The Road to Excellence

The Road to Excellence is also available in .pdf format.

A CONTINUED HISTORY OF THE ILLINOIS COLLEGE OF OPTOMETRY
1997 – 2000

PREFACE
The conclusion of the book Optometry in America (1872-1995) offered a glimpse at the Illinois College of Optometry’s bright future. In February 1995, the College received a positive accreditation review by the American Optometric Association Council on Optometric Education (COE). Also that same year, the first stage of an ambitious campus expansion was completed in the building of a new residential complex on Indiana Avenue at 33rd Street.

By March 1996, however, the school’s bright future was overshadowed by controversy. A politically motivated article appeared in a Springfield, Illinois newspaper. This news item was picked up and published by the Associated Press. These two events triggered a series of allegations and investigations that resulted in the resignation of ICO President, Dr. Boyd B. Banwell.

Upon Banwell’s departure, a management team was formed by the Board of Trustees that included: Board Chairman Dr. John E. Brandt, Chairman-Elect Dr. Albert H. Rodriguez, Jr., and Trustee Dr. Joseph Henry. The team worked to maintain the daily operations of the college and assuage the concerns of faculty, students and staff. They also worked with legal counsel to satisfy the Office of the Illinois Attorney General, the Internal Revenue Service and the College’s financiers.

A search committee, chaired by Dr. Henry, initiated the recruitment of a new college president. This team included representatives from the Board of Trustees, faculty, staff, and students. After an exhaustive search, Dr. Charles F. Mullen – who was serving as the Director of Optometry Service at the Department of Veterans Affairs in Washington, D.C. at that time – was appointed the Illinois College of Optometry’s fourth president. Taking office on November 1, 1996, the college that Dr. Mullen encountered was not quite the utopian institution which many – both inside and outside the college – believed existed.

Dr. Mullen quickly realized that although a plan had been developed for the physical expansion of the campus, a more comprehensive plan was required that encompassed improvements in ICO’s academic culture, administrative operations, financial health, institutional image, revenue streams, as well as the physical plant. Working with the President’s Advisory Council, an administrative team assembled from existing faculty and senior staff, Dr. Mullen began the Herculean task of putting the college back on course and preparing it to meet the challenges dictated by the rapid changes in the health profession’s educational requirements.

Recording the events that took place since Dr. Mullen took office, The Road to Excellence serves as a supplement to Optometry in America, chronicling – in his own words – Dr. Mullen’s first four years at Illinois College of Optometry.

INTRODUCTION
Given the Illinois College of Optometry’s historically prominent position within the field of optometric education, I was concerned when I learned of the difficulties the college was experiencing in 1996. I believed these matters had the potential to harm not only ICO, but possibly even the profession of optometry itself. When I was offered the position of president, I felt it was my responsibility to my profession to accept this role. I was confident that, in a relatively short period of time, I could redirect the college’s resources and energies, creating a culture in which all members of the ICO community were actively engaged in strengthening the institution.

We immediately made a philosophical shift from emphasis on facility development to emphasis on programmatic improvements and on the personal service provided to our students, patients and alumni.

We set out to realize a culture at ICO that was based on innovation and creativity: where personal initiative coupled with individual and collective accountability are the norm. Our goal was to develop an institution managed by fact and outcome measures, resulting in heighten productivity; a model of ethical behavior and integrity; and a culture committed to growth and improvement.

The pages that follow document our progress in realizing this new culture at ICO.

CHAPTER ONE
DEFINING EXCELLENCE

Documented in the 1996 book Optometry in America, the Illinois College of Optometry (ICO) can trace its origin to 1872. ICO, however, has only existed under its present name only since 1955: the result of the merger of the Northern Illinois College of Optometry and the Monroe College of Optometry.

Between 1955 and the present, ICO has had only four presidents: Eugene W. Strawn, O.D. (1955-71), Alfred A. Rosenbloom, O.D. (1972-82), Boyd B. Banwell, O.D. (1982-96) and now, Charles F. Mullen, O.D. (1996 – present).

The ICO Board of Trustees appointed Dr. Mullen as President on November 1, 1996. He assumed his duties on a full-time basis one month later. Mullen brought with him twenty-six years of administrative experience. He had served as Special Assistant to the President for Clinical Development (1970-76) at New England College of Optometry; as Executive Director, The Eye Institute (1976-1990) at Pennsylvania College of Optometry; and as Director of Optometry Service of Veterans Health Administration (1990-96) at the Department of Veterans Affairs, Washington, D.C.

Three years after he took office, Dr. Mullen discussed his initial impressions and objectives in a guest editorial that appeared in the Journal of the American Optometric Association (September 1999):

“Although I found there was an understandable sense of uncertainty regarding the immediate future of the College, morale was surprisingly good. It was my perception that faculty and staff were not only willing, but eager, to ‘right the ship’ and to positively engage in strengthening and improving the institution. I felt confident I could immediately assemble a capable administrative team from the existing faculty and staff.

My initial objectives included:

  • Initiation of a strategic and tactical planning process.
  • Enhancement of the academic culture by increasing support for faculty development, research and scholarly activity.
  • Expansion of the clinical educational program by initially adding 50 community-based training sites.
  • Initiation of a search for a new Dean/Vice President for Academic Affairs.
  • Review and modification, as appropriate, of the administrative organization.
  • Enhancement of the institutional culture, by improvement of services to students, patients, alumni and employees.
  • Ensurance of the financial stability of the institution, including the enhancement of revenue streams.
  • Review and modification of the master buildings and facilities program.
  • Improvement of management information systems.
  • Enhancement of personnel management.
  • Development and implementation of public relations and fund-raising programs.
  • Redirection of resources formerly allocated to an ambitious building program into programmatic improvements.

I believed that it was vital that our planning process promote open avenues of dialog with internal and external constituencies.”[1]

To achieve his objectives, Dr. Mullen formed the President’s Advisory Council (PAC) that included senior administrative management for the College and the Illinois Eye Institute (IEI),which is the school’s clinic facility. The PAC began to develop a strategic plan that defined the term “excellence” as it relates to ICO. The plan, titled Prescription for Excellence, contained five major goals, accompanying appropriate action, identification of departmental responsibility for each goal and designated completion dates.

CHAPTER TWO
PRESCRIPTION FOR EXCELLENCE
YEAR ONE

Dr. Charles Mullen understood the importance of open communication between internal and external constituencies in both the planning process and the implementation of each designated strategy in the Prescription for Excellence. As part of this process, President’s Advisory Council (PAC) members were given the opportunity to voice their opinions and concerns on a variety of subjects and to experience full responsibility for the achievement of each department’s goals. To begin their work, PAC commissioned surveys that addressed alumni and alumnae needs and concerns and student satisfaction. The compiled results had immediate impact on Dr. Mullen’s Prescription for Excellence.

In order to establish improved dialog with the community and to include them in the planning process, Dr. Mullen established a Community Advisory Board (CAB). Leaders of neighborhood organizations, school principals, clergymen, representative of community-targeted government agencies and senior ICO administrators were invited to join this team. The CAB continues to consider such issues as employment opportunities, real estate transactions, and minority student recruitment that have a direct impact on both ICO and its surrounding community.

In the Journal of the American Optometric Association (September 1999), Dr. Mullen discussed his strategic plan in great detail:

“It was now our task to channel these processes into a tangible plan of action. With input generated through countless meetings, reviews, evaluations, and re-evaluations, we created a 70-page document, the Prescription for Excellence. It contains five major goals, each with detailed, quantifiable action steps and completion dates. These action steps also identified the department responsible for their implementation. Regular monthly meetings were scheduled to evaluate our progress. These meetings – which continue today – are open to all members of the ICO community.

The Prescription for Excellence was immediately effective. The goals and directions we established continue to be important, but even more important is the process we created whereby each member of every ICO constituency has the opportunity to be meaningfully involved in the planning process…

Several important themes emerged during the planning process that have helped create a new culture at ICO. Through the planning process, five major goals were crystallized:

  1. Provision of excellence in education and scholarly activity.
  2. Creation and maintenance of reputation as an institution that is characterized by exceptional accountability.
  3. Provision of excellence in service, as defined by our students, patients, alumni, and employees.
  4. Provision of excellence in health care.
  5. Achievement of recognition as a center of influence within the profession and the community.

These goals are now the basis for the performance agreements that exist between every member of senior administration and the President, as well as an agreement between the Board of Trustees and the President. These agreements are what each of us is measured by: they are the basis for budgeting and for departmental planning.”[2]

The results of that first year of implementation were noteworthy. Dr. Mullen reported those achievements to the ICO community at his first “State of the College Address” in October, 1997:

“What I have to share with you today is important to all members of the Illinois College of Optometry community. Today’s address deals with where we are at this point in time …and what our future course needs to be.

ACADEMIC CULTURE
“We have made steady progress in evaluating and improving the quality and cost effectiveness of our external clinical affiliations and our satellite facilities with a goal of achieving budget neutrality. Contracts have been renegotiated (and) as a result…we have reduced the net cost of our satellite programs by approximately $172,000. At the same time, we were achieving these reductions in costs, we have expanded our community based clinical affiliations from a handful to 75 (collaborations), providing more than 210 student rotations annually.

We have made several significant changes in ICO’s curriculum. The focus was changed to give students an overview of an optometric examination with a greater emphasis on technical skills. The optometry sequence has been modified…to complete the teaching of technical skills by the end of the winter quarter of the second professional year. This will make room…for closely supervised clinical experiences prior to the more independent work done during the third professional year…An interpersonal skills course has been added to the spring quarter of the second year including topics (such as) inter -and intra-professional communication.

