Department of Neurology



Anthony J. Furlan, M.D.

Professor and Chairman
Department of Neurology
Case Western Reserve University
University Hospitals Cleveland Medical Center



Dear Colleagues:

The Department of Neurology at Case Western Reserve University is a national pacesetter in a major revolution underway in how we deliver care to our patients with neurological conditions. The mission of the Department of Neurology through the Neurological Institute (NI) is to provide our patients with neurological conditions with the highest value healthcare through a systems approach to care.

There is a long and honored history of neurological excellence within the Department of Neurology at University Hospitals of Cleveland. The Neurological Institute now provides University Hospitals Cleveland Medical Center, the University Hospitals healthcare system and Case Western Reserve University with a tremendous opportunity to provide neurological leadership both locally, nationally, and internationally. The challenge for the Neurological Institute, including the Department of Neurology, is to integrate a system of patient care ("to heal"), education ("to teach") and research ("to discover") that delivers the highest value care within both the academic culture of the University and the increasingly competitive healthcare environment. The goal of the new medical condition model (the "Institute") is to integrate patient care, education, and research into a highest value system of neurological healthcare. This is the philosophy underlying the creation of the Neurological Institute at University Hospitals Cleveland Medical Center.

Michael Porter and Elizabeth Olmstead Teisberg, in their book Redefining Health Care, offer three guiding principles that they believe will define high value healthcare in the 21st century.

1. Healthcare value will be defined in terms of improved outcomes per healthcare dollar spent. While the healthcare dollar may be spent entirely across the spectrum of direct patient care, at academic medical centers a significant portion must go towards education and research. The challenge for the academic healthcare organization is to demonstrate the value of education and research by linking them to patient outcomes.

2. Healthcare delivery should be organized around medical conditions rather than strict departmental lines. The goal of the new medical condition model (the "Institute") is to integrate all components of patient care, education, and research related to a particular neurological condition into a system of care. This represents a patient centric departure from the traditional departmental structure and an evolution of the multidisciplinary group practice model.

3. Outcomes must be actually measured to determine healthcare value. Although many healthcare organizations profess a belief in outcomes assessment, few have committed the necessary resources to actually do it. Most either do not report outcomes at all or report only on process, which may reflect the delivery of quality care but not necessarily the outcome of care. Many physicians also feel threatened by outcomes assessment. Regardless, outcomes assessment will be a hallmark of the successful healthcare organization in the 21st century.

The challenge for the academic healthcare organization is to demonstrate the value of education and research by linking them to patient outcomes. Direct linkage of education and research to patient outcomes requires a departure from the healthcare organizational past. Historically, healthcare organizations have been dichotomized into those oriented toward education and research or those oriented toward patient care. In the new healthcare model high value patient care is contingent upon education and research. Conversely, while education and research are necessary components of high value healthcare, they are by themselves insufficient to deliver such care. The successful organization must blend all three elements to provide the highest value healthcare. In my role as Chairman of the Department of Neurology and Co-Director of the Neurological Institute, I am constantly striving to achieve this goal. I welcome you to learn more about us.

Anthony J Furlan, MD