Krauss K, Smith J
Mead Point Group, Greenwich, CT 06830, USA.
Acad Med. 1997 Jul;72(7):571-5. doi: 10.1097/00001888-199707000-00008.
Academic medical centers (i.e., medical schools and their principal hospitals) are following very similar strategies in attempts to secure their futures. It is likely that these undifferentiated strategies will fail, since most of them have been copied from the lower-cost, geographically better-positioned hospitals and health systems. Despite a wealth of innovative, entrepreneurial talent and the potential to reshape the world that AMCs live in, most AMCs are in reactive modes. Future directions and strategies are almost always shaped, forced, and justified by external pressures. The major problem with the strategic plans of most AMCs is that they are based on conventional industry wisdom. Strategic plans tend not to be analytically driven. The insight and understanding of those factors that drive the demand for AMCs' services and determine the performances of AMCs are lacking. The authors note some questions that are critical to the formulation of strategies for AMCs. For example, how can the research mission be changed from a cost-based to a value-based endeavor? Most AMCs cannot answer these questions, and if they do address them in the planning process, they do so superficially. Several examples of the factors that need to be understood are also given, such as patients' purposes and needs in seeking specialty care. Alternative strategies are listed, such as maintaining and exploiting the economic irrationality of the market rather than acting as if it were economically rational or forcing it to become so. Last, the authors outline the scope of the changes that are required and urge AMCs to reject conventional wisdom, determine their own unique situations, and work from there.
学术医疗中心（即医学院及其主要附属医院）在试图确保自身未来发展时都采取了极为相似的策略。这些毫无差异的策略很可能会失败，因为其中大多数都是照搬那些成本更低、地理位置更优越的医院及医疗系统的做法。尽管学术医疗中心拥有大量创新型、具有企业家精神的人才，且有潜力重塑其所处的世界，但大多数学术医疗中心仍处于被动应对模式。未来的方向和策略几乎总是由外部压力所塑造、驱使并合理化。大多数学术医疗中心战略计划的主要问题在于它们基于传统的行业认知。战略计划往往并非由分析驱动。对于那些推动对学术医疗中心服务的需求并决定其绩效的因素，缺乏深入的洞察和理解。作者们指出了一些对于学术医疗中心战略制定至关重要的问题。例如，如何将研究使命从基于成本的努力转变为基于价值的努力？大多数学术医疗中心无法回答这些问题，即便它们在规划过程中有所涉及，也只是流于表面。文中还给出了一些需要理解的因素的例子，比如患者寻求专科护理的目的和需求。列出了一些替代策略，比如维持并利用市场的经济非理性，而非装作市场是经济理性的或迫使它变得如此。最后，作者们概述了所需变革的范围，并敦促学术医疗中心摒弃传统观念，确定自身独特的情况，并以此为基础开展工作。
