Clinical Enterprise Strategic Plan
Duke Health
A Strategic Plan for Continued Growth,
Leadership, and Excellence
Through our extraordinary union of clinical excellence, research insight, educational achievement, and
community engagement, we work together to advance health for patients and their families throughout
our region and around the world. We deliver tomorrow’s health care, today.
A rapidly changing environment creates challenges, opportunities
The health care ecosystem is being reshaped by continued consolidation, by consumer expectations
for on-demand, high-touch services, and by the continued pressure on all organizations to deliver value.
Consumerism and digital health have become powerful opportunities for us to achieve new levels of
patient service and engagement. Advances in health care delivery — from the continued trend toward
outpatient and in-home services to machine learning — create opportunities for us to transform our
delivery system, diversify our revenue streams, and increase our access points.
Locally, our population has grown rapidly over the past five years, and we’ve grown with it to serve
more patients and provide more care for our community. Due to market consolidation and new
pressures from payers, new entrants, and disrupters, our potential for future growth has been
constricted. And we need to grow. Growth helps us ensure all of our patients have access to the
highest quality care. Growth helps us maintain the depth and breadth of our subspecialties, recruit
top talent, invest in research and education, and be an advocate for positive change in the
communities we serve.
Importantly, some of the challenges we face are longstanding but demand renewed commitment
and prioritization. The global coronavirus (COVID-19) pandemic has exposed inequities and had
disproportionate impact on minority and disadvantaged communities. We are called to address these
issues together, with a unified purpose.
Our strategic plan positions us for continued growth and leadership
Our strategic plan will provide the basis for sustained growth so that we remain the leader in
clinical excellence in one of the fastest growing parts of the country. Expanding our clinical presence
will enhance our ability to manage population health, engage in value-based care, negotiate fair
reimbursements and health plan participation, and make the highest quality care more accessible and
more equitable for all North Carolinians. It will also enable us to continue to advance our research and
teaching missions, with new sites for training, expanded clinical research settings, and financial support.
Over the last five years, we have remained strong in our finances and in our missions. This year, we
rallied to support each other and our community with a shared purpose to combat the pandemic and
weather the economic crisis.
When we act with unified purpose as One Duke Health, there is nothing we cannot accomplish. This
strategic planning process aims to be more inclusive and responsive to all our constituents’ needs than
ever before. With your assistance, we will continue to live our mission, achieve our objectives, and be a
force for positive change for our communities, near and far, and for our industry.
Sincerely,
William J. Fulkerson, Jr., MD
Executive Vice President, DUHS
John Sampson, MD, PhD
President, Private Diagnostic Clinic
Duke Health Clinical Enterprise Strategic Plan Page 1
Table of Contents
Introduction .................................................................................................2
Strategic Objectives and Opportunities ...........................................3
Strategic Planning Process ......................................................................7
Key Findings from the Current State Assessment ........................ 9
Vision and Goals .......................................................................................11
Strategies for Achieving Our Goals ...................................................12
Implementation .......................................................................................19
Leadership ................................................................................................... 24
Duke Health Clinical Enterprise Strategic Plan Page 2
Introduction
The Duke Health Clinical Enterprise recently completed a chapter in its
journey, which was largely defined by a five-year strategic plan that guided
a remarkably successful course through 2020. As we look ahead to the next
five years and beyond, Duke stands as an international leader in education,
medical research, and clinical excellence. To retain our leadership position
and advance each of our missions, we must build on our momentum
and further strengthen our culture of achievement by pursuing the clear
strategic and organizational imperatives outlined in this plan.
2020 proved to be a year like no other. The global coronavirus (COVID-19)
pandemic had unprecedented public health, social, and economic impacts
in all communities we serve. Yet, this once-in-a-century crisis has taught us
many lessons, the most important being: When we act with unified purpose,
there is nothing we cannot accomplish.
It is with that spirit that we embark on the next chapter for the Duke Health
Clinical Enterprise, which encompasses the clinical missions of the Duke
University School of Nursing, the Duke University School of Medicine, the
Duke University Health System (DUHS), the Private Diagnostic Clinic (PDC),
and the 31,000 faculty members, clinicians, and research, administrative,
and front-line staff who make up Duke Health. This new strategic plan
crystalizes our shared organizational priorities for the coming years.