A summer curriculum will be added to the third professional year beginning in May, 1998. The benefits (of which)…will include a smoother transition from pre-clinical training to actual patient care experience and more patient care experiences for third year students.

An agreement has been reached with the Department of Ophthalmology and Visual Science at the University of Chicago to coordinate clinical, medical, educational and research programs with ICO. This is only the second such agreement between a college of optometry and a university ophthalmology program in the country…Among its benefits will be the creation of an O.D./Ph.D. program; increased opportunities for collaborative research; shared lecturers; and an expanded clinical base.

(The) faculty now has a voice in the deliberations of ICO’s Board of Trustees through elected representatives. A Faculty Council has been created with a written constitution and leadership provided through an elected Executive Committee.

In our efforts to develop external funding for research, we have made significant progress in improving our opportunities with various Federal Agencies by making certain we are in compliance – or making substantial progress toward compliance – in several areas from institutional protocols to record keeping.

ADMINISTRATIVE ISSUES
“We have thoroughly reviewed our organizational structures. We will shortly be submitting to the Board a revised organizational chart that reflects functions rather than individuals and is organized in a way to maximize our efficiency and service to our students and our patients.

Simultaneously with this review, we have taken steps to review all personnel and initiate changes to improve their efficiency. These include the creation of the ‘President’s Advisory Council’ to assist me in managing ICO. We are committed to diversity in our staff, faculty and student body and have taken steps to ensure a diverse ICO community.

FINANCE
“We have reorganized the Business Office to improve our financial management. We have completed a structured budgeting process with time lines and approval processes built in to insure that all ICO needs will be addressed in the budget process and properly prioritized within our educational and patient service commitments ….(and) to improve accountability.

We have also constructed a long-term debt management plan. ICO currently has an outstanding tax-exempt variable rate of indebtedness of $37 million dollars. We have been successful in negotiating productively to refinance this debt in a way that minimizes its burden on ICO and maintains our position of excellence in optometric education.

INSTITUTIONAL IMAGE
“How we see ourselves to a very large extent projects how others view us. For that reason, I have made improving internal communications (among faculty and staff) a high priority during the past year and will continue to do so.

We have attempted to address the information needs of our external constituencies, especially our alumni…This was the impetus for the creation of a quarterly newsletter. We are also in the process of creating an Internet mailing list of our alumni and developing a web site for ICO’s alumni and friends. We have initiated a mentoring program with the Illinois Optometric Association to link optometry students with practicing optometrists in Illinois, the majority of whom are graduates of ICO, furthering the ties between the College, our students and our alumni.

We have also created a public relations program with specific goals and objectives in the areas of media relations, community relations and greater visibility in professional journals and optometric associations. The public relations program contains a strong marketing component, chiefly (involving) the Illinois Eye Institute.

OPERATIONS
“The future of both health care and education will be greatly influenced by developments in communications. Without a significant increase in capital spending, ICO has moved forward aggressively in this arena through the efforts of our Information Systems Department.

Personnel management has been enhanced through greater accountability. Formal performance agreements have been created for each member of the administration, creating an objective measurement against which (each employee can be evaluated for his or her) performance.

PHYSICAL PLANT
“We are continuing to make necessary improvements to our (physical) plant. We recently installed exterior signage, increasing our visibility in the community and improving the marketability of our (Illinois) Eye Institute. We will shortly be changing our internal signage as well, making it more informative, user friendly, consistent and within Federal regulations.

Renovation of the Illinois Eye Institute is nearly complete. When finished, we will have a facility whose exterior and interior appearance matches the outstanding qualities of those who serve there.

At the same time, we have carefully evaluated the existing construction master plan, not only in terms of our needs but also within the framework of sound financial considerations and the need to maintain a competitive economic stance. As a result of this review, we have reduced the previous master plan by more than $23 million dollars over the next five to seven years.

REVENUE STREAMS
“We have made significant progress in increasing (the number of) alternative sources of revenue for ICO…(because) we cannot afford to neither compromise excellence nor over-burden our students with significant tuition increases.

We have begun with the creation of a marketing plan for the Illinois Eye Institute that recognizes that in addition to its educational mission the IEI must be competitive in its efforts to attract patients.

We have reinvigorated our commitment to fundraising, or ‘development,’ – so named in recognition of the fact that the creation of a significant philanthropic base is a developmental process (that occurs) over time.

In order to better fulfill our educational role to practicing optometrists – and to improve our revenue stream through education – we have adopted a more user-friendly stance toward continuing education or CE. We are in the process of creating a CE program (that will be) systematically planned and timed to coincide with the two-year cycle of CE requirements for licensure renewal in Illinois and one that stresses advanced competency.

We are also strongly committed to enhancing our efforts at student recruitment and retention, but please let me emphasize that this must not ever come at the expense of quality.

Our focus this year was to move admissions from a paper oriented (process) to more of a people-oriented process. In August, we held an open house for prospective students. An aggressive schedule of visits to undergraduate campuses for recruiting purposes has begun. Before the year is out, members of our faculty and staff will have visited more than 50 colleges and universities.

STRATEGIC PLANNING
“A Strategic Plan for an institution such as ICO…must do more than chart a course for the future. It must reflect the collective wisdom of the College. We have created such a plan and named it the Prescription for Excellence. It is now in the process of some final revision before being presented to our Board. It is available to all who wish to review it in its entirety. It is a living document in that it is intended to be amended as conditions and opportunities warrant. It addresses all aspects of our continued growth as an institution of health care education. And, as its name implies, it requires excellence as the standard of all our efforts. This is not a mere title, but a recognition of our potential and also of what will be required of those who will thrive in today’s health care environment…..I am confident that ICO and its students, faculty and staff will be among those who excel.”[3]

During this same month, Dr. Mullen was installed as Illinois College of Optometry’s fourth president at a ceremony that was held on October 18, 1997 in the Rockefeller Chapel on the University of Chicago campus.

CHAPTER THREE
PRESCRIPTION FOR EXCELLENCE
YEAR TWO

During Dr. Mullen’s second year at ICO, the benefits of his mandate for openness and communication among the student body, faculty, staff, alumni and administration became more apparent. Working closely with Janice E. Scharre, O.D., M.A., who had been appointed Dean/Vice President for Academic Affair in November 1997, a faculty opinion survey was developed and distributed to determine the College’s perceived strengths and weaknesses. The information was gleaned and processed into a series of positive actions that were designed to enhance ICO’s academic culture.

A similar survey was sent to students, requesting input on virtually every aspect of student life. Improved communication among the student body, faculty and administration produced a more user-friendly Student Guide; increased flexibility in student leave policies; and an expanded and simplified work study program.

The responses to an alumni-directed questionnaire would result in an initiative to freeze tuition, increased funding for scholarships and incremental reduction of entering class size.

In his second “State of the College Address,” which he presented on October 2, 1998, Dr. Mullen detailed some of the accomplishments achieved during the year.

FINANCE
“Let me start with our successful bond issue of $45 million dollars (in variable-rate, tax-exempt bonds by which ICO was able to successfully restructure the College’s debt. This freed $22 million in assets, which were previously held as collateral. Those assets were freed up to be applied to more flexible investments). This guarantees the sound financial footing we need to successfully continue ICO’s tradition of excellence into the next century…But the real significance of the bond issue is not in dollars, but in the confidence the financial community demonstrated in ICO’s future.

STUDENTS
“I am pleased to be able to report that the state of our student body – whose progress in advancing the profession is the yardstick by which we are all ultimately measured -remains extremely strong…We have implemented several new avenues for their input. Town hall meetings were instituted. The Dean’s Advisory Group has been reinvigorated and a student satisfaction inventory was administered last month, seeking input form every ICO student about virtually every aspect of student life.

(To enhance the students’ educational experience,) ICO continues an aggressive expansion of the externship program…(which has) grown from 13 sites in 1996 to 79 (sites which are) currently located throughout the United States and abroad…We have implemented an evaluation and monitoring process for our sites…(and) taken care to remain fiscally prudent during this period of expansion. We will continue to analyze our community-based sites, seeking to renegotiate financial arrangements when possible; increase patient volumes; and modify our time commitment to individual sites when desirable. External sites, such as (the ones) we have developed, allow students a greater breadth of experience. They allow students to choose diverse locations and types of clinical settings, better preparing them for the realities they will face as practicing optometrists.

FACULTY
“The state of the faculty is also strong. A revised Faculty Handbook, which consolidated the old handbook and academic policy manual – was developed cooperatively by the faculty and the Dean. During the past year, significant emphasis was placed on faculty scholarly activity….Faculty attendance at professional meetings increased by 71 percent during the past year…Twenty-seven faculty presented (papers) at last year’s American Academy of Optometry meeting. Publications by junior faculty have increased significantly.

The faculty has also made a concerted effort to increase research, specifically in securing external research funding. ICO received over $100,000 in external research grants in fiscal year 1997-98, including significant grants from the Pearle Vision Foundation and the Illinois Society for the Prevention of Blindness. To insure that progress continues in this area, we have been sending faculty members to AOA grant writing workshops as well as the Academy Research Symposium.

Continued improvement of faculty teaching effectiveness is a high priority. We have created a Faculty Teaching Circle, in which informal monthly meetings focus on various teaching topics. One outcome of these meetings has been the creation of student-faculty colleague groups. A faculty retreat featured guest speakers from the University of South Carolina and the University of Chicago who spoke on the importance of developing effective feedback mechanisms from students so educational techniques might be refined and improved at ICO.

