At the request of Governor James E. McGreevey, the Commission on Health Science, Education, and Training (the Commission) has assessed medical and allied health care education in the state and formulated recommendations designed “to enhance the quality of education, to increase their overall competitiveness as institutions of health care learning, and to foster healthy synergy amongst these institutions.” Based on this assessment, the Commission hereby submits to the Governor this Report of The Commission on Health Science, Education, and Training (the Report).
With advances in knowledge, technology, and increasing national wealth there has been expansive growth of health care institutions, such that medical care now constitutes approximately 13 percent of the American economy.1 Moreover, health research and education reach more and more deeply into many areas of knowledge from physics, biology and the mathematical sciences to the behavioral sciences, engineering, business, philosophy and history, among others. The reach of health across research and scholarship is increasingly illuminating the determinants of health and providing challenges and opportunities for scholars in a wide range of disciplines and schools to develop theoretical and analytic perspectives in their own areas of knowledge and to take advantage of research opportunities in health related areas. In such diverse fields as the material sciences, artificial intelligence, psychology and ethics, increased access to medical settings and collaboration with health scientists provide extraordinary opportunities for synergy.
Because the University of Medicine and Dentistry of New Jersey (UMDNJ) is the only provider of medical education and a major provider of allied health education in the state, it was initially the focus of the Commission’s work. However, it soon became clear that understanding the full potential of research and clinical developments in medical science and technology required a more far-reaching inquiry into synergies available through potential alliances outside the health sciences university. With the Governor’s consent and consistent with Executive Order No.14, the Commission thus conducted a targeted analysis of the quality and systems of Rutgers, The State University of New Jersey (Rutgers), with focus on its health science and related offerings. In making its recommendations, the Commission strived to assess the impact of our recommendations on the comprehensive educational enterprise as well as the health sciences.
Responding to a specific request from the Governor, the Commission also summarized national trends in hospital ownership and best practices and makes several overarching recommendations regarding University Hospital in Newark.
Our recommendations emerged as we analyzed publicly available information, benchmarked major quality-related measures; visited top schools nationwide; interviewed UMDNJ and Rutgers leaders and faculty as well as New Jersey Institute of Technology (NJIT) leadership; sought community input through public hearings; and leveraged the expertise of Commission members, many of whom have managed universities, health schools or hospitals. In combination, these activities enabled the Commission to evaluate the various accomplishments and inherent shortcomings of the existing institutions.
Based on our assessment, the Commission recommends that the state:
The Commission separately examined the current ownership structure of University Hospital in Newark. The Commission recommends that the university maintain ownership of the University Hospital to best carry out the academic mission of the New Jersey Medical School and to ensure high quality ongoing service to the Newark community.
The remainder of this Executive Summary describes – in brief – the findings
that influenced these recommendations and our rationale in making them.
FINDINGS INFLUENCING THESE RECOMMENDATIONS
The Commission’s assessment of UMDNJ
At UMDNJ, whose eight schools enroll approximately 4,700 students, the Commission found that – despite significant strides in recent years – the goal of excellence has not been achieved. For example, academic quality at UMDNJ’s allopathic medical schools, the Robert Wood Johnson Medical School and the New Jersey Medical School, is at or somewhat below the national average and significantly below the top 10 state medical schools in the country on a number of parameters such as student and faculty metrics, residency programs (with some exceptions), and the research enterprise. However, all the UMDNJ medical schools, including the School of Osteopathic Medicine, distinguish themselves on community service for which the Commission wishes to commend them.
Similarly, national comparisons reveal average rankings, in general, for other UMDNJ schools including the School of Osteopathic Medicine, the Graduate School of Biomedical Sciences and the Nursing School, though each has distinguished itself in specific ways detailed in the Report. The New Jersey Dental School attracts a diverse cadre of students who perform at or slightly above national averages. Few nationally comparable metrics are available for the new School of Public Health. The School of Health Related Professions has a strong track record in community collaborations and service but again collects few quality metrics to permit comparison.
In addition to assessing quality of academic offerings at UMDNJ, the Commission examined the university system itself, which is critical to creating a quality academic experience. We found that the current centralized system of governance constrains the ability of the campuses and schools to function optimally – both from an academic and operational perspective. School leaders and faculty expressed concern with a “one-size-fits-all” vision, which does not focus on defined areas that would be the basis for a national reputation. This centralized governance makes the UMDNJ system unique in that it is the only multicampus health science university in the country.