Duke Health Clinical Enterprise Strategic Plan | 2021-2025 Page 2
Duke Health Clinical Enterprise Strategic Plan Page 3
Strategic Objectives and Opportunities
Realizing and articulating the “Duke Difference” is an underlying theme for this strategic
plan. We believe we are, and will continue to be, clearly differentiated from other health
systems in the nation. As consumers engage with Duke Health, we want them to have
the kind of excellent experience that will prompt them to return to us throughout their
health journey. Our patients should experience the Duke Difference as superior outcomes,
compassionate teams, and convenient services. The experience must be consistent across
all of Duke Health, regardless of program, site, service (in-person or virtual), or provider. Our
commitment to consistently delivering the Duke Difference requires us to continuously
improve how we work together to deliver tomorrow’s health care, today. By providing a
truly differentiated experience, we will also be well positioned to engage with health care
consumers and payers on next-generation reimbursement structures designed to keep
populations healthy.
Objectives
Among the leaders of Duke Health, there is universal agreement that the need for a clear and
actionable Duke clinical enterprise strategic plan has never been more urgent. Co-sponsored
by DUHS and PDC senior leadership with the active involvement of School of Medicine and
School of Nursing chairs and faculty, the Clinical Enterprise Strategic Plan is framed by these
overarching imperatives:
§ Our plan must be characterized by action and effective execution.
§ It must be flexible, to respond to and proactively prepare for an accelerated pace of
change and the increasing importance of patient/consumer needs and demands.
§ It must address the critical importance of social justice and health equity.
§ It must be consistent with our values and focused on providing the highest quality care
and experience for our patients
§ We must have engagement in and commitment to the plan across the organization.
§ Our actions and behaviors should reflect the core values of Duke Health.
Duke Health Clinical Enterprise Strategic Plan Page 4
Drivers of Change
The historic drivers of change are intensifying and manifesting themselves in new ways.
These drivers create opportunities for us to establish a unified vision for Duke Health’s mission
of advancing health together by transforming our delivery system, diversifying our revenue
streams, increasing access points to reach more people, building healthier communities, and
investing in our teams.
Drivers of Change
Accelerated pace of change and
continued consolidation across the region
Consumerism and advances in
digitally-enabled care disrupting
traditional patient engagement and
care delivery models
Advances in health care delivery models
for non-hospital site of care and new
applications of technology and data
science that increase the speed of
diagnoses and treatment efficacy
Health care reimbursement and
purchaser demands pressuring our
capacity to invest in all our missions
National recognition that health
disparities and racism are unacceptable
and must be addressed by leading
organizations
Heightened need to address provider and
employee stress, exacerbated during the
pandemic, and to promote wellness
Duke Health Opportunities
Creative, consumer-centric growth to
achieve new levels of patient service
and engagement
Alignment and collaboration across
Duke Health are more critical than
ever to connect our breadth of
expertise and tools to advances
in health excellence and patient
experience
Our deep commitment to our
communities is front and center
Renewed commitment to our people
and teams as our most critical asset
More nimble and dynamic strategic
planning and implementation with
effective execution
Regional and national differentiation
on the basis of quality and safety
Duke Health Clinical Enterprise Strategic Plan Page 5
Strategic Opportunities
Consolidation and consumerism are accelerating the disruption of health care. Consolidation
in the health care industry has evolved to take many forms. Traditional consolidation between
hospitals and providers has accelerated, creating a handful of large systems across North
Carolina. Less traditional consolidation opportunities have also arisen due to the evolving
payer landscape, with payers entering the provider space aggressively. And powerful new
entrants from outside the health care field — such as Amazon and Walmart — raise the
potential for profound disruptions.
Consumers continue to demand that health care offer the same degree of convenience
as other industries. These industries provide digitally enabled access, and high-touch and
personalized services located closer to and in the home. Digitally enabled care has become
pervasive during the COVID-19 pandemic and has proven its value as a new modality of
care delivery.
We must renew our commitment to our most critical asset — our people and teams.
The success of our strategic plan and the success of Duke Health rest solely on our people.
However, provider shortages and team burnout rates are on the rise, especially in academic
medical centers, where team members are asked to do more across multiple missions. Duke
Health team members are deeply proud of and committed to our work and mission. We must
continue to promote a culture and environment of inclusivity and diversity, where all team
members feel valued and supported.
Our extensive resources and assets must be strategically aligned and coordinated if we
are to maintain our strategic position and clinical excellence. Organizational silos and
misalignments across Duke Health often prevent us from delivering our full scope of expertise
and capabilities to patients, employers, partners, and payers. Silos between clinical programs,
between the academic and clinical missions, and between the sites and services must
be systematically addressed to unleash the full potential of Duke Health. Our historically
robust financial performance has enabled significant investment in the community and into
the academic mission, both of which are needed to maintain our differentiation. Moving
forward, we must focus on value improvement, revenue diversification, growth, and new
payer strategies to provide excellent care to our patients, support our ability to invest, and
ultimately succeed in a value-based environment.
