UND MEDICAL SCHOOL: Performance audit reveals weaknesses

A performance audit of the UND School of Medicine and Health Sciences criticizes Dean H. David Wilson's management style and states the school must develop a stronger organizational structure and a better system for monitoring its own operations and complying with state law.

The audit had been ordered by the North Dakota Legislature in 2005 and was released Wednesday

The auditor's most positive words were saved for the school's faculty, which it called "talented" and "committed," and for the school's "remarkable accomplishments" in research, particularly in the school's neuroscience and rural health programs.

The audit states Wilson's management style has alienated faculty, lawmakers and other key medical school constituencies. That management style also likely was a factor in public rancor over the 2004 merger of the school's departments of family and community medicine, and the 2002 closing of a family medicine residency program in Fargo, according to the audit.

The dean decides

The audit describes Wilson's management style as "vested personally in all decisions without relying on formal, faculty-driven processes and without - at least in some circumstances - an appreciation for the political consequences of these decisions."

Wilson responded Wednesday, saying he had made tough, sometimes unpopular decisions that were aimed at benefiting the school. He also said he consulted with associate deans and department chairs before making major decisions.

"Anytime you have a job as complex as this one, with four campuses, 1,000 students and a large faculty, if you make a decision, not everyone's going to be happy," Wilson said. "But sometimes you have to make decisions. I make them and I stand by them.

"If I make a mistake, I try to admit it. The bottom line is this is an outstanding medical school that's been benefited by its administrators, including me, and I stand by our record."

Calling himself fair and patient, Wilson said he's willing to accept criticism, but will defend his management style. "Will I try to be more soft and cuddly? I'm not sure that's the way a good manager handles a complex organization."

The 63-page audit report includes 35 recommendations for improvements at the medical school. They range from creating a formal process to ensure the school complies with state law and creating a comprehensive organization chart, to filing more timely reports on employee time devoted to federal grants.

Wilson said an audit of any large organization would be bound to reveal flaws and weaknesses. "We'll address the procedural things," he said. "We could have told you that before the audit, which took over a year at tremendous expense for the school and the state."

The medical school was required to pay about $100,000 to hire DJW Associates, an outside consulting agency, to perform a portion of the audit. Audit Manager Gordy Smith said the private consultants include former officials at other medical schools; their work was necessary, he said, to assess issues specific to a medical school.

When asked Wednesday whether the audit was worth the cost, Wilson said that was an issue for the Legislature and the public to decide.

Smith described Wilson and other top medical school management as seeming to believe the audit was unnecessary, which he said impeded the process and could mean the school is less likely to implement the recommended changes that would improve operations.

"They would have preferred it didn't occur," Smith said. "A lot of clients feel that way. In some cases that made it a little more difficult than if they'd welcomed us with open arms." Legislature's role

State Sen. Judy Lee, R-Fargo, was among a group of legislators who advocated for the audit during the 2005 legislative session. Wednesday, Lee said she had not read the final product yet, but that her goal had been to help the medical school run more smoothly.

Lee said some medical school administrators "spent a fair amount of time defending themselves before any audit report was out, and I thought that was perhaps inappropriate. It's like going to your accountant at tax time. You figure out what you did this year and how you should do things differently next year. You don't beat up on your accountant because of what the accountant might find."

In 2005, the audit was a contentious legislative issue that at one point threatened to block passage of the higher education budget.

Audit opponents argued the school's 2006 reaccredidation process was sufficient to examine difficulties and the funds for an audit could be better spent elsewhere in higher education.

A compromise struck at the end of the session barred the auditor's office from beginning its work before reaccredidation was complete.

What's next

Each audit document recommendation is followed by a response from the medical school either agreeing or disagreeing with the recommendation. When consensus wasn't reached, the auditor's office added a concluding remark after the medical school response.

Smith cited the number of concluding remarks as evidence that the medical school had not accepted some of the audit's basic premises.

Smith will present the audit to the Legislature's Audit and Fiscal Review Committee on Nov. 19. Medical school officials and UND President Charles Kupchella will answer lawmakers' questions at that meeting and have the chance to counter some of the audit's claims.

Kupchella said Wednesday that he planned to release a response letter in the next few days.

Part of the audit focuses on a disconnect between the medical school's practice and a 1945 state law that charges the school with endeavoring to provide doctors and other health professionals to every town in the state. The audit notes that law may be outdated and suggests the school work with legislators to update it.

Tuesday, Wilson touted some of the school's efforts to serve rural areas while calling the law's goal of placing a doctor in every town unrealistic.

An audit report addendum also suggests a new regional center model of rural healthcare delivery, where progressively higher-credentialed healthcare providers would be available as residents approached the center.

Marks reports on higher education. Reach him at (701) 780-1105; (800) 477-6572, ext. 105; or jmarks@gfherald.com .