CONTINUING EDUCATION
“Through our Institute for Advanced Competency, 197 practicing optometrists received 358 hours of continuing education. In this fiscal year, we have already provided 323 hours of continuing education for 270 optometrists. We have also entered into agreements with various members of the ophthalmic community to provide CE. Included are: Cole Vision, EyeQuest, Consolidated Vision Group, Vistakon and TLC.

ILLINOIS EYE INSTITUTE
“The Illinois Eye Institute continued to make great progress in successfully marketing its services to the community. Through a fiscally conservative strategy…including print and radio advertising, direct mail and an increased presence at health fairs and neighborhood events, IEI (patient visits) increased by 4 percent in 1997-98, while producing a 10 percent increase in revenue. Through the first two months of this fiscal year, figures indicate that patient encounters are up by 16 percent as compared to the same period one year ago.

Various venues for patient feedback gave been created, such as surveys and a telephone comment line. Responses are being analyzed and changes in IEI resource allocation will be influenced by patient response.

In the realm of managed health care, the College is committed to enhancing the role of the optometrist as the primary eye-care provider. Along with our affiliate, the University of Chicago, we are in the process of developing a university-based, comprehensive eye-care product.

TECHNOLOGY
“While focusing on human elements, we have not neglected the bricks and mortar side of ICO during the past year, as well as computer software and hardware. Compulink, a new clinical software system, is about to enter the testing and training phase. Our target date to have this system “live” is late January of 1999. The CARS system, our financial and administrative system, is approximately 75 percent complete. We have upgraded all of our desktop computers with the addition of Windows 95 and Office 97. (And) Internet access was provided to most desktop computers. Currently, a new library system us under evaluation and selection. The long anticipated One Card System, which will allow ICO students (to use) a single card for security access, identification and purchasing, is on schedule and will be implemented in 1999.

BOARD OF TRUSTEES
“With the support of our Board, we remained fully committed to increasing diversity at ICO last year. One outcome of this commitment was the appointment of ICO alumna, Dr. Millicent Knight, to the Board the first female African American to so honor her alma mater.

COMMUNITY
“(ICO has) successfully reached out to the community. The recently created Community Advisory Board is comprised of eleven individuals, representing area churches, schools, community groups, government agencies, and members of ICO Administration. (Its purpose) is to discuss areas of mutual concern and to formulate plans for improving the quality of life for all the residents of our community.

Our students have played a significant role in strengthening our ties to the community. Through patient care in the IEI and also through such neighborhood projects as unity day, the literacy program and donating toys for Christmas, students have helped show our care and concern for our neighbors on a very real, one to one basis.

ALUMNI
“As the largest college of optometry in the country, ICO benefits from having the largest number of alumni of any of the schools or colleges of optometry. Through newsletters, direct mail, individual and group meetings and receptions at various professional meetings, we continue to forge strong bonds with our alumni.

A benefit to our students, we hope, will be an increased commitment on the part of the alumni to the ICO Endowment Fund. We are aggressively pursuing deferred and major gifts from our alumni and our friends in the ophthalmic industry to add to our endowment.

OPHTHALMIC INDUSTRY
“We are continuing to reach out to our partners in the ophthalmic industry. The Practice Opportunities Symposium (which took place) this past spring was enthusiastically endorsed by representatives from a wide range of practice options. (This symposium provides the students with the opportunity to learn about all modes of optometric practice.) Through both… our alumni and our partners in the ophthalmic community, we have realized over $300,000 in pledges and gifts this year.

ACCREDITATION SITE VISITS
“During this past fiscal year, we benefited from two highly successful accreditation site visits: the Council on Optometric Education Interim Site Visit and the Primary Care Residency Reaccreditation. The COE visit confirmed that recommendations and suggestions made in its earlier report had been accomplished. The Primary Care Residency Reaccreditation was also highly successful as the accrediting team reported that all nine of its standards had been fully complied with. Preparations are now underway for the North Central Association accreditation visit in March of 1999…I am fully confident we will benefit from this examination and once again exceed expectations.

One year ago, I stood before you and announced that we had completed a strategic plan, our Prescription for Excellence (which would be) a living document to guide us through the coming year and into the next century….To date, of the 798 action items contained in the plan, 438 (items) or 55 percent have been completed. (Although) the Prescription for Excellence will continue to be our guide for the coming year…we have already begun the next phase of planning – identifying outcome measures, adding baseline data, and revising the plan to include new initiatives and linking a five-year operational budget to the plan.

As you know, this year we officially began our observation of our 125th anniversary as America’s oldest college of optometry. Over the years, the manner in which our profession is practiced and the way in which it is taught, has changed, but through it all our commitment to excellence has remained firm. With that continued commitment, I am confident that our progress over the next 125 years will be just as exciting.”[4]

It was during this academic year that Dr. Mullen led the school on a two-year journey toward excellence.

CHAPTER FOUR
JOURNEY TO EXCELLENCE
YEAR ONE

ICO’s 125th anniversary year (1998-99) marked not only a celebration of the College’s long history and its stature in the optometric profession. It also commemorated the beginning of momentous changes which would positively position the school as it entered the twenty-first century.

At the spring Interim Board Meeting, the Board of Trustees acted upon an alumni-inspired initiative and approved freezing tuition at the 1998-99 level ($22,668), while simultaneously increasing allocated funds for scholarship aid to $400,000 and gradually reducing entering class size for five years beginning in 2000. These directives had a crucial impact on ICO’s budget planning process, requiring mandatory expense reduction in order to maintain a balanced budget.

An ambitious $8.5 million campus capital improvement program – funded with revenues from the restructure of ICO’s debt – was completed during that year. The program included renovations to the physical plant; the purchase of new ophthalmic equipment; and the installation of extensive informational systems technology. With improvements to the campus’ external appearance along with other college-owned property, ICO participated in the continuing resurgence of community development.

Affiliation with the University of Chicago continued to flourish. A course in basic eye-care procedures for second-year University of Chicago medical students was developed and implemented.

In his “State of the College Address,” which he delivered on October 22, 1999, Dr. Mullen reflected on his years at ICO and the challenges that the College would face to maintain its leadership position:

“In preparing this year’s address, I found it useful to reflect back upon my arrival at ICO in 1996. At that time, I said three elements would characterize my presidency. (These were:)

  1. The need to recognize the challenges that confront us and to clearly define them.
  2. The importance of pervasive and detailed planning so we might marshal our resources and measure our progress in meeting these challenges, making adjustments as necessary.
  3. Open and productive dialog among all members of the ICO family … the Board of Trustees, alumni, our many friends and partners in the ophthalmic community and businesses, and the residents of the community in which we are located.

I believe that our commitment to these three concepts provided the basis for significant progress at ICO during the past year. We have now successfully completed over 70 percent of the action items in our original strategic plan, Prescription for Excellence.”

Dr. Mullen further described in this same address some of the noteworthy accomplishments from that year as well as some of the challenges that lay ahead:

“We are in the process of (establishing) a faculty practice plan making ICO more attractive to (present) and prospective faculty.

Thanks to the hard work of our community based education staff, we have continued to expand our externship program…at over 100 sites throughout the United States and abroad. From these sites, combined with the Illinois Eye Institute, our students will benefit from more than 150,000 clinical teaching opportunities, significantly enhancing their educational experience. Student–patient encounters are up 68 percent compared to three years ago.

Our residency program has grown to include residencies in cornea/contact lenses and anterior segment/refractive surgery.

With the support of the Board of Trustees, we have embarked on a bold course to insure our position of leadership…(by freezing) tuition while simultaneously increasing scholarship aid. At the same time we committed to gradually reducing the size of future entering classes, beginning with a reduction by five for the class admitted in the year 2000.

To do this will be a tremendous challenge, but I am confident we can do it. However, these are not the only challenges facing ICO as we prepare for the next millennium. To maintain our position of leadership we must do the following:

  • Continue to emphasize strategy and tactical planning with outcome-based assessment as the measure of progress.
  • Amplify the voices of students in College affairs, including representation on the Board of Trustees.
  • Continue to expand our recruitment of gifted foreign students beyond the confines of North America, while remaining a strong institution of choice for outstanding students from our neighbors to the north.
  • Increase the size of the Board of Trustees, furthering its diversification. And recruiting members with needed expertise and philanthropic capabilities.
  • Further enhance personnel relations within the ICO family, particularly as it pertains to fostering a positive attitude and respect for one another.
  • Restructure the clinical education program to be more cost-efficient while we maintain academic quality.
  • Accelerate the upgrade of instructional technology.
  • Ensure that our curriculum is consistent with defined entry-level attributes.
  • Develop and implement an advanced competency curriculum.
  • Significantly increase the revenues of the Illinois Eye Institute.
  • Implement a faculty practice plan.
  • Continue to improve faculty scholarly activity with more externally funded research, clinical trials and publications.
  • In cooperation with the University of Chicago, develop our role as a provider of comprehensive eye care services within the Chicagoland managed health-care market.
  • Achieve continuing accreditation from the Council on Optometric Education.
  • Achieve accreditation for the Illinois Eye Institute from the Joint Commission on Accreditation of Health Care Organizations, a first for an eye-care facility (that is) affiliated with a college of optometry.
  • Launch major capital and deferred-giving campaigns to sustain an ongoing and significant development effort in keeping with our status as America’s largest college of optometry.
  • Complete the cultural shift of the institution to one devoted to the continuous improvement of our programs, services and products.

