Survival Analysis and Kaplan Meier Curves

Faculty Senates Faculty MeetingThe Voice of the FacultySeptember 26, 2013

Joseph Romagnuolo MD MSc FRCPC FASGE FACG AGAF FACP

President, Faculty SenateProfessor, COM (Div of GI and Hepatology)

1OutlineYear in review in the Senate;Ongoing issues involving the Senate;Outgoing FS President's Vision for the Faculty Senate;

Introduction of New Faculty Senate Officers;Incoming FS President's address;

Open Discussion/FeedbackPurposesSummarize what the Faculty Senate does and has doneGather input on how we have handled issues, and how to handle ongoing/future issuesAsk for your support in these ongoing issues, either as a Senator or as a policy-maker outside the SenateIntroduce the incoming Senate officersOverview of the SenateVoice of the faculty 66 senators, 21 alternatesElectoral Units having 50 or fewer qualified (F/T) faculty represented by four SenatorsElectoral Units having between 51 and 100 qualified members represented by six SenatorsElectoral Units with more than 100 qualified faculty members shall have six Senators and elect one additional Senator for every 33 additional qualified faculty members in excess of 100Common myth debunked FS is all non-clinical/non-COM faculty: Not true!COM-CS: 34 senators, 14 alternatesCOM-BS: 6 senators, 2 alternates

3 officers (president, VP, secretary)6 electoral unit leaders (COM-CS, COM-BS, CON, COP, CHP, COD, DLSI)3 standing committee chairs (FIR, IA, CE)4 ad hoc committees (peer-review, clinical affairs, modified faculty, space)Officer elections in July, Senator elections in Sept

The Senate ConstitutionThis Constitution defines the composition of the Faculty Senate, its role in the academic affairs of the University, and the basic principles of self-governance of the faculty of the Medical University of South Carolina as authorized by the Bylaws of the Board of Trustees of the Medical University of South Carolina, Section 6, Article b, August 1976.

Article II Purpose The purpose of the Faculty Senate shall be to act as the sole representative body of the faculty, to receive, organize and, if deemed appropriate, execute business of the faculty that is submitted to it by members of the faculty, the administration, or the Faculty Senate itself, and to represent the views of the faculty to the administration. The Faculty Senate serves as the voice of the faculty. In accordance with its vision and as permitted by state law, the Faculty Senate serves as an advisor to the administration in ensuring the success of the University's mission in teaching, research, and service.

Year in Review from the SenateA full year, indeedChallenges?No protected time for Senate activitiesBusy schedules, volunteered timeNo administrative supportNo financial infrastructural support

