm just going to say that Dr. Coopersmith and I collaborated on this, even though we didn't. So the academic missions inform and improve patient care. And this figure kind of gives a sense of that, so let's orient a little bit. First, in the middle of the figure is where patient care is. Just like on an interprofessional team in the ICU, the patient is in the middle. Here patient care is in the middle. It should be. This is where we try to provide the best value of care that we can provide for our patients. We have structures and processes in place that provide better outcomes at lower cost. That's what we're trying to do. And then around that, surrounding that, are all of these academic missions. Now some of these academic missions, specifically patient safety and quality improvement, affect the clinical operations directly, right? Patient safety and quality improvement directly affect the structure and process by which we provide better care, higher value care. And then in addition, all of these missions, patient safety, quality improvement, but also research, education, and professional development, inform patient care through discovery, innovation, and sustainability, not just of the critical care organization, but also of critical care itself. And integrating these broad range of academic missions is important. First of all, it avoids a lot of confusion and conflict. As you might imagine, if you had each one of your contributing groups to the CCO trying to perform all of these academic missions on their own, they're each going to come up with a different answer. They're each going to come up with their own way of doing things. And now if they try to incorporate that, they all try to incorporate their way of doing things into the same unit, all you're going to find is a lot of confusion and frustration. And so that's why the integration of these missions is additionally important. Integration also leverages the broad resources of the critical care organization, leverages economy of scale, and potentially supports missions at lower cost. Now, you may have looked at that figure on the last slide and said, well, wait a minute. My institution has some of those missions, but maybe some of the other missions are not as well-developed. That's okay. Whatever missions your institution has are the ones that you should integrate. So maybe you have an extremely robust patient safety and quality improvement mission. But maybe your research mission is that's just not a part of your institution. And that's okay. We want to act based on the values of our institution. And so whatever missions your institution has, those are the ones that you should integrate. Okay. We're going to talk about some initial steps to integrate some of these missions. And the four general steps are introspection, outreach, collaboration, and communication. For introspection, each contributing group to the critical care organization, whether that is different departments or different areas of the hospital, whatever it happens to be, each part or each group should evaluate their own academic missions. And a SWOT analysis is typically quite helpful for this, particularly a SWOT analysis that includes budgetary and productivity issues. And so look inward first to see what you're doing well, where are the places that you might improve, and what are the opportunities specifically for the next step? What are the opportunities that you might be able to take advantage of or that other departments or other contributing groups in the CCO might be able to help you take advantage of? The next part is outreach. So now that you've looked inward, now's the time to reach out. You want to share your academic mission evaluations with academic leaders within the CCO. Identify potential areas of collaboration. Seek opportunities to integrate. This is an active process. You are actively reaching out to others in other areas of the hospital, other departments, divisions, what have you. And you're reaching out and say, hey, we have this strength. We see you have that opportunity. Or we have this opportunity. Do you have a strength that we might be able to take advantage of? The next step is collaboration. Particularly important with collaboration is creating a shared identity as a critical care organization between the participating groups. So while maybe different departments may choose to, are obviously going to have their own identity as a department or division, there should be part of that where they identify as this is the critical care center or this is the critical care department. The CCO leaders need to develop a detailed plan for integration. They need to find areas to integrate and, most importantly, prioritize the order of integration because it's going to be very hard for this to happen all at once. And finally, accept that it might just not be possible to integrate completely. This is not a cookie cutter process, as we'll talk about in a moment. This is a very individualized process, very individual to different institutions and dependent upon the various history and culture and needs of that, of your particular institution. And so sometimes you can integrate fully. Other times it's not quite as easy to do that. But integrating, the process of integration and integrating as much as possible is very important for CCOs. And finally, the last initial step is communication. Communication goes beyond being an initial step and actually goes towards being an ongoing process, something that's ongoing that needs to be done. But part of the initial step is to identify all of the key stakeholders that we've heard about already from my learned colleagues up on the dais here, particularly primary decision makers that are going to be involved with approval, organization, and funding of the critical care organization or of the particular academic mission. You want close and frequent communication. This is something that goes well beyond initial steps. You want to keep those communication lanes open all the time as various things come up within the CCO. You need to know your audience. As Dr. Cooper-Smith was saying, when you pitch this CCO idea to the higher-ups in administration, you need to know what their language is. You need to know what their interests are. Now, the key stakeholders for academic missions doesn't necessarily stop at administrators. It