The leadership of a Health Professions Partnership Initiative (HPPI) program is a unique experience for a dean or vice president. It presents challenges and opportunities for leadership that require a special set of skills and commitment in order for the program to be successful. In the following article, I present a number of personal observations relative to the organizational and operational structure of an HPPI site that will assist interested persons in organizing and managing such a program and, incidentally, have broader relevance to the training of a diverse health professions workforce. Particular focus will be placed on the role of the principal investigator and the authority and qualifications of the project director.
Identification of the Principal Investigator
The Robert Wood Johnson and the W. K. Kellogg Foundation guidelines required that the dean of the health professions school or the vice president of the health sciences center be the principal investigator at the 26 HPPI sites. These sites were led predominantly by medical school deans, but six were directed by vice presidents of health sciences centers, five by deans of public health schools, and two by deans of nursing schools. Several organizational factors influenced the determination of the principal investigator.
The original HPPI grants required sites to involve a medical school and one or more health sciences schools, such as nursing, dentistry, pharmacy, or allied health. In subsequent funding cycles, it was not mandatory for the medical schools to remain as one of the partners, and this opened an opportunity for schools of public health and schools of nursing to be brought into the initiative. Also, as you know, medical schools are often part of a larger organization that may include other health profession schools. The administrative structures of these health sciences centers or academic health centers have also influenced the identification of a principal investigator for HPPI programs.
If the organizational structure is a health profession school, then the dean is typically the highest ranking institutional administrator. If the organizational structure encompasses several health profession schools, the highest ranking institutional administrator has various titles, including president, vice president, chancellor, or vice chancellor (for purposes of this article, the title of vice president will be used). The 26 HPPI sites were all unique; yet, there was a commonality in the talents, directions, ideas, and commitments that each provided.
One Principal Investigator’s Experience
As vice president for health sciences and dean of the School of Medicine at Creighton University, I was the principal investigator for the Health Professions Partnership Initiative at my institution. Titled the Creighton Collaborative Health Professions Partnership (CCHPP), the project’s goal was to increase the pool of qualified applicants by identifying students early in the pipeline. The CCHPP targeted economically and educationally disadvantaged minority students, particularly black Americans, in five Omaha public and parochial schools, and provided shadowing, college-prep planning, academic counseling, mentoring, tutoring, and other interventions. (See the Creighton case study earlier in this issue.)
Organizationally, through my role as vice president for health sciences, this project was housed under the larger entity of health profession schools, which included the Schools of Medicine, Dentistry, Pharmacy and Allied Health, and Nursing. I appointed the associate vice president for multicultural and community affairs, Omofolasade (Sade) Kosoko-Lasaki, MD, MSPH, MBA, to be the project director of the HPPI. As a highly accomplished academic clinician, Dr. Kosoko-Lasaki served as a role model for the students and had credibility with the deans, faculty, and community leaders. Her office was adjacent to mine, and we met routinely and frequently to discuss HPPI issues.
As with any project with the size and scope of the CCHPP, challenges to successful implementation became apparent and had to be addressed. Among these were the following:
* ▪ The CCHPP was initially focused on recruiting black American students from North Omaha. By the second year of the grant, it became clear that we would not be able to reach our recruitment goals without expanding our focus. After extensive discussions with the leaders of the partnership organization (executive board), we extended our recruitment to Hispanic students from South Omaha.
* ▪ One of our partnership organizations, 100 Black Men of Omaha, was initially responsible for providing the mentoring function. For a variety of reasons, this expectation was not met. Thus, an extensive mentoring program using faculty, staff, and upper-level health professions students from the university was developed internally. This mentoring program has proved to be very successful and is now being emulated at other institutions.
* ▪ Inadequate funding existed to support the many activities supported by the CCHPP. To assure that the goals of the CCHPP were met, institutional funds were provided by the offices of both the principal investigator and project director. Many of these activities are now fully supported by the institution and its partners as an investment for the future.
These challenges demonstrate the rationale behind the grant requirement that the HPPI principal investigator be either a dean or vice president. The complex challenges that arise within a program of this scope require leadership with reach across the institution.
Observations about HPPI Leadership
Personal and professional qualities
One of the most important determinants of the success of an HPPI program is the strong personal leadership of the principal investigator. Most deans of health profession schools and vice presidents of health sciences centers value diversity, and many have deeply held convictions about educational opportunities for the disadvantaged and underprivileged. Although a personal belief in diversity on the part of the dean or vice president is essential, it is not sufficient. The difficult work is in incorporating those personal values into the organizational culture. At a minimum, it involves (1) articulating values of the HPPI concept at every opportunity, both orally and in written materials; (2) getting deans on board (if the organization is the health sciences center) and department chairs and other key institutional leaders (if the organization is a medical or other health professions school); (3) selecting new leadership if necessary; (4) incorporating the HPPI concept into the strategic plan of the institution and reporting on progress at faculty meetings; and (5) realigning incentives, such as recognizing faculty contributions for promotion and tenure considerations and providing release time for faculty involvement in such projects.
