Change comes to the organization of academic health centers

American Journal of Pharmaceutical Education, Summer 1998 by Kabat, Hugh F

Roger J. Bulger, MD, President and CEO of the Association of Academic Health Centers (AAHC), presented the keynote address at the 1998 American Association of Colleges of Pharmacy (AACP) Academic Management Symposium. Drawing upon a year-long study on the changing organization of academic health centers, he addressed its implications for Colleges of Pharmacy. The concepts that were presented in the AAHC Report have specific relevance for all institutions that educate health professionals.

Bulger noted that most academic health centers have come to recognize that educating competent health professionals in academic isolation from their student colleagues, and in clinical settings organized along outmoded delivery patterns is no longer acceptable. The AAHC report dwells less on the evolution of the health care marketplace and more on the need for centers to concentrate on their core missions: education, patient care, research and service to the community. In his remarks, Bulger emphasized that managed care organizations, on behalf of patients, are demanding a seamless transition of services across the spectrum of preventive, curative and chronic health care. These organizations have the expectation that health profession students will learn to collaborate with their colleagues while providing optimum care with the patients' best interest as a primary focus.

Large purchasers of health care are concerned that the costs of care provided in academic health centers are too high and that students are not being prepared to collaborate with colleagues in the provision of the seamless care that patients need. The AAHC study addressed this critical issue by identifying those characteristics prevalent in centers that have successfully reorganized. The study revealed that these academic health centers were oriented toward the center's goals and objectives rather than toward individual disciplines, schools or professions. In these academic health centers, institutional reconfigurations defined, in detail. the ownership, governance. leadership, organization and financing necessary to efficiently manage the center's core missions. Their change strategies focused on targeted priorities linked directly to resource allocation and reward systems. Benchmarks and performance metrics in core mission areas addressed cost concerns and the demands by external constituencies for accountability. An information infrastructure that generated appropriate efficient information transfer was crucial for management of the planning, resource allocation, tracking, coordinating, outcome's evaluation and decentralization activities in the reintegrated academic health center.

The report commissioned by AAHC, noted that most academic health centers are altering the programs and structures of their schools and clinical facilities in order to achieve their societal potential while insuring their financial solvency and guaranteeing their long term survival. There was no single evident format but certain common elements emerged. The change strategies chosen by successful individual centers were a function of their institutional history, culture and mission as well as the local circumstances and characteristics of their parent university. These changes involved deep cultural shifts, however, altering the roles of leaders at all levels, with enormous impact on faculty and their closely held traditions! The report suggests that a successful change process would bring about the following transformations. Integration and scale forces departmental chairs to share power with new leaders charged to direct the academic health center's education, patient care, research and community service core missions. Disciplinebased faculties become members of interdisciplinary teams addressing the core missions of the center. The resulting reintegration at the academic health center level was designed to create improved levels of patient care, health profession education and research. For these changes to succeed there must be a strong shared vision by both administration and faculty of the academic health center's goals and priorities.

The AAHC study also observed that higher education, in general. and education in health care disciplines, specifically, was experiencing the same change forces that are buffeting health care delivery. Society's concerns about cost, quality and access to education are leading to demands for accountability, active student-learning and evaluation of outcomes. The public perceives that the importance of education has been devalued by the dominance of the patient care and research missions in academic health centers. In addition managed care organizations are forcing change in the health care delivery system based on their belief that the health care needs of an aging, and increasingly diverse population can most effectively be met when there is cost effective collaboration across the health professions and related social support svstems. However, despite the growing shift to health care delivery by integrated interdisciplinary teams, in academic health centers there is little emphasis on interdisciplinary student education. This is certainly an area of concern for all of us.