At Rush University System for Health, a five-year transformation of the dermatology department has reshaped not just operations, but culture, access and long-term sustainability.
Since 2021, the department has grown from 22,000 to over 70,000 annual patient visits, expanded from three to 10 sites, took the residency program from probation to full ACGME accreditation with zero citations and doubled its size, and built a financially durable academic model. For David C. Reid, MD, chairperson of Rush’s Department of Dermatology, the work was less about quick fixes and more about rethinking how a department functions at its core.
“When I accepted the role, there had been instability, attrition, financial underperformance and delayed reinvestment,” said Dr. Reid. “Communication was fragmented, and morale was poor, so we had to do a comprehensive rebuild.”
“I didn’t come in with a master restructuring plan, but I did come in with principles first—listening to the team and understanding their experience,” he said. “What emerged was a belief that we needed to establish clarity around mission, strategy and execution.”
Rather than treating the challenges as a motivation problem, Dr. Reid and his team identified a deeper issue: structure. The department needed a framework that connected individual roles to a shared purpose, something that could turn effort into impact.
“We built a framework where people could see how their work connected to something larger than themselves, and to each other,” Dr. Reid said. “After that happened, engagement and morale changed. It became a collective purpose.”
“When I joined Rush four years ago, the department was at the precipice of this huge transformation. Both our dermatology faculty and residency program have doubled in size since then, and we now have nationally renowned dermatologists providing expert-level subspecialty care,” said Parul Goyal, MD, a dermatologist with Rush University System for Health. “Being part of the journey from then to now has been incredible, and I am excited to see the growth continue over the next several years."
Rush University System for Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Redesigning how work gets done
That clarity translated into a fundamental shift in day-to-day operations. The department moved away from siloed workflows and hierarchical problem-solving toward a more integrated, team-based model.
“We made a deliberate shift to reduce hierarchy while elevating expectations,” Dr. Reid said. “Solutions could come from anywhere on the team, based on the quality of the idea—not the title of the person.”
To support that shift, the department introduced regular forums, cross-functional workflow redesign and transparent performance metrics. These weren’t just structural changes—they altered how teams approached problems.
A key example came from addressing documentation gaps that were slowing prior authorizations. Instead of pushing the issue downstream, the department brought together physicians, nurses, medical assistants and administrative staff to redesign the workflow collectively.
“That wasn’t a small fix,” Dr. Reid said. “It changed how people viewed problems and how they came together around them. When problem-solving becomes more collective and less territorial, innovation and efficiency accelerate.”
By embedding collaboration into everyday operations, the department created a system where improvement became continuous rather than episodic.
Building trust through transparency
As workflows evolved, so did the department’s culture. Trust became a central pillar—but not through messaging alone. Instead, it was built through consistent transparency and visible decision-making.
“Trust doesn’t come from saying ‘trust us,’” Dr. Reid said. “It comes from consistency, predictability and transparency. We made financial performance, operational metrics and strategic priorities clearly visible. We shared where we were strong and where we weren’t.”
That visibility extended to reinvestment decisions, helping staff see how improved performance translated into tangible benefits. One moment in particular stood out: the arrival of a new laser. It was the department’s first in years.
“It became a symbol,” he said. “People could see that their work was leading to reinvestment. It made financial performance real.”
Equally important was accessibility. Dr. Reid made a deliberate effort to remove traditional leadership distance, creating space for ideas from across the organization. He recalls an early meeting with a medical assistant who was reportedly disengaged and likely to leave.
“She came in with two pages of concerns and ideas,” Dr. Reid said. “That’s not someone disengaged—that’s someone who cares deeply and was ready to contribute the moment she had the right environment to do it.”
Five years later, that medical assistant remains with the department as a clinical leader. It is an example of how cultural shifts can unlock untapped potential.
Rethinking hierarchy and expectations
Central to the transformation was a reframing of hierarchy—not eliminating it but redefining its role.
“Hierarchy isn’t inherently bad. You need structure and authority to make decisions,” Dr. Reid said. “But unexamined or symbolic hierarchy can be problematic. If you de-emphasize that while elevating expectations and accountability, it works extremely well in my experience.”
