Clinical Partnerships Updates

April 6, 2018: Clinical Partnership Update

April 6, 2018: Clinical Partnership Update

Dear Colleagues,

Last week I compared our progress in developing our new relationship with Fairview to the Turtle Derby. This week I will add to the animal theme by comparing our teams to the early bird trying to catch the worm. Members are so determined to commit the time we need to move forward that meetings now start as early as 5:30 or 6 a.m. In addition to caffeine, I am grateful for the strong and ongoing support from President Kaler for this effort.

Our team of James Hereford, Laura Reed, Osman Akhtar, Mac Baird, Brian Burnett and I moved forward along the timeline this week, finding common language around service lines and joint clinical enterprise, finding balance by clarifying areas where UMN and Fairview will have the independence to pursue other relationships, cleaning up some outstanding issues, and developing bilateral incentives both short and long term. We are pursuing an aggressive (but still dynamic) timeline that places the potential reinvention of our agreement squarely in 2018.

On the pediatric side, all deal teams have been working hard under the self-imposed pressure of a tight timeline. There are hurdles to be faced, but we will continue to do as we have done—facing rather than avoiding the difficulties and working to fix them one by one. It seems that our brains are hardwired for hope. The process is intense but the product, with the help and support of our community, could be a game changer.

Thank you,

Jakub Tolar, MD, PhD
Dean of the Medical School, interim Vice President of the Health Sciences

March 30, 2018: Clinical Partnership Update

March 30, 2018: Clinical Partnership Update

Dear Colleagues,

Please look at the signatures at the bottom of this page. James and I are writing our update jointly this week because we are energized by the progress we are making in creating a new M Health agreement that better aligns our vision and purpose.

turtle derbyHave you ever watched the Turtle Derby (held for most of its 32 years outside University of Minnesota Medical Center - Fairview Health Services hospital)? The races are incredibly slow and the turtles seem to wander all over the place, but for people with a turtle in the “running,” it is really exciting.

Today’s communication shares our turtle’s progress. Here are the key points from this week:
We know that our organizations are tired of the often stressed and difficult relationship of the past 20 years.
We are getting to the root causes of our joint difficulties and developing plans to fix them.
In the end, both organizations will be different than we are today.
We are working to find “both/and” solutions that meet our collective needs, rather than compromising on a middle ground that doesn’t help us fulfill our potential.
The vision and structure of our enterprise will combine our strengths to focus on shared core values of high-value, patient-centered care, academic inquiry and innovation.
We have agreed to:

  • Capital improvements at UMMC.
  • Joint strategic planning.
  • Align the incentives of our leadership.
  • Significant academic support.
  • Enthusiasm about the service line structure.
  • Have University of Minnesota Physicians remain an independent organization that, following our land grant mission, will work with other partners and will maintain our brand in the market, as will Fairview. 
  • Maximize collaboration and minimize competition with each other as much as possible. 

In principle, we agree that we:

  • Need to simplify our agreements into one “master” contract.
  • Can combine some business functions and share best practices.
  • Will expand research and education through the system and provide access to training for additional health science professionals.

As we continue working, we are developing the incredible potential our two organizations have together. There are many details yet to determine and the teams from both Fairview and UMN are working hard to find our way forward. Our deepest thanks to them for their resilience and to you for your ongoing support.


Jakub Tolar, MD, PhD
Dean of the Medical School and UMPhysicians Board Chair

James Hereford
Fairview President and CEO

March 23, 2018: Clinical Partnership Update

March 23, 2018: Clinical Partnership Update

Dear Colleagues,

This week we had the opportunity to give the Board of Regents a snapshot of how negotiations stand and how we plan to move forward. The Regents made it clear that they support our efforts and care deeply about ensuring faculty have the resources they need—including finances, operations and political self-determination—to be able to thrive and grow. They share our budding optimism that we will succeed in creating strong partnerships and in making this a great place to educate, practice and research.

Before now, I did not fully appreciate all the difficult and somewhat tedious effort that goes into a negotiation process. If you notice the word “stamina” cropping up in my reports, it’s because this is a slow, incremental progression of small steps. I am deeply impressed with my team members’ resilience, staying power, willingness to be flexible and embrace change, and deep commitment to the principles of academic vision and the land-grant University mission.

