The challenge of governance: the relationship of the teaching hospital to the university.

In an academic medical center, patient care is primarily the business product of the hospital and its organized medical staff, while education and research belong primarily to the medical school dean and the faculty. Each unique business--patient care, education, or research--must be managed with regard for the others, but first it needs to be considered separately and operated for results related to its primary goal. It is essential that governing bodies understand the business they govern. Mutual understanding, trust, and integrity are keystones in executing primary responsibility for the different activities in pursuit of the overall shared missions. Ten principles seem reasonable for governance and management of academic medical centers. They recognize the businesses, define potential problems, set tasks, and, if every person fulfills his difficult work, provide the organizational means for resolving conflict. The principles are listed in this paper.