 Thank you all for coming this is you know every we've had retreats now for five years and Every year the retreat has gotten bigger and bigger and this is by far our biggest retreat And we really appreciate you all coming. We're gonna use you today as as many as many mentioned You're here. We hope to help us to think about how we can do better and in in our interest in growing as an organization is real and We really need your your input and they're expecting it today. So first before I start let me explain the arm I've I don't have any hundreds of times. I've explained it so this way I can explain it to a whole group of folks all at once So I broke my ulnar styloid Not this last Saturday with Saturday before it's about 10 days ago. I was horse and around with my kids Simple, you know playing around like you usually do run around the house Stumbled and land into a countertop a lot like that one Just like this broke my styloid And it's a big pain Six weeks ago. I did this to myself also with my kids I've said it's a skateboarding accident. I wasn't actually on the skateboard my seven-year-old was and I was trying to keep him out of some broken glass and tripped into a you know a tree well and struck the asphalt with my chin and the blood everywhere and It was a big mess. So The wonderful thing about having young children minor seven and nine is that they keep you feeling young But the reality is very different From the feeling so so anyway just hopefully I'll learn to be less clumsy So last year I presented a little story to sort of kick us off And it was it was a story Mike my son tail He was eight at that time and he you might remember he talked about why is a train stop here I told a story about a train in Colorado that we had taken we were on a family trip in Colorado that sort of just ended nowhere and We talked about how that train had actually been part of a large network and that network had developed After 1918 57 so 1857 just a few trains out west and then the trains reaching a peak in 1918 with trains everywhere and Then trimmed down dramatically to what you what you see in 2006 and we talked about how trains represented a kind of Transition both in terms of the technologies and the systems that they were the biggest industry for a while and then and then They came crashing down and now maybe are being revisited So now this year I went back to Colorado again So why do I go back to Colorado my family's from Colorado? So I went back to visit the folks again in Colorado and in this year I'm going to tell a story about this town it's at some ways a similar story But I I think I think it's useful in thinking about what we're hoping we can we can do together today So this actually is probably what this town looked like in 1850 Nothing there really. This is actually just down the street from where the town actually is In but it you know a beautiful valley up in the mountains of Colorado But then in 1859 they discovered gold and this is an actual Rock ingot whatever you call it for of gold that was found in in this town in Colorado Had a huge impact. No surprise. I mean 1849 here 1859 in Colorado And With that there were a collection of miners that came in and then people that supported them And they decided they needed the post office. They needed the only post office that would be between Denver And salt lake city and so they applied for it And they decided to use the name of the guy on the right And he was a vice vice president With james bucane at the time I blocked out his name because I'm trying to I'm going to tease you a little bit about what what this town is And it ended up that later this guy He he went to the confederate side And this was right around the time this these were democrats He was a southerner went and so the town changed its name by misspelling his name So another little clue to where we're talking about but they misspelled his name and that's become the name of this town By the late 1800s the town looked like this So a thriving town lots of buildings. This is I can't quite date this It's got to be a little later than late 1800s, but it looks something like this So what about population well in 1850 the estimates were that there were three people in in this town And 1860 with the with finding all that gold the population went up to about 500 there aren't good numbers But that's what they think it was And that's when they applied for the post office and all of that But already by 1870 things had changed They got the easy gold sitting there on the surface And then there was easier gold elsewhere. And so it the town dramatically shrunk But then Then they developed a new technology And this is not a picture from from this town, but it it could have been it looks just like this This is hydraulic mining and what they do is they just disrupt the earth break up the rocks So that you can get to the oars the ore much more quickly and of course it's very destructive And they did this all through this valley So, you know it when I was a kid actually the valley looked very much like this with rocks everywhere So with that came a Um an increase in the population So that by 1880 the population was now we're on a different scale the population was our was all the way back up to 1700 So lots more people required lots more gold also silver pulled out But then of course that dried up as well And the population went down in down in down So that actually in in 1936 They dropped Breckenridge from the the us maps the official us maps even though it still did have a post office And so it declared itself as a kingdom And it still celebrates being a kingdom today That continued to drop until The skiing was discovered. So this is an old picture from the 1960s an advertisement to bring people to