Transformative change in our health care is not just coming—it is here. Of course, what we do clinically is always changing, but what is happening now is different, much broader and much faster. To give North Carolina examples, 142 independent hospitals have become about 14 in just the last 30 months, and there has been a similar change in physician employment. And the genie cannot go back into the bottle: these changes are irreversible.
But what form the future health care system takes in the end is not inevitable—it depends critically on what we do now—on our leadership as individuals, as clinicians and as a department. I believe these changes may represent the first steps towards a health care system that produces better outcomes at lower cost with better patient experience. This year we are embarking on a major transformation of our practice that includes the installation of a new system-wide electronic health record; “lean-redesign”—the first in the UNC Health System—that will enable us to intentionally review our staffing and structure; redesign our workflows and implement team based care more fully; and renovation of our physical space. In addition, we continue to extend beyond the walls of the Patient-Centered Medical Home to employee-based wellness and to home care to improve care for the sickest of patients.
The synergy between our clinical and academic missions is powerful. We are heavily engaged as leaders of the largest change in the UNC medical student curriculum since the school’s founding in the 1950s, even as we transform our statewide residencies to fulfill and evaluate the new ACGME system for accreditation. The I3 Collaborative, which includes 24 family medicine, internal medicine and pediatric residencies, sets a national pace for implementing the Triple Aim for residency practice, while our researchers are working to improve both the content and effectiveness of care nationally for important problems such as smoking, the elderly with cognitive impairment, osteoporosis, hypertension and other conditions.
Warren Newton, MD MPH
William B. Aycock Professor and Chair
UNC Family Medicine