The Roles of Academic Health Centers in the 21st Century

A Workshop Summary

Committee on the Roles of Academic Health Centers in the 21st Century

Linda T. Kohn, Editor

Board of Health Care Services

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.



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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary The Roles of Academic Health Centers in the 21st Century A Workshop Summary Committee on the Roles of Academic Health Centers in the 21st Century Linda T. Kohn, Editor Board of Health Care Services INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C.

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. Support for this project was provided by The Commonwealth Fund. The views presented in this report are those of the Institute of Medicine Committee on the Roles of Academic Health Centers in the 21st Century and are not necessarily those of the funding agencies. Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s home page at www.nap.edu. The full text of this report is available at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2002 by the National Academy of Sciences. All rights re served. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary Knowing is not enough; we must apply. Willing is not enough; we must do. —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary Committee on the Roles of Academic Health Centers in the 21st Century JOHN EDWARD PORTER (Chair), Partner, Hogan and Hartson, L.L.P., Washington, D.C. LINDA AIKEN, Claire M. Fagin Professor of Nursing and Sociology, Director, Center for Health Outcomes & Policy Research, University of Pennsylvania, Philadelphia, PA J. CLAUDE BENNETT, President and Chief Operating Officer BioCryst Pharmaceuticals, Inc., Birmingham, AL HENRY BIENEN, President, Northwestern University, Chicago, IL NANCY-ANN MIN DEPARLE, Adjunct Professor of Health Care Management, Wharton School, University of Pennsylvania; Senior Advisor, JP Morgan Partners, New York City EDWARD W. HOLMES, Vice Chancellor for Health Sciences and Dean, School of Medicine, University of California, San Diego, La Jolla, California LAWRENCE LEWIN, Founder, Lewin and Associates, Independent Consultant, Washington, D.C. NICOLE LURIE, RAND Corporation, Arlington, VA STEVEN M. PAUL, Group Vice President, Lilly Research Laboratories, Eli Lilly Company, Lilly Corporate Center, Indianapolis, IN PAUL G. RAMSEY, Vice President Medical Affairs and Dean, School of Medicine, University of Washington, Seattle, WA ROBERT REISCHAUER, President, Urban Institute, Washington, D.C. JOHN W. ROWE, Chairman and CEO, Aetna Inc., Hartford, CT MARLA SALMON, Dean and Professor, Nell Hodgson Woodruff School of Nursing, Professor, Rollins School of Public Health, Emory University, Atlanta, Georgia CHRISTINE SEIDMAN, Director, Cardiovascular Genetics Services, Brigham and Women’s Hospital, Investigator, Howard Hughes Medical Institute, Boston, MA M. ROY WILSON, Vice President for Health Sciences and Dean, School of Medicine, Creighton University, Omaha, NE Liaison from the IOM Health Sciences Policy Board: JAMES CURRAN, Dean & Professor of Epidemiology, The Rollins School of Public Health, Emory University, Atlanta, Georgia IOM Staff LINDA T. KOHN, Ph.D., M.P.H., Study Director RONNÉ WINGATE, Project Assistant JANET M. CORRIGAN, Ph.D., Director Division of Health Care Services

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: ROBERT M. DICKLER, Association of American Medical Colleges, Washington, D.C. SUZANNE W. FLETCHER, Harvard Medical School, Boston, MA MITCHELL T. RABKIN, Harvard Medical School, Boston, MA Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by DAVID H. SOLOMON, the RAND Corporation. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary Contents     Introduction   1 Section I   Changing Needs and Trends in Health Care   4     How AHCs Can Meet the Future of Health Care   4     Future Trends and Directions in Health Care   5     Changing Expectations among AHC Constituencies   8 Section II   Creating a Vision for the Future   11     The Clinical Service Role   11     The Education Role   13     The Research Role   18 Section III   Creating an Environment to Support Needed Changes   22     Critical Issues to Confront in Studying AHCs   22     Financial Issues Affecting the Future of AHCs   26     An AHC’s View on Cross-Subsidies   29     Variation in the Roles Pursued by AHCs   31     Appendices         A. Workshop Agenda and Participants,   35     B. Comments Submitted by Ellen Stovall,   41     C. Comments Submitted by Peter Kohler,   43