Reforming the structure and management of academic medical centers: case studies of ten institutions.

The authors describe a variety of strategies that academic medical centers (AMCs) are using to preserve their missions in the face of changing demands and declining resources. The report is based on comparative studies of ten centers conducted by the authors in 1997 and 1998. (AMCs are defined as medical schools and their owned or closely affiliated clinical facilities.) The studies show that the kinds of reforms that AMCs are making in the conduct of their missions and the results they are aiming for are often characteristic of successful organizations described by experts in organizational change and management. The major reforms found included balancing planning and opportunism; developing new approaches for faculty participation in governance; experimenting with the organization of core functions; listening to the customer; aligning incentives; creating a sense of urgency for change; and reducing the emphasis on paper credentials when recruiting for management positions. While these findings are encouraging, it seems clear that AMCs will need to change and adapt at an ever-increasing rate. Competitive pressures will require them to continuously improve the ways they achieve all their missions. New technologies such as informatics will threaten AMCs' near-monopoly in teaching and research. The new environment will require rapid decision making, the setting aside of traditional professional or departmental structures when they inhibit efficiency or quality, and more effective communication with external publics. How well AMCs can maintain their commitment to core values while adopting new methods in pursuit of those values will determine their futures.