Variable recognition of Senates role by some committees and some MUSC entities

Restrictions on use of legal fundHighlights the non-compete:Victory for the Senate and faculty - MUSC-P was successfully persuaded to rescind their revised/expanded restrictive covenant (non-compete) agreement, albeit after threat of injunction by F.Senate legal counselStarted under Paul Jacques as President Survey, use of Legal fundHandled badlyFaculty threatened with termination of MUSC-P pay if they did not sign, within days of receiving the contract faculty resignations occurredNon-compete was misrepresented as part of the university contractChairs misrepresented the contract as better because of smaller radius, smaller penalty, without disclosing/realizing the expanded restrictions (referral base, liquidated damages, any termination, expansion of types of employment disallowed, center of the radius including p/t satellite clinics, etc)MUSC-P refused to work with the Senate to revise language (before injunction) claiming they do not deal with faculty but rather membersSenate represents MUSC faculty; and some of our faculty are your members; nearly all of your members are our facultyUniversity admin did not seem to take joint responsibility or claim jurisdiction to correct the errors, even though our handbook, and our malpractice situation, clearly states the President/MUSC has ultimate power over the MUSC-P entity8Non-compete contdFS still locked out of negotiations and official place on MUSC-boardFaculty made a pitch at TH - just as much effort should be paid to retention as is put into devising a non-competeIt is not clear that this pitch was heard and acted uponNon-compete contdMany of us oppose the concept, other than perhaps of an amortized penalty/payback of recruitment investmentNon-competes can allow administration to invest less in other retention effortsRather there be effort to strive to be the preferred place of employment rather than the only place you can work without leaving townEven when non-enforceable, the threat of our pockets are deeper than yours is powerfulCaged people obsess on leaving, finding a loophole, etcPeople who want/need to leave do not make good faculty members and co-workersMedical providers are people, with families, kids in school, spouses working in town, and cannot easily leave town when MUSC does not work out as an employerSomething becoming widespread does not mean its rightOther HighlightsLegal fund was replenished thank youSpace ad hoc committee (I. Koutolas) was formed because of concerns over PI responsibilities in lab space moves, and clinical space reallocationsGovernance committee (M. Mueller) changed our by-laws to allow officers to be elected a few months earlier than the Senate elections, to allow a transition period passed by BOTOfficers-elect are on executive as non-voting membersBetter continuity of businessHighlights contd F. EvaluationFIR committee (A. Rheingold) proposed changes to the handbook re Faculty evaluation languageRATIONALE: Faculty Handbook section 9.02 Faculty Evaluationneeded revision as current version was not accurate and was vague in its description of evaluation procedures.9.02 Faculty Evaluation CURRENT WORDING:The State of South Carolina requires that all state universities and colleges evaluate faculty performance. In order to comply with this requirement, MUSC has developed a faculty evaluation procedure, which has been approved by the Division of Human Resources of the State Budget and Control Board. Each college of the University has an approved Performance Appraisal form (faculty evaluation). See Appendix 6.05 for copies of these forms. The form is completed annually for each faculty member, and is kept in a permanent file under the purview of the dean or director. The faculty member has a right to full disclosure of the Performance Appraisal.The faculty member is required to sign the appraisal, indicating s/he has read the evaluation form, but has the right to make written comments concerning agreement or disagreement with the evaluation.9.02Faculty Evaluation PROPOSED REVISION:The Medical University requires regular evaluation of each faculty members performance. EachMedical University Collegehas an approvedfacultyperformance evaluation form (Appendix 6.05a).Evaluation is based upon the core faculty responsibilities of teaching, research/scholarly activity, clinical activity, institutional activity, professional growth, and other activity, as appropriate. Any change to performance evaluation form requires concurrence from faculty representatives within each College.Department Chairs or Division Directors must meet at least annually with each of their faculty members to review attainment of goals proposed in the previous year's evaluation, appraise the quality of his/her work, and to establish specific, mutual agreement for the coming years goals. Written justification is required on the evaluation form for unacceptable or marginal ratings. The faculty member has the right to make written comments regarding the evaluation, and to have them included in the evaluation. The faculty member signs the performance evaluation form, confirming that she/he has read the comments of the supervisor.The record of this meeting becomes part of the faculty members permanent record, retained by his/her Chair or Division Director, under the purview of theCollege Dean.Faculty has the right to full disclosure of the performance evaluationand the right to appeal the findings reported in the evaluation (Section 8.01, Faculty Grievance and Appeal Procedure).12Highlights contdFIR (A. Rheingold) reviewed revised COI policy and committee charge documents with minor suggestionsIA committee (A. Begle/T. Brown) new process of tracking approved documents through university hierarchyCE committee (S. Drayton) organized a Promotions and Tenure Workshop (Fall12) and a New Faculty Orientation (NFO) (Summer13)Both well-receivedUnclear whether NFO to be continued by FSHighlights contd- Peer ReviewPeer-review ad hoc committees (C. Davies) recommendations

HistoryFollowing a number of complaints from clinical faculty, the Faculty Senate first examined the MUSC Hospital peer-review system in spring and summer of 2011This included meetings between representatives of the Senate and Dr. Pat Cawley (Medical Executive Director), culminating in some modifications to the published peer-review policyFurther revision was deemed necessary, however, and in November 2011, the Faculty Senate charged an ad hoc committee to investigate the MUSC hospital peer-review process system and to make specific recommendations.The committee considered the AMA document which explains the rights afforded to physicians in the peer-review process by the Health Care Quality Improvement Act of 1986 (HCQIA).