Duke Health Clinical Enterprise Strategic Plan Page 6
We need to grow, and grow in new ways. Continued clinical growth is imperative for us to
achieve sufficient size and reach to support our position as a regional and national specialty
services leader. Growth enables us to maintain the depth and breadth of our subspecialties,
recruit top talent, invest in research and education, and partner for positive change in the
communities we serve. The competitive spirit of the local health care economy will require
Duke to grow beyond our primary and secondary service areas. This growth will require a
wider array of expansion considerations, including new affiliation models, revenue streams,
and industry collaborations across local and national geographies. Duke’s future digital
capabilities will create paths and enable connections previously unrealized.
A clear, widely shared sense of purpose across Duke Health is more critical than ever for
success. The pandemic has demonstrated that when we act with unified purpose, there is
nothing we cannot accomplish. Our success in the future will require Duke Health to come
together with persistent organizational focus, clear prioritization of effort and investment,
and accountability for execution of strategic initiatives.
Our mission to support our communities is front and center. A national conversation is
underway regarding critical issues of social and racial injustices that permeate communities,
creating vast disparities and health inequities. New evidence emerges daily about the
importance of social and behavioral drivers of health. Duke must fulfill our mission and
leadership role by addressing these issues.
Our strategic planning and implementation process must evolve to be more dynamic and
nimble. The health care environment evolves faster than a five-year strategic planning cycle
can foresee and address. Our new evergreen approach will allow for real-time assessment,
course correction, and prioritization of initiatives, informing our financial and operational
processes to achieve our goals.
Strategic Opportunities Continued
Duke Health Clinical Enterprise Strategic Plan Page 7
Strategic Planning Process
The strategic planning process was commissioned by the executive leadership of DUHS and
the PDC and was completed over eight months beginning in March 2020. The Executive
Vice President of DUHS and the President of the PDC co-sponsored the process, with the
Enterprise-Wide Clinical Strategy Committee (EWCS) serving as the steering committee
for the effort. Despite the pandemic’s impact on our ability to engage in person, the
strategic planning process allowed for broad and intense collaboration across the enterprise,
incorporating input from over 250 people via various channels.
New, “Evergreen” Process
The plan represents the first step in a restructured strategy formation and execution process
for Duke Health that will be increasingly dynamic, nimble, and evergreen. This evergreen
approach promotes a more continuous assessment of the internal and external challenges
and opportunities we face, improved tracking and measurement of success for the initiatives
we undertake, and an ability to pivot more rapidly to take advantage of developments and
opportunities we cannot anticipate today.
Evergreen
Improvement
Critically evaluate
results and assess
current landscape
Measures of Success
Implement unified scorecard
with measures and reporting
processes to support
implementation
Strategic Imperatives
Determine critical areas of
focus, considering industry
and consumer requirements.
Develop Five-Year Goals
Validate our goals
Initiatives/Interventions
Agree on specific initiatives
with clearly identified
accountable parties
01
02
03
04
05
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Strategic Planning Process Continued
Four Phases of Development
The plan was developed in four phases. During the first two phases, major baseline inputs
were developed — a “diagnostic” of external trends and internal performance, and a survey
of Duke Health leaders on organizational strengths, weaknesses, opportunities, and threats
(SWOT analysis). These diagnostics informed a series of working sessions with the co-sponsors
to set an initial strategic agenda with target areas of focus for the EWCS to take up and further
develop. Work sessions with the EWCS led to a new vision statement and a set of five-year
organizational goals.
In the second two phases, six clinician and staff workgroups were formed to develop and
recommend initiatives and tactics to achieve our aspirations. An implementation structure
was designed as a core element of the evergreen process and approach to facilitate rapid
implementation.
I
Preplanning/
Framing
II
Current
Assessment
III
Future Direction
IV
Implementation
Planning
§ Confirm desired
outcome
§ Develop,
validate,
and confirm
strategic
planning process
§ Review and
confirm existing
strategic goals/
strategic
initiatives
§ External
assessment
§ Internal
assessment
§ Strengths,
Weaknesses,
Opportunities,
Threats (SWOT),
including
barriers to
success for
the strategic
planning process
§ Review/confirm
mission, vision,
and goals
§ Develop and
gain consensus
on key planning
activities
§ Identify needed
supporting
plans and gain
consensus on
path forward,
resources, and
responsibilities
§ Create
framework and
communication
plan to
transition to
implementation
and monitoring
process
Duke Health Clinical Enterprise Strategic Plan Page 9
Key Findings from the Current
State Assessment
A detailed current state assessment included a rigorous diagnostic of external trends and
internal Duke performance, and an organizational “SWOT” assessment by Duke Health leaders
on Duke’s major organizational strengths, weaknesses, opportunities, and threats. A summary
of those key findings and their associated strategy imperatives for Duke further underpins the
drivers for change and opportunities for Duke Health looking ahead to 2025.
