The UNC Health Care system, harshly criticized in the past year for its executive bonuses and aggressive bill collections, is working through a series of changes following a critical review of its chief executive, Dr. William Roper.

Roper, who is also dean of the medical school at UNC-Chapel Hill, informed faculty of the changes this spring. System officials, however, made no mention of the lengthy list when Roper was given a five-year contract extension in April.

Roper said Tuesday that most of the changes are well under way and some are completed. He made it clear to faculty in April that the changes were related to the evaluation of his first three years of work. After delivering his remarks, the address was e-mailed to the medical school faculty.

"I firmly believe we each are made better by receiving regular and candid feedback -- whether we like it at the time or not," Roper said in April. "It is in that spirit that I have read these reports of my reviews and responded to the recommendations."

Roper's evaluations, which involved two separate review committees, were overseen by UNC system President Erskine Bowles. They also included UNC Health Care system board Chairman Bill McCoy and UNC-CH Chancellor James Moeser.

After the reviews were completed, Bowles recommended Roper's contract extension to the UNC system Board of Governors on April 9. Roper addressed the faculty on April 11, saying he had made mistakes and would make changes.

"Dr. Roper and I did set up specific goals, objectives and timelines," Bowles said this week.

"He put them forward and Chancellor Moeser, Mr. McCoy, and I agreed to them. It's always important to define success and have accountability."

Under Roper's direction, the UNC Health Care system was widely criticized for the $2.5 million it paid in bonuses in 2006 and the difficulty some poor families were reporting in obtaining health services.

Part of the system's mission as a public hospital is to provide indigent care to North Carolinians.

Last year's bonuses were made public in October, less than two months after Bowles received a petition signed by 1,100 people charging that health care system officials were more interested in improving financial performance than providing all poor patients with medical care.

Signed by three members of the General Assembly, the petition urged UNC Health Care to return to its mission.

In January, Roper announced the system would stop referring its delinquent accounts to the state Attorney General's Office. That approach sometimes resulted in the system placing liens against homes of patients who had spent heavily on medical care.

In May, the board announced it would no longer offer performance bonuses to key leaders. Roper was paid a bonus of $110,010 on a base salary of about $460,000.

Florence Solstys, a retired UNC faculty member who is among the most vocal critics of the system, said the changes have clearly helped. She also believes more change is needed, particularly in ways that would make the board more diverse.

"The representation on the board has changed a bit, but it is run by an elite group that is not connected to the community it is supposed to serve," she said.

Roper's first comments to the faculty in April involved his relationship to them. He promised to be "a more visible and engaged dean" within the School of Medicine, including 35 meetings with the faculty of each department.

His second promise to faculty involved the way he leads the school.

"It is clear that the School of Medicine wants a more open and transparent leadership process," he said.

Toward that end, he set up liaisons to work with the school's leadership team. The liaisons represent the basic sciences and clinical departments.

Other changes covered in the letter to faculty include:

* The transfer of $10 million from the UNC Health Care system to the medical school for research and teachers.

* The transfer of $15 million to UNC Physicians and Associates to bolster clinical efforts.

* Continued study of whether to expand the medical school, possibly with a satellite campus in Charlotte.

* The addition of 50 nonlicensed beds this year to ease chronic capacity problems.

* A push to improve the quality and safety of health care.

"The nationwide effort to measure and report results -- in order to drive improvement -- will only grow in scope and sophistication," Roper said, according to a transcript of the faculty address. "We must do this as a unified organization -- we cannot afford not to, and we will not succeed unless we do."

More changes are expected, some of which will be outlined this fall when a long-range plan for the hospitals and the school of medicine is scheduled for release.

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