Fontenelle Forest Nature CenterFriday, March 25, 2005 7:30 a.m. – 3:00 p.m.

2005-2008 Strategic Planning Retreat

Rubens J. Pamies, M.D., FACPRubens J. Pamies, M.D., FACPModeratorModerator

Staying Competitive Staying Competitive in thein the

Global Health Care Global Health Care MarketMarket

Mr. Joe B. GrahamMr. Joe B. GrahamChief Operating OfficerNebraska Medical Center

Rodney S. Markin, M.D.Rodney S. Markin, M.D.Associate Dean, COM

Mr. Nizar MandaniMr. Nizar MandaniExecutive director

Sheila Ryan, PhDSheila Ryan, PhDProfessor, CON-Parent-Child, Admin Ed & Science

PanelistPanelist

American International Health Allianceadvancing global health through professional, volunteer, peer-to-peer partnerships

Donald W. Fisher, PhDChairmanPresident and CEOAmerican Medical Group

Association (AMGA)

Roger J. Bulger, MDSecretaryPresident and CEO Association of Academic Health Centers (AHC)

Larry S. Gage, JDPast ChairmanPresident National Association of Public Hospitals and Health Systems (NAPH),and a partner at Powell, Goldstein, Frazer & Murphy, LLP

DennisP. Andrulis, MPH, PhD Research Professor Department of Preventive Medicine at the State University of New York Health Science Center/Brooklyn

Daniel P. Bourque, MBASenior Vice President, System Operations VHA Inc.

Henry A. Fernandez, JD Vice President and CEO New York State Historical Association & the Farmers' Museum in Cooperstown

SheilaA. Ryan, PhD, RNProfessor University of Nebraska Medical Center College of Nursing

Louis W. Sullivan, MD President-EmeritusMorehouse School of Medicine

Alan Weinstein, MBAConsultantto healthcare companies

Board of DirectorsBoard of Directors

 International Health Medical Education Consortium

Sara E. Pirtle, MBASara E. Pirtle, MBA

Update Co-Editors International Studies and Programs

University of Nebraska Medical Center985735 Nebraska Medical Center

Omaha, NE  68198-5735

Tel: (402) 559-2924 / Fax: (402) 559-2923sepirtle@unmc.edu

GLOBAL INVOLVEMENT OF GLOBAL INVOLVEMENT OF AHC’sAHC’s

AHC’s is Growing RapidlyAHC’s is Growing Rapidly

Some Some recent recent examples examples include:include:

Columbia Ben Gurion University

N.Y.U. Sackler

Cornell Quatar

Duke Singapore

Harvard Macy Institute

Multiple countries including Germany

Dartmouth Copenhagen

John’s Hopkins Several Asian countries

University of Minnesota SON

Central Asia Republic

And And many many more . . .more . . .

GLOBAL HEALTH/PARTNERSHIP GLOBAL HEALTH/PARTNERSHIP UNMC , NMC, UNeMed, IMAUNMC , NMC, UNeMed, IMA

4646 collaborative partnerships with medical institutions in

2525 countries

Export Control RegulationsExport Control RegulationsExport Control RegulationsExport Control Regulations

Commerce Department Export

Administration Regulation

Where are we now?

Where do we want to be in the future?

Next Steps Next Steps

in our global presence…in our global presence…

STAYING COMPETITIVE IN THE STAYING COMPETITIVE IN THE GLOBAL HEALTH CARE MARKETGLOBAL HEALTH CARE MARKET

Mr. Nizar G. MamdaniMr. Nizar G. MamdaniExecutive Director of International Healthcare

Nebraska Medical Center

GLOBAL HEALTHCARE REALITIESGLOBAL HEALTHCARE REALITIES

1.1. The revolution in communications technologies has raised our hopes that earth's current patchwork of countries may yet become a true global community. The growing globalization of businesses and enterprises has already begun

2. One major arena that stands to gain the greatest benefit

from globalization is healthcare

3. Key components of understanding the dynamics of global health systems are: policy, financing, education, organization, leadership, and management

