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Spinning the Press-Ganey Survey

6/29/2016

32 Comments

 
Once again, for those new to this blog site, at present there are 20 posts on the blog and each has its own set of comments. To read the comments you have to hit the word "Comments" at the beginning or end of the post. Somewhat confusing is that when you bring up the comments for a specific post it eliminates the other posts from the screen. To bring the other posts back up simply go back to the top of the page and click on Blog. Finally, to understand the development of the blog it is best to read it from the bottom post (Dr. Paul Kearney Case) up. One point of note here, to read the earliest posts you have to click on the word "<<Previous" at the very bottom of the posts available.
* Note: To see PDF Documents cited in this post simply click on the underlined segment​

In a previous blog post (Press-Ganey Physician Engagement Survey) we discussed both the survey itself and its relationship to the current low morale situation that exists in both the UK Healthcare complex and in the College of Medicine. I always thought that, with respect to these types of surveys, a very good barometer of the character of any administration is how they view and use the results of a survey like this. In other words, do you bury it or do you use it constructively to try to make things better. From all that I have seen and heard thus far, one can only be disappointed in the path chosen by our hospital and College administrations. So let’s just briefly overview:
 
  1. To begin with, the administration limited the sharing of a partial summary of the results of this survey as a presentation to a select group of physicians on a Friday afternoon prior to the Memorial Day weekend.  Fortunately for us, someone was kind enough to send me this presentation so that I might likewise share it with blog readers (if you have yet to see it, it is here).
  2. Not having the opportunity to attend this meeting, I would be interested in hearing how the data on pages 22 and 23 (see survey), evaluating Engagement and Alignment, were presented to this audience. Clearly the numbers themselves reveal very little, and in fact tend to be counterintuitive. Numbers like 3.52 and .43 would appear to most to be small and seemingly insignificant, and rankings that show a movement from 2nd to 1st and 5th to 1st could easily be misinterpreted as improvement rather than the going from pretty bad to the worst ranking in the greater than 1,200 healthcare organizations surveyed.
  3. The leaking of this survey appeared to have had at least a small impact on the administration, in that on June 8, 2016 Dr. Karpf sent a broadcast email to the UK physicians claiming, "We've Heard You" and that "we need to understand the issues." Hmmm, understand the issues? A good start would be to ask what the issues are. Of course unless you did that in some manner that provides anonymity, the only voices you will hear from are the people who have no issues.
  4. Then on June 24, 2016 Dr. Karpf made a presentation to his ultimate boss, the UK Board of Trustees Health Care Committee.  This presentation included four slides (see Trustees Presentation) that contain somewhere on them the results of the 2016 Press-Ganey survey where "physician engagement" was calculated to be this obtuse 3.52 score.  Unfortunately, on none of the four slides did Dr. Karpf include what is shown on slides 22 and 23 of the Press-Ganey Survey document (see Survey): that the score of 3.52 corresponds to a national ranking in the bottom 1%.
 
All of this unfortunately suggests that this hospital and even university administration, only wish to bury the results of this survey. Furthermore, the past history of this administration suggests that the University’s General Council is more likely to be consulted about these problems than the university physicians, faculty and staff. Hopefully the new Dean will take these survey results more seriously than Dr. Karpf has, but I am not going to hold my breath on that.
 
In conclusion, my Mom always told me, “If you can’t be part of the solution don’t be part of the problem.” In this vain I invite the physicians, faculty and staff reading this blog the opportunity to offer “constructive” suggestions for improving the morale and working environment in the hospital and College. I would be happy to pass them on to the BoT and administration.
32 Comments
Tom
6/29/2016 02:30:52 pm

Suggestions, well here's some: 1) Return Dr. Kearney's patient and teaching privileges. 2) Provide an avenue for physician input where retaliation is not a factor. 3) Identify and hire administrators that actually listen to physician and faculty voices. 4) Reduce the number of administrators so the ones that are there actually have to work for these huge salaries they are receiving. 5) Quit keeping everything a big secret like you have something to hide. In other words, obey the Attorney General and provide open records like the law requires. 6) Treat the people with respect.

I am sure I can come up with more.

