The Academic Health Center: …

The Academic
Health Center:
                                               A
                                                      n academic health center is defined as an
Evolving                                              accredited, degree-granting institution of
                                                      higher education that consists of:
Organizational                                 ·   A medical school (either allopathic or
Models                                             osteopathic)
                                               ·   One or more other health professions schools
                                                   or programs (e.g., Allied Health Sciences,
By Steven A. Wartman, MD, PhD
                                                   Dentistry, Graduate Studies, Nursing,
                                                   Pharmacy, Public Health, Veterinary Medicine)
                                               ·   An owned or affiliated relationship with a
                                                   teaching hospital, health system, or other
                                                   organized health care provider.
Academic health centers
                                               Academic health centers may be private or public
undergo reorganization
                                               institutions; they may also be university-based or
towards a structure that                       free-standing. As they have evolved over the last
spans the totality of the                      50 years, academic health centers have changed the
academic health center                         nature of education in the health professions,
enterprise                                     prompted new arrangements for the delivery of
                                               health care, accelerated growth of federal
                                               involvement and influence in health professions
                                               education and research, and created new linkages
                                               between academe and all sectors of the economy.



                                               ACADEMIC HEALTH CENTER
                                               ORGANIZATIONAL MODELS
                                               There is a perception that a wide variety of
                                               academic health center organizational models
                                               abound, when in fact only two prototypical models
                                               have dominated over the last decades: (1) the fully
                                               integrated model, where academic, clinical and
                                               research functions report to one person and one
                                               board of directors; and (2) the split/splintered
                                               model, where the academic and clinical/health
                                               system operations are managed by two or more
                                               individuals reporting to different governing boards.
                                               The latter is best exemplified by a defined affiliated
                                               relationship between a medical school and a
                                               teaching hospital. Obviously, there are various
                                               nuances of the two types, including locating the
                                               responsibility for a faculty practice plan.
                                                    The debate over the benefits and risks of each
Association of Academic Health Centers         structure has been ongoing since the establishment
     Leading institutions that serve society
                                             ASSOCIATION OF ACADEMIC HEALTH CENTERS


                 "Ultimately, the type of model existing                  for research) that extend beyond the individual
                 at a given institution reflects a                        health professions schools, along with a greater
                                                                          emphasis on team-oriented approaches to strategic
                 combination of history, politics, and
                                                                          planning, operations, and problem-solving.
                 economics."
                                                                               Findings from a survey of one half of the
                                                                          AAHC members in 2005 found that in 78% of
                 of academic health centers in the late 1960s, when       responding institutions that owned a teaching
                 it was considered quite necessary to have an             hospital, the academic health center leader had sole
                 integrated system. With the advent of managed            authority over the head of the hospital. Seventy-
                 care and changes in reimbursement systems for            three percent of leaders at institutions that owned a
                 patient care in the 1980s, there was a growing           health system said they had sole authority over the
                 perception that business effectiveness and               head of the health system. And 14% of the
                 efficiencies could best be achieved by separating the    responding academic health center leaders served
                 clinical enterprise from the other mission areas.        as both the academic health center president (or
                 Occasionally, the organization of some academic          equivalent title) and CEO or vice president of the
                 health centers cycled between these two models,          health system or medical center. The topic of
                 depending on the local economy, health market            academic health centers being a fully integrated
                 trends, university politics or personalities of the      enterprise, including the clinical component, under
                 leaders involved. Ultimately, the type of model          a single leader and a single board is now emerging
                 existing at a given institution reflects a               as a major issue.
                 combination of history, politics, and economics.              Other features of "corporate" management for
                                                                          academic health centers include markedly increased
                                                                          efforts to relate to stakeholders (i.e., the public,
                 CURRENT TRENDS                                           patients, practitioners, politicians, policymakers,
                                                                          and business community); an international focus to
                 Today, academic health centers are recognized as         increase global competitiveness; enhanced
                 national economic engines and complex business           programs in translational and applied research in
                 enterprises. In increasingly competitive national        response to the growing pressure to accelerate the
                 and global economies, they must achieve                  translation of biomedical research into practical
                 unprecedented scales of efficiency and agility in        implementation; and, focused business operations
                 their mission areas of education, patient care, and      with enhanced strategic planning, new methods of
                 research in order to grow and flourish. Failure to       budgeting and more rigorous assessment and
                 do so will result in a struggle to maintain the status   accountability for faculty, staff, and administration.
                 quo.
                      The major response of academic health centers
                 thus far to these challenges has been a trend            CONCLUSION
                 towards more "corporate" management. In recent
                 visits to a substantial number of academic health        In the years ahead, a continuing horizontalization
                 centers, it is clear that this management transition     and consolidation of the academic health center
                 is in varying stages (depending on the particular        enterprise throughout its mission and management
                 institution) but is essentially characterized by a       areas will be apparent. As this happens, academic
                 reorganization along non-disciplinary lines towards      health centers will undergo a process of accelerated
                 an administrative structure that spans conceptually      change as the result of strategic planning processes
                                                                          that drive leaders to make the hard decisions about
                 and operationally the totality of the academic
                 health center enterprise and encompasses all
                 mission areas.
                                                                          "Academic health centers will undergo
                      The result has been expanded roles for existing     a process of accelerated change as the
      EVOLVING   positions (such as vice presidents for health affairs)   result of strategic planning processes
ORGANIZATIONAL   or the creation of new roles (e.g., academic health      that drive leaders to make the hard
       MODELS    center-wide compliance officers or vice presidents       decisions about resource allocation."

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                              ASSOCIATION OF ACADEMIC HEALTH CENTERS


resource allocation. These changes are essential to
ensure accountability at higher levels of authority
as well as buy-in from faculty and staff, who must
adapt to new rules that involve more
interdisciplinary collaboration and institutional
team play. In academic health centers that are not
fully integrated with their clinical enterprise, there
is the potential for heightened conflict with their
clinical partner as their strategic visions may vary.
     It is increasingly evident that with regard to
future academic health center growth and
development, particularly in the research and
patient care arenas, an integrated system provides
the structure to increase benefits, decrease financial
risks, advance scientific progress, and heighten the
institution's reputation and trust with the public in
a more efficient and organized fashion.
     It is critical that the new "corporate" paradigm
not overshadow the fundamental academic ethos
and the creativity, intellectual spirit and unique
public standing of these institutions. It has never
been more important for the academic health
center enterprise to take to heart the full
implications of the societal missions of their
institutions as they evolve into global competitive
enterprises. The greater public good--which means
balancing all mission areas to serve the public--
must always be the raison d'etre behind the
organization and structure of the academic health
center for the future.



Steven A. Wartman, MD, PhD, MACP, is president and
CEO of the Association of Academic Health Centers.




                                                                       EVOLVING
                                                                       ORGANIZATIONAL
                                                                       MODELS



                                                                            3
Association of Academic Health Centers
     Leading institutions that serve society




VISION
To advance the nation's well-being
through the vigorous leadership of
academic health centers.


MISSION
To improve the nation's health care
system by mobilizing and enhancing the
strengths and resources of the academic
health center enterprise in health
professions education, patient care,
and research.


1400 Sixteenth Street, NW Suite 720
                         ,
Washington, DC 20036
202.265.9600
202.265.7514 fax
www.aahcdc.org




© 2007 by the Association of Academic Health Centers