Internal Strengths and Weaknesses
§ Duke is a leader in quality and safety with room still to improve vis-à-vis our peers.
§ Duke Health has unrivaled talent, yet we are not fully harnessing our capabilities.
§ Duke has a strong financial history but must be judicious in the current environment to
protect its ability to make bold investments.
§ Duke has opportunities to improve our patient experience and better create a digitally
enabled end-to-end care experience.
§ Duke has the opportunity to maximize current payer incentives while improving
patient care.
§ Duke requires organizational focus that comes from clear prioritization and clear
organizational accountability for timely execution and success.
External Opportunities and Threats
§ The “pace of change” continues to accelerate locally and nationally, with more than 90%
of North Carolina hospital beds now consolidated and four mergers/acquisitions taking
place in the past year in North Carolina.
§ Traditional referral patterns — from primary care providers to specialists — have been
disrupted.
§ Price transparency and convenience are top-of-mind for consumers and employers in
selecting a health care provider.
§ Consumers are engaging with providers in new ways and are demanding timely,
innovative care models closer to and even within the home.
§ Payers are entering the provider space and steering patients (e.g., Optum is now the
leading employer of physicians in the country).
§ Employers are taking a more active role in changing health care models (e.g., Walmart,
Amazon, state of North Carolina).
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Strategic Imperatives
§ Differentiate regionally and nationally on the basis of quality and safety.
§ Enhance regional and national reputation for clinical excellence, which improves patient
preference and our competitive position in North Carolina and the region.
§ Provide a best-in-class physician practice model to align physicians and meet
recruitment objectives.
§ Ensure an enterprise value improvement model is in place to promote sustained
investment in missions.
§ Empower clinical teams to continuously reduce clinical delivery and clinical outcome
variation.
§ Define health equity as the foundation of quality.
§ Ensure a consumer-centric model is in place for accessing and navigating all of
Duke’s services.
§ Structure payer arrangements that materially enable us to improve quality of care and
lower cost of care.
§ Serve as a national leader in digitally enabled care.
§ Use nimble decision-making processes and an agile implementation model for strategic
initiatives.
§ Be the employer of choice with a rich culture that is inclusive, empowers staff, and
supports long-term success.
The opportunity for Duke is significant and time sensitive, and success will require a
focused strategy where prioritized initiatives are adequately resourced and teams are held
accountable for successful implementation. The impact and lessons of the pandemic — along
with an ever-evolving and competitive health care landscape and economy locally, regionally,
and nationally — form the impetus for a new five-year plan for the Duke Health Clinical
Enterprise.
Key Findings from the Current
State Assessment Continued
Duke Health Clinical Enterprise Strategic Plan Page 11
Vision and Goals
Vision
Our vision is that Duke Health will Advance Health Together by Delivering a Healthier
Tomorrow. This will require All of Us, and the Best of Each of Us.
Goals
We will achieve our vision through five goals that are purposeful, aspirational, and
uniquely Duke:
§ Lead in Clinical Excellence. Design and deliver remarkable, high value, personalized, and
precise care, powered by advanced data sciences, clinical innovation, and a culture of
kindness.
§ Forge Our Digital Future. Create cutting-edge digital health services that are
customized, convenient, high quality, and accessible to all.
§ Build an Indispensable Network. Build unrivaled, seamlessly integrated health
networks as the preferred provider and partner.
§ Advance Health Equity. Establish health equity as the foundation of quality and
promote the health and well-being of our communities, as we address the social and
behavioral drivers of health and eliminate health disparities.
§ Foster Joy in Work. Promote a nurturing environment that is diverse, inclusive, and
just — where everyone is deeply connected to purpose and committed to providing
remarkable, compassionate care.
The Clinical Enterprise Strategic Plan is built on a strong framework, focusing on those
elements that are foundational, essential, or distinctive. This framework provides a sharp
focus while purposefully building on each layer.
Duke Health Clinical Enterprise Strategic Plan Page 12
Strategies for Achieving Our Goals
Foster Joy in Work
Advance Health Equity
Build an
Indispensable Network
Lead
in Clinical
Excellence
Forge our
Digital Future
Distinctive: How we will continue to elevate and set Duke apart
Essential: How we will meet the needs of patients in the most
effective and efficient manner, providing highest quality care
Foundational: How we will strengthen our unified identity as Duke
Health to achieve nimble execution in an ever-changing environment
The Framework for Our Plan
Duke Health Clinical Enterprise Strategic Plan Page 13
Deliver a Remarkable Experience - Accelerate speed-to-
diagnosis and redesign the end-to-end patient experience to
exceed industry standards and consumer expectations.