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Mole Sauce
6/29/2016 03:11:31 pm

I am hearing that Capilouto is trying to use the (dis) engagement survey along with the recent Hazard Cardiology "scandal" to accelerate the inevitable Karpfexit. But in a surprise twist, the people he trusts (ie will go along with what he wants) to run UKHC are either politician/healthcare administrator Mark Birdwhistell or (in an interim capacity) Provost Tim Tracy (presumably because now that he has fixed "student success" by firing people and ballsing up the honors college he is looking for a new challenge that will help him eventually become president of UK). Karpf of course favors handing the reins over to Dean Dipaola (after of course an extended period of on the job training with Karpf). If Karpf does get ousted it remains to be seen how the COM workforce will respond to Capilouto’s uninspiring and unqualified "leadership" picks, particularly since neither of these individuals are physicians. And, as I explained before, this is all being done so that Capilouto can control the UKHC/KMSF enterprise profits to offset the massive debt incurred by the campus building project. So, all of you may get your wish of seeing Karpf ousted. But as I predicted the replacement regime may be even more focused on making money but with no prior experience of running a large academic healthcare enterprise. What could possibly go wrong?

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Dan Noonan
6/29/2016 03:28:42 pm

Laughing to myself, well that didn't take long. Thanks Tom and Mole Sauce for your constructive comments. Some good suggestions in there Tom, but I would be surprised to see many come to fruition unless….. perhaps Mole Sauce's information pans out to be true.

Mole Sauce, to tell you the truth, you made me dizzy with this one. There were just too many ifs in this, but I give you an *A* for intrigue…. or should that be an I? Whatever it is, thanks for contributing.

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Mole Sauce
6/29/2016 03:46:44 pm

Karpf will be gone, possibly sooner rather than later. If my suggestions are not correct who else do people here think will replace him?

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Bill
7/1/2016 03:45:43 am

One thing that we could really use, especially if they persist in these appointed Chairs scenario, is the faculty evaluating these administrators on a 3 year basis. This would need to be done by an outside agency that safeguarded anonymity. Something like what was done for Dr. deBeer a couple years back. Sure it might be a bit more expensive, but heck, didn't someone say we had a 192 million dollar profit. Why not spend a small amount of that profit on the employees and not just on mortar and bricks.

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Dan Noonan
7/1/2016 03:48:55 am

Thanks for the comment Bill. I like the idea.

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The Green Mole Sauce with Extra Habanero
7/1/2016 03:53:20 am

Yes Bill. A $192 million profit (at least as I'm sure there is some "fuzzy math" going on behind the scenes). Here's my post from the last entry complete with the link for those interested...

Wanted to make sure everyone saw UK Healthcare's latest "Voluntary Nonprofit" statistics.

They reported a $192,033,000 profit.

Yes, that's $192 million. A truly incredible profit for a "nonprofit" hospital. If that's what they report publicly on the surface I wonder what lies underneath?

https://www.ahd.com/free_profile.php?hcfa_id=cddd343d7bfb79150a3be9d7fc8f58ea&ek=a73d15db1e099a65a31ebb415c3b7809

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Dan Noonan
7/1/2016 10:31:15 am

Thanks Green Mole Sauce for the comment and reposting this URL. I guess the question becomes, "whose profit is this?" I suspect the university president could make the valid argument that we are all one big family and therefore it is the university's to do with as its leaders see fit, but I can also hear Mike Karpf declaring it is KMSF's (that so called non-affiliated private company) money and they should have total control over it. If KMSF's we will never have a full accountability of how it is being used, because their lawyers have deemed them not subject to accountability. This appears to be an interesting conundrum for the university president though, in that his General Council is the one that argued so vehemently (some might even say insultingly) with the Attorney General that KMSF is not affiliated with the university.

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Dan Noonan
7/1/2016 11:07:16 am

It looks like we made the Herald Leader again, only this time it is in the political cartoon section.

http://www.kentucky.com/opinion/editorial-cartoons/joel-pett/article86708572.html

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Mole Sauce
7/1/2016 03:57:21 pm

Tiny Tim Tracy just appointed a slew of internal/interim deans to fill positions that he has not been able to recruit for.

http://uknow.uky.edu/content/provost-appoints-interim-deans-three-colleges-and-graduate-school

And it also appears that the Pharmacy Dean search has failed so the only external Dean they have managed to hire is DiPaola in Medicine.