Tomorrow night we will officially conclude our… celebration of our 125th anniversary. The highlight of the evening’s festivities will be the recognition of 125 individuals, organizations and institutions for their outstanding lifetime contributions to optometry. Some have contributed through research, others through practice, some through teaching, and some in the business world. Their contributions are as varied as their numbers…They have witnessed tremendous change in the way optometry is taught and the way it is practiced. They have learned to thrive in an environment of rapid change.

In the last year we have accomplished much…I look forward to reporting further progress in the years ahead.”[5]

Dr. Mullen then devoted the next year to the implementation of additional initiatives that had emerged during the previous identification and developmental period.


CHAPTER FIVE
JOURNEY TO EXCELLENCE
YEAR TWO

The mandate to successfully freeze tuition and increase the scholarship budget while maintaining a balanced budget and preserving the quality of education had a visible impact on ICO. Working on a 5-year budgeting plan, necessary expense reductions were made and continue to be implemented each year to achieve ICO’s goals.

A Voluntary Early Retirement Incentive Program was approved by the Board of Trustees, which took effect on January 1, 2000. Full-time employees with at least ten years of service and who are age 55 or older were eligible. Seven employees accepted the early retirement package. Responsibilities were reassigned so that, in most cases, those employees were not replaced.

The College worked diligently to increase income from non-tuition sources. Assets that could be invested grew by $6.5 million to more than $27 million since 1996. A Vision for the Future Campaign has been launched with the goal of growing the total endowment to $60 million by the year 2010. The Office of Institutional Advancement helped the President raise more than $1 million during the previous year.

Anticipating challenges such as the contracting student applicant pool and the changes in the healthcare industry, the administration tackled each situation head-on. Dr. Mullen reported these changes in his fourth annual “State of the College” address:

“We have had an outstanding year, thanks to every member of the ICO community. I am especially grateful to those who have played important roles in our ongoing strategic planning process. Much of our current and future success stems from those efforts.

It has allowed us to open new avenues of dialogue – within the college and within the profession, the healthcare industry and our constituents at large. It has allowed us to implement performance-based monitoring and measurement of our progress. And it has allowed us to positively engage faculty, administration and students in continuously improving our institution and our performance.”

Dr. Mullen then recounted some of the year’s achievements and strengths.

“Academically, we are stronger than ever. We have expanded externship sites to 118 (current sites) today…The (Illinois) Eye Institute and (these sites) now provide over 180,000 clinical encounters for our students each year. Our students’…pass rate on the National Board exams, at time of graduation, now stands at 94 percent. ICO has historically performed very well on the clinical sections of the National Boards and this year’s performance in Basic Science…significantly exceeded the national average.

Our student attrition rate is at an all time low of only 2.7 percent. We have expanded residency programs in cornea and contact lenses, refractive surgery and primary eye care…(We) have built research laboratory facilities and made significant technological improvements in our lecture centers.

Our graduates enter into practice better prepared to succeed thanks to significant improvements in our practice management course and programs such as the Practice Opportunities Symposium, Private Practice Club and ICO Placement Services.

Our affiliation with the University of Chicago’s Department of Ophthalmology and Visual Science stands unique among colleges of optometry. Our collaborative course for medical students speaks directly to our rigorous commitment to the arts and science of both medicine and optometry. We have also formalized our cooperative O.D./M.S. and O.D./Ph.D. programs with the University of Chicago.

Our faculty has enhanced its pursuit of scholarship. During the past year, a total of seven research grant proposals were submitted and six were funded. In addition, 21 articles were published in professional journals. Faculty representation in the American Academy of Optometry at the fellowship and diplomate levels stands at 87 percent up from 48 percent just four years ago.

Clinically, we are stronger as well. (There are) marked improvements in patient satisfaction and a 23 percent increase in Illinois Eye Institute revenues since 1997. Professionally, we have strengthened our outreach and built better relationships with other health care professionals and organizations through our Professional Advisory Board.

Financially, we are stronger than ever. Our (investment-worthy) assets have grown to more than $27 million, up more than $6.5 million in just four years. We have launched our Vision for the Future Campaign, with its goal of growing our total endowment to $60 million by the year 2010. Through a grant from the State of Illinois for $250,000, we have reestablished our indigent patient care program. We expect to reach thousands of high-risk patients in the coming year with this support.

We have also been able to freeze tuition at its level of two years ago (while increasing) the scholarship budget by nearly 50 percent…I want to recognize both the faculty and the students for independently and successfully launching and funding new scholarship programs to benefit students. Governance has grown even stronger through the Board’s concerted efforts to increase and diversify its members. We now have a voting faculty member on the Board of Trustees and student representation as well. But we cannot rest on our achievements and expect to maintain excellence. Challenges lie ahead. We must face them squarely. We can and we will.

Over the next few years, we have pledged ourselves to meet these challenges through continuous refinement of our strategic planning capabilities. Soon we will enhance patient care and clinical education by developing and implementing a Faculty Group Practice Plan.

In the face of a decreasing student applicant pool, we continue our commitment to recruit and admit only the most qualified students and assist them in managing the high cost of a quality education by continuing to freeze tuition and by increasing scholarship support.

Financially, we have committed ourselves to refining our financial planning in line with the goals of our strategic plan, Journey to Excellence. And we will continue to sustain and strengthen our capital and planned giving efforts. We will continue to enhance our academic culture through support of our faculty in their roles as teachers and through expanded opportunities for faculty research and scholarship. We will evaluate and modify our curriculum, striving to maintain an effective entry-to-practice model. We can prove our commitment to excellence in patient care by going forward with seeking accreditation from the Joint Commission on Accreditation of Healthcare Organizations.

The state of the College is strong because of the hard work and dedication of a great many people. Today, I would like to thank all of you…We’ve had an extraordinary year. We have an extraordinary future ahead of us as we continue to provide an outstanding education for future eye care professionals. I look forward to continuing on our Journey to Excellence with each and every one of you.”[6]

By meeting each of the Prescription for Excellence’s goals and applying the strategies in the Journey to Excellence, ICO is now prepared to face the future with confidence and a commitment to excellence.

CHAPTER SIX
COMMITMENT TO EXCELLENCE
WHAT LIES AHEAD

During these early years of the twenty-first century, both optometric education and the profession of optometry are facing new challenges: challenges that are both necessary and inevitable. Dr. Mullen predicted what the profession and Illinois College of Optometry might face in a guest editorial that appeared in the Journal of the American Optometric Association, (September 1999).

“The challenges facing ICO – to a greater or lesser extent – are the same issues that face many of the schools and colleges of optometry. In general I see the following trends in optometric education:

  • We will see a lessening of our dependency on campus-based clinics for the clinical education of third- and fourth-year optometry students. Driven initially by economics – but, I believe, providing for greater diversity of educational experiences – we will see more community-based training sites or externships for fourth-professional-year students and some third-year rotations.
  • Campus-based clinics will remain valuable for first- and second-year students.
  • College-based clinics will serve a significant role as (the) faculty practice becomes more important as a means to enhance faculty income and improve (both) schools’ and colleges’ ability to recruit and retain highly qualified clinicians.
  • We will see a movement away from traditional classroom teaching toward more technology-assisted self-learning through the rapid advances being made in communication and computer-based technology. The college, however, must be prepared to assist the faculty in changing their teaching strategies.
  • Acquisition of critical analysis skills will become as important as a solid foundation in the basic and health sciences.
  • There will be recognition that the function of a school or college is to prepare doctors of optometry for a life-time of learning in their field.
  • We will have to redefine the entry-level attributes of our students and modify our curriculum to emphasize a lifelong commitment to learning.
  • While graduates must learn to be well-grounded in the fundamentals of their profession, the purpose of this grounding must be to position them to continue the learning process.
  • Students must learn to focus on the opportunity for interaction with faculty and with one another while on campus. They must commit to a philosophy that emphasizes the acquisition and appropriate application of knowledge over information absorption and memorization.
  • We will see the development and utilization of a national faculty in several disciplines, linked through developing technology. All schools and colleges of optometry will be able to access a faculty made up of our very finest educators.
  • Cooperation between optometry and ophthalmology that began at the New England College of Optometry’s Boston clinics and carried forward at PCO (Pennsylvania College of Optometry) with Hahnemann University and at ICO with the University of Chicago – will continue and intensify.
  • We must then be prepared to offer meaningful advanced competency education to practicing optometrists as a core value of optometric education.
  • Residency programs will continue to increase, but at a more modest rate. I believe the future direction of the profession of optometry will be fueled by the economics of the managed care marketplace.
  • The cooperative environment among opticians, optometrists, and ophthalmologists that exists at the academic level and – in several instances – in other practice modes will intensify.
  • Distinctions in practice modes will continue to blur among the three groups. Economic realities will override emotional opposition and force closer cooperation. Individual claims of priority and historical territorial imperatives will be forced to give way.
  • Quality assurance programs and advanced competency certification and accreditation will become increasingly important.
  • The expansion of the scope of practice of optometry will consist mainly of amendment and clarification to existing practice laws.
  • Ultimately, all states will grant appropriate and extensive prescription authority to optometrists.
  • The expanded use of laser technology by optometrists will evolve slowly over the next two decades.
  • Consultation among practicing professionals will take advantage of advances in technology. Consultants with national eye centers of excellence will become the norm, as precise retinal images and other data are instantly transmitted from one point to another in real time.
  • We will see fewer independent, private practitioners of optometry in the future and more multi-practice settings, more optometrists in HMOs, hospitals and other institutional settings. What is often termed ‘corporate optometry’ will continue to expand for the foreseeable future.
  • Schools and colleges of optometry will recognize their responsibility to expose their students to a wide variety of practice modes and to discuss each opportunity openly and honestly.
  • Health care third-party payers will continue to exert enormous influence on the practice of health care-eye care included. In this vein, it is imperative that optometry solidify its position as the primary eye care provider within the managed care market.