In addition, no top universities with medical schools on multiple campuses are administered centrally – rather, co-located schools report to a campus president or chancellor. This UMDNJ system also results in an opaque and complex administration that hinders effective research grant management, knowledge sharing, budgeting, student services, and other processes. This is in stark contrast to other outstanding systems where campuses have significant autonomy in determining their direction and in administration. The Commission believes that this structure permits local accountability, greater responsiveness to school and community needs, and increased campus entrepreneurship.
The Commission’s assessment of Rutgers
A similar, although less intensive, assessment was carried out of Rutgers’ health science offerings and its institutional quality. This effort revealed that the quality of Rutgers’ educational programs is good overall and excellent in several specific areas. However, it is the view of Rutgers’ faculty and administrators that Rutgers’ national and local reputation does not adequately reflect the school’s true academic quality and future potential. Many see the addition of a medical school and other health schools as an asset that would contribute to the visibility of its reputation, increase educational and research opportunities for undergraduate and graduate students, and enhance the quality of faculty and students attracted to the University in many areas of study.
Overall Rutgers’ academic quality is well above the national average for state schools, though below the top state schools. The New Brunswick campus is ranked 20th among state universities for undergraduate education. Notably, several of its health sciences institutes and departments are nationally renowned for the quality of their faculty and research, but overall faculty distinctiveness is below the top state schools. The school attracts strong health-sciences graduate students and has several nationally recognized non-health graduate programs.
The Commission noted, in particular, that Rutgers has doubled its external
research funding in the past 10 years, with most of this funding awarded
to the New Brunswick campus. As with UMDNJ, the Commission also assessed
Rutgers’ strategic vision, structure and governance, leadership, processes,
and funding. Among other things, this assessment revealed several
academic collaborations between Rutgers and UMDNJ in New Brunswick and
Newark, although the Commission frequently heard frustrations with various
administrative matters related to these partnerships. Commission
also heard that recruiting top faculty in some science areas is difficult
in the absence of a medical school. In terms of funding, the Commission’s
analysis indicates that state support for Rutgers is on the low end of
the national range, lags the Higher Education Price Index, and is a decreasing
share of the state budget.
RATIONALE FOR THESE RECOMMENDATIONS
While the attached report documents all the factors that shaped these recommendations, the Commission wishes, with this Executive Summary, to highlight the rationale underlying these recommendations.
Creating a single New Jersey research university system
The Commission believes strong synergies can be gained by combining UMDNJ, Rutgers, and NJIT given the geographic proximity of the campuses, the strong undergraduate student pools, complementary graduate programs, similar infrastructure (e.g., labs and equipment) and existing scientific collaborations. The establishment of three universities whose schools and programs with similar offerings could capitalize on academic synergies, build on existing collaborations, and share a single administrative and operational umbrella under the unified structure. Our vision addresses many of the structural issues identified at UMDNJ and creates a platform for building excellence in education in New Jersey. While our initial focus was on the health sciences, the Commission believes that programs in areas outside the health sciences will not experience negative effects from the restructuring. On the contrary, they have much to gain from this restructuring in terms of improved administrative processes and increased prominence of the university system.
In addition to promoting academic excellence, the structure of UNJ would also address many of the system issues the Commission identified at UMDNJ. Below we list some of the main benefits that UNJ offers.
Benefits impacting the whole university include:
UNJ STRUCTURE AND UNIVERSITY PROFILES
The Commission was inspired by the structure of the great state university systems, which have the university as the center for most academic and administrative powers. The campus-based structure permits these systems (e.g., University of California, University of Texas, and others) the freedom to build local visions of excellence, thereby enhancing the whole system.
Based on the example of top university systems in the country, the Commission recommends that the three universities of UNJ have significant academic and administrative autonomy. The primary reporting would be to the university president with oversight from the Office of the University Chancellor on issues such as government relations, and system-wide coordination. A Board of Regents would have ultimate governance authority over the system. We would advocate that the Office of the University Chancellor be located in Trenton to maintain neutrality vis à vis the universities.
A potential structure for UNJ is shown below:
While the detailed composition of each UNJ university would be the province of the Review and Implementation Task Force, we outline the basic facts about each university and potential schools, based on current composition.
THE COMMISSION’S REVIEW OF THE UMDNJ-UNIVERSITY HOSPITAL RELATIONSHIP
The Commission also investigated the optimal relationship between University Hospital (UH) and UMDNJ, as we were tasked with addressing the question of whether UH should be divested from UMDNJ. The Commission found that medical schools need a close and collaborative relationship with their principal teaching hospital to achieve excellence in education and research. We also recognized that UH plays a critical role in providing care for Newark residents regardless of their ability to pay and is thus a valued community resource.
