Facing complex issues that cut across academic health centers, departments must now become more flexible and more interdependent. The real challenge is to take a department-oriented institution and integrate it such that it allows interdepartmental and interdisciplinary programs to emerge and be successful. This new emphasis on cooperation and interdependence is readily apparent in much of the work being performed by the department's vice-chairs. As vice-chair for affiliations and outreach, for example, Stiles works closely with officials from the Medical Center's Affiliations Office and community hospitals and physicians to create an integrated provider network throughout the region. Building such a regional network of affiliated providers, though, requires cooperation not only between Duke and community physicians and hospitals, but also within Duke, among the various Duke departments, asserts Stiles, who also oversees the affiliations effort for the Private Diagnostic Clinics.
Every component is important.
If I go out and offer employers the best cardiovascular services in the world, but they have to contract with another hospital for general surgery, and another hospital for pediatrics, then they're not going to be interested. What it comes down to now is that we are only as strong as our weakest link, so that if any service is not providing quality care and user-friendly service, then that has to be fixed because it impacts on the whole rest of the operation. The same need for cooperation between and within departments is also instrumental to Duke's efforts to build a large-scale primary care practice. The department's existing primary care capability was stretched to the limit last year when the University switched its employee health plan to Duke Managed Care. Of the 33,000 Duke employees and family members who signed up for Duke Managed Care, about 12,500 chose doctors in the general internal medicine practice as their primary care provider, virtually double the 6,500 patients formerly seen in the general internal medicine clinic.