We live, learn, teach and practice in tremendously exciting times. I believe the future of optometry is as great as our ability to translate our vision for the profession into strategic and tactical plans of action – as promising as our courage and tenacity to implement those plans.”[7]

——————————————————————————–

[1] Excerpted from “Interview with Charles F. Mullen, O.D.” Journal of the American Optometric Association 1999; 70:556-60. (Copyright © 1999 by the Journal of the American Optometric Association. Reprinted with permission.)

[2] Excerpted from Interview with Charles F. Mullen, O.D. Journal of the American Optometric Association 1999; 70:556-60. (Copyright © 1999 by the Journal of the American Optometric Association. Reprinted with permission.

[3] Excerpts from “State of the College Address – October 01, 1997” which was delivered by Dr. Charles F. Mullen.

[4] Excerpts from “State of the College Address – October 02, 1998” which was delivered by Dr. Charles F. Mullen.

[5] Excerpts from “State of the College Address – October 22, 1998” which was delivered by Dr. Charles F. Mullen.

[6] Excerpts from “State of the College Address – October 20, 2001” which was delivered by Dr. Charles F. Mullen.

[7] Excerpts from “Interview with Charles F. Mullen, O.D.” Journal of the American Optometric Association 1999; 70:556-60. (Copyright © 1999 by the Journal of the American Optometric Association. Reprinted with permission.)

First published in 2001 by
Illinois College of Optometry
3241 South Michigan Avenue, Chicago, IL 60616 USA

Cover design:
Anistatia R. Miller
Jared M. Brown

Book design:
Alan Pouch

Photographs:
Ray Reiss, Sparkfactor
Andrew Fils, The Paul Studio
Alan Pouch, Illinois College of Optometry

Preface & commentary:
Barbara B. Renard
Copyright © 2001 by Charles F. Mullen, O.D. and Barbara B. Renard

All rights reserved.
No part of this book may be reproduced, stored in or introduced into a retrieval system, or transmitted in any form or by any means (including electronic, mechanical, photocopy) whatsoever without written permission from the above publisher of this book, except by reviewers who may quote brief passages to be printed be a magazine or newspaper.

ISBN #: 0-9652759-Printed in the United States by Paperback Mfrs.

Interview with the Journal of the American Optometric Association (AOA)

Three years have passed since Charles F. Mullen, O.D. assumed the presidency of the Illinois College of Optometry (ICO), the oldest and largest educational facility dedicated solely to the teaching of optometrists. This fall, ICO concludes its year-long celebration of its 125th anniversary. In response to the Editor’s questions, Dr. Mullen shares his responsibilities at ICO, his objectives for the college, and to what degree they have been achieved. He also discusses the future direction of ICO, optometric education, and the profession of optometry.

Why did you accept the position of President of the Illinois College of Optometry?

Given ICO’s historical position of prominence within optometric education, I was concerned when I learned of the difficulties the college was experiencing in 1996. I believed these difficulties had the potential to harm not only ICO, but possibly even the profession of optometry itself. When approached by the Search Committee, I felt a responsibility to my profession of thirty years to interview for the position. Since I had extensive experience in health care management and clinical education, I felt confident that with the support of the Board of Trustees, faculty, and staff, we could redirect the resources and energies of the college toward programmatic improvements and that in a fairly short time we could create an institutional culture in which faculty, staff, and students were positively engaged in strengthening the institution.

The interview process for the presidency began in the summer of 1996. I met with the faculty. The faculty provided anonymous evaluations of my potential as ICO’s new president. The returns were favorable. By November, I was commuting between Washington, D.C. and Chicago. In December 1996, I assumed the presidency of the Illinois College of Optometry.

What were your expectations and initial objectives when you arrived at ICO?

Although I found there was an understandable sense of uncertainty regarding the immediate future of the College, morale was surprisingly good. It was my perspective that faculty and staff were not only willing, but eager, to “right the ship” and to positively engage in strengthening and improving the institution. I felt confident I could immediately assemble a capable administrative team from the existing faculty and staff.

My initial objectives included:

  • Initiation of a strategic and tactical planning process.
  • Enhancement of the academic culture by increasing support for faculty development, research, and scholarly activity.
  • Expansion of the clinical educational program by initially adding 50 community-based training sites.
  • Initiation of a search for a new Dean/Vice President for Academic Affairs.
  • Review and modification, as appropriate, of the administrative organization.
  • Enhancement of the institutional culture, by improvement of services to students, patients, alumni, and employees.
  • Ensurance of the financial stability of the institution, including the enhancement of revenue streams.
  • Review and modification of the master buildings and facilities program.
  • Improvement of management information systems.
  • Enhancement of personnel management.
  • Development and implementation of public relations and fund-raising programs.
  • Redirection of resources formerly allocated to an ambitious building program into programmatic improvements.

I believed that it was vital that our planning process promote open avenues of dialog with internal and external constituencies. I knew from my PCO experiences that each graduate of ICO is important to the college. I needed their perspective, but – even more importantly – I had to make them part of the decision-making process. I commissioned a survey of alumni/alumnae needs and concerns that not only had an immediate impact on our strategic planning, but led to the creation of ongoing communication channels that continue to affect our strategic planning. One very dramatic outcome of alumni input was ICO’s recent decision to freeze tuition, increase scholarship funding, and reduce the entering class size.

We also brought the broader community into the planning process. The Illinois Eye Institute had a long and well-recognized record of serving the community and we wanted to be even better neighbors. We appointed a Community Advisory Board (CAB). This Board includes leaders of neighborhood organizations, school principals, representatives of government agencies serving the community, clergymen, and members of ICO’s senior administration. We deal with various issues of mutual interest to ICO and the community, such as employment opportunities, construction projects, real estate transactions, and minority student recruitment.

It was now our task to channel these processes into a tangible plan of action. With input generated through countless meetings, reviews, evaluations, and reevaluations, we created a 70-page document, the Prescription for Excellence. It contains five major goals, each with detailed, quantifiable action steps and completion dates. Thee action steps also identified the department responsible for their implementation. Regular monthly meetings were scheduled to evaluate our progress. These meetings – which continue today – are open to all members of the ICO community.

The Prescription for Excellence was immediately effective. The goals and directions we established continue to be important, but even more important is the process we created whereby each member of every ICO constituency has the opportunity to be meaningfully involved in the planning process. The Prescription for Excellence is now in its second generation, as the Journey to Excellence.

Several important themes emerged during the planning process that have helped created a new culture at ICO. Through the planning process, five major goals were crystallized:

  • Provision of excellence in education and scholarly activity.
  • Creation and maintenance of reputation as an institution that is characterized by exceptional accountability.
  • Provision of excellence in service, as defined by our students, patients, alumni, and employees.
  • Provision of excellence in health care.
  • Achievement of recognition as a center of influence within the profession and the community.

These goals are now the basis for the performance agreements that exist between every member of senior administration and the President, as well as an agreement between the Board of Trustees and the President. These agreements are what each of us is measured by; they are the basis for budgeting and for departmental planning.

What progress have you made in addressing your objectives and have your expectations been met?

Strategic planning has been very successful at ICO and not just by our own measurement. Nearly 70% of the initial action items contained in the original plan have been completed. The following are all the direct outgrowth of ICO’s planning process:

  • Appointment of Janice E. Scharre, O.D., MS, as Dean/Vice President for Academic Affairs.
  • Achievement of continuing accreditation by the North Central Association of Colleges and Schools, without stipulation or monitoring.
  • Creation of open dialog with key constituency groups.
  • Achievement of strong financial position for the institution.
  • Diversification of the Board of Trustees, including the appointment of faculty representatives and minority representation.
  • Achievement of increase in patient encounters at the Illinois Eye Institute.
  • Successful restructure of ICO’s debt through the issuance of $45 million in variable-rate tax-exempt bonds, which allowed more flexible investment of $22 million in assets.
  • Institution of numerous financial controls and safeguards.
  • Reorganization of the administrative team, including the formation of a President’s Advisory Council
  • Improvement of student services and culture by response to a comprehensive student satisfaction survey.
  • Affiliation with the Department of Ophthalmology and Visual Sciences at the University of Chicago.
  • Expansion of externships from 9 sites to 97 sites in the United States and abroad.
  • Completion of $8.5 million in campus capital improvements, including renovations to the physical plant, purchase of new ophthalmic equipment, and installation of extensive informational systems technology.
  • Achievement of an all-time high student retention rate of 97.1%.
  • Participation in the continued resurgence of the neighborhood development around the College by improvement of the external appearance of the college campus and other college-owned property.
  • Reinstatement of a faculty practice plan.
  • Enhancement of employee and trustee communications by issuance of a comprehensive Employee Manual, a revised Faculty Handbook, and a Board of Trustees compendium of Resolutions and Action Items.
  • Receipt of a report from the Council on Optometric Education, during an interim site visit in 1998, that ICO had addressed all previous recommendations and suggestions.
  • Revision and improvement of the Practice Management course, including the initiation of an annual practice opportunities symposium, in which students have the opportunity to learn about all modes of optometric practice.
  • Enhancement of faculty governance with creation of the faculty executive committee and expansion of the committee structure.
  • Achievement of increased student-patient care encounters by 68%.
  • Development and implementation of a course for University of Chicago second-year medical students in basic eye care procedures.
  • Expansion of ICO’s residency program to include residencies in cornea/contact lenses and anterior segment/refractive surgery.
  • Achievement of increased quality of entering students, as measured by average GPA and OAT scores over the past three years.
  • Settlement of all outstanding legal matters.
  • Freeze of the tuition at FY98-99 level.
  • Achievement of increased scholarship funding.
  • Improvement of relations with the corporate community.