And Diane Snow who I thought did a great job with the honors college is apparently not acceptable to be dean but has paradoxically been able to get a position as dean of the honors college at a significantly more highly ranked undergraduate institution than UK.

I think everyone is well aware of the difficulties in recruiting top faculty and administrators at UK and this probably explains why the BOT is willing to pay Capilouto more to keep him here. He is sort of OK and more to the point it would be a huge pain and a risk to have to try to replace him

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Mole Sauce
7/1/2016 01:31:24 pm

The large "profits" of UKHC are what Capilouto wants to get his hands on. Right now most of this money is "invested" in the various building projects and spent on the "enterprise transfer" to the COM that pays for all of the faculty salaries and operating costs that don't come from grants or the dwindling state funds (don't forget that the medical school tuition money stays over on the other side of campus). The question is what will happen when this money is taken away from the COM?

The posts above make it clear that you want a drastic change in the administrative philosophy of the COM/UKHC but who do you think will provide this? And why do you think that things will be run better with Capilouto and "Tiny" Tim Tracy pulling the strings- neither of them have any experience running a large healthcare business. Which of the upper level UKHC "leaders" will be tapped to run UKHC? Or do you think they will try to hire someone from outside?

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MK
7/1/2016 01:51:06 pm

And in the words of the immortal Freddie Mercury:

And another one's gone, and another one's gone and another one bites the dust!

Rumor has it David Moliterno, VP for Clinical Affairs and Chair of Internal Medicine has resigned.

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Mole Sauce
7/1/2016 02:03:18 pm

He resigned from his position as vice president for clinical affairs and is now focusing on being IM chair, apparently after coming to the realization that he had been neglecting the academic and faculty development roles of the chair for the past 5 years... His email to the faculty is below.

I assume this means that he has lost out in the sweepstakes to replace Karpf and was able to negotiate staying on as IM chair to save face and (possibly) give him time to find another position.

What does this "6 year commitment" mean? Does he have some sort of a contract that could be accessed through an open records request?


Colleagues--

Before any rumors starting circulating, I wanted you to know that I have just made a very important decision to take off several hats and direct my efforts more solely as the Chairman for the Department of Internal Medicine.

A couple weeks ago I went to the Internal Medicine Residents graduation dinner—and to be candid, it was an eye-opening event for me. I did not know these trainees, and honestly, I know they did not know much about me. As I listened to the faculty mentors talk about the terrific residents, I asked myself where I had been their last three years.

I knew I was not at their grand rounds or their morning reports, and I had the chance to only work with a few of them on the cardiology consult service. As some of you may know, shortly after accepting the position as Chairman of Internal Medicine in 2011, I assumed a number of other responsibilities including serving on the KMSF Executive Committee, acting as the UK liaison to the Lexington VAMC, reviewing files for the Kentucky Board of Medical Licensure, and working closely with Dr. de Beer in the Dean’s Office and with Dr. Karpf in the EVPHA Office. Wearing these several hats has kept me busy while also helping recruit faculty for the clinical departments and scrambling to plan coverage for our busy in-patient and out-patient areas—so like many of you know, it has been like drinking from a fire hose.

Yes there are a number of things the residents (and maybe some faculty) would probably not know about me—including that I have a true and deep-seated passion for education and research while insisting on high-quality patient care. I am not one to toot my horn—that’s not my nature. The residents would not know that I have been blessed to help lead over $1B (yup with a “B”) in clinical trials. Since joining UK in 2004, I have had the chance to work with many talented fellows and faculty both at UK and around the globe and publish over 180 manuscripts—including several in NEJM, Lancet, and JAMA. I have helped lead educational initiatives locally and nationally for the American College of Cardiology, where I served a 3-year term as chair of the interventional Annual Scientific Sessions. During this time, I and my office produced 7 medical textbooks.

