Transformative Work

To the YSM Community:

As I near my third anniversary as a member of the Yale School of Medicine community, I have been reflecting on all that we have accomplished, as well as all that we have yet to do. You–our students, faculty, and staff–amaze me every day with your intellect, your thoughtfulness, and your commitment to our missions.

During department town halls, we have discussed our cross-cutting goals. We are working to:

• Create an environment of inclusive excellence where all members of our community can thrive and to which we can continue to recruit the best talent in the world
• Break down silos to advance creativity and innovation and promote interdisciplinary research to increase our impact
• Build and steward resources necessary to serve as a biomedical discovery powerhouse of the 21st century
• Realize our potential as a premier academic health system through strategic alignment and partnership with Yale New Haven Health System

Actualizing these goals will, at times, require us to work differently.

For example, we recruit brilliant and talented students, trainees, and faculty. To retain them, we must be intentional in our efforts to mentor, sponsor, and proactively support these talented individuals by eliminating barriers to their success and providing the right resources at the right time. The conversations fostered by the Faculty Development Annual Questionnaire (FDAQ) process are intended to catalyze this approach.

We must be willing to take risks. Making change involves experiments or pilots, and we know as scientists that not all experiments succeed but that we can learn from the unexpected outcome. To continue with the example of career development, the working group that developed the FDAQ borrowed heavily from the best practices of others, piloted the process in a few departments, and will continue to iteratively improve on the tool and process with input from you. If, at some future date, we replace the FDAQ with a better tool or process, that will mark progress, not failure.

As I wrote in 'On Discipline' two years ago, we must learn to replace transactional interactions with innovative, strategic thinking: “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.” “Strategic planning” is not an exercise in which independent individuals or units each advocate for their own needs, and whomever advocates most effectively “wins.” For those who would like to learn more about strategy, there are many rubrics developed for business that can be adapted for academia, such as the work of Hambrick, D. C., and Fredrickson, J. W. (2001). The NextGen research strategic planning conducted by Deputy Deans Tony Koleske and Brian Smith in 2021 applied many of these principles. Importantly, strategic planning should not involve a “top-down” approach, but one that encourages creativity and engages our rising stars, staff as well as faculty, and collaborators across the university and our broader communities. Our annual presentations to our newly constituted Scientific Advisory Board will provide a forum in which to identify additional cross-cutting themes.

As we develop priorities within our school as well as in partnership with the Yale New Haven Health System, we will have robust conversations about future directions. We must continue to create an environment in which all feel engaged and comfortable espousing different viewpoints. We need to address obstacles and problems openly and think creatively together about solutions. And when, after a vigorous conversation, we develop priorities, we must work together to realize them even if our individual preference did not reach the top of the list.

And, again from 'On Discipline:' “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.” Here, we have made progress. For those interested in statistics on climate, diversity, and inclusion, we will continue to expand the data at our online archive. Leaders in the health system and school are working to develop better dashboards to enable individual physicians as well as departments to track measures of quality and performance. We must develop similar analytics around our research cores, contracting, and grants management to enable even greater discovery. Attention to routine processes will enhance the return on investments in predoctoral training, cutting-edge new cores such as FIB-SEM and MERFISH, the creation of a new biorepository, and biomedical informatics and data science. We have begun this work in the Yale Center for Clinical Investigation, and you will be hearing more about that in the coming months.

As we revise the flow of funds between the hospital and the school to align with strategic priorities and to incentivize desired behaviors, some may need to relinquish a “learned helplessness.” With agency comes responsibility. Support for departments and sections will be transparent and equitable. We will have the opportunity to grow funding for all missions, but that will require execution. We will have to challenge prior assumptions and analyze root causes. We are already beginning to see changes that we could not have imagined a few years ago. The creation of the aligned physician enterprise will eliminate inefficiencies, enhance clinical care and service, improve the lives of our clinicians, advance educational opportunities for our students, and better integrate our missions of discovery and clinical care.

Yale School of Medicine is an extraordinary institution where excellence and a collaborative culture coexist. We are making considerable investments and progress in realizing our overarching goals. We have some old habits that hold us back from time to time, but we are learning to work differently, and this will be transformative.

Sincerely,

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