I can honestly say that my expectations have been greatly exceeded. I attribute this to the dedication, hard work, and perseverance of ICO’s Board of Trustees, faculty, staff, and student leadership for their support and willingness to adjust to my management style.

I am very proud of our affiliation with the Department of Ophthalmology and Visual Sciences at the University of Chicago. It came about, in part, as a result of the account of my earlier experiences with cooperative efforts between optometry and ophthalmology that had appeared in Archives of Ophthalmology. Terrance Ernest, M.D., Ph.D., chairman of the Department of Ophthalmology and Visual Sciences at the University of Chicago, had read the article I co-authored with Myron Yanoff, M.D. in 1990 on the affiliation between Hahnemann University and PCO. Dr. Ernest believes – as I do – that there is tremendous potential for further cooperation between optometry and ophthalmology. Now that I was at ICO, Dr. Ernest approached me with the possibility of a similar agreement with the University of Chicago. The proposed affiliation quickly became part of our planning process. In October 1997, Dr. Ernest and I signed the affiliation agreement as one event of my inaugural-week activities. The affiliation continues to be highly successful as the relationship expands and new elements are added to the basic agreement.

What is the future direction of ICO, optometric education, and the profession of optometry?

Although in retrospect I believe I may have underestimated the complexity of the issues facing optometric education when I assumed the presidency of ICO, I remain as optimistic of the future as I did on my arrival. But I do see changes ahead for ICO and optometric education. Indeed, my optimism is grounded in the belief these changes are not only necessary, but inevitable. I believe for ICO to continue to excel, we must:

  • Successfully mange the decreasing optometric and health care student pool.
  • Reduce student indebtedness.
  • Address issues of eye care manpower.
  • Restructure the clinical education program to be more cost-efficient while we maintain academic quality.
  • Launch major capital and deferred giving campaigns and sustain an intense development effort.
  • Significantly increase the Illinois Eye Institute revenues and expand our faculty practice plan.
  • Further diversify the Board of Trustees and increase its size by recruiting Board members with needed expertise and philanthropic capabilities.
  • Continue to provide students with a voice in College affairs, including representation on the Board of Trustees.
  • Improve faculty scholarly activity – specifically, externally funded research, clinical trials, and publications.
  • Greatly expand instructional technology.
  • Ensure that curriculum is consistent with defined entry-level attributes.
  • Continue the emphasis on strategic and tactical planning with outcome-based assessment as the measure of progress.
  • Develop and implement an advanced competency curriculum.
  • Enhance our position – in cooperation with the University of Chicago – as a provider of comprehensive eye care services within the Chicago-land health care market.
  • Develop and implement and O.D./Ph.D. program in cooperation with the University of Chicago.
  • Achieve continuing accreditation by the Council on Optometric Education.
  • Improve personnel relations with ICO – particularly as it pertains to positive attitude and respect for one another, with a special effort to acknowledge individual and group achievements.
  • Expand our foreign student recruitment program to extend beyond North America.

The challenges facing ICO – to a greater or lesser extent – are the same issues that face many of the schools and colleges of optometry. In general, I see the following trends in optometric education:

  • We will see a lessening of our dependency on camps-based clinics for the clinical education of third and fourth-year optometry students. Driven initially by economics – but, I believe providing for greater diversity of educational experiences – we will see more community-based training sites or externships for fourth-professional-year students and some third-year students.
  • Campus-based clinics will remain valuable for first- and second-year students.
  • College-based clinics will serve a significant role as faculty practice becomes more important as a means to enhance faculty income and improve the schools’ and colleges’ ability to recruit and retain highly qualified clinicians.
  • We will see a movement away from traditional classroom teaching toward more technology-assisted self-learning through the rapid advances being made in communication and computer-based technology. The college, however, must be prepared to assist the faculty in changing their teaching strategies.
  • Acquisition of critical analysis skills will become as important as a solid foundation in the basic and health sciences.
  • There will be recognition that the function of a school or college is to prepare doctors of optometry for a lifetime of learning in their field.
  • We will have to redefine the entry-level attributes of our students and modify our curriculum to emphasize a lifelong commitment to learning.
  • While graduates must learn to be well-grounded in the fundamentals of their profession, the purpose of this grounding must be to position them to continue the learning process.
  • Students must learn to focus on the opportunity for interaction with faculty and with one another while on campus – they must commit to a philosophy that emphasizes the acquisition and appropriate application of knowledge over information absorption and memorization.
  • We will see the development and utilization of a national faculty in several disciplines, linked through developing technology. All schools and colleges of optometry will be able to access a faculty made up of our very finest educators.
  • Cooperation between optometry and ophthalmology – that began at the New England College of Optometry’s Boston clinics and carried forward at PCO with Hahnemann University and at ICO with the University of Chicago – will continue and intensify.
  • We must then be prepared to offer meaningful advanced competency education to practicing optometrists as a core value of optometric education.
  • Residency programs will continue to increase, but at a more modest rate.
  • I believe the future direction of the profession of optometry will be fueled by the economics of the managed care marketplace.
  • The cooperative environment among opticians, optometrist, and ophthalmologists that exists at the academic level and – in several instances – in other practice modes will intensify.
  • Distinctions in practice modes will continue to blur among the three groups. Economic realities will override emotional opposition and force closer cooperation. Individual claims of priority and historical territorial imperatives will be forced to give way.
  • Quality assurance programs and advanced competency certification and accreditation will become increasingly important.
  • The expansion of the scope of practice of optometry will consist mainly of amendment and clarification to existing practice laws.
  • Ultimately, all states will grant appropriate and extensive prescriptive authority to optometrists.
  • The expanded use of laser technology by optometrist will evolve slowly over the next two decades.
  • Consultation among practicing professionals will take advantage of advances in technology. Consultations with national eye centers of excellence will become the norm, as precise retinal images and other data are instantly transmitted from one point to another in real time.
  • We will see fewer independent, private practitioners of optometry in the future and more multi-practice settings, more optometrists in HMOs, hospitals, and other institutional settings. What is often termed “corporate optometry” will continue to expand for the foreseeable future.
  • Schools and colleges of optometry will recognize their responsibility to expose their students to a wide variety of practice modes, and to discuss each opportunity openly and honestly.
  • Health care third-party payers will continue to exert enormous influence on the practice of health care – eye care included. In this vein, it is imperative that optometry solidify its position as the primary eye care provider with the managed care market.

We live, learn, teach, and practice in tremendously exciting times. I believe the future of optometry is as great as our ability to translate our vision for the profession into strategic and tactical plans of action – and as promising as our courage and tenacity to implement those plans.

Charles F. Mullen, O.D.
Journal of the American Optometric Association.
September 1999. Volume 70. Number 9.

Illinois College of Optometry Recovers from Scandal

New president spearheads the school’s efforts to bounce back from charges of fraud against his predecessor.

In April 1996, the Illinois College of Optometry (ICO) was rocked by scandal. President Boyd Banwell, OD, and chairman of the board of trustees Joseph Ebbesen, OD, resigned under pressure after an internal investigation alleged that the two doctors had worked to defraud the college out of more than $2 million. The school and the Illinois Attorney General filed civil charges against the doctors and Dr. Banwell sued the school, claiming wrongful termination…

The current situation is a far cry from what Dr. Charles F. Mullen, OD, FAAO saw when he came to the campus in December 1997 as acting president after spending 6 years as the Director of Optometry Service for the U.S. Department of Veterans Affairs. “When I arrived, I would say morale was generally low among the faculty and the staff. I would describe the student body as more confused over the issue than having low morale,” he said. “Naturally, there was some initial surprise and concern for the stability and future of the institution,” agreed Michael Chaglasian, OD, chairman of the faculty executive committee.

Faced with the challenge of restoring the reputation of the 125 year old institution, Dr. Mullen brought with him an inclusive style, soliciting opinions from the faculty, administration and even students. His style is a stark contrast to his predecessor’s.

Shortly after Dr. Mullen arrived he began meeting with individual classes on campus to discuss the legal difficulties with students. He now meets monthly with the faculty executive committee, which had not met regularly under the former president. The faculty also now has two representatives on the board of trustees.

Dr. Mullen also introduced a “Prescription for Excellence,” a strategic direction for the faculty, students and college as a whole.

ICO also began informing alumni about the controversy and the positive developments occurring at the college. Efforts to reach out to alumni were well received said Patrick McCallig, ICO’s vice president for institutional advancement. An alumni newsletter was started, and Mr. McCallig began meeting monthly with the president of ICO’s Alumni Council. “The Alumni Council felt that they had been virtually ignored in everything that was going on,” Mr. McCallig said. “Rather than the alumni being put off by this, my sense is they really welcome the opportunity to be involved.”

