Kralewski J E, Hart G, Perlmutter C, Chou S N
Health Services Research, School of Public Health, University of Minnesota (UM), Minneapolis 55455, USA.
Acad Med. 1995 Oct;70(10):867-72. doi: 10.1097/00001888-199510000-00008.
The authors review characteristics of successful group practices, health maintenance organizations, and integrated service networks and then identify the critical actions that academic medical centers must take in order to compete with such service-oriented community providers. Centers must (1) form the clinical faculty into a competitive medical group that offers more price-competitive and user-friendly services; (2) restructure clinical training to be more relevant to the emerging practice situation; and (3) clearly delineate funding streams and identify the cross-subsidies taking place in the teaching, research, and patient care enterprises. These changes have the potential to strengthen clinical training and improve the financial positions of both the faculty and the university hospitals. The authors maintain that centers can make these and other necessary changes while still providing high-quality care and maintaining their educational and research functions; they cite organizations that have succeeded in these ways. However, as with all complex, large-scale organizations, public and private alike, the major factor limiting centers' ability to make the organizational changes required to successfully compete in the new health care environment is the lack of political will. It will be very difficult for academic medical centers to unite their powerful internal interest groups and take action without first experiencing a rather severe external jolt. The challenge for the leaders of academic medical centers is to prepare for the managed care jolt so that they can then guide their institutions to a new, more competitive position.
作者回顾了成功的集团医疗实践、健康维护组织和综合服务网络的特点，然后确定了学术医疗中心为了与这类以服务为导向的社区医疗服务提供者竞争而必须采取的关键行动。各中心必须：（1）将临床教员组建成一个具有竞争力的医疗团队，提供更具价格竞争力且用户友好的服务；（2）调整临床培训，使其与新出现的医疗实践情况更相关；（3）明确划分资金流，并确定教学、研究和患者护理业务中存在的交叉补贴情况。这些变革有可能加强临床培训，并改善教员和大学医院的财务状况。作者认为，各中心在进行这些及其他必要变革的同时，仍可提供高质量的医疗服务，并维持其教育和研究功能；他们列举了已通过这些方式取得成功的机构。然而，与所有复杂的大规模组织一样，无论公立还是私立，限制各中心进行必要的组织变革以在新的医疗环境中成功竞争的主要因素是缺乏政治意愿。学术医疗中心若不首先经历相当严峻的外部冲击，就很难团结其强大的内部利益集团并采取行动。学术医疗中心领导者面临的挑战是为管理式医疗冲击做好准备，以便随后引导其机构迈向新的、更具竞争力的地位。
