Exit, stage left. Exit, stage left. Exit, stage left. Exit, stage left.
Brenda Nevidjon, chief operating officer of Duke Hospital, resigned Thursday, becoming the fourth senior administrator this week to resign from the University or Health System.
In a simultaneous announcement, Hospital officials unveiled a revamped and expanded senior management structure designed to give clinicians a more direct say in day-to-day decisions.
Nevidjon, who became COO in 1996, will take a faculty position in the School of Nursing, where she will work in a research center, trying to devise creative solutions to critical care issues facing large medical centers.
"I am proud to have been a part of the team that has built a strong infrastructure for a new organization, and I have enjoyed enormously my time as chief operating officer of Duke Hospital," she said in a statement. Nevidjon could not be reached for comment Thursday evening.
Mike Israel, CEO of Duke Hospital, praised Nevidjon's performance.
"I think she's had an absolutely tremendous effect on both Duke University Hospital and in working with me closely to develop the integration of the Health System," he said. He did not attempt to persuade her to reconsider.
In the wake of Nevidjon's departure, Israel took advantage of the opportunity to reorganize the Hospital's management structure. "It sort of gave us the opportunity to take the organization apart and put it back together again," he said. Israel said that even before Nevidjon informed him Monday about her departure, he had been thinking about ways to give physicians more influence in decision making.
The restructuring adds several more senior officers who will report directly to Israel: chief nursing officer Mary Ann Crouch and chief medical officer Dr. William Fulkerson, who is also the executive medical director of the Private Diagnostic Clinic, Duke's faculty practice organization. Director of Clinical Operations Dr. Peter Kussin, will report to Fulkerson.
The reshuffling will give physicians and nurses more influence in day-to-day operations, said Israel, whose background is in hospital management, not medicine. "What we have attempted to do is work through an organization in which all groups feel that they can have an impact-and they can have a profound impact-on the operations of Duke University Hospital," he said.
The changes will also take some of the burden off the COO's role, narrowing the focus to operations. "We don't have a number two. We have number twos," Israel said.
Bobby Clapp, associate vice chancellor for Medical Center administration, will become the interim COO next week, although Nevidjon will continue working on a few projects before formally leaving the Hospital in July.
Israel said he does not plan to start a search for another six or nine months. "There's too much change. There's too much going on now. We're not going to be distracted with doing that," he said.
Israel is still searching for a chief financial officer, who would become the last member of the senior administrative team.
Clapp and the chief financial officer will be dealing directly with making sure the Hospital works within "financial reality," Israel said, an increasingly problematic constraint for all academic health centers.
The Hospital has been struggling to make up for cuts in Medicare reimbursements, and officials recently eliminated 170 positions as part of a series of cost-cutting moves. The Hospital is projecting a $17.5 million operating surplus this fiscal year, down significantly from $29.3 million last year.
"From every possible dimension, you're encountering difficulty and you're trying to make a system work so you can best serve your patients, at a time when resources are more scarce than they've ever been, where regulations or complying with regulations is tougher than it's ever been," Israel said.
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