With a great team of faculty and staff, what has happened in the Department of Internal Medicine over the past few years is also nothing short of amazing. We have been fortunate to recruit many new research and clinical faculty including chiefs for cardiovascular medicine, pulmonary/critical medicine, medical oncology, hematology/bone marrow transplantation, digestive diseases, hospital medicine, and infectious diseases. We have started three new divisions: biomedical informatics, hospital medicine, and palliative and supportive care. Together we have grown our patient volume by several-fold. In 2011, it was not uncommon to have a total in-patient internal medicine census (hospitalist teams, MICU, and CCU) of around 100-120 patients. At present, we range between 250-280 patients! Our ambulatory practice has also steadily and dramatically grown both on-site and around the state, despite severe space constraints. More importantly, our patients have received top-notch care with O/E for mortality of around 0.8 year after year, as but one example.

As an academic medical center, it has taken passion and perseverance to grow our education and research missions, and we have had success. We have pursued our educational mission and expanded both our department’s residency and our fellowships, and the caliber of incoming and outgoing trainees is truly impressive. We now have or are adding many new fellowships including: cardiac electrophysiology, advanced cardiovascular imaging (CT/MRI), heart failure and cardiac transplantation, interventional-advanced endoscopy, inflammatory bowel disease, bone marrow transplantation, and others. We have advanced our research programs remarkably through a combination of mentoring junior faculty to great success in recruiting established investigators. While the federal grant dollars can be assigned to servicelines, centers, or departments, among faculty in Internal Medicine this past year we had approximately $10.8M in associated NIH funding, making us a top tier

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Dan Noonan
7/1/2016 04:12:52 pm

Thank you for your contributions Mole Sauce and MK. I am impressed with this humble presentation of Dr. Moliterno's accomplishments. I am dazzled that he could fit all of that in 5 years. Just think what he could have done if he had received any help. You have a point there Mole Sauce, if these are 6 year appointments then that would mean his reappointment should be coming up shortly. I wonder if the Internal Medicine faculty will have any say in that or even if his boss the Provost will have any say.

With respect to your concern about Dr. Capilouto's inexperience with the healthcare business, I think it worth noting that he does have a doctorate in Dental Medicine and a MS degree in epidemiology from UAB, but perhaps more importantly he has a doctorate in Health Policy and Management from Harvard School of Public Health. At least from a education perspective I would suggest that trumps a BA and MD from the University of Pennsylvania. The point being, although he does not have an MD and has not run a hospital before, I don't think I would sell him short on understanding hospital management. I can't say the same thing for the Provost Dr. Tim Tracy. I think Dr. Capilouto fully understands the significance of UK Healthcare and its value to the university, and I am not so sure the president of the university shouldn't have a dominating voice on what happens to the "profits" the UK healthcare is generating. Although Dr. Capilouto has been a disappointment in my eyes, UK Healthcare is a part of the university and he is the president of this university.

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Mole Sauce
7/1/2016 04:49:25 pm

Karpf did run the UCLA Hospitals/Primary Care business before coming to UK (yes, I know you are going to say that went badly) and he has done a good job with the overall strategy for UK Healthcare (yes, I know that was done at the expense of a lot of people and things you care about). So I think its a bit churlish to dismiss him for not having taken business school classes. I think these changes are coming sooner rather than later. I am quite interested in seeing what happens (while escalating my efforts to leave UK).

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Dan Noonan
7/2/2016 08:12:53 am

Thanks again for the comment Mole Sauce. I really wasn't downplaying Dr. Karpfs considerable previous experience in hospital management (although somewhat tainted as you noted), but rather pointing out that Dr. Capilouto, unlike his predecessor Lee Todd, does have a knowledge base in this area and probably fully understands its value and its requirements.

This may just be me, but my problem with Dr. Karpf is that every time I have heard him speak he has always come across as a used car salesman. I generally come away questioning how much of what he is saying is true, how much is conjecture and how much is simply BS. With all that has recently happened, I am currently leaning heavily towards the latter of these three.