Faculty/Senate Victory - Over a year of negotiations, almost all Senate-approved recommendations have been accepted by Legal Counsel and Danielle Scheurer, and the most recent package is now ready to go back to the Senate for approvalTimeline:October 2012 Recommendations document developed by Senate ad hoc Peer-review committee November 2012 Recommendations document passed by SenateDecember 2012 Recommendations document presented to Medical Executive by Jack CrumbleyJanuary 2013 - Joe Romagnuolo, Jack Crumbley and Chris Davies met with Annette Drachmann and Danielle Scheurer to go over documentFebruary 2013 Written response to recommendations received, but some legal questions still outstanding.March 2013 JC and CD met with DS to go over their initial response. June 2013 Legal opinion issued by AD August 2013 JR, JC and CD met with AD and DS to resolve remaining differencesSeptember 2013 Outcome of negotiations approved by Senate ad hoc Peer-review committee

October 2012 Recommendations document developed by Senate ad hoc Peer-review committee November 2012 Recommendations document passed by SenateDecember 2012 Recommendations document presented to Medical Executive by Jack CrumbleyJanuary 2013 - Joe Romagnuolo, Jack Crumbley and Chris Davies met with Annette Drachmann and Danielle Scheurer to go over documentFebruary 2013 Written response to recommendations received, but some legal questions still outstanding.March 2013 JC and CD met with DS to go over their initial response. June 2013 Legal opinion issued by AD August 2013 JR, JC and CD met with AD and DS to resolve remaining differencesSeptember 2013 Outcome of negotiations approved by Senate ad hoc Peer-review committee

14Bottom Lines:Form letter with no information saying you were being reviewed, is now a detailed half-page summary of the specific incidentDetailed data will be given in 90% of cases within 45d (reportable quality metric) to the accusedDepartmental Peer Review committee, not just the ChairPublished guidelines re ProcessAbility to represent oneselfNo concern prior events N/A to review panelRemoval of COI, permanent voting members (memory), non-overlap between MEC and PRC voting membershipChair does not have submit a letter on your behalf for you to appealAppeal process is now independent from PRC:3-member independent committee consisting of (1) Hospital Chief Medical Officer (2) Highest ranking medical staff physician in the faculty senate (3) a 3rd member dually appointed by the first 2 members

Peer Review RecommendationsComplaint Entry RecommendationsDepartmental PR RecommendationsMedical Staff PR RecommendationsFindings of PR RecommendationsAppeals Mechanism RecommendationsMembership of MS-PRC RecommendationFaculty Education RecommendationRevised Workflow

Highlights contdParking Rate IncreasesInadequate disclosure of 5-year planInadequate justification of how parking structure investments (to increase clinical, research and tuition revenue) that are not returning enough to make up for the investment are being born by employeesCofC parking cheaper, Roper/VA parking freeLack of consensus on whether salary-stratified, rather than value-stratified payment structure is acceptableWe pleaded for further discussion but deniedHighlights contd Legal Fund HomeFS Legal fund:Used to be housed outside of MUSCBrought into MUSC system for ease of accountingObstructions of its use:Need for approval from State Attorney GeneralCapping of hourly legal reimbursement at $150/hrApproval for release of payment by MUSC/MUSC-Legal CounselAction (as opposed to advice) may be difficultMUSC vs MUSCGathered information on the legal and accounting costs of having a separate, off-campus legal fundFeasible for new donations; difficult to move donations already in the MUSC account to an outside accountExecutive committee passed a motion to pursue a legal fund outside of MUSC walls