The work this week proceeded with the focus on service lines and the independence of UMP. We have momentum and are working out the details as quickly as possible.

A few thoughts from the week that stand out to me are:

  • We need to measure ideas and progress rather than judge them.
  • Personal relationships can be key to getting beyond organizational culture differences.
  • It is more important to learn about the negotiating partner’s position than to continually reiterate our own position.
  • If we just try to avoid losing, we may accidentally avoid winning.
  • Your patience and support are greatly appreciated.Our work continues on Monday.

Thank you,

Jakub Tolar, MD, PhD
Dean of the Medical School, interim Vice President of the Health Sciences, and UMPhysicians Board Chair

March 19, 2018: Addressing Faculty and Staff Feedback

March 19, 2018: Addressing Faculty and Staff Feedback

Dear Colleagues,

Most of the feedback from the questions at the end of my messages has been very kind. Thank you.

The message about the ongoing negotiations, however, brought out deeper, more impassioned, far less flattering responses, and that is exactly what I have been hoping for. While I would like to respond to each comment individually, I am quickly realizing that is a better idea in theory than in practice, so I will address them periodically as a group and incorporate them into other messages.

No matter what any one of us thinks or feels, it is guaranteed that amongst the over 1,200 faculty there is someone (or many people) who thinks and feels the exact opposite. It is only by hearing all of these views that we can develop a consensus.

I get it. Many people are frustrated by the lack of detail offered in negotiation updates. Because negotiations are fragile things, constantly changing, sometimes even reversing course at the least provocation, I have been trying to communicate the values by which we are steering the negotiations. Truth be told, no one knows the outcome yet. It is uncomfortable (to say the least), but we have to go through this phase of not knowing in order to create something better.

However, we are not going to make feedback anonymous. I need to be able to know where comments are coming from. I have no intention of being punitive or retaliatory; that isn’t the purpose. The purpose is to learn and to hear different points of view. I am giving you my opinions and thoughts publicly. I expect you to do the same.

I’ve included some specific responses to a few of your questions and statements (paraphrased) below:

A tangible (and possibly under-recognized) benefit to my patients and to me of referring within UMP is the ability to communicate easily within the same EMR. This has benefits for cost (minimizes duplication of testing) and can improve patient care.

Excellent point; we are working on it.

What is happening in CSC Operations?

Please see this March 9 communication we sent to UMP Providers and Staff.

It is important that the Medical School ensure that all students, trainees and staff have the time and opportunity to vote on Election Day. At this critical time, every vote counts.

I agree, what steps do you suggest we take to make sure this happens?

We should expand our advertising to show us providing service to the community, not just to individuals.

Excellent idea; we have our communication team on it.

It would be good to recognize and reward what we do for the community as volunteers, perhaps even requiring service hours.

This is a great idea that ties in with the advertising idea above. The Dean’s office will develop a database to track this so that people receive recognition for their volunteer efforts.

We are missing the opportunity to co-produce health care initiatives with communities (different from providing services and offering knowledge). Ongoing community partnerships should include the knowledge and resources of the community, not just the University.

Excellent point. Where do we start with this?

We need to improve the communication of our accomplishments to the community and tell our story.

This is a critical part of strengthening our “brand” as well as our relationship to the people we serve.

Finally, what I want you to know is that I do read all of the feedback, and it doesn’t have to be positive to be welcome. This is one area where pursuing excellence is more important than being kind.

Do you have suggestions or ideas for how to create the improvements listed above? How would you like to help make it happen?

Please share your thoughts at the feedback form linked below.

Thank you,

Jakub Tolar, MD, PhD
Dean of the Medical School, interim Vice President of the Health Sciences, and UMPhysicians Board Chair

March 15, 2018: Clinical Partnership Update

March 15, 2018: Clinical Partnership Update

Dear Colleagues,

We had another active week pursuing enhanced clinical partnerships. We worked to separate essential needs from the merely important ones, and to find solutions along the line of compromise without surrendering our principles.

Pediatric Academic Health System:

  • Deal teams are continuing to meet to discuss details of the practice plan structure, funds flow, governance, structure of the philanthropic organization and our communication plan. We feel positive about the level of partnership in these discussions and are continuing to drive toward action in April.