skiing But important for this town too was in order to get there from any major metropolitan area You had to drive through this tunnel or before that it was level and pass Long way up and over closed all the time You know as a kid we we started a little avalanche that closed it down So if I could do that, you know, you know, it's gonna it's gonna close down frequently Open this tunnel up in in the 1970s that had a huge impact on the on the town And then they this is actually a current picture There's still these piles lying around but the They cleaned up almost all of these big piles and turned the river that runs through the valley into a beautiful river And added a added a biking trail And what happened then over time is I mean, you know the rest of the story The population went way up and it wasn't just the population that lives there This actually became the number one ski or the most visited ski area in north america and it still vacillates around there with Um with a couple other places So I think I said it by accident, but the name is This is breckenridge. So his name is actually not spelled that way That's the way the town spelled it was spelled with an i and they changed it To an e to to diss him And this is what it looks like today So the word the key word today is sustainability And obviously this is a town that went through dramatic changes over a long period of time And they were changes that were forced on it by You know shifts in the economics, you know, what's valuable shifts in technology shifts in population shifts in culture and what people did Took way too long for that town to make changes, but of course, you know, that was typical for for What was possible at that time So what what about us? Why are we talking about this? Well, we have Serious drivers for change. We can't just exist like we always have or like we even do today And first let me just take a step back and say We that's never been true for us, right? We've changed dramatically from year one to where we are today We're a very very different organization. I think the retreat is Demonstrates that but your activities those of you who are doing work within ctsi really demonstrate that how they've changed over time how How we've created brand new programs how we've created brand new opportunities So what are our drivers? Well, we know that the systems need improvement and you know, we've talked about this doubling of an itch budget without a Doubling of return. That's one Um demonstration of that but we're just not run like a responsive business, right academia has been Entrenched in tradition And that's slowed it down in terms of being adaptive and providing the optimal services We are charged in our ctsi grant with innovating not just with doing stuff But solving these bigger problems and not just solving them for ucsf, but moving them beyond ucsf And so we got to do that if we're going to survive and continue to get an itch funding We know now that our core support will change We have the new announcement And we know that the support that we get from an itch is going to go down It's going to go down somewhere between 15 and 30 percent Um And so we've known we've anticipated that that was the case And so that means too that we can't rely on stable funding from an itch For our programs and we need to move on to thinking about not just sustaining but growing in spite of that Expected or really promised decrease in core support Also, the other thing is that we if we've talked about this a lot is that we want to define our mission We know that we're you know about accelerating research to improve health. We know that NIH has been great in terms of Getting us to embark on this mission together But we you know, we changed actually from reporting into ncrr national center for research resources into incats national center for accelerating translational sciences In this past year incats has a different agenda than we were given before And even though they've given us freedom to define our agenda as broadly as we have today and we were fortunate that that's the case We still would rather not be saying well, what is it that NIH wants us to do? We should do what they want us to do But we also want the freedom to do what we think needs to get done That means having support that comes not just from NIH but from other other sources We need to envision what would happen to all this great work if the NIH funding went away and we know that one of our our One of the institutions that went in with us initially has now Failed to recompete twice and won't be funded And that's a fantastic institution the only one that did better than us when we first went in that was that's duke So it is not secure that we will get this funding. So we need to think too about About how can we exist? How do we survive even if we had no NIH funding? So those are strong Drivers i'm not trying to scare everybody. We do have stable funding. We did great in the renewal We are such a strong program I can't imagine that harm is going to happen to us on the other hand We really should be thinking about diversifying the sources that come in to support the work that we're doing Okay, so we set out to do this already We thought about this and we put this into our renewal and I showed this last year that we sort of Our goal is to get to 50 percent of our support coming from non NIH sources So here from recharge institutional support or from industry and philanthropy So how are we doing so far? Well, it ends up many didn't want me to show you this that Because it we probably set the goal a little too low for ourselves because we're actually really close to that already this year I mean we made some changes definitely But we're already at 45 55 in NIH 45 coming from