What is a medical school?
If that is a dumb question, why is it that the current websites for five major allopathic medical schools (of the 141 total) offer neither a statement of “vision” or “mission” as suggested in the LCME requirements for accreditation? Ten do not offer a mission statement; 54 percent do not describe a “vision” for the school; and 70 percent do not state the values or “guiding principles” for the institution.
These facts do not appear to interest Gunderman and Lynch, whose advice to prospective applicants is to ignore the usual public data in favor of a “biopsy” of the “culture” of the schools that interest them. The questions in their proposed biopsy suggest that the procedure only can be done on site by the student. Neither Gunderman (professor of radiology at Indiana University), Lynch (assistant dean of admission at Florida), nor any of first 14 people to comment on the article suggested that it might be useful for prospective applicants to read what the schools say about themselves on their websites.
Does it matter whether organizations say to themselves and others what they want to create (vision), why they exist (mission), and how the organization works (values/goals)? Of course it does, but medical schools are somewhat insulated from the reality of the marketplace: Essentially there are a fixed number of first-year positions, at least two qualified applicants for each of them, and an average of 14 acceptable schools per applicant.
Insulation from the market is not the case for graduate medical education, research (of any kind), or patient care when a competitive edge in the respective markets has been created by an institution’s store of professional intellect.
It is interesting that the LCME, in its “Functions and Structure of a Medical School,” speaks to “vision, mission, and goals” (in that order) while noting that there may be appropriately “diverse institutional missions.” At its core, however, in order to gain and hold LCME accreditation, a medical education program must “provide assurances that its graduates exhibit general professional competencies that are appropriate for entry to the next stage of their training and that serve as the foundation for lifelong learning and proficient medical care.”
“Vision” cannot be imposed from above; it is a commitment that must be shared by all who work for the organization—from governance and executive leadership down to the people who most frequently interact with students, patients, faculty, and other “customers” in the process of carrying out the organization’s work. For example, “perfection” is a vision, as is “universal satisfaction.” “World-class” is not a vision, nor is “best” (in a geographic area) because they imply mere acceptance of being among the members of a peer group. If it takes 25 to 50 years to attain a vision, as many leaders and scholars say, one of the reasons is that the vision has to be sufficiently satisfying and important that new as well as existing employees will make a commitment to it and not just be compliant in accepting something proposed by others.
“Mission” answers the question of the purpose of the organization: Why does it exist? The core mission of medical schools is undergraduate medical education, underpinned inextricably by research and patient care. Basic, clinical, and translational research, and increasingly health services research, have been the province of medical school faculty: another mission supportive of undergraduate medical education, but not a primary mission for a medical school (even though 13 of them list “research” first). Similarly, for patient care, eleven schools list it first.
“Increase diversity of the physician workforce,” “reduce/eliminate health care disparities,” “improve health/lives” (usually, but not always, for a defined geographic area), “transform health care,” and “create the future of medicine,” are also listed among many so-called missions, rather than being recognized as “values” that define how the organization works.
“Values,” also referred to as “core values” or even “processes,” appear on the websites of less than a third of the medical schools. Yet values set forth what is appropriate or inappropriate with respect to what the organization and the individuals within it do and how they do it. Values provide the framework for the “self-motivated creativity” or “responsible entrepreneurialism” of individuals at the “care-why” level of professional intellect. In an important sense, these individuals become self-managing because they have committed to, or taken ownership of, the organization’s vision and know how their contributions will help move the organization toward achieving it. Within that framework, their individual incentive and reward is a high degree of autonomy within organizations characterized by decentralization of authority.
Why are vision, mission, and values important? It is virtually impossible to effectively lead and manage an organization that does not have them. Without them, any path is a good path, regardless of where it leads. Without them, any applicant is a good recruit. Without them, student, faculty, and staff have no guideposts or milestones by which to measure their own success, or the institution’s progress toward its vision. On the other hand, perhaps it is better to have no statements of vision, mission, and values than for them to have the appearance of being spewed from a buzz-phrase generator as some do.
—James E. Lewis, Ph.D., is an independent consultant to departments and schools of medicine, and teaching hospitals. He served as Deputy Dean for Operations and Vice President for Academic Administration, The Mount Sinai School of Medicine and Medical Center, and Senior Executive Officer, Department of Medicine, University of Alabama at Birmingham. His quarterly column, “Pattern Analysis,” appears on Wing of Zock. He can be reached at firstname.lastname@example.org.