Highlights contd MDM, 2FA Mobile Device Management, 2-Factor AuthenticationSought FS input early one (~1 y ago)Concerns expressed, but importance understoodCommunication/roll-out not idealPosters/Sign-up desks before dissemination of informationRemain concerns re privacy:Phone trackingApps trackingPhone content wipingRemain concerns re practicality:In off-site meeting, out of country, etc getting phone call to access emailRemember, you can opt outHighlights contd COM compensation proposal COM electoral unit Leader (A. Smolka) and the Executive summarized the faculty concerns at a Town Hall, and Constructed a survey: 337 faculty responded (~50% of clinical COM)Plus 150+ written comments for each of 2 questions re the advantages of the model, and suggestions for improving the model these were forwarded to the Dean.Survey results:Revision of COM salary structure is necessary and beneficial for the institution Agree (96, 28.4%), Disagree (152, 45%), Don't Know (90, 26.6%) Missing 1 (0.3%)How do you expect your salary to change under the new plan? Increase (8, 2.4%), Decrease (209, 62.4%), No Change (118, 35.2%) Missing 4 (1.2%)The new compensation plan will likely be more standardized and transparent than the existing models Agree (86, 25.5%), Disagree (159, 47.2%), Don't Know (92, 27.3%) Missing 2 (0.6%)I believe that faculty was adequately consulted during the development of the new compensation planAgree (15, 4.5%), Neutral (48, 14.2%), Disagree (274, 81.3%) Missing 2 (0.6%)My Chair and/or Division Director has detailed, or will detail soon, the metrics he/she will apply in determining my 2014-15 compensation Agree (152, 45.2%), Disagree (98, 29.2%), Don't Know (86, 25.6%) Missing 3 (0.9%)I am confident that metrics devised for my job description will be relevant and achievable for me Agree (77, 22.9%), Disagree (146, 43.5%), Neutral (113, 33.6%) Missing 3 (0.9%)