Adult Services:

  • Met again this week with James Hereford and his team.
  • Clarified that our planning needs to be anchored in today’s reality. We can talk about our future, but must be working on the problems of today. Only by seeing tangible results to these problems can we pave the way for our ability to grow and achieve a stronger alignment.
  • Discussed the new Fairview organizational structure and its service line focus. We agreed that service lines need academic leadership. We will work with Fairview to define the service lines and the roles within them. As I continue to reiterate, it is critical that our faculty report to faculty. I believe this has been heard and that academic service line leaders will report to the CEO of UMP.
  • There is agreement that UMP will remain an independent organization, that this alignment is not exclusive, and that the term is through the end of the affiliation agreement in 2026, with an option for renewal.
  • Our teams have begun to discuss the innovative opportunities for growth that will be possible when we can resolve our differences and focus on our future.

Again, progress is being made. We are continuing to develop a better understanding of what each organization needs to do for this partnership to be successful. We are identifying the main points of divergence and stripping each back to its essence to find the key to solving it. It is heartening that we are having constructive conversations about solutions rather than digging into oppositional positions.

Thank you,

Jakub Tolar, MD, PhD
Dean of the Medical School, interim Vice President of the Health Sciences

March 09, 2018: Clinical Partnership Update

March 09, 2018: Clinical Partnership Update

Dear Colleagues,

This week we had another good meeting with James Hereford, Osman Akhtar, and Laura Reed of Fairview. We moved forward into the details of the executive summary along the points I outlined in last week’s update. Further, we have improved the organizational chart so it now has a parallel and integrated structure of operations, with comparable units aligned on the University of Minnesota and Fairview sides.

We have been working with a self-imposed deadline of 24 hours for revisions (both teams), which we met. This weekend we will review the revised documents in preparation for next Tuesday when we plan to further develop the term sheet and timeline.

Importantly, the capital investment of $111 million for the main hospital has been approved by Fairview leadership and is in progress. I do not expect the future to be easy, but we will work hard, remain fair and consistent, stay open minded, and focus on doing the right thing in this partnership. To quote Max Planck, a physicist that James and I both like, “When you change the way you look at things, the things you look at change.”

The Pediatric Academic Health System discussions are proceeding at an even quicker pace. We are finalizing the documents for the high-level letter of intent. Marc Gorelick, the five “deal teams,” and I are focused on governance, funds flow, practice plan, philanthropy, and communications. The deal teams have met several times this week, debriefed individually, and then debriefed as a group this morning.

We continue to guide both processes toward agreements that will lead to stability, and to emphasize that we remain committed to exploring the possibilities that will lead to success.

Thank you,

Jakub Tolar, MD, PhD
Dean of the Medical School, interim Vice President of the Health Sciences

March 02, 2018: Clinical Partnership Update

March 02, 2018: Clinical Partnership Update

Dear Colleagues,

We had a good week. We are looking at the way we approach our clinical partnerships with a different perspective and we have made substantial progress on commitments around key goals and positions. We are aligned in support of a robust UMPhysicians (UMP) organization and in the ideal of academic leadership. We know that those ideals have to be continued with efficiency and in order that our actions create the results we require.

Next week we plan to announce the first of several concrete actions. You will see that some of the old paradigms are changing rapidly and that our focus is now centered on the future.

Specifically, with Fairview Health Services we have discussed that:

  • Fairview will proceed with moving ahead on the $111 million in capital improvements at the University Hospital that are allocated in Fairview's FY 18 budget.
  • The term of any new agreement will be 8.5 years, corresponding with the current academic affiliation agreement that expires on December 31, 2026.
  • We will do our work in tiered dyads to create the functionality desired for efficiencies and high-quality patient-centered care. In these dyads, academic leaders will report to the CEO of UMP and ultimately the UMP Board and the Dean. Executive leaders will report to the Fairview COO, and ultimately to the CEO and the Fairview Board of Directors.
  • We will maintain the integrity and full functionality of UMP.
  • Fairview will provide increased incremental academic support to the Medical School.
  • Both organizations continue to work diligently to accomplish a pediatric academic health system.