4. Regardless of the country, the health sector generally responds to the same political, social and financial pressures as other industries

US GOVERNMENT POSITIONUS GOVERNMENT POSITION

1. The US Government, NIH, AHC, WHO, World Bank – all deliver the same message that the Global Health Care is vital to the growth and stability of the countries and that the developed nation have a social and sometimes a selfish reason to help in the promotion of decent healthcare

2. USAID Director Natsio’s speech in Spain this month reinforced US’s committed $16 billion to country stabilization programs

What Other US Medical Institutions Are DoingWhat Other US Medical Institutions Are Doing

1.1. Realizing the in inevitable progression and opportunities in the Global Healthcare Markets, most major medical institutions have substantial commitments to their international programs

2. Some institutions have also already taken their programs overseas in light of the post 9/11 situation about visa in the US: John Hopkins in Singapore, Thailand, Panama, China Harvard in India, United Arab Emirates, Japan Cornell in Qatar Emory University in India

3. GLOBAL-HEALTH is a reality today-UNMC needs to make a move now to secure a prominent position in this important market place and attain a long-term global presence

Current Handling of International Initiatives at UNMCCurrent Handling of International Initiatives at UNMC

1.1. Several departments at UNMC are pursuing international activities in a variety of ways - there are no cohesive institutional policies or objectives

2. There is no ongoing sustainable follow up

3. Counter-productive to pursue international programs without adequate planning and follow up

4. International programs are discouraging because they take a longer time to mature - can only be effectively achieved through institutional commitment, persistence and support

Take Advantage of International Assets at UNMCTake Advantage of International Assets at UNMC

Partnerships with 76 medical institutions in 28 countries

Over 400 professional researchers/students from 40 countries

Provide training to 100s of international professionals

Hundreds of international patients have come to the Medical Center for their treatments

Have created a dynamic 2nd opinion consultation program, currently being utilized by over a dozen global institutions

Have signed significant cooperative agreements with key institutions in Japan, India and China for educational and research initiatives

Have people with great international contacts and network

Proven viability - have generated millions of dollars for the Medical Center in patient billings

Possible Areas of Global Opportunities for UNMC Possible Areas of Global Opportunities for UNMC

1. UNMC's Research program expansion in key countries

2. Foster strong relationships for UNMC's Biotech initiatives/markets

3. Promote UNMC CON's RN to BSN programs internationally

4. Create a Telehealth Center of Excellence in collaboration with the Peter Kiewit Institute of Technology & UNMC's Allied Health Dept.

5. Take advantage of USAID’s new Country Stabilization programs, especially in Haiti, Somalia, Iraq and Afghanistan

6. Take advantage of professionals on our campus who have very valuable relationships and networks to help us achieve our goals

Benefits to UNMCBenefits to UNMC

1. Make UNMC's global presence a REALITY

2. Research collaboration opportunities

3. Initiate BioMed programs to enhance international reputation and revenue

5. Strong international presence will enhance UNMC’s reputation, help attract top researchers/professionals to our institution

6. Establish UNMC's Educational and TeleMed Programs globally

7. Be a pioneer to take up the much needed standardization of the international medical education accreditation

8. Opportunities for UNMC faculty, physicians, healthcare professionals, researchers and students to experience medical diversities in other countries

9. Faculty and students exchange programs in over two dozen countries

10. Build professional and personal international relationships

11. Fulfilling a social commitment to help the less fortunate countries through training and assistance programs and participating in Federal programs

12. Will be financially quite lucrative

CONCLUSIONCONCLUSION

1. Global healthcare has become a reality to reckon with

2. UNMC has the assets and the stature to have a positive impact in the Healthcare Globalization

3. Priority must be given to developing a viable infrastructure at UNMC that can follow through on international developments on a sustained basis

4. Important to embark on a coherent program to fulfill the social needs of helping the less fortunate nations – will also give us an opportunity to closely work with international NGO’s and Federal programs

5. The program will significantly raise UNMC’s standing and reputation in the US and Global healthcare arena

6. A well conceived international program will be self-sustaining, revenue generating and gratifying undertaking for UNMC

Global and International Global and International HealthcareHealthcare

Sheila Ryan, PhDSheila Ryan, PhDProfessor, CON-Parent-ChildAdministration Education & Science

The Globalization Of The Globalization Of Society Places Increasing Society Places Increasing Demands On Us ToDemands On Us To

Understand differing perspectives, traditions, religions, politics, cultures, health behaviors and health systems.