Highlights contd COM compensation proposal Survey results contd:In your opinion, how long before implementation of the new compensation plan should all performance metrics be announced by COM or Department Chairs? 1 month (11, 3.3%), 2 months (9, 2.7%), 3 months (26, 7.8%), 6 months (287, 86.2%) Missing: 6 (1.8%)In your opinion, what effect will the new compensation plan have on the ability of MUSC to recruit qualified faculty? Easier (7, 2.1%), More Difficult (289, 86.5%), No Effect on Recruitment (38, 11.4%) Missing: 5 (1.5%)What impact will the proposed compensation plan have on your continued employment at MUSC? Increase the likelihood of remaining (8, 2.4%), Decrease the likelihood of remaining (226, 69.1%), Has no impact on my decision to remain at MUSC (93, 28.4%) Missing: 12 (3.5%)Individual component concerns:>80% rated 20-40% at risk and at risk subject to institutional funds avail and performance impacted by things out of faculty control as high concern>2/3 rated lack of specific rules re timing and metrics and institutional metrics used as high concernConcessions:64-83% ok with each of the alternate components proposed by SenateOnly 13% felt incentive-based compensation was COMPLETELY unacceptableFaculty feedback.Quotes (re FS response to COM Compensation Plan TH):Just wanted to send a quick note to thank you and the faculty executive committee for an excellent and measured response to the clinical faculty compensation plan. As you have outlined the plan is a disaster and I believe will potentially cause a mass exodus of the clinical faculty.I would like personally to thank you folks for this email, which is exemplary in being candid, informative, clear, and balanced. Thank you for all of the hard work you are doing on behalf of the MUSC faculty. I really appreciate all of your efforts.Many thanks for your email detailing the Faculty Senate executive response to the COM 2014 clinical faculty compensation plan. As was the case with the non-compete 'agreement' of 2012, the administration's hubris in proposing the compensation plan is shocking. I agree with each of your itemized responses and thank you for addressing the larger spectrum of interrelated problems rather than only the most vulgar aspects This is fantastic. Thank you for your hard work!I really, really liked the statements here. They are well written, cogent arguments, and speak for a real set of truths.Although the administration shenanigans do not affect me anymore, I want to congratulate you for your efforts on behalf of the clinical faculty. I just wanted to thank you for representing the faculty. The communication you have instituted this year is unparalleled in my 10 year experience here. You have been very transparent, and for those of us who are not always able to attend these meetings or catch up on the videos, I wanted to say thank you for your efforts and your service to us. It is greatly appreciated.Ongoing IssuesUnfinished businessOngoing Issues Industry Relations PolicyFIR and IR subcommittee (N. Sutkowski) reviewed a draft of Industry Relations Policy, which was rejected. Why? Examples:Restriction on earning money on personal time to only things of academic purposes; activities could not be just for financial gainVague definition of industry which included professional associations, non-profit organizations, etcVague wording may be prohibited, may be allowedRestrictions on faculty being used by industry to get feedback for marketing, product promotion, etc or demonstrating a productRestrictions on CME, slides, etcRestrictions on activities outside academic settingRestrictions on consulting for financial institutions, legal, etcWorking group organized by the Provost, with FS representation (N.S.)Newer version still had issues:Department approval of off-hours consulting activitySeveral iterationsPre-final version now submitted to Exec and Senate for reviewOngoing Issues- Post-tenure reviewFIR committee (A. Rheingold) proposed changes to the handbook re Tenured Faculty Post-tenure review (Section 6.05)Rationale:1.FIR would like to strengthen Facultys involvement in the development of faculty goals that will subsequently be the topic of evaluation, therefore wording to includemutual agreementbetween faculty member and supervisor was added. This will allow faculty a stronger voice in negotiating behaviorally specific goals and related duties for the upcoming year that will be evaluated. Given the recent financial strain and pressure for faculty to assist with funding salaries, by adding mutual agreement would allow faculty to help determine goals evaluated for post-tenure review that would be within their direct control.2.There is no single way of protecting ALL faculty members within a standard evaluation procedure. However, FIR believes that faculty evaluation would be strengthened by faculty assisting in determining weights of applicable categories to be evaluated. Further, benefit/costs were weighed for keeping current wording related to evaluation based upon majority of categories versus changing evaluation based upon weighting of categories. a.Majority of categories:Benefits: Allows for evaluation across categories to be even, therefore if there is a deficit in only one category, post-tenure review would not be threatened.Costs: Does not distinguish between primary and secondary responsibilities (for example, if a faculty members main responsibilities are clinical and excels in clinical evaluation, but is evaluated poorly in teaching which only encompasses a minimal amount of time, the faculty member would still be placed up for post-tenure review). May be difficult to address if faculty has even number of applicable categories. b.Weighting of categories:Benefits: Allows for faculty to be evaluated based upon main responsibilities, therefore if there is a deficit in secondary responsibilities, post-tenure review would not be threatened. Allows for choice of equal weighting (i.e., majority of categories).Costs: Folks may view weighting equivalent to funding, which is not the intention. Opportunity exists for faculty to become bad citizens for the university in that s/he may devote themselves to only one aspect of their work.

