Columbia University Medical Center

Karina Davidson: Increasing Organizational Effectiveness at P&S

By: Kathleen Lees 

Karina Davidson, Vice Dean for Organizational Effectiveness at P&S

Karina Davidson

This spring, P&S created a new role of vice dean for organizational effectiveness and appointed Karina Davidson, PhD, MASc, to the position.

In her role as vice dean for organizational effectiveness, Dr. Davidson will focus on implementing faculty recommendations for enhancing work quality of life at P&S. She also will work on assessing and optimizing the learning environment for medical students and empirically assessing innovative approaches for improving the work and learning environment at P&S.

The CUMC Newsroom asked Dr. Davidson a few questions about her new role:

How can P&S be a more effective organization?

Improving P&S means changing the organizational environment as well as motivating change in the behavior of the people that make up P&S. Doing so is needed to ensure that everyone gets the most they can out of the time they spend with us. It means ensuring that the time spent here—whether as a patient, faculty member, staff member, or student—is full of opportunities to not only receive the highest quality care, research support, and education, but also to contribute unique skills and values and to be recognized and appreciated by the institution for those contributions.

When an organization is effective in thinking through the systems that are in place, it can fulfill its mission more efficiently, and its members are happier.

My last 20 years have been devoted to changing behavior—behavior of patients, behavior of providers, behavior of trainees, and, ultimately, the behavior of a system.

Sometimes there are small changes that can make a big difference. When an organization is effective in thinking through the systems that are in place, it can fulfill its mission more efficiently, and its members are happier. For example, if there’s too much meaningless documentation in the electronic health records, it may lead to distracted attending physicians, which in turn leads to students not learning as efficiently as possible. In that scenario, my office would work with the Physicians’ Organization and the CMIO to identify best approaches for reducing inefficient documentation. We will also help create models in which support staff at an appropriate expertise level can augment physicians, so that each team member can focus on their primary task. Often the best way to get people to be truly effective is by designing systems and work processes that allow them to do what they uniquely can do at work.

Other times, larger shifts are necessary for organizations to be truly innovative, to become centers of excellence for work, learning, and patient care. I am very interested in the dimension of autonomy vs communality of purpose for an organization. For an academic medical center, the individuals that make up the organization have both autonomous and communal goals, but I have found that organizations are most successful when individual and institutional goals are closely aligned, and sometimes this takes a strategic intervention, either by changing institutional culture or by selecting new members, as that alignment rarely happens by lucky coincidence.

How can we ensure our students have the best clinical learning environment?

The quality of our medical education is the highest priority to us at P&S, and we are always seeking ways to further improve the excellence of our medical training, mentoring, and educational activities. We have a number of opportunities to continually improve our approach. We’re always looking at other places that have had both challenges and successes at introducing exciting new learning methods and trends that can be brought to bear on the way we teach the next generation of doctors, and I’m joining Drs. Ronald Drusin and Lisa Mellman in considering ways to transform how we approach undergraduate medical education.

But rather than just adopting something that looks like a best practice from elsewhere, we want to innovate and test new methods at P&S. We have some of the world’s best educators and scientists here who can determine which experimental design should be used to determine the value of a new educational practice, and we will bring scientific methodology to bear for continued improvement of our clinical learning environment.

We also regularly ask students for feedback and ideas for improvement, and I think that’s a great way to ensure that we continuously evolve and refine the ways in which we deliver our educational content. Some of the more innovative ways to engage students involve multi-media delivery and self-directed learning; increasing emphasis on team-based care, simulation modeling of difficult work, education, or clinical care situations; and creating appropriate competency-based learning goals that are tailored to each student. We have many exciting ways to identify opportunities to enhance learning.

Improving education also involves asking students what outcomes are important, so that students actually choose what it is that we’re measuring to determine whether we are succeeding. Changing the metric can sometimes lead us to a different solution than we would have chosen otherwise.

Name one area in which we might improve the environment for faculty.

As a faculty member, I have seen firsthand the increases in bureaucracy and regulatory burden. I have felt, as many do, that much of the regulatory and reporting processes, while good-intentioned, are inefficient and even counter-productive.

The quality of our medical education is the highest priority to us at P&S, and we are always seeking ways to further improve the excellence of our medical training, mentoring, and educational activities.

So I think one of the challenges is to increase the efficiency of the processes that should be there to support faculty and students attain their goals. Some faculty can have 15 to 20 web-based training courses—in areas such as ethics, grant effort reporting, patient privacy, good clinical practices, or billing compliance—that they must complete. The courses are on different websites with different passwords, require different time commitments, and have different deadlines. The potential for a frustrating experience is high. One way we can create systems that will help faculty is by creating a personalized dashboard for each faculty member that lists the mandated trainings that must be completed, their deadlines, and estimated time for completions. These can be accessed with one master password and with suggested sequence of activity. Although this would be a simple change, it is many of these kinds of seemingly simple improvements that together will enhance quality of work life. Over time, these types of simple changes evolve to more complex system shifts. Partnering with many leaders across P&S, I will be an integral part of this change process and will play a leadership role to improve the research, clinical care, and educational missions of P&S.

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Dr. Davidson has been a member of the P&S faculty since 2003 and is professor of behavioral medicine (in medicine and psychiatry) and executive director of the Center for Behavioral Cardiovascular Health in the division of cardiology. She is a member of the U.S. Preventive Services Task Force and has been the leader of many national and international behavioral medicine professional societies and organizations.

Her clinical work and research focus on behavior change interventions to improve mental and physical health outcomes in patients with cardiovascular disease. She has conducted randomized controlled trials of depression treatment and anger management for patients with hypertension and heart disease. She is currently testing a nationwide depression screening practice in cardiovascular disease patients.

Dr. Davidson received a PhD in clinical psychology and a master’s degree in industrial and organizational psychology from the University of Waterloo in Canada.