Souba W W
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02115, USA.
Surgery. 1996 Jan;119(1):1-8. doi: 10.1016/s0039-6060(96)80205-4.
Academic medical centers have responded to health care reform initiatives by launching a series of strategic plans designed to maintain patient flow and reduce hospital expenditures. Thought is also being given to processes by which the faculty can individually and collectively adjust to these changes and maintain morale at a time when reductions in the labor force and pay cuts are virtually certain. Physicians are concerned because managed care threatens their autonomy and jeopardizes the traditional ways in which they have carried out their multiple missions. Some doctors believe that it will become increasingly difficult to obtain genuine satisfaction from their job.
The strategies that academic medical centers have begun to use to address the numerous challenges posed by a system of health care based on managed competition are reviewed. Potential mechanisms by which academic departments can continue to find fulfillment in an environment that threatens their traditional missions and values are discussed.
A study of the social and historical origins of medicine in the United States reveals that the introduction of corporate medicine in the United States was destined to happen. Strategies implemented by academic medical centers in response to managed care include building an integrated delivery network, the acquisition of primary care practices, increasing cost-effectiveness, and creating physician-hospital organizations. Emphasis must be placed on integrating traditional core values (excellence, leadership, and innovation) with newer values such as patient focus, accountability, and diversity. A shift from rugged individualism to entrepreneurial teamwork is crucial. These reforms, although frightening at the onset, can serve to reaffirm our commitment to academic medicine and preserve our mission.
The evolving managed care environment offers unique opportunities for academic medical centers to shape and positively impact health care delivery in the twenty-first century. In a reconfigured model that combines core values with newer values, university-based physicians can continue to reap the intangible rewards derived from patient care, research, and education.
学术医疗中心已通过推出一系列旨在维持患者流量和降低医院开支的战略计划来应对医疗保健改革举措。同时也在思考教师个人和集体如何在劳动力削减和减薪几乎确定的时期适应这些变化并保持士气的过程。医生们感到担忧，因为管理式医疗威胁到他们的自主权，并危及他们履行多重使命的传统方式。一些医生认为，从工作中获得真正的满足感将变得越来越困难。
回顾学术医疗中心已开始用于应对基于管理式竞争的医疗保健系统所带来的众多挑战的策略。讨论学术部门在威胁其传统使命和价值观的环境中继续找到满足感的潜在机制。
一项对美国医学社会和历史起源的研究表明，美国企业医学的引入是注定要发生的。学术医疗中心为应对管理式医疗而实施的策略包括建立综合服务网络、收购初级保健业务、提高成本效益以及创建医师 - 医院组织。必须强调将传统核心价值观（卓越、领导力和创新）与诸如以患者为中心、问责制和多样性等新价值观相结合。从强硬的个人主义向创业团队合作的转变至关重要。这些改革虽然一开始令人恐惧，但有助于重申我们对学术医学的承诺并维护我们的使命。
不断演变的管理式医疗环境为学术医疗中心在 21 世纪塑造并积极影响医疗保健服务提供了独特机遇。在将核心价值观与新价值观相结合的重新配置模式中，大学附属医院的医生可以继续从患者护理、研究和教育中获得无形回报。