24Ongoing Issues- Post-tenure reviewProposed Changes:6.05 Post Tenure Review ORIGINAL WORDINGEach tenured faculty member undergoes annual reviews. The faculty members annual review is integral in determining performance. The Department Chair/Division Head will use the five-point scale for annual reviews (unsatisfactory, marginal, satisfactory, very good or outstanding), but for the purposes of reporting to the Provosts Office, overall performance will be summarized on a three-point scale (superior, adequate, inadequate). If a faculty member is rated as below satisfactory in a majority of applicable performance categories on the five-point scale, they will receive an inadequate overall evaluation on the three-point scale. Each year, the faculty member must be made aware of specific requirements to attain an adequate annual review so that he or she is given the chance to meet these specific requirements. 6.05 Post Tenure Review RECOMMENDED WORD CHANGESEach tenured faculty member undergoes annual reviews. The faculty members annual review is integral in determining performance. The Department Chair/Division Head will use the five-point scale for annual reviews (unsatisfactory, marginal, satisfactory, very good or outstanding), but for the purposes of reporting to the Provosts Office, overall performance will be summarized on a three-point scale (inadequate, adequate, superior). At least once per year, the weights of the applicable categories will be decided by mutual agreement between the faculty member and the Department Chair/Division Head. If a faculty member is rated as below satisfactory in the weighted overall majority of applicable performance categories on the five-point scale, they may receive an inadequate overall evaluation on the three-point scale. Each year, the faculty member and Department Chairman/Division Chief must agree on the specific requirements needed to attain an adequate annual review so that he or she is given the chance to meet these specific requirements.25Ongoing issues- Relationship with MUHA/MUSC-PFS involvement in MUHA and MUSC-P inadequateA Faculty and Clinical Leadership Relations Committee is being considered by Governance CommitteeRepresenting faculty interests at the Medical Executive Committee (MEC) of the Hospital/MUHA, reporting relevant upcoming changes to the Senate Executive, through an appointed active Medical Staff clinical faculty representative from FCLR, who will attend MEC meetings.Representing faculty interests at MUSC-Physicians Board meetings, reporting relevant upcoming changes to the Senate Executive, through an appointed MUSC-P member clinical faculty representative from FLCR, who will attend MUSC-P meetings.Reviewing changes in MUHA/MUSC-P Policies that affect faculty rights, freedoms and ability to carry on their University duties; policies would ideally be sent for Senate review by MUHA/MUSC-P, or alternatively by interested Medical Staff or MUSC-P clinical faculty who become aware of such a change.Determining faculty impact by policies implemented by MUHA/MUSC-P through survey, faculty assembly, or other meansLobbying for change in policies implemented by MUHA/MUSC-P that are not in facultys best interests

Ongoing issuesGovernance committee definition of % for full-time statusChoosing a %, confirming a list of faculty meeting eligibilityEmerging Performance-Based compensationCOM X-Y-Z Model, SuccessFactors, etcMoving FS Legal Fund outside MUSC passed by FS execPolicing and assessing success of Funds FlowFaculty privacy vs patient privacy - MDMPolicy Development and University/ Clinical Leadership structural changes outside the SenateDefining faculty input in handbook and in university cultureSpace allocation, reallocationCofC collaboration/mergerMUSC University President Search (FS rep)Outgoing Presidents Vision Opinions on Direction and EmphasisWhere should we go?Funding for the SenateAll 3 entities MUSC, MUSC-P, MUHA NEED to have Senate involvementReprimands, from the highest level, of university/faculty policy development outside the Senate, with supervision of this by the MUSC entityMUSC President/Admin has to clarify their oversight and power of these clinical entitiesCaution re occult taxes - MUSC/MUHA/MUSC-P make investments, but is it appropriate to tax faculty with a new fee if investments do not pan out?MUHA/MUSC-P are beginning to make decisions re efficiency and expansion that may potentially hurt educational and research goals of MUSCPolicy decisions that threaten other MUSC missions (e.g. efficiency threatening student/resident education) need to be reported promptly to the SenateEar to the ground re new Compensation/Evaluation modelsBeware the new non-competeCareful not to allow post-tenure review to become over-used and diminish the meaning of tenureReport and oppose any intimidation that Senators face in doing their jobContinue to have a strong, united voice regardless of whether the issue is in YOUR college, or affects YOUWe are weakest when dividedEmphasis on recruitment/retention of faculty needs to be pushedWorries me that current strategic plan may not be congruent with this

Thank youFacultyFaculty SenatorsExecutive CommitteeDr. Sothmann and other administrators that have worked with us over the yearMy fellow officers Jack Crumbley (VP), Laura Carpenter (Secr)I apologize for explicitly indicating I was not available to run for the customary second termAppreciate the kind words, encouragement to continue, etcIntroduction of New FS OfficersNew blood, New energyNew FS Officers (effect. 0ct8, 2013)President:Tom Smith PhD, Professor, DLSI

Vice President:Angela Mund CRNA DNP, Assistant Professor, CHP

Secretary:Amy Thompson PharmD, Assistant Professor, COP

Incoming Presidents AddressDr. Tom SmithOpen Discussion and FeedbackOpen Mike