NURSINGNURSING, , as the largest health workforce, as the largest health workforce, is essential to add value to global is essential to add value to global partnershipspartnerships

• Collaborate with international research to promote health and well being and better manage chronic care for all

• Examine lessons of emerging and remerging threats to international health

• Reduce burden of disease and disability

UNMC -UNMC - CON asCON asThe The Global Leader in Global Leader in International Nursing EducationInternational Nursing Education

•Leader in distance education•Leader in instructional technology•Leader in online course access

•Leader with international “connections”

India

China

Jordan

Mexico

Leader in Leader in Online Program AccessOnline Program Access

• RN-BSN• BSN• MSN

8 specialties, 2 with combined and integrated areas

CE models

Benefits to UNMC

• Increase cultural sensitivity of faculty/students• Internationalize our curriculum• Increase faculty and student exchanges• Global classroom model for global outreach• Add to research site and samples• Multidisciplinary international doctoral program• Additional international students to all programs

• -------------------------------------------------------------------------------------------------------------------------------------------------------------

Profitable and Cost-Effective Profitable and Cost-Effective Online Tele-educationOnline Tele-education

By 2010• Increase enrollment by

1500/year from five country• New financial models: Cost

plus • High Revenue Product with

Low Cost Risk• Partner with international

societies and organizations

Leading Infectious Leading Infectious Causes of Death Worldwide, 2001Causes of Death Worldwide, 2001

CauseCause RankRank Estimated Number of Estimated Number of DeathsDeaths

Respiratory infections 1 3,871,000

HIV/AIDS 2 2,866,000

Diarrheal diseases 3 2,001,000

Tuberculosis 4 1,644,000

Malaria 5 1,124,000

Measles 6 745,000

Periussis 7 285,000

Tetanus 8 282,000

Meningitis 9 173,000

Syphilis 10 167,000SOURCE: WHO, 2002b

Global PartnershipsGlobal Partnerships of dialogue, collaboration and of dialogue, collaboration and shared planning can:shared planning can:

• Decrease international nursing shortage

• Increase professional standards and stature of nursing

• Prepare nurse leaders for emerging healthcare roles

International International BusinessBusinessStrategic Strategic FitFit

Mr. Joe B. GrahamChief Operating OfficerNebraska Medical Center

International Business

Strategic Fit

How does it advance our mission

For

Education?

Research?

Service?

Outreach?

As positioned today

International Business can advance the

Mission(s) at the margin.

If embraced more fully, it has the potential

to be a separator in all of our missions.

However,

it must produce

cash.

Low High

High

Pro

fit

Mission

Cash Cow

Houdini

Winner

Keeper

Low High

High

Pro

fit

Mission

Cash cow

Houdini

Winner

Keeper

Low High

High

Pro

fit

Mission

X

Cash Cow

Houdini

Winner

Keeper

Low High

High

Pro

fit

or

Mis

sion

Risk (legal, distraction, etc.)

Good Risk

Low Risk

Calculated Risk

Bad Risk

Low High

High

Pro

fit

or

Mis

sion

Risk (legal, distraction, etc.)

Good Risk

Low Risk

Calculated Risk

Bad Risk

Low High

High

Pro

fit

Risk (legal, distraction, etc)

X

Good Risk

Low Risk Bad Risk

Calculated Risk

Low High

High

Mis

sion

Risk (legal, distraction, etc)

X

Requirements for Success

• Sound Plan

• Commitment

• Time / Patience

• Adaptability