The college’s renewed focus on its alumni has paid immediate dividends. In the past, ICO had done little in the way of soliciting alumni donations, but in 1998 annual giving to the school increased 100% from the previous year, Dr. Mullen said.

In what some might consider the college’s darkest days, the University of Chicago approached ICO to engage in a wide-ranging affiliation. The university had been interested in this partnership for some time, but could not reach an agreement with the previous administration. “We were actually negotiating this right through all the worst publicity. We now have this in place, and it is working extremely well,” Dr. Mullen said.

Members of the faculty of the University of Chicago’s department of ophthalmology and visual science have been providing clinical education for nine fourth year optometry students per quarter on ICO’s campus and have been staffing the school’s Center for Advanced Eye Care. ICO students have been receiving training at the University of Chicago and its affiliated facilities, and the ICO faculty members have been assigned to work with the University of Chicago’s faculty and ophthalmologic residents. Second-year medical students from the University of Chicago have been taught basic eye care procedures by ICO faculty.

Future endeavors between the schools will include the creation of a joint optometry-Ph.D. degree program combining ICO’s clinical training with the University of Chicago’s research capabilities. The schools are developing the program and funding methods and hope to have them in place within the next 2 years, Dr. Mullen said.

Dr. Mullen also has expanded ICO’s externship program. When he arrived on campus in December 1996, the school had 12 affiliations for students to develop clinical experience with patients while working with optometrists and ophthalmologists outside of classes. ICO now has 76 externship affiliations with health care institutions across the country.

Enrollment at ICO did not drop after the incident, according to Mr. McCallig, and graduating students did not suffer as a result of the negative attention surrounding the institution. ICO’s placement program brings together students and alumni and practices that are adding staff. During the past 5 years, the school has seen increases in the number of inquires from practices, said Mark Colip, OD, dean for student affairs.

To protect the college against problems in the future, Dr. Mullen instructed the school’s administration that it was their responsibility to report directly to the board any action by him or any senior officer that seemed out of line.

ICO has since hired Peat Marwick, a well-known auditing firm, to analyze the school’s books. The college has begun addressing each of the firm’s suggestions, Dr. Mullen said. The school recently refinanced its bonds, and Standard & Poor’s reviewed the college’s financial status and awarded it a preliminary investment grade rating for the bonds. This underscores ICO’s efforts to address its financial policies and controls and to ensure history will not repeat itself, Dr. Mullen said.

Today the incident is almost an afterthought on campus, says the new president. Although he still meets with the college’s attorneys regarding the pending litigation, Dr. Mullen believes the scandal is largely in the past for the school’s students, faculty, alumni, external stockholders and affiliated institutions. “I would say the majority of people have put it behind them,” he said.

Primary Care Optometry News. Volume 3, Number 6. June 1998.
Excerpts of Article written by Chris Rosenberg, Staff Writer.

Affiliation Between Hahnemann University and Pennsylvania College of Optometry

This article outlines the nature, describes the implementation process, and summarizes the status of operations to date of the affiliation between Hahnemann University (HU) and the Pennsylvania College of Optometry (PCO).

Health care financing and provision are issues that affect virtually every individual in the United States today. As health care costs continue to rise, providers, third-party payers, and patients alike actively seek more effective and efficient provision systems. If providers fail to provide quality and cost-effective health care, they will be left behind in the increasingly competitive market. Similarly, if patients and third-party payers do not use more effective and efficient systems, they will assume an even greater share of the rising health care expense.

Affiliation between professional institutions presents numerous opportunities for enhancing the educational and clinical training of students, residents, and practitioners. Institutions that are developing their respective professions can collaborate in many ways of mutual interest.

Two Philadelphia health care institutions, located within 9 miles of each other, HU and PCO, cognizant of the changing health care environment and the possible benefits of collaborative education, have begun to explore new approaches to patient care provision and ophthalmic education. On March 2, 1988, the two institutions signed an agreement for an affiliation. The agreement, effective July 1, 1988, proposes that the professions of medicine and optometry combine resources to develop unique approaches to ophthalmic education, eye care provision, and ophthalmic research.

The Context and the Decision to Affiliate
Ophthalmology and optometry have existed as separate, often antagonistic, professions since their inceptions, so why affiliate now? The impetus comes from outside parties – particularly third-party payers, health care policymakers, and legislators – who will attempt to define the roles each profession will play in the future of eye care provision if the two professions do not actively define these roles themselves. The ophthalmology community maintains that the diagnosis and treatment of eye disease should be restricted to physicians. The optometry community, on the other hand, proposes that optometrists should be the primary eye care providers and should offer an even greater range of eye care services than they do now. Interprofessional disputes involving the treatment of eye disease by optometrists, preoperative and postoperative management, and the use of laser technology in refractive treatment remain unresolved in many areas of the country. Debates in journals and in legislative chambers, however, may or may not produce satisfactory outcomes for either profession. In our opinion, the time has come for ophthalmologists and optometrists alike to acknowledge that through collaborative efforts the two professions can define a future for eye care provision that will satisfy their needs as well as those of patients and policymakers.

Pennsylvania College of Optometry, which graduates approximately 140 optometrists each year, and HU, comprising a medical school, graduate school of health sciences and humanities, and a teaching hospital, considered the potential benefits of a cooperative arrangement between the professions of medicine and optometry. In 1987, they began to explore the possibility of an affiliation. Such an affiliation was unprecedented and, given the political environment, highly controversial. Therefore, before agreeing to proceed with the affiliation discussions, representatives from both institutions considered the following issues:

  1. How will the professional communities respond to the affiliation?
  2. How will alumni and other constituencies respond?
  3. Should the services rendered under the affiliation be marketed? How will the professional communities react to joint marketing efforts? Will the managed health care systems accept a joint provision model?
  4. What are the roles of ophthalmology and optometry in primary care?
  5. How will patients be managed under the terms of the affiliation agreement?
  6. Will the model of patient care provision defined by the affiliation be in compliance with state and federal laws and regulations?
  7. Will the affiliation create competition between ophthalmology residents and optometry students for primary care encounters?
  8. How will the introduction of new technology, such as lasers, be administered under the terms of the affiliation?
  9. What is the proper and ethical role for each institution in the areas of patient management and financial agreements?
  10. What are the positive and negative consequences of such an affiliation?

Of these issues, those involving the reactions of health care communities were perhaps the most sensitive. Some ophthalmologists feared that the affiliation would undermine ophthalmology’s role in primary eye care. Locally, some ophthalmologists threatened to refer patients elsewhere if HU proceeded with the affiliation; in fact, a number of ophthalmologists did stop referring patients after the affiliation took effect. Nationally, some ophthalmologists voiced their disdain for a cooperative agreement between medicine and optometry (Argus. November 1988:8, June 1989:4, and December 1989:22). Optometrists nationwide questioned whether or not the affiliation would place their profession in a subordinate role to ophthalmology.

Alumni of HU voiced their disagreement with the affiliation through letters, telephone calls, and refusals to continue to support the school financially; PCO alumni, on the other hand, tended to view the affiliation positively.

Given the emotional nature of the affiliation, the marketing issue was all the more troublesome, and the planning stages proceeded with deliberation. The first efforts at marketing involved educational radio announcements, simply informing the public that the two institutions now offered joint services. These proved successful in piquing the interest of potential patients and third-party payers, such as health maintenance organizations. Marketing in the future will use both radio and newspaper media.

Issues regarding the provision of services and the roles of ophthalmologists, optometrists, students, and residents are addressed in a series of protocols, which will be discussed in greater detail below. Currently, these protocols are in draft form and are revised as necessary. However, they still constitute the backbone of the affiliation, and set the rules by which we operate. If care is not provided according to the terms of the protocols, the affiliation will fail, perhaps causing irreparable damage to the future of relationship between ophthalmology and optometry.

Recognizing a mutual desire to influence the future direction of the eye care professions, the two institutions decided to move ahead with the affiliation despite the risks and expected negative reactions. A primary goal of the affiliation is to define the role each profession will play in the changing environment before third-party payers and regulatory agencies mandate new policies. By engaging in curriculum discussions and in joint research efforts, the institutions hoped to enhance their own educational and research programs and, at the same time, design a health care provision system that would become a national model acceptable to all parties: ophthalmologists, optometrists, patients, and policymakers.