That balance allowed team members to bring more authenticity to their roles, while maintaining high standards across the department.
“For us, excellence was non-negotiable,” he said. “If we fell short, we had to address it and identify a way forward.”
The result is a culture where individuals feel both empowered and accountable, which is an essential combination for sustained performance.
Recruiting for alignment, not just talent
As the department stabilized, recruitment and retention became critical to scaling the transformation. But the approach differed from traditional hiring models.
“Individual excellence is necessary, but alignment is crucial,” Dr. Reid said. “I was less interested in polished resumes and more interested in whether people could contribute to our environment.”
Candidates were evaluated not only on expertise, but on their ability to work within a shared system and contribute to a collective mission. The department also prioritized internal development, promoting individuals earlier when they demonstrated both capability and alignment.
“We focused on building a leadership pipeline that was sustainable,” he said. “Over time, culture compounds.”
That intentionality extended to pacing. Rather than rushing to fill roles, the department waited to identify candidates who fit both the technical and cultural criteria.
“Once we got the first few people with the right values and talent, it allowed us to recruit more downstream,” Dr. Reid said. “The team just grew exponentially from there. Now we have a very large department with a lot of alignment and a lot of talent.”
“I’ve been at Rush for six years and the department has seen exponential growth in physician recruitment and retention in that time,” said Kyle Amber, MD, a dermatologist with Rush University System for Health. “We’re also seeing more patients from a broader geographic spread and now have the capacity to lead more research. It’s been enjoyable to be a part of this massive but substantial expansion.”
Aligning mission with financial sustainability
Another key shift involved reconciling what are often seen as competing priorities in academic medicine: mission and margin.
“There’s discomfort around finance in medicine because we’re trained in service,” Dr. Reid said. “But financial sustainability without mission is hollow, and mission without sustainability is just aspiration.”
Instead of treating financial performance as separate from academic goals, the department reframed it as an enabler.
“We made it explicit that financial sustainability wasn’t the goal—it was the mechanism,” he said. “It funds education, research, infrastructure, physicians and staff.”
By making that relationship visible, financial discussions became less abstract and more directly tied to the department’s purpose.
“When you have incentives, they shape behavior whether they are acknowledged or not,” Dr. Reid added. “It’s important to understand why we are doing what we are doing, what that could lead to for the team downstream.”
Scaling culture as the department grows
As the department expanded geographically and operationally, maintaining alignment required new strategies. What worked in a smaller, tightly connected team didn’t automatically scale and needed to evolve.
To address that, the department invested in distributed leadership, identifying individuals with the right talent and values to lead across sites and operational areas. These leaders were given autonomy within a shared framework, allowing the department to grow without losing cohesion.
At the same time, centralized elements—such as department-wide forums and transparent metrics—remained in place to reinforce alignment.
“We institutionalized visibility around priorities, operations and expectations,” he said. “Even as things became more complex, our performance remained elevated, and our culture remained durable.”
A model for transformation
Looking back, Dr. Reid sees the department’s evolution as both a structural and human achievement—one that extends beyond dermatology.
“The transformation worked because we reduced hierarchy while elevating expectations,” he said. “We opened problem-solving beyond roles, made leadership more accessible, made standards more explicit and built a shared purpose larger than any one role.”
In a health care environment that can often feel fragmented and isolating, that sense of connection has become a defining strength.
“At a time when health care is complex, that connection really matters,” Dr. Reid said. “Our performance and culture compounded together. It was both a human and structural accomplishment, and that’s what allowed us to scale.”
“Most health care organizations are navigating the same tensions—financial pressure, competing priorities, difficulty retaining talent,” he said. “What we found is that those challenges often share a common root in how the organization is structured. Get that right, and you create the conditions where progress on everything else becomes possible.”
“Be genuine with your team about the challenges and opportunities in front of you, and unite them around the work of the organization,” Dr. Reid added. “Everything else follows from that. Authenticity, hiring people with great talent and great values, connecting people to their work, holding to standards of excellence, and being transparent about how financial performance enables mission—that’s what drove outsized performance.”
