11.9.15
执行概要
这个问题
公平还是不公平, the economic engine of an academic medical center (AMC) is its clinical enterprise, also known as the academic health system (AHS)—namely the combined assets of the 教学 hospital, 临床医学系, 以及附属或拥有的非学术(或“社区”)云顶集团40011官网. 他们自己, the research and 教学 programs are underfunded through their traditional revenue streams and need steady investment from the margin of the clinical enterprise. This critical source of investment from the AHS is at risk for organizations that are not strategically and organizationally well positioned. 在《云顶集团40011官网》(ACA)出台之前，医疗市场已经充满了挑战。, ahs的逆风进一步加剧, as they need to demonstrate they provide higher-quality care at an appropriate cost. 这一挑战也存在于非学术机构, however AMCs are far more complex as they grapple with the Rubik’s Cube of issues that emerge from a three-part mission (clinical care, 教学, and research) while balancing the dynamics of a three-component organizational structure (教学 hospital, 医学院, 和教师小组实践[FGP]). 进一步, AHSs have very little room for error since they face unique business disadvantages in the marketplace, including a less favorable payer mix and a traditionally higher overhead due to their academic mission.
最近的研究和文献，包括来自 美国医学院协会 (AAMC)和 医学研究所 (IOM), reinforce the idea that the success of each AMC component entity is inextricably entwined with the others; therefore, the components need to find ways to increase collaboration as external market factors continue to present new challenges. Many AMCs are responding and have made or are planning to make significant changes to improve performance. For example, 31% of Association of Academic Health Center (AAHC) members are 改变他们的治理结构或重要的报告关系. The market has seen major transactions at AMCs such as Vanderbilt or Northwestern in recent years, where the clinical assets are shifting to bring the hospitals closer together with the physician organizations. 然而, the majority of the AMCs that do not already have a highly integrated clinical enterprise appear hesitant about making major structural changes; many are unsure of the best approach and are unwilling to assume the risk without understanding the tangible benefits of more closely aligning the 教学 hospital with the FGP. 毕竟，更大的结盟或整合究竟意味着什么? 如果AHS从根本上更加一体化, 它会带来更好的利润并提高护理质量吗? This study attempted to address these and other questions by examining the organizational architecture and functional behavior of AHSs and determining whether a correlation exists between their level of integration and their performance.
这项研究
The ultimate goal of this study was to determine whether AMCs with more integrated AHSs outperform those that are considered less integrated, with a central focus on the clinical enterprise—the relationship between the adult primary 教学 hospital and the FGP. The first step was to analyze the degree of integration demonstrated by 104 AHSs in the United States and categorize each as being more integrated or less integrated based on empirical data and institutional insight. The two groups were then compared based on five primary areas of organizational performance: reputation, 护理质量, 经济上的成功, 研究经费, 住院医师项目排名(1).e.，研究生医学教育[GME]).
结果
The results suggest that AMCs where the adult primary 教学 hospital and FGP (i.e., the AHS) are more structurally and/or functionally integrated materially outperform those that are less integrated when measured in the aggregate. 整合程度更高的ahs在五个性能类别中的四个方面表现更好. 财务业绩是一种与之相反的衡量标准, 这项研究为这种差异提供了一种可能的解释, 包括整合程度更高的资产管理公司的弱势付款人组合.
结论
The findings presented from this study substantiate the widely held belief that the more an AHS is strategically, 在财务上, 其他方面对齐, 整个AMC的业绩就越好. 尽管如此，企业结构的全面整合(如.g., merger into a single-CEO structure for the 教学 hospital and FGP) alone may not be the only pathway to integration nor is it a realistic option for some. 事实上，功能集成已被证明同样有效. Institutions that are not corporately integrated have demonstrated that with the reinforcement of a contemporary affiliation agreement (i.e., 履行和分担财务风险的双边承诺), a high level of functional integration can be achieved through coordinated planning and execution in a number of areas, 比如战略规划和联合预算. 另一方面, full corporate integration through a merger or alternative means may be the best solution at some organizations in order to solidify relationships and ensure that their strategic and financial interests are completely aligned.
大多数AMC领导人承认, 至少, their clinical enterprise should be more integrated to compete in today’s market, but there is often a deficit of political will to pursue such an initiative among key stakeholders. 然而, the focus on performance must ultimately trump politics in order for an organization to thrive in today’s healthcare environment; and, 这项研究表明, AHSs that are more integrated perform at a higher level than those that are not. The opportunity cost of not taking steps to build a more integrated AHS will be high for the clinical enterprise, 并会对整个资产管理公司产生直接的不利影响(例如.e., together with the university and 医学院) as fewer resources will be available to reinvest in the academic mission.