With respect to the Pediatric Academic Health System (PAHS) discussions:

  • We have five work groups defining various aspects of a partnership: governance, financial issues, practice plan structure, philanthropy and communications.
  • We are focused on ensuring that PAHS has the appropriate link to the Medical School and the University and addressing the impact on UMP.
  • We will have new academic support for the pediatric mission of the Medical School and PAHS.
  • We will ensure that PAHS has the financial structure and assets to be successful.
  • Our team is working to ensure our communications reflect the value that we bring in terms of research, innovation and training to care for the children in our community.

Our partnerships, when they are the right partnerships, are truly critical in achieving our ambitions. We will create structures where our faculty, staff and students can focus on all that we do best.

Thank you,

Jakub Tolar, MD, PhD
Dean of the Medical School, interim Vice President of the Health Sciences

Feb 22, 2018: Update On Our Clinical Enterprise

Feb 22, 2018: Update On Our Clinical Enterprise

Our leaders—Dr. Mac Baird, Brian Burnett, University SVP for Finance and Operations, and I—met with James Hereford, Osman Akhtar and Laura Reed of Fairview again this week. In place of exchange of paper memos, we keep talking and use the flexibility of our gray matter. We are gaining clarity about how we can work together to create success and growth for both organizations.

We know that high-quality specialty and primary care is our market advantage. Research and innovation is our differentiator. Training the next generation of physicians is our legacy. Fairview’s new leadership team brings strength and experience in operations, efficiency, and a focus on quality. Together we can be a powerful force, but we will not continue with a status quo focused on conflict and internal struggle. The history of our relationship will not determine the future, and any partnership going forward must value the strengths we bring to it.

In a true academic health system, academic leadership must be integrated throughout. Our discussions with Fairview Health Services have recently focused on creating a structure that makes that possible, both from the management/organizational side and in governance. This would mean significant responsibility for the Dean, for our department heads, for University of Minnesota Physicians (UMP) leadership, and for academic leadership of service lines reporting to UMP. For me and for our team, the unmovable fact is that UMP, as the clinical practice of the Medical School, must remain strong and intact. This is essential for us to fulfill our land grant mission to provide the highest level of health care to Minnesotans.

Thank you,

Jakub Tolar, MD, PhD
Dean of the Medical School, interim Vice President of the Health Sciences

Feb 6, 2018: Update on Negotiations with Our Clinical Partners

Feb 6, 2018: Update on Negotiations with Our Clinical Partners

Dear Colleagues,

I know you may have questions about the state of negotiations with our clinical partners, and we are all ready for new direction towards our future. We have the responsibility and the opportunity to take control of our own destiny; we cannot continue to run in place but must move forward.

In all negotiations, we are guided by three facts:

  • Our faculty are our strongest asset; they bring the essential knowledge, skills, and energy that drive our mission of outstanding patient care, education and research. We can achieve nothing without them.
  • We have a unique charge as a land grant university to provide service to the people of Minnesota.
  • We need a unified system of clinical practice, research and education.

Here is an update.

  • We respect the ability of our faculty to govern itself. As an academic, multispecialty physician group, we depend on our talented and committed faculty to create and operate a system that is compassionate, efficient and fiscally responsible. In any partnership we form, empowered faculty leadership is critical—as it is in all of the top academic health systems and medical schools. We have combined the CFO, COO, and Board Chair/Dean positions between UMP and the Medical School so that we have an aligned, efficient, informed structure that will assure continued support of all our missions in the future.
  • The Fairview system will continue to be an important partner to us. We will continue our work to find the best way to harmonize the efforts of UMP, the Medical School, and Fairview into a top-level academic medical center and to ensure support for ongoing contracts and obligations to capital improvements in our hospital.
  • Our vision of a truly new Pediatric Academic Health System is going forward. UMP is currently collaborating and negotiating with the University, Children’s Hospitals and Clinics of Minnesota, Fairview, and Allina. We are committed to pursuing this unique opportunity to create something exceptional for children’s health in our region.

The pursuit of excellence starts with you. We need to hear your ideas, solutions, comments, and questions. Let us know what we can do to support you. Please send your responses to msdean@umn.edu or share them with your chair or division head.

Thank you,

Jakub Tolar, MD, PhD
Dean of the Medical School, interim Vice President of the Health Sciences