Fuzzy Math
7/2/2016 06:34:21 am

The profit numbers posted by UK Healthcare are absolute nonsense. There are more books cooked in that place than peanuts cooked on Winchester Rd. Show use the massive debt Michael Karpf has burdened use with...and yes, us...the taxpayers of Kentucky.

What ever happened to the 127million UK Healthcare "borrowed" from the general university a couple years ago. Wouldn't that be extremely relevant now with record tuition hikes and layoffs taking place.

A recession or a drop in healthcare payments and that place will implode. Good thing neither of those two things look likely in the near future. (wink, wink.)

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Dan Noonan
7/2/2016 08:17:56 am

Thanks for the comment Fuzzy Math. I had forgotten about that 127 million. Good question. I have a funny feeling that Mole Sauce will elaborate on this.

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Mole Sauce
7/2/2016 08:55:13 am

I'm afraid I don't know anything about this "borrowing" of $127M. Is the point being made here that UKHC is less "profitable" than is being claimed (with the insinuation that this misrepresentation is being made to justify high salaries and "secret bonuses")?

There may be some truth to that point of view but I think its possible for UKHC to be reasonably sustainable financially although this is largely due to incompetence of the local private hospitals and UKHC's receiving of large amounts of medicaid payments from the federal government in return for treatment of indigent and uninsured patients (which may not be sustainable).

I am much more concerned about spending $2 Billion on campus construction and the likelihood that this can be recouped by turning UK into a quality educational product that people will pay for.

And while I am here, in addition to the prior experiences noted above Karpf got his start in healthcare administration at Pitt working with people who clearly now how to run a high quality academic healthcare program. I know you don't like him and I agree that he has surrounded himself with terrible people and has largely ignored the academic side of things but on the other hand he did come to us with highly relevant prior experience.

Does anybody here think that Capilouto could hire someone who is currently or has recently run a large public university Healtcare system to replace Karpf? And if he could wouldn't this person want to either also be Dean of the COM or to pick their own Dean?

I think that by hiring DiPaola, Capilouto has made it almost inevitable that Karpf will be replaced by someone internal. The question is who will this be?

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Foggy Memory
7/2/2016 04:09:11 pm

Sorry, the figure was off. It's hard to keep track of all these millions of dollars flying around.

http://www.kentucky.com/news/local/education/article44370186.html

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Paul Crummy
7/2/2016 09:48:55 am

I just laugh when I hear about how horrible Karpf was (is) and yet how the medical center has grown since he joined. We can all agree that UK was a medical center mediocrity before Karpf showed up. In many areas, it has improved tremendously. Seems like Dan Noonan would rather UK suck as an academic medical center just so the "good ol boys" like Kearney can do whatever they want.

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Dan Noonan
7/2/2016 01:29:17 pm

Thanks for contributing Paul. Hmmm, “Seems like Dan Noonan would rather UK suck as an academic medical center just so the "good ol boys" like Kearney can do whatever they want”. Clearly our Dr. Kearney hater has surfaced again. I have just a couple of problems with the logic in your statement here Paul. You begin with a declaration that basically says that UKHC and the CoM have flourished under the leadership of your protégé Dr. Karpf, and then you put down or in some way attempt to argue that the people, the “good ol boys”, that brought it to this status had nothing to do with it. Or was it all Dr. Karpf that made this happen? This is somewhat confusing because I suspect in the 13 years he has been working here he has never seen a patient, has never taught a student, has never had a research grant and probably has never published a paper. On the other hand, I also would feel fairly secure in stating that Dr. Kearney in his 27 years here has taught more students, has won more teaching awards, has published more papers, has had more endowments in his name and has saved more lives than yourself Mr. Crummy. Sounds a bit like jealousy to me.

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Crummy Bummy
7/2/2016 04:01:46 pm

I must correct you Dan. Karpf sees many patients. He does his wealthy person rounds every day. Ask any nurse and they will confirm. He has a nose for those with money (or perhaps, more accurately, his conies with bloated salaries report this information to him) and he makes sure he personally visits them while they are in the hospital. This has gone on since he first started.

Mole Sauce
7/2/2016 06:39:43 pm

There definitely is some sort of UK Healthcare "platinum" for elite/preferred patients. Not sure how that works though.

