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Lessons Learned from Urban Transportation Systems

Successful Administration Fosters Quality

Second only to politics, the big topic of discussion in DC right now is the Metro (rail and bus) system.  After years of lackadaisical (being kind) management that culminated in two underground rail fires resulting in death and hospitalization, as well as a number of city bus drivers who viewed pedestrians as moving targets in a shooting range, a new administration was brought in.  There have been massive numbers of early retirements and a total administrative structure reorganization.  The Metro’s new mission – safety first – is the guiding principle.

Rail service has been restricted dramatically to accommodate aggressive repair and rebuilding operations.  As you might imagine, there have been complaints.  Lots of them.  But the active communications outreach and messaging — safety first — has connected with the DC region stakeholders.  Despite the inconveniences caused by the comprehensive maintenance efforts, the system is working.  Riding on the bus or train is no longer a threat to life and limb.  The process is working.  And, by the way, alternate modes of transportation are thriving!

Program Directors and CEOs of metropolitan transportation systems share many attributes.  They are professionals, practitioners, and executives who rely on effective, efficient administration to make their respective programs work.  People depend on them to create safe and effective milieus that deliver promised results.  Late trains lose customers.  Ineffective training programs loose top candidates.  Worse case scenarios – poorly managed metro systems have tragedies that cost lives and livelihoods; poorly run training programs can put the safety, privacy or health of their trainees and patients at risk.  Good administration makes a real difference.

Dictionary.cambridge.org defines administration as: “The arrangements and plans needed to control an operation of an organization.”  Program administration may not be a sexy topic, but it can surely make or break a program.   That’s why it is one NNPRFTC’s eight Accreditation Standards.

Administration is as important as the curriculum, the faculty/preceptors, and the trainees.  Imagine the chaos if the EMR didn’t work well (actually, we’ve all been there when the computer system goes down…)  Or think about launching a dynamic, innovative program that is explicitly designed to meet previously unmet needs in your local community.  Over the first six months, the patient pool diminishes to a trickle because a competing healthcare system has opened next door and you did not have an agreement with your sponsoring institution to assure sufficient clinical experiences.  Well-designed administrative procedures protect your program and allow it to function in the expected way. I love the imagery in this quote by Peter Turla: “Don’t get sidetracked stomping on ants when you have elephants to feed.”

So, thoughtful and comprehensive administrative functioning is essential if the trains are going to run safely and on time.  Another Peter Turla quote: “A plan is what, a schedule is when. It takes both a plan and a schedule to get things done.”  Effective administrative functioning is essential if training programs are going to provide safe, quality clinical experiences that result in high performance, competent and capable trainees.

The NNPRFTC’s administration standard specifies that the training program must have the full support of a clearly identified, single sponsoring organization.  There must be alignment of respective mission, values, and strategic objectives.  There needs to be organizational sponsorship and organizational accountability for resources.  This isn’t just a day-dream; success requires dependable institutional sponsorship and accountability.

So what is organizational sponsorship?  What are organizational responsibilities and resources?

Organizational sponsorship – There needs to be a single sponsoring organization with sufficient resources for core and specialty elements of the program (eg: clinical sessions, preceptors, and didactic sessions.)  There needs to be an adequate range and number of patients for educational and training goals.  Optimally, there is a formal academic partnership or affiliation.  The organizational chart should describe key functional areas and clearly document the roles, responsibilities and contributions of multiple individuals and departments.  There needs to be documentation of the resources dedicated to the support of the program in carrying out its objectives and accomplishing its missions.  And there needs to be sufficient resources for that purpose.

Organizational Responsibilities and Resources – Clinical sites need to be aligned with the core mission of the program.  Trainees need ready access to current clinical electronic technology such as EMRs.  Trainees need appropriate dedicated space within the clinical practice environment so they can interact as full partners on the clinical inter-professional team. There needs to be sufficient qualified administrative and clinical faculty to operate the program and to fulfill obligations of the program to enrolled trainees. There must be sufficient financial resources, general organizational resources and specific human resources (eg: liability coverage, compensation package, safe and secure environment) to ensure that the program can function in accordance with its mission and goals.  Ongoing quality assurance and quality improvement foster timely adjustments, sustainability, quality, and innovation.

Henry Ford was a master of designing efficient and effective delivery systems.  As he is reported to have said: “Coming together is a beginning; keeping together is progress; working together is success.”

Until next time,