Align Systems of Care - Develop platforms that seamlessly link
the full breadth of expertise, tools, and resources across Duke
Health to improve clinical outcomes and the care experience.
Enhance Network Development - Broaden and deepen the
menu of clinical services provided by Duke regionally and
nationally through an expanded network of sites and providers
that is extended through digital services.
Optimize High-Value Care - Continuously improve the quality
and cost-effectiveness of care to provide value to our patients
and develop new and innovative models with payers and
purchasers.
Eliminate Health Disparities - Develop high-impact internal
and community-focused interventions that eliminate structural
barriers to health equity and social justice.
1
2
3
4
5
Strategies and Recommended Initiatives
Five strategies and 15 specific initiatives underpin these goals to form our strategic roadmap.
These defined strategies and recommended initiatives are all interrelated, and our ability to
achieve our aspirations depends on the successful implementation of each.
Duke Health Clinical Enterprise Strategic Plan Page 14
Strategy 1: Deliver a Remarkable Experience
Accelerate speed-to-diagnosis and redesign the end-to-end patient experience to exceed
industry standards and consumer expectations.
Design and Deliver the “Duke Experience”
§ Define the “Duke Remarkable Experience Promise” by elevating the voice of the
consumer (patients, referring providers, employers, payers, others) and committing to a
culture of patient-centered care that is convenient, seamless, and superior.
§ Achieve our vision for a unified Duke Health access center that provides the best
experience for accessing and navigating Duke services.
§ Establish an advanced model of primary and episodic team-based care to lead in the
coordination of complex chronic patients.
Develop and Implement the Duke Quality Blueprint and Lead in Transparency
§ Establish a multi-year comprehensive quality and process improvement framework
with specified annual objectives, applying the Lean Management System.
§ Innovate in the definition and use of novel measures such as healthy life years and
disease-specific survival and complication rates.
§ Communicate clinical experience and outcomes metrics through consumer and
referring physician channels including digital platforms.
Integrate Clinical and Data Sciences for High-Impact, Translational Work
§ Establish a data science implementation unit that integrates existing initiatives and
units across Duke Health.
§ Leverage data and data sciences to create predictive models to effectively guide clinical
decision-making for patients and ultimately reduce the burden of disease.
§ Enhance our site-based research portfolio by optimizing efficiencies and risk models,
reducing trial start time frame, and broadly expanding the diversity of participation
across Duke Health.
Duke Health Clinical Enterprise Strategic Plan Page 15
Strategy 2: Align Systems of Care
Develop platforms that seamlessly link the full breadth of our expertise, tools, and resources
across Duke Health to improve clinical outcomes and the care experience.
Deploy Service Lines and Operating Models
§ Establish service lines as cross-sectional models between CSU and Departmental
functions to consistently provide the consumer the highest quality care across our sites
and geographies.
§ Strengthen service line performance and encourage innovation by launching training
for service line leaders and providing accessible, actionable data.
§ Build support mechanisms for external and internal referring providers to support care
coordination and develop strong relationships.
Ensure Seamless Integration of Care
Primary, community, specialty/subspecialty
§ Identify care coordination functions between primary and specialty care to establish a
medical home model for patients and ensure smoother transitions.
§ Organize care and case management into a payer-agnostic unit to effectively manage
chronic conditions across the care continuum.
§ Empower families and caregivers as part of the care team with training materials and
tools enabling confidence and superior care.
Optimize Capacity and Care Models Across the Continuum to Extend Our Reach
§ Utilize the full care continuum, inclusive of virtual care offerings, to support optimal
care settings and increase system-wide capacity.
§ Increase hospital capacity for continued growth through CareHub and service
rationalization between sites.
§ Identify alternative care team models for provider and clinical care team efficiency.
Duke Health Clinical Enterprise Strategic Plan Page 16
Strategy 3: Enhance Network Development
Broaden and deepen the range of clinical services provided by Duke regionally and nationally
through an expanded network of sites and providers, supported by digital services.
Enhance Access and Community Care Models in Important Geographies
Sites, provider recruitment, employment/affiliation models with consistent provider
infrastructure
§ Recruit and retain providers to achieve network adequacy needs and growth goals for
prioritized specialties and geographies.
§ Establish more tightly affiliated provider partnerships by developing a menu of
employment and affiliation options for community providers.
§ Develop a provider infrastructure with consistent support functions available to current
and future Duke and affiliated providers.
Implement Digital Health
§ Develop a business plan for centralized digital health services, enabling more convenient,
accessible care.
§ Establish virtual care as a location-agnostic service to extend access to specialty referrals
nationally for new and returning patients.
§ Provide virtual services as an additional care option to patients to improve access and
enhance value.