The Agreement
Philosophically committed to the affiliation, representatives of the two institutions began to define the elements of the agreement. It was decided that the firm foundation and base of the agreement would be education, on which other aspects of the agreement would be built. Many months of negotiations culminated in the written agreement to affiliate. Salient aspects of the agreement are summarized below:

  1. Each institution will retain autonomy over its operations and finances.
  2. An Affiliation Executive Committee will provide guidance, advice, and oversight on matters relating to the affiliation, including education, research, clinical, and administrative issues.
  3. The Chairman of the Department of Ophthalmology at HU and the Dean of Academic Advancement at PCO will be responsible for administering the affiliation.
  4. Appointments to the faculty or staff of either institution will be made in accordance with the policies and procedures of each institution.
  5. On request, the clinical faculty and house staff at HU will provide consultative subspecialty medical/surgical services to the patients of PCO in a location dedicated to subspecialty care. Consultative subspecialty services will be provided for a full spectrum of medical ophthalmic conditions, including, among others, cataracts, cornea and external disease, diseases of the ocular adnexae, diseases of the retina and vitreous, glaucoma, neuro-ophthalmic disease, ocular trauma, pediatric ophthalmic disease, and strabismus. In addition, HU will provide continuous emergency medical/surgical backup services to patients of PCO.
  6. Clinical faculty, residents, and other staff at PCO will provide consultative optometric, vision rehabilitative, and other services to patients of HU on request. Consultative optometric services will include contact lens evaluation and fitting, low-vision rehabilitation, eyeglass dispensing, orthoptics, and learning and disability evaluation and treatment.
  7. Patients will be referred to HU or to PCO, as appropriate, when such referrals are in the best interest of the patient, are agreed to by the patient, and are consistent with applicable laws and regulations, such as those mandated by the Medicare and Medicaid programs and by professional ethics.
  8. Students at HU, with approval from the dean of the School of Medicine, may take courses taught by PCO faculty. Likewise, PCO students, with the approval of their dean of Academic Advancement, may take courses taught by HU faculty.
  9. The faculties of both institutions will engage in joint educational programs, such as didactic and continuing education lectures, clinical preceptorships, seminars, electives, and grand rounds.
  10. The faculties of both institutions may participate in joint research efforts. Joint research programs will be approved and administered in accordance with the polices and procedures of each institution.
  11. The faculty and administration of both institutions will seek to develop new and innovative health care provision systems.
  12. All publicity, marketing, and fund-raising materials regarding the affiliation must be approved by the Affiliation Executive Committee.
  13. Neither institution will use the affiliation for its own or its profession’s political gain.
  14. All health care providers operating under the affiliation must have appropriate and adequate professional liability insurance as required by law.
  15. Each institution will make available to the other institution, on request, all pertinent information regarding legal, financial, contractual, managerial, and other issues relevant to the affiliation. All such information will be held strictly confidential.

An interim financial agreement was added as an addendum to the original agreement. A global financial agreement addressing the provision of clinical as well as educational services is still under negotiation. It will supersede the interim agreement as soon as it is finalized.

The faculty, medical staffs, and administrations of both institutions were informed of the affiliation discussions and most supported the initiative.

The Model and the Implementation Process
The model of eye care provision eventually agreed on assumes that ophthalmology and optometry are complementary, and it seeks to emphasize the strengths of each profession. It stipulates that primary eye care provided at PCO is delivered by optometric staff. Patients with conditions requiring subspecialty medical or surgical intervention are referred for consultation, management, or both to the HU ophthalmology staff. After the consultation and any necessary medical or surgical treatment are completed, the patient is referred back to the referring optometrist for ongoing care. Likewise, patients who receive their primary eye care by ophthalmologists at HU and who require contact lenses, low-vision rehabilitation, orthoptics, or learning disability services are referred to PCO optometric staff for treatment. Ongoing medical/surgical care is provided by ophthalmologists. In our opinion, therefore, ophthalmologists and optometrists work in tandem to provide appropriate, cost-effective, and high-quality care.

Educational Programs
A fundamental goal of the affiliation is to develop joint education and research programs. Therefore, much effort has been spent in restructuring existing programs and creating new ones. Basic science and clinical faculty at HU currently offer courses in ocular microbiology/immunology, pharmacology, clinical medicine, and microanatomy at PCO. In the future, HU faculty will be offering courses designed for students of optometry in general and medical pathology and physical diagnosis.

Programs in clinical education also are being redefined. Ophthalmology residents accompany HU faculty on rotation in subspecialty care at PCO’s clinical facility, The Eye Institute. In addition, PCO’s faculty offers ophthalmology residents rotations in contact lens and low-vision rehabilitation services. Similarly, optometry residents and a few students are afforded the opportunity to rotate through ophthalmology subspecialties under the tutelage of the ophthalmology staff. Further, ophthalmology faculty participates in clinical conferences at PCO. Students and residents of both institutions are thus exposed to a broadened clinical base and an array of ophthalmic disorders. The hope is that such exposure will result in a more well-rounded clinical education.

Faculty of PCO have commented that the educational programs have enabled them to enhance their own clinical skills and knowledge base. However, educational programs are not limited to the faculty and students of the affiliated institutions; programs have been designed to benefit community providers as well. Faculty of HU have lectured at PCO grand rounds and have participated in the college’s continuing education seminars. Programs such as these encourage interaction between the professions and therefore, are consistent with the goals of the affiliation.

Clinical Services
Before clinical services were actually provided under the terms of the affiliation, clinical faculty of both institutions worked together to draft patient care management and referral protocols, to outline the management process, and to establish quality assurance standards. To date, protocols have been approved for referral from PCO to HU regarding the following aspects of care: (1) cataracts, including preoperative and postoperative care; (2) cornea and external disease; (3) disease of the ocular adnexae; (4) disease of the retina and vitreous; (5) glaucoma; (6) neuro-ophthalmic disease; (7) ocular trauma; (8) strabismus; and (9) pediatric ophthalmic disease.

When a patient is referred to HU for management, the ophthalmologist assumes ultimate responsibility for treating the disorder. The referring optometrist may observe the operation and may assist in the preoperative and postoperative care. However, medical/surgical care is always rendered personally by the physician. Referrals from HU to PCO may include the following: (1) contact lens care; (2) eyeglass dispensing; (3) orthoptics; (4) low-vision and vision rehabilitation; and (5) learning disabilities.

The protocols define a “closed loop provision system” that enables providers to monitor more effectively the quality of care rendered. Under PCO’s previous program, patients were referred to independent consultant ophthalmologists for medical/surgical treatment. This system was open-ended, and methods of record keeping were informal. In the closed system model, providers are in regular communication, and referral information is compiled and reported on a monthly basis. Furthermore, independent computer systems currently being implemented at both HU and PCO will allow providers to monitor care more effectively and determine when patients miss appointments or leave the system so that appropriate follow-up communication can be initiated.

While the protocols were being finalized, administrative staff began to define the operation of the provision system. Issues such as scheduling, personnel, space requirements, equipment requirements, medical records management, and billing policies and procedures were addressed. Given the high volume of clinical activity at The Eye Institute, HU employs a full-time office manager at that facility to oversee the Department of Ophthalmology’s clinical and financial operations. This person is responsible for patient scheduling, registration, charge entry, and medical record preparation. Pennsylvania College of Optometry operates contact lens and low-vision services at HU one-half day each week. The Eyewear Center, located at HU, and also operated by PCO, is open 5 days each week and is staffed by PCO employees.

Joint clinical chiefs’ meetings are held regularly to monitor the progress of the affiliation in general and, in particular, to evaluate the protocols, discuss quality assurance issues, and to review clinical programs. These meetings help maintain open communication among the providers and facilitate patient care provision. To date, revisions have been made in the glaucoma and cataract protocols.

Research
The affiliation agreement encourages joint research ventures and, indeed, opportunities for collaborative research are considerable. Approximately 75,000 outpatient visits are recorded each year at The Eye Institute. Likewise, 282,000 outpatient visits for medical problems, including eye disease, are scheduled at HU. As a result of the affiliation, investigators have a large base from which to draw patients for studies. Faculty at both institutions are currently working together on research projects, which include learning disabilities and macular degeneration. Protocols for excimer laser investigations also have been discussed. Should these be pursued, optometrists will engage in basic research while ophthalmologists and other physicians will conduct clinical trials.

Of special note is the fact that research areas have not been limited to eye disorders and disease. Faculty at HU’s Department of Neurology and Psychiatry have joined faculty at the PCO’s Learning (Disabilities) Center in research investigating learning disabilities.

Recent Developments and Future Directions
Over the past year, many of the goals of the affiliation have been realized, and the future looks very bright to us. As participants of the PCO externship program, a few selected optometry students soon will have the opportunity to share in patient care in the Department of Ophthalmology at HU. New projects under discussion include a joint prison eye care program and the establishment of satellite clinics and faculty private offices, which will be structured according to the provision model previously described. Satellite clinics would be geographically located in the Philadelphia area to serve areas populated by the “underinsured” – the working poor who do not have adequate health care coverage. The faculty private offices would be strategically located to enhance the marketing potential of the affiliation.

Marketing initiatives already are underway; efforts will be directed to optometrists in private practice, primary-care physicians, managed-care systems, commercial insurers, and the general population. The opportunities for marketing are perhaps greatest in the managed-care sector. The model of eye care provision developed under the eye care affiliation is consistent with that used by many managed-care systems, i.e., optometrists provide primary eye care, while ophthalmologists provide medical and subspecialty care. The vehicle for marketing services to managed-care systems will be EyePA Ltd, Philadelphia, a for-profit subsidiary of PCO. On a contractual basis, EyePA Ltd provides eye care services to managed-care systems, self-insured corporations, and other insuring entities. EyePA Ltd is a multifunctional specialty organization that (1) manages utilization of eye care services; (2) provides, on a capitated or fee-for-service basis, a full range of professional eye care services through a network of contracted professionals; and (3) credentials specialty eye care providers and institutions.

Comment
Many individuals maintained that doctors of medicine and doctors of optometry could not work together as colleagues sharing the same goals and aspirations.

Looking back over the past 17 months, we believe that the skeptics were wrong. The affiliation has exceeded our expectations and has progressed much more quickly than any of the planners had imagined. Events to date suggest that joint educational, clinical, and research programs have been advantageous to both medicine and optometry, and that teams of medical doctors and optometrists can work together as colleagues in one eye care provision system.

Archives of Ophthalmology
Controversies in Ophthalmology
Volume 109, Number 2. February 1991.
Charles F. Mullen, O.D.
Myron Yanoff, MD
Laura A. Wilson, MS