Chapter I: Expanding Academic Geriatrics Programs
4. Using Consultants
The challenge: To call in outside help—or not—when your program’s growth and development hits a roadblock
Summary
CoEs sometimes encounter roadblocks or reach plateaus. Leaders may wonder if it would be helpful to bring in outside consultants. In fact, a number of CoE directors have used consultants strategically; some thought their use should receive greater support because of the benefits.
Among the most popular consultants were senior geriatrics leaders who: (1) had extensive program development experience and were also knowledgeable about other CoEs; and (2) had specific areas of expertise, such as business models to establish palliative care services. External advisory committees were also mentioned by several leaders as sources of guidance and insights that have proved invaluable for early planning and during critical junctures when a change of course might be in order. Consultants can also be extremely helpful when embarking on a new initiative that is meeting resistance.
Strategies
Use a consultant for objective insights. A consultant with expertise in academic geriatrics can bring a reality-based perspective to your program. They can help you make crucial decisions about goals based on: (1) other successful programs; (2) their own program’s particular stage of development; and (3) roadblocks they have faced. A consultant can hold up a mirror and provide an objective perspective on what your program looks like from the outside. Consultants don’t always tell you what you want to hear, but the lessons are valuable by providing objectivity and advice on future directions.
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A small investment can yield a big return. “A consultant is a relatively small investment to obtain an external calibration of your program’s strengths and weaknesses.” Christopher Callahan, MD, Indiana University |
Use a consultant when you want your leadership to really hear what your program needs to succeed. A consultant from another well-established, highly regarded program can help get your dean’s or chair’s ear. Even if the consultant tells the leadership the same thing you have been telling them, they hear it in a different way. A geriatrics leader who has served as a consultant visited a CoE and met with the dean and the chair of medicine. Having been an interim dean himself, he was able to talk with the leadership in their own language about how to help their new division chief succeed, and how to position geriatrics within the larger institution.
Use a consultant to tell uncomfortable truths to administration. Senior consultants from well-established geriatrics programs can sometimes better explain and sell what a dean may not want to hear. Academic administrators are often focused on programs becoming financially self-sufficient, an outcome that relies, in part, on strong reimbursement for clinical services—clearly not the case for geriatrics. Nevertheless, while “self-sufficiency” may not be a realistic goal for academic geriatrics, a consultant can identify steps adminstration can take to ensure a robust program that contributes to the institutional mission.
Use a consultant to help launch new (or misunderstood) programs. Several CoEs have used consultants to help launch palliative care programs, particularly when meeting resistance from hospitals concerned with losing revenue. According to leaders who have brought consultants to their campuses, hospital administration was able to hear “the same message a little better” when it came from a consultant specializing in creating business plans for palliative care rather than when it came from geriatrics staff engaged in palliative care. There was a “180 degree shift,” noted one leader. (See Resources below.)
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Close-up A steady diet of consultants. Dr. Christopher Callahan reported that Indiana University’s geriatrics program used Harvey Cohen, MD, from Duke University as a consultant. Dr. Cohen had “an interest in providing advice and cheerleading for expanding the nation’s aging centers.” In turn, he recommended George Maddox, PhD, from Duke, who focused on Indiana’s aging research initiative. Drs. Cohen and Maddox helped geriatrics leaders understand various developmental phases, starting with the need to build a strong foundation. Their messages included the need for consistent leadership and investment over a long period with incremental growth, and for building on local strengths and local culture. Dr. Callahan recalled that “consultants can also ‘speak truth to power.’ When asked by Indiana’s administrative leadership how long it would take our program to become self-sufficient, Dr. Cohen—director of one of the most successful programs in the country—answered, ‘Never.’ You could have heard a pin drop! However, Dr. Cohen explained what the institution could expect out of this endeavor in the short run, if they wouldn’t saddle it with too many research themes or curriculum development. Although it sounded shocking when he said it, it worked and was extraordinarily important,” he said. Dr. Callahan also noted the contributions of other senior leaders, such as Jeffrey Halter, MD, from the University of Michigan, who served on Indiana University CoE’s external advisory committee for the first few years. |
For a case study of a palliative care consultation, see: Two Struggling Academic Palliative Care Centers Get Management Advice to Help Stabilize on the Robert Wood Johnson Foundation web site: http://www.rwjf.org/reports/grr/046742.htm
Continue to Section 5, Big Picture Perspectives on Expanding Geriatrics Program ⇒
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