Contrary to some perceptions, the University of Miami Miller School of Medicine is not an island. As the only academic medical center in a continuously growing region, the Miller School is a unique institution and has a very specific role and responsibility to fulfill in advancing knowledge, training health care providers, and caring for patients and their families.

Academic medical centers do not exist for themselves—they are institutions that are expected to provide leadership in health care service delivery, health policy, and community outreach to guide and provide mechanisms by which the overall health status of the community can be improved. Academic medical centers are rightly expected to produce the next generation of health care providers, particularly physicians, and through the interaction with community-based providers and hospitals throughout the region, they are intended to have a general uplifting effect on the quality and capability of health care services. This is the view maintained by the Miller School’s leadership team.

One can say that the Miller School should expand the role of UM’s medical enterprise to the greater community, but if you can’t execute on the fundamental things back on home base, then you can’t really deliver in the best way possible in broader initiatives. So one area the leadership team will be focusing on is organizational effectiveness: how we make decisions; how we organize to execute on decisions; the rigor with which we measure how we’re performing; the willingness to be honest with ourselves and with our employees about whether things are going well or not; the ability to have employees feel engaged with what the institution is trying to accomplish; and the ability to reward people when things go well.

If the institution is not measuring up, there are reasons why. It’s a matter of diagnostics and therapeutics. You cannot solve a problem you do not understand, and you cannot understand that there’s a problem if you are not measuring against a definition of success.

We’re in the process of strategic plan development to define together what we want to measure and how. This process will set objectives and help the school decide where to spend its energy.

Places like UM are idea factories—there are new notions and new possibilities that arrive every day. If you chase every one of them, then you dissipate the institution’s capability to execute them. You have to choose some things that are important to do, and you focus on those until they’re done. Otherwise employees come to work, and they don’t have a context for what the institution is trying to do. Human beings don’t function well without a context. It’s true in our everyday lives. We have our view of what’s going on around us and where we fit into it and what’s important and what’s not—and if the leaders of the institution are not effectively communicating a context for the work its people do, then they’ll make up their context as best they can, and they may well not get it right. Some organizations work better than others, and if you look at the ones that work well, the mission of the organization is clear to everyone who works there.

Some would say this is just common sense, but there’s more to it than that—there are many sophisticated things one can and should do in a complicated institution such as the Miller School. But there’s no substitute for clear communication and clear thinking, and that applies to all of us. And that will be how we move the institution into the future and as one of the country’s premier academic medical centers.

William Donelan is vice president for medical administration and chief operating and strategy officer of the Miller School of Medicine.