Explore Mutually Beneficial Partnerships to Advance Health
Import/export expertise through industry relations, centers of excellence, employer partners
§ Identify priority programs for expansion based on clinical expertise or need through centers
of excellence and/or other models/partnerships.
§ Launch industry relations forum with employers, payers, and other organizations to identify
partnership, philanthropy, and co-development opportunities.
§ Explore best-in-class expertise to fuel rapid innovation and improvement in Duke processes
and operations.
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Strategy 4: Optimize High-Value Care
Continuously improve the quality and cost-effectiveness of care to provide value to our
patients and develop new and innovative models with payers and purchasers.
Identify and Achieve a Three-Year Value Improvement Target
Build accountable clinical teams to reduce variation and enhance efficiency
§ Establish Value Improvement Committee.
§ Embed Finance and Performance Service staff with Service Line leads to improve
performance and data sharing.
§ Utilize existing committee structures to empower clinicians with actionable data by
benchmarking internally and externally and identify outlier opportunities in clinical
variation and quality improvement.
Modernize Our Business Planning Process and Diversify Our Revenue Portfolio
§ Implement shared resource models to reduce staff overhead and increase efficiency.
§ Diversify revenue-driving activities through innovative care models.
§ Rewrite business plan template to address emerging opportunities.
Optimize Payer and Contracting Practices to Fully Enable Value-Based Care
§ Improve the accuracy of risk-adjustment factor (RAF) scoring for Medicare Advantage
populations and close clinical gaps.
§ Build and implement payer contracts aligned with Duke quality initiatives.
Duke Health Clinical Enterprise Strategic Plan Page 18
Strategy 5: Eliminate Health Disparities
Develop high-impact internal and community-focused interventions that eliminate structural
barriers to health equity and social justice.
Create a Community Health Council
Coordinate efforts and embed health equity and social justice metrics into Duke’s
standard work
§ Create a centralized Duke Health Community Health Council to maximize Duke
Health efforts.
§ Build the principles of health equity and community health needs into Duke reporting
and culture.
§ Empower community-based organizations and Duke Health employees through a
streamlined communication channel.
Deploy an Organizational Evaluation Framework to Enhance Community Impact
Practice a culture of humility in outreach, research design, and clinical care
§ Establish a universal framework to ensure that Duke Health’s community impact is
robust and comprehensive.
§ Enhance data collection and data use in areas of health equity and health disparities.
§ Create channels to spread community learnings across Duke Health to ensure
community programs are optimally accessed.
Establish Performance Management Practices and Training to Promote Health Equity and
Social Justice as Standard Behaviors
§ Create a culture that leads with humility.
§ Build a community-driven orientation and training curriculum to ensure that
Duke Health team members are aware of and considerate of health disparities and
social justice.
§ Develop care models and outreach that are focused on recognizing and eliminating
health disparities.
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Implementation
Implementation Teams and Leadership
Successful implementation of the strategies and initiatives recommended in the strategic
plan will be critical to the achievement of our long-term goals. Implementation teams, guided
by implementation leaders and champions, will put the strategic plan into action through
structured collaboration across the enterprise and at all levels of leadership.
Deliver a
Remarkable
Experience
Align Systems
of Care
Enhance
Network
Development
Optimize
High-Value
Care
Eliminate
Health
Disparities
1.1 Design
and deliver
the Duke
experience
2.1 Deploy
Duke service
lines
3.1 Enhance
access and
community
care models
4.1 Identify
and achieve a
3-year margin
target and
empower care
teams
5.1 Create
community
health council;
embed health
equity and
social justice
into standard
work
1.2 Develop
and implement
the Duke
Quality
Blueprint
and lead in
transparency
2.2 Ensure
seamless
integration of
care
3.2 Implement
digital health
4.2 Modernize
business
planning
process and
diversify
our revenue
portfolio
5.2 Develop an
organizational
framework
to maximize
community
health impact
1.3 Integrate
data sciences
for high-impact
transitional
work
2.3 Optimize
capacity and
care models
across the
continuum to
extend reach
3.3 Explore
mutually
beneficial
partnerships
to advance
expertise
4.3 Maximize
payer and
contracting
practices and
fully enable
VBC
5.3 Embed
cultural
humility into
Duke’s hiring,
training, and
performance
management
practices
Implementation Teams and Their Initiatives
Duke Health Clinical Enterprise Strategic Plan Page 20
2021 and 2024: Progress Benchmarks
To evaluate our progress and maintain momentum toward our goals, interim achievement
benchmarks have been established for 2021 and 2024.
