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 125^th 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.