other sources Some of this too it may get a little worse next year because we also don't want to be distracted by Missions that aren't our core mission. This is something we really need to talk about Some of the resources that are brought in are not in our core mission And we've got to think about actually reducing that support That that source of revenue over time or better justifying it as making sense for the overall institution Okay, so how do we how how do we do this how you know what? Um, how do we even know whether we're on the right course for doing this? Well, I'm just going to show you kind of the way I think of this right now Um, I just chose CRS because it's a huge program and this is a really big issue for for CRS, you know This is clinical research services And it includes all the The clinical research centers and a big hunk of what ctsi does and what We do that's very useful to investigators. So CRS is meeting the needs of the investigators And I'm sorry about this image of investigators. We're not all kind of like that. But anyway, it's a And and these very happy patients, you know, these the the population that we're caring, you know, that we're we're treating bringing into our studies Um, so it's it's meeting those those goals and it gets some feedback from from them to to change what it does And then of course CRS reports into ctsi and this is where we've got this sort of Some might say painful. Sorry for breeze process of Of sort of judging what CRS is doing and having a review which can't be perfect, right? It's got a it there's it's an abstract of what they really do and it's always polished before it's presented And then they're difficult and easy things to assess in that review process So so already there's a you know with us judging what they're doing We're losing something in terms of accuracy of us directing them But then of course we report to NIH right and CRS knows that and so they're now They've got metrics too that they're reporting to NIH which may not be that relevant to Whether we're meeting the needs of investigators or patients, right? So all of a sudden we've got this Cascading away from what our core mission is and then of course they report to congress And then congress tells them what to do which may be different from what they're telling us to do and then that leads It oh my goodness So that them actually meeting their mission because of the way we're we're managed and orchestrated is Is very different from them thinking in a focused manner about how best Can I solve the problems? Can I meet the needs of the investigator community and The participants that that they bring in That's the core question, right? How can I do this better from CRS's perspective? How what are their needs? How do I best meet them within whatever constraints I have? Now of course a capitalistic system does that right so capitalism This is whether you're you know, wherever you are on the political spectrum This is one thing that capitalism Does it aligns The CRS's delivery To the needs if people aren't going to pay for it Then you probably haven't provided a service that's worthwhile to them Now of course if they can't pay for it, that's a different story You need to figure out why and solve that problem Also, if it's a service that they can't get their job done without it too That may be a place too where you want to want to intervene But at least having some element of what we're doing being responsive to the needs creates a kind of Automatic governance that guides itself and that's one side effect. That's actually advantageous about us thinking about These sorts of aspects of sustainability So it's not just a distraction It actually can actually be useful as a more sort of proximate governance strategy More responsive To our communities Okay, so key questions for today. I haven't seen the five minute thing go up. So I must be doing okay Who who benefits when we meet our mission? So this is a question that we all need to be asking, you know, so we want to benefit Everyone right we want to benefit our community. Who is that community? What it who is it that's benefiting of those who's willing to support that work? Um, can we do a better job of meeting that group's needs? So if we're if they're kind of yeah, you're pretty good, but if you did this you'd be better Um That we want to know right so then we can adapt to that and grow and modify what it is we do over time And then the last question is does this distract us from our mission or allow us to meet it better? So if we're running a business to support our mission That's could very well be a distraction. However if Running our if if running parts of our Of our what we do as a business supports our mission and allows us to expand What we do then that's a good thing And we fortunately have the luxury at least right now with other sources of of revenue to to think creatively about where Where we can and where we should not look for other sources of revenue Okay, so Um, we really do have a great retreat today. Um, so we've got about 260 people Here in the audience you all are key ingredients to our success. Thank you very much for for coming and it should be a really interesting retreat so I think you made the right decision about a way to spend your your afternoon We've got many of our our campus leaders and we really appreciate you all coming to and Working with us. We have some superstar panelists One of which I don't see oh they're the first two are here And you'll see a bunch of several others and thrilled to have them as well And I think Two that you all will see and we hope that you'll see that your presence here is worthwhile and that we really are serious about Gathering input to think about how we can do what we do better