Goals Achievements by June 30, 2021 Achievements by June 30, 2024
Lead in Clinical
Excellence
Identify measures & methodology to share
transparently
Define the “Duke Remarkable Experience
Promise” and value proposition by consumer
segment (patients, referring providers,
employers, payers, others)
Evaluate and optimize existing data science
groups to ensure translational support for
incorporation into clinical practice
Designing & delivering highest quality,
personalized care as measured by
clinical and patient-reported outcomes
Patient experience and on-demand
24/7 access
Value as defined by our constituents
Forge Our
Digital Future
Develop and create governance for digital
health
Finalize Business Plan with hybrid (virtual &
in-person) care model
Establish Virtual Patient Advisory Council(s)
Lead in patient-centered care and
convenience
Optimize site of care and create
additional clinical capacity
Serve patients in broader geographies;
in their communities and on their
schedule
Build an
Indispensable
Network
Implement menu of employment and
affiliation models for community providers
Plan provider and site growth with focus in
priority geographies
Identify non-traditional partners and models
to expand and develop priority programs
Serve two million patients as the
preferred provider through partnerships
Care for at least 35% of our primary
service-area population
Be a leader in transitions-of-care
performance across the full delivery
continuum
Advance
Health Equity
Establish Duke Community Health Council
and develop impact evaluation framework
In partnership with the University and
Durham community, launch strategic
advisory groups for five social-driver focus
areas
Advance community mapping project
Reduce health disparities in populations
Duke Health serves
Deploy at least three high-impact
collaborative community interventions
with demonstrable progress
Establish racial, social, and health equity
as foundational in decision-making
across the clinical enterprise
Foster Joy
in Work
Develop credo that defines who we are and
what we stand for
Define supporting leadership attributes and
behaviors to advance desired culture
Engage front-line caregivers to define and
align core values
Top talent organization where everyone
boasts about the opportunity to work
at Duke
Diversity in Leadership reflects the
organization and community
Top-tier workforce engagement with
strong retention and low vacancy rates
Duke Health Clinical Enterprise Strategic Plan Page 21
2025: Measures of Success
What will the future look like when we achieve the goals set out in our Clinical Enterprise
Strategic Plan? By 2025, through our goals, strategies, and initiatives, and through our
evergreen process to refresh and realign our strategic plan, we will achieve five specific
outcomes:
1. Differentiated Quality & Experience
Harness the full breadth of our clinical and innovative capabilities to rapidly diagnose, treat,
and ultimately prevent disease and provide a remarkable consumer experience that is
accessible, convenient, affordable, and digitally connected
2. Connected & Distributed Network
Develop robust, close-knit networks of providers and facilities to offer comprehensive care
along the continuum and cultivate long-term relationships with patients and referring
providers
3. Unified Team & Purpose
With a unifying mission, Duke Health attracts and retains highly engaged team members
inspired by a singular purpose: to be unparalleled in the region and nation
4. Successful Value-Based Ecosystem
Deliver sustainable value by reducing clinical variation, developing more efficient models of
care, and serving new populations
5. Healthier Communities
Partnering with our communities, Duke Health commits to tackling the root causes of health
disparities and social injustice
Our vision is that Duke Health will Advance Health Together by Delivering a Healthier
Tomorrow. This will require All of Us, and the Best of Each of Us.
Duke Health Clinical Enterprise Strategic Plan Page 22
Critical Enablers
Four critical enablers will underpin this strategic plan and its execution, and each will be
linked to the evergreen planning approach and process: a financial plan, a communications
plan, project management support, and talent and organizational design.
Financial Plan. The strategic plan initiatives require differing levels of investment, which may
be met through either redeployment or reallocation of existing resources or allocation of
new resources for capital and operating expenses. In parallel to the regular rolling five-year
financial plan, we will ensure that the identified priorities in this plan are integrated and
aligned. Annual strategic plan reviews will be conducted to consider ongoing operating and
capital needs for successful implementation. These reviews will align with the annual budget
development processes for DUHS and the PDC, linking these key processes in our evergreen
model.
Communications Plan. We will develop a menu of engagement tools to communicate the
plan and progress across all levels of the organization, including dashboards to track progress,
tools and forums to facilitate ongoing engagement and education on emerging health care
trends, and mechanisms to solicit feedback and input on the strategic plan implementation
and new initiative development.
Project Management. A project management function will be formed in coordination with
the Duke Strategic Planning Office and other business units as needed to support both
implementation needs and tracking of specified success measures for enterprise progress and
reporting for all key constituencies.
Talent and Organizational Design. Several of the initiatives included in this plan are
organizational in nature. We will coordinate implementation of these changes with
appropriate leaders and units. Together, we are building a strong culture supported by
behaviors and values that will help us achieve our strategic plan goals and foster joy in work.
