Governing Academic Medical Center Systems: Evaluating and Choosing Among Alternative Governance Approaches

Abstract

The ability of academic medical centers (AMCs) to fulfill their triple mission of patient care, medical education, and research is increasingly being threatened by rising financial pressures and resource constraints. Many AMCs are, therefore, looking to expand into academic medical systems, increasing their scale through consolidation or affiliation with other health care systems. As clinical operations grow, though, the need for effective governance becomes even more critical to ensure that the business of patient care does not compromise the rest of the triple mission. Multi-AMC systems, a model in which multiple AMCs are governed by a single body, pose a particular challenge in balancing unity with the needs of component AMCs, and therefore offer lessons for designing AMC governance approaches. This article describes the development and application of a set of criteria to evaluate governance options for one multi-AMC system-the University of California (UC) and its five AMCs. Based on a literature review and key informant interviews, the authors identified criteria for evaluating governance approaches (structures and processes), assessed current governance approaches using the criteria, identified alternative governance options, and assessed each option using the identified criteria. The assessment aided UC in streamlining governance operations to enhance their ability to respond efficiently to change and to act collectively. Although designed for UC and a multi-AMC model, the criteria may provide a systematic way for any AMC to assess the strengths and weaknesses of its governance approaches.

Adapting an Interdisciplinary Learning Health System Framework for Academic Health Centers: A Scoping Review

“…The scientific component, which identifies questions and IT structures posited to the LHS framework, was identified in 11 included studies. 6,10,36,38,40,41,46,54,55,56,57 Stoto et al (2017) stated that “addressing these questions requires a scientific approach to quality improvement that is characterized by a basis in theory.” 6 These questions are content- and context-specific since the capabilities of answering them are determined by the organizational capacity to support and absorb research endeavors. Academic health centers embedded within research universities are particularly well suited to address the scientific component of the LHS because they maintain the capacity to support research and translate that research into evidence-based practice.…”

“…Academic health centers typically maintain the necessary infrastructure of clinical practice, research, and administrative capabilities to fulfill 3 primary roles within research universities: research, education, and patient care. 1–3 As part of a university, they also often have access to administrative and managerial networks, ethical review boards, informatics or technological support, and financial systems. 1,3 As a result, they are able to develop effective, interdisciplinary, collaborative learning health systems (LHSs) that would be unattainable for private or teaching hospitals not affiliated with a university system.…”

Inventory and analysis of literature on the organisation of eight European academic medical centres—A scoping review

“…Despite these common factors, during our research, we came across a variety of reasons why a particular governance organisation and ownership structure was chosen. A multitude of internal and external conditions, challenges, and objectives drive organisations to rethink and adapt their organisation and legal structures [11,12,106]. Examples from our study illustrate these different national perspectives and circumstances.…”

“…These include growing medical knowledge, staff shortages, emerging expensive technologies, and ageing patient populations with new demands for care. AMC leaders must cope with tension regarding the distribution of financial resources and competition with other healthcare providers [1,[12][13][14]. Governments have increasingly emphasised the public and social role of AMCs [15,16].…”

How Do STEM Career Change Teachers Experience the Transition?: A Comparison Between Dutch and Australian Teachers

“…Wat we weten over effectieve besluitvorming is dat het verschillende harde en zachte aspecten bevat (Birnbaum 2004). ('Harde') formele regels, procedures en processen fungeren als de steigers van de besluitvormgingsstructuren van een instituut (Chari 2018) en omvatten elementen zoals commissies, rapportagelijnen en duidelijkheid over verantwoordelijkheid, aansprakelijkheid en autoriteit (Kezar 2004, Casiro en Regehr, 2017. Binnen dit kader zijn er verschillende andere ('zachte') menselijke processen die het functioneren van de besluitvormingsprocessen verder vormgeven.…”