could be department heads who may be more interested in the data that you have to share. So it's important to know your audience, to present your plan in a way that is going to be helpful for that person and be interesting for that person. And yet, at the same time, you need to create and present a comprehensive integration plan to those stakeholders. They need to be able to put all of these pieces into context. So not just the academic missions, but how that fits in with business operations, how it fits in with clinical operations, how it fits in with accountability within the institution, within the critical care organization. Okay. As you're going through implementing this plan for integration, remember that the devil is in the details. There are 100 little details that are going to come up that you have not planned for. It's important to accept that. It's also important to keep communication lines open to be able to deal with them efficiently and effectively when they do. This is one of my favorite cartoons from Gary Larson from the far side, where this poor painter was not in touch with the details, and there may be some consequences for this poor guy, but we don't know exactly what they will be. You also want the CCO to be responsive to concerns. Concerns will come up, whether that's from leadership or from individual ICUs or different groups, and you need to be responsive to those in real time. So the person responding should not only know what the system is, but why it was designed that way and how it might be changed for the better. And then finally, make sure you celebrate success, because all of those key stakeholders that are providing the support and funding and so on are more apt to continue to support the CCO if they know that there are successes happening. So take all of those successes, celebrate them, let the key stakeholders know this is all about doing good and taking credit. Okay, so we'll now get into a little bit of the specific aspects of these academic missions that you may want to integrate at your institution. First of all, we want to improve consistency of care across ICUs. To the extent that we can, obviously there are different types of ICUs and they have different patient populations and so on, but there's a lot of overlap, and we want to have a particular plan of practice, not only within ICUs, but also across ICUs. We want to be able to coordinate the selection of technology and electronic medical record applications in patient care. This was touched on a little bit already, but the electronic medical record should be working for us, working for the patient, working for the various contributors to the CCO, not the other way around, hopefully. So having the opportunity to select the type of EMR that your institution has because you have a CCO that has some degree of sway is also going to be important. We want to enhance the ability to provide support during times of surge. Certainly Dr. Puri touched upon this a little bit earlier. This is no longer an academic exercise. We experience surges all the time now, and it really has become over the last several years a part of our lives clinically. And then finally, facilitate multidisciplinary solutions to complex clinical problems. These are problems that maybe have a little bit of a rare population, but a specifically complex population that needs a multidisciplinary solution. And it's easier to do that within a CCO. For quality improvement, we want to align the QI metrics of our critical care organization with those of the institution. We want to strengthen multidisciplinary contribution to both QI initiatives and to education. And we also want to leverage our patient databases to serve all of the ICUs and participating groups in the CCO. For research, we want to increase the number and quality of studies that improve value-based critical care. This is how research and other academic missions are going to contribute and inform and improve patient care through discovery, particularly. We want to provide further research opportunities and enhance professional recognition for those who participate in research. And we also want to support efforts to develop and fund interprofessional critical care research groups, not only within the CCO, but also outside of it. For education, just like we want to develop a shared identity as a critical care organization within the institution, I think it's important to create a shared identity of trainees as integral parts of the critical care organization. As a program director, this is something I'm very close to, but having that shared identity of not just someone that comes from a particular department or division, but someone that is a critical care trainee. We want to leverage interprofessional training opportunities, which there are bound to be several of. We want to foster teaching innovations, discovery, and outreach, and we want to optimize educational methods to provide both cost savings and, depending on what the method is, even potentially some educational revenue. And finally, for professional development, we need to create a sustainable pool of interdisciplinary expertise for all of these academic missions. We need a pipeline. And so that pipeline of expertise includes maintaining institutional memory. It includes mentorship. We want to provide a structured pathway for professional advancement, whatever that looks like at your particular institution. We want to identify and develop future critical care organization leaders, and we want to improve job satisfaction, reduce turnover, and enhance academic productivity. And again, I'll mention again the importance of mentorship and having a mentoring program as part of professional development. We really need that to develop a pipeline of developing professionals coming up through the various contributing groups of the CCO so that the CCO will have good leadership in the future. So in summary, leverage the benefits of your critical care organization, avoid confusion and conflict through open and frequent communication and collaboration, and remember that integration will happen differently for each critical care organization based on local needs and cultures. I have a few references here. Thank you very much for your time. Thank you.

academic missions

critical care organizations

collaboration

communication

integration process