Duke Health Clinical Enterprise Strategic Plan Page 23
Advancing Health Together
Align systems
of care
Foster Joy in Work
Advance Health Equity
Build an
Indispensable Network
Lead
in Clinical
Excellence
Forge our
Digital Future
Optimize
high-value
care
Eliminate
health
disparities
Enhance
network
development
Deliver a
remarkable
experience
Duke Health Clinical Enterprise Strategic Plan Page 24
Leadership
Thank you, Duke Leaders
M. Abbott
P. Allen
B. Alman
S. Alston
E. Alyea
J. Anderson
S. Aronson
D. Attarian
M. Babb
J. Bae
L. Bains
R. Balu
S. Balu
M. Barber
A. Barfield
L. Baxter
M. Becker
G. Belvett
T. Berry
D. Biederman
L. Bleecker
J. Boswick- Caffrey
E. Boulware
M. Bowers
R. Brandon
R. Brassil
A. Broach
H. Brookover
M. Broome
A. Brown
M. Brown
E. Buckley
B. Burton
A. Cain
B. Cameron
M. Campbell
Z. Cantor
B. Carter
P. Cates
A. Cho
J. Christensen
E. Clark
D. Claxton
K. Cooney
A. Cooper
L. Criscione-
Schreiber
C. Cummer
L. Curtis
S. Curtis
M. Datto
M. De La Fuente
G. DeCarlucci
F. DeMarco
H. Deng
A. Dimsdale
L. Dupere
P. Edwards
S. Emory
J. Engel
M. Erickson
G. Faerber
R. Famiglietti
J. Ferranti
R. Fillipo
C. Flintom
H. Francis
A. Friedman
T. Friedman
M.A. Fuchs
W. Fulkerson
K. Galbraith
S. Gibson
C. Goertz
L. Goller
T. Gosselin
R. Green
P. Grossi
C. Gudaitis
R. Gupta
M. Gustafson
R. Hall
B. Halstater
G. Hassell
J. Hauser
J. Hawes
J. Hecht
N. Heilbron
B. Hendrix
C. Hendrix
S. Henninger
A. Hernandez
D. Heron
S. Holleran
C. Howard
J. Hoy
J. Huang
R. Hudson
B. Hughes
A. Husain
R. Jackson
I. Jamieson
E. Jelovsek
K. Johnson
M. Jones
E. Kale
A. Kamath
M. Kastan
J. Keller
E. Kharasch
T. Kinard
A. Kirk
B. Klein
S. Kline
M. Klotman
S. Knetchle
P. Kramer
C. Kuhn
N. Lad
S. Lando
J. Langdon
M. Lazar
R. Lee
J. Lewis
C. Liao
P. Lindia
M. Lindsay
C. Linton
M. Lipkin
J. Loftis
E. Long
H. Lowe
M. Lyn
K. Lytle
J. MacIver
B. Mallory
A. Mangum
H. Marstiller
M. Martin
G. Maslow
L. Mason
J. Massey
R. Mather
J. Mathew
C. McCall
K. McGann
R. McGavin
H. McLean
G. McNeil
E. Medearis
M. Mehrotra
K. Merritt
A. Milazzo
J. Minchew
J. Mordach
A. Muir
P. Newman
D. Nolley
K. Norcross
R. O’Brien
K. O’Neill
M. Oden
R. Odom
E. Ohman
C. Olsen
V. Orto
T. Owens
J. Paat
T. Pappas
C. Patel
K. Patel
M. Patel
N. Patel
N. Patel
E. Paulson
S. Pearce
D. Peter
J. Peterson
H. Phillips
D. Phinney
L. Pickett
K. Pope
A. Porter-
Tacoronte
E. Postel
M. Prestwood
V. Price
P. Ramseur
A. Reed
M. Richardson
D. Robinson
J. Rogers
M. Roman
A. Ross
C. Roth
M. Rynn
J. Sampson
E. Sanders
D. Sangvai
W. Schiff
N. Schlichting
G. Seaford
C. Seastrunk
S. Selig
C. Shaffrey
K. Shah
C. Shannon
R. Shannon
S. Shelton
G. Shulby
S. Smith
S. Sondej
M. Sorensen
A. Spector
M. Spiritos
Y. Spurney
K. Stanley
D. Staples
F. Stone
K. Stover
R. Sudan
K. Sullivan
E. Taylor
K. Thomas
S. Thompson
A. Toth
L. Tuttle
K. Ulrich
C. Unger
D. Uzarski
A. Viera
A. Visco
M. Volkringer
R. Wagoner
M. Wahidi
T. Walczak- Daege
E. Washington
M. Watson
A. Weidner
C. Willet
K. Williams
S. Williams
S. Wilson
B. Wofford
J. Wosik
J. Yeatts
Collaborating
Partners:
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