Creating university hospitals: rationales and realities.

This article analyzes the reasons given for the founding of three early university hospitals: those at the University of Michigan, the University of Pennsylvania, and Johns Hopkins University. The hospital at the University of Michigan was founded to ensure medical students' access to clinical instruction. The University of Pennsylvania's desire to have not only access to but control over hospital affairs provided the impetus to build a university hospital. Johns Hopkins University, building upon the examples of Michigan and Pennsylvania, firmly joined the hospital and medical school and introduced research as a link between these institutions. The early histories of these three institutions demonstrate how each created a different mission for its university hospital. Today, as in the past, university hospitals must choose which of their multiple roles to emphasize. The meaning of "university hospital" has always been ambiguous, and this ambiguity can provide useful flexibility to institutions responding to a changing environment.