I suppose when Eli is running the show he could pop in to do a few fillings..Tiny Tim and Mark "Medicaid" Birdwhistell don't have any medical qualifications so at least they will be immune from being criticized for not seeing patients.

Mole Sauce
7/3/2016 05:34:17 am

Also, Karpf does have a chair endowed in his name, same as Kearney (and I think for more money).


· $1.5 million from the William T. Young Foundation of Lexington pledged to establish and endow the Dr. Michael Karpf Endowed Chair in Precision Medicine at the Markey Cancer Center. The endowed chair is in recognition of Karpf's service as executive vice president for health affairs at UK. Young was a Lexington businessman, thoroughbred horse owner and breeder and UK benefactor.

http://uknow.uky.edu/content/uk-board-trustees-accepts-gifts

Dan Noonan
7/3/2016 08:08:59 am

Thanks again for the comment Mole Sauce. This recent endowment to Dr. Karpf was noted previously in one of the earlier blog postings. Please note that my references to the endowment and other Dr. Kearney accomplishments were directed at Mr. Crummy and not Dr. Karpf.

But speaking of endowments, I would like to note that during Dr. Karpfs reign there appears a paltry number of endowments to both the hospital and the research being performed in the College and the hospital. It was on a slide at a presentation he was making at one of the budget meetings I attended. I remember noting this to Dr. Karpf at that meeting and his response was, "that is the responsibility of the researchers".

Abe
7/2/2016 03:09:27 pm

Paul Crummy, sometimes it not what you have accomplished but rather how you have accomplished it. Throughout history, some of the greatest advances have been made under some of the most corrupt leadership. If you are an “end justifies the means” person then I suppose being first is all that you see or care about. All of this secrecy, refusal of open records, evidence of money mismanagement and these sudden departures of senior Karpfites (e.g. Boulanger, Griffith, and now Moliterno) would suggest that those in the know are getting out while the getting is good. This may work for you, but some of us take pride in being part of a public university and would prefer the truth.

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Paul Crummy's Estranged Brother
7/2/2016 03:51:51 pm

Who is saying that UK is a great medical center? I would argue the care is no where close to acceptable. Let's see how great CT surgery, transplant and trauma are now that Karpf has run off the faculty. Need I bring up the pediatric cardiac department? Anyone that trained at another medical center will tell you that the medical students graduate there with a very mediocre experience. Yes, Karpf has done a good job of improving the public image with a bottomless advertising budget, but the care is far better at the private hospitals in town. The areas you speak of that UK has improved since Karpf came are all superficial. Big building...check. Medicine is moving away from inpatient hospital care...in case you haven't heard. I hear it time and time again, the place has no soul.

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Mole Sauce
7/2/2016 03:31:31 pm

Paul Crummy is right- UKHC was solidly in the crapper pre Karpf and probably would have ended up either folding or being assimilated by a private healthcare business (like UofL). Presumably Dan Noonan is aware of this since his colleague David Watt (an organic chemist with no experience in healthcare) was actually running the hospital before Lee Todd hired Karpf.

Abe may be right. But that remains to be seen.

Also, Dan, your ad hominem response to Paul Crummy misses the point- Kearney also didn't do all of the great things you think he did by himself and, as he is now finding out, he can't continue to do anything without people and facilities to do it with/in. Karpf was part of making this happen.

Anyway, what I am most perplexed about is why, after all of this faculty engagement debacle, Moliterno decided to announce that he has been "recommitted" to as chair of medicine on the basis of some sort of a private agreement with DiPaola and Karpf but without any faculty consultation of any evaluation process whatsoever. And this apparently for 6 years. It just beggars belief that none of them realize this is exactly the sort of thing that leads to these terrible faculty engagement scores.

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Dan Noonan
7/2/2016 04:32:58 pm

Thanks everyone for your comments.

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Dan Noonan
7/4/2016 03:12:17 am

HAPPY 4th of JULY to all. Be safe.

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Nothing to hide?
7/5/2016 04:43:14 pm

UK and its foundation sue former student in open-records appeal.

http://www.kentucky.com/news/local/education/article87736192.html

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