On Discipline

To the YSM and Alumni Communities:

Sometime during our training most physicians have experienced a “bad code.” Clinicians from four corners descend upon a room to resuscitate a patient, but it does not go as planned. Perhaps the leader does not communicate effectively. Others in the room deviate from their assigned tasks. Without coordination, despite their individual expertise and sense of purpose, the group never becomes a high-functioning team. In the research setting, an analogous lack of rigor or attention to detail, while not life threatening, can lead to wasted resources, irreproducible results, and misleading data that sets discovery back. In both cases, the culprit is a lack of discipline.

As we start a new year, I have been thinking about discipline. We have accomplished much during the last year, but we aspire to achieve even more. To execute on our plans to develop our talent, grow transformative research programs, enhance accessibility to cutting-edge clinical care for all, and increase diversity and inclusion, we will need to be disciplined.

In academic medicine, we value autonomy and often equate it with creativity. An overemphasis on autonomy can create duplication, however, whereas efficient, well-documented processes and clearly defined boundaries can paradoxically provide groups with the time and the freedom to discover and to innovate. In addition, autonomy sometimes conceals narcissism or tribalism that undermines our ability to reach common goals. “Strategic planning” becomes independent individuals or units advocating for their own needs. In the coming years, we will work to develop a practice of strategic planning that engages all stakeholders, identifies our strengths and differentiators, recognizes potential weaknesses and obstacles, and articulates a common vision with a plan to achieve it.

In the absence of discipline, academic communities often create redundant structures. We tend to love committees. Committees are generally effective at identifying issues and in giving stakeholders a sense that they have been engaged, but less effective at implementing solutions. In fact, cynical administrators have sometimes utilized committees to slow progress. In her book Yale Needs Women, Anne Gardiner Perkins, YC ’81, relates that President Kingman Brewster often appointed committees to stall actions.

Many of our standing committees such as the Faculty Advisory Committee (FAC) and our faculty and student affinity groups are vitally important as venues for bidirectional communication. To execute on our goals, however, we will tap task forces with specific objectives, such as the recent task force on Physician Scientist Development led by Peter Glazer and the Wellness Task Force led by Bob Rohrbaugh. We will delegate responsibility, commit to timelines, hold ourselves accountable for meeting those timelines, and communicate our outcomes. Only then, will our community gain trust in our ability to deliver.

To hold ourselves accountable, we must also become comfortable with sharing data about our performance. This should include everything from metrics of clinical excellence and research impact, to measures of diversity and inclusion, to the functioning of cores and administrative operations such as contracting. We must create a culture in which we respond dispassionately to data to identify problems and address them. We must also understand that to reach our goals, we must take risks and we will sometimes fail; we must make YSM a safe place to share our failures, as well as our successes.

Lastly, as a highly functioning organization we must also be disciplined about taking breaks. During the COVID-19 pandemic, we have developed bad habits. We jump from Zoom meeting to Zoom meeting without time for reflection. Our work hours have expanded as we have responded to each challenge. Yet, functioning at a high level requires taking time to reflect, process, plan, and rejuvenate even when it does not seem convenient or possible. This concept underlies our triennial and sabbatical leaves policy. This is the reason that, while faced with a larger than usual number of faculty coming forward to take leaves following the COVID-19 pandemic, we are committed to honoring the ability of faculty to take well-planned leaves to the extent that clinical responsibilities permit. I would propose that we also commit to a weekly pause and agree to minimize email communications during a 24-hour period from noon on Saturday through noon on Sunday.

We have extraordinary talent at YSM. There is no end to what we can achieve with discipline.

Sincerely,

Nancy J. Brown, MD
Jean and David W. Wallace Dean of Medicine
C.N.H. Long Professor of Internal Medicine