While multiple successful models exist, the best practices for the medical school-hospital relationship require strong leadership at the medical school and are largely independent of the hospital ownership structure. Best practices include: creating alignment of academic and hospital missions by giving the medical school dean the authority to make key decisions concerning the hospital; ensuring coordination in certain strategic areas (e.g., building selected tertiary care capabilities, agreeing on how to compete for private patients); ensuring transparency of reporting around agreed metrics; establishing a hospital advisory board; and selecting a hospital CEO who is committed to academic medicine and the medical school’s educational mission.
The Commission looked at four ways medical school-hospital relationships are frequently structured – a university-owned hospital (current model), the hospital as a state-owned corporation, the hospital as a private, not-for-profit, or 501(c)(3) organization, or the hospital as a private, for-profit institution. The Commission determined that while separate ownership has increased nationally over the past eight years, the top state systems continue to own their own hospitals.
Based on our assessment, the Commission recommends that the university
should retain ownership of UH and monitor how UH’s performance is affected
by the new university and direct, unambiguous and single reporting of the
CEO to the Dean of the New Jersey Medical School. The Commission
also recommends formalizing the reporting relationship of the CEO of UH
to the Dean of the New Jersey Medical School; implementing best practices
of medical school-hospital alignment; making capital investments; and reassessing
ownership options, if required by worsening external and/or UH economics.
However, while UNJ and UH leadership will continue to strive to improve
the quality and competitiveness of UH, the state’s commitment to UH must
be paramount, to avoid exposing UNJ-North to undue financial risk.
RECOMMENDATIONS ON THE REVIEW & IMPLEMENTATION TASK FORCE
While the Commission has made recommendations to frame the general principles for establishing the University of New Jersey, should these recommendations be accepted by the Governor, more investigation will be needed to examine and develop a comprehensive plan for implementing this vision.
The Commission therefore recommends the establishment of a three-tiered UNJ Review and Implementation Task Force (the Task Force) to review and optimize the impact of the restructuring on both health and non-health schools and create a detailed implementation plan based on the Commission’s recommendations within 12 months. Following this, the implementation will likely be staged, with key milestones at one, three, and five years.
A Governing Committee of the Task Force, which would include UMDNJ, Rutgers, and NJIT leaders as well as selected academic experts, would set the vision and mission for UNJ consistent with the overarching recommendations in this Report, and approve all recommendations. The Governing Committee would include top leadership from UMDNJ, Rutgers and NJIT, as well as a group of independent academic experts. The Governing Committee would be supported by a Project Office, which would coordinate the work of all the committees. Three University Committees, drawn from the local leadership from UMDNJ, Rutgers, and NJIT at each location, would report to the Governing Committee. The Commission also envisions the need for Issue Working Groups, which would assess implementation options and report to the University Committees, and in the case of university-wide issues, the Governing Committee. These Working Groups could, include groups focused on health school interactions, faculty reviews, student issues, non-health school issues, standards and relations, the physical plant, operations, human resources, information technology and communications, finance and accounting, support and student services, public affairs and legal issues, and alumni affairs.
Advisory groups would provide ad hoc counsel to the Issue Working Groups, the University Committees and the Governing Committee. The Commission recommends creating at least two advisory groups: a Community Advisory Group and an Academic Expert Advisory Group.
The most critical issue during the transition will be continuing operations of the existing universities. While the plan for UNJ is being developed and the Task Force deliberates specific recommendations, it will be critical to keep classes running, to keep leadership motivated, and to manage faculty retention and recruitment. Among other challenges to be negotiated will be issues related to community employment, operational continuity, finances, communication, cultural differences between schools, and legislative processes.
We believe that this vision, although significantly shifting the status quo, will maximize the quality and competitiveness of health education while also improving the higher education system in New Jersey. Further, we believe this vision is feasible given the foundation already existing in New Jersey. If the vision is accepted by the Governor, its implementation will require support and ongoing commitment from the Governor, legislators, and all other stakeholders in New Jersey. Given the tremendous potential benefits to all stakeholders (e.g., students, faculty, local communities, the broader New Jersey community), we believe that such support will be forthcoming.
1Health Affairs, 2002, Volume 21, Number 1.
2We would leave to university leaders and stakeholders the decision on the actual name to be adopted.
3Fall 2001 figures.
Note: The entire 133-page report can be
downloaded as a pdf
file from the Governor's website.