TY - JOUR
T1 - Functional alignment, not structural integration, of medical schools and teaching hospitals is associated with high performance in academic health centers
AU - Keroack, Mark A.
AU - McConkie, Nathan R.
AU - Johnson, Erika K.
AU - Epting, Gladys J.
AU - Thompson, Irene M.
AU - Sanfilippo, Fred
PY - 2011/8
Y1 - 2011/8
N2 - Background: Debates continue regarding optimal structures for governance and administration between medical schools and their teaching hospitals. Methods: Structural integration (SI) for 85 academic health centers was characterized as high (single leader or fiduciary) or low (multiple leaders or fiduciaries). Functional alignment (FA) was estimated from questionnaire responses by teaching hospitals' chief executive officers, and an index was calculated quantifying organizational collaboration across several functional areas. SI and FA were examined for their association with global performance measures in teaching, research, clinical care, finance, and efficiency. Results: AHCs with high SI had significantly higher FA, though overlap between high-SI and low-SI institutions was considerable. SI was not significantly associated with any performance measure. In contrast, FA was significantly associated with higher performance in teaching, research, and finance but not clinical care and efficiency. Conclusions: FA between medical schools and their primary teaching hospitals more strongly predicts academic health centers' performance than does SI. As demands for greater collaboration increase under health reform, emphasis should be placed on increasing FA rather than SI.
AB - Background: Debates continue regarding optimal structures for governance and administration between medical schools and their teaching hospitals. Methods: Structural integration (SI) for 85 academic health centers was characterized as high (single leader or fiduciary) or low (multiple leaders or fiduciaries). Functional alignment (FA) was estimated from questionnaire responses by teaching hospitals' chief executive officers, and an index was calculated quantifying organizational collaboration across several functional areas. SI and FA were examined for their association with global performance measures in teaching, research, clinical care, finance, and efficiency. Results: AHCs with high SI had significantly higher FA, though overlap between high-SI and low-SI institutions was considerable. SI was not significantly associated with any performance measure. In contrast, FA was significantly associated with higher performance in teaching, research, and finance but not clinical care and efficiency. Conclusions: FA between medical schools and their primary teaching hospitals more strongly predicts academic health centers' performance than does SI. As demands for greater collaboration increase under health reform, emphasis should be placed on increasing FA rather than SI.
KW - Academic health centers
KW - Health care governance
KW - Leadership of health care organizations
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U2 - 10.1016/j.amjsurg.2011.05.001
DO - 10.1016/j.amjsurg.2011.05.001
M3 - Article
C2 - 21718960
AN - SCOPUS:79961002676
SN - 0002-9610
VL - 202
SP - 119
EP - 126
JO - American Journal of Surgery
JF - American Journal of Surgery
IS - 2
ER -