Leadership, staff, and facilities issues
Initiatives such as the HPPI cannot function without committed partners from the broader community. Many HPPIs have an executive board of partners that consist of the top-level leadership from the affiliated schools, school districts, and community organizations. The dean or vice president must foster a good working relationship with these key leaders, be the convener of the executive board meetings, lead the discussion on higher-level policy issues, and strive for consensus on issues discussed. The dean or vice president must monitor the progress of the partnerships in achieving their goals and be willing to offer midcourse corrections in strategy if necessary. A major goal of the HPPI is to sustain the programs and partnerships after grant funding ends. Therefore, it is important that each partner becomes invested in the success of the program. To this end, each partner must feel valued and must be a part of the decision-making process. The dean or vice president must assure that this happens.
It is critical that the dean or vice president play an active role as described above if the HPPI is to be successful. It is unrealistic, however, to expect that he/she will be able to manage the day-to-day activities of the project. Thus, the person or staff to whom the principal investigator delegates the implementation of the project is an important consideration. A natural home for HPPI is in the institutional office for “diversity and multicultural affairs” (the actual name of the office varies by institution) and the head of this office is the logical person to be the HPPI project director. This is a reasonable strategy, but it must be emphasized that the title, qualifications, and authority of the person in charge of this office are important factors to consider.
A person’s title may seem to be a trivial matter, but the title communicates relevant information about the organizational hierarchy and relative importance of the position. If the organizational structure is a health professions school, the title of associate dean or equivalent is preferable to that of “director.” If the organizational entity is a health sciences center headed by a vice president, then an appropriate title might be that of associate vice president or equivalent. Titles that are not uniformly used in academia and not easily identifiable in the usual organizational hierarchy, such as “special assistant to the vice president,” should be avoided.
The most important consideration in the selection of this person is the commitment he or she has to promoting diversity in medical (and/or health professions) education. There is no substitute for passion. Without it, diversity programs such as the HPPI are not likely to flourish. The qualifications of the person who heads the “diversity/multicultural” office, however, are also an important consideration. The qualifications of this person must be commensurate with the title and generally consistent with that of other associate deans or associate vice presidents. In this regard, possessing a terminal degree is not absolutely necessary but is certainly desirable.
There are many examples of heads of “diversity/multicultural” offices and of the HPPI project directors who do not hold professional or doctoral degrees and yet are successful in their positions. I know some of these individuals, and they all possess an infectious passion for their work, an unusually persuasive nature, and a strength of conviction that demands attention. They are rare individuals.
For most individuals, possessing academic credibility, which at a minimum translates to having a terminal degree, is an important factor that can affect to what extent his/her voice is heard in an academic environment such as a medical or other health professions school. To be maximally effective, this person must invariably communicate with and relate to the dean of professional schools and/or department chars and with faculty. He or she must be involved with broader issues involving the functioning of the school, such as student admissions, retention, advancement, and curriculum development. For diversity to flourish, this person’s voice must be heard.
A related consideration is that of appropriate office space and staffing. Ideally, the office should be within the office suites of the dean or vice president. Such placement of the office sends the message that the HPPI function is important and facilitates communications between the HPPI project director and the principal investigator.
The funding provided by the HPPI cannot be characterized as overly generous. It was never intended to be a source of ongoing funds for the promotion of diversity. Rather, the goal of the funding was to provide initial infrastructure support such that partnerships could be forged to create a pipeline from the lower educational grade levels to the college level to facilitate the identification and entry of capable, educationally disadvantaged students into the health professions.
Even with grant support, implementing and maintaining diversity programs are costly, and they do not generate revenue. The HPPI is no exception. Supplemental institutional support is invariably required to sustain these programs. The support needed is becoming greater as federal programs, such as those under Title VII, are increasingly under threat of budget cut or elimination. The attainment of diversity and the creation of a pipeline of students to assure diversity in the future must thus be a part of the institutional culture and be adequately supported through institutional funds as required.
In summary, the 26 funded HPPI sites differed programmatically and operationally in many respects. It is of interest that highly successful and innovative HPPIs shared commonalities. First, a true partnership with shared responsibility and accountability was created with schools of different grade levels, school districts, and community organizations. Second, the HPPI director was passionate about his or her work and commanded respect from other parts of the institution. Third, supplemental institutional funds were provided to assure that the HPPI effort was sufficiently resourced.
Finally, successful and innovative sites had strong leadership from the principal investigator who was at the top of the administrative chain. That person was able to drive the HPPI effort in such a way that the goals established early in the funding cycle were met and program problems that arose were overcome. By making the HPPI concept a core value of the institution, the effort to build a pipeline of underrepresented students was sustained after foundation funding ceased.