Academic Health Centers Leading Change in the 21st Century (2004) / Chapter Skim
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8 Creating Systems for Change in the AHC
8 Creating Systems for Change in the AHC
Pages 127-143
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From page 127... ...
Clinical care is the primary focus of the hospital and faculty practice plans. They must meet the needs of patients who want the best care possible.
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From page 128... ...
. Health professions education, research, and clinical care are performed by many organizations that have no affiliation with an AHC.
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From page 129... ...
All parties should have access to performance information about the entire AHC enterprise for sound decision making and resource allocation (The Blue Ridge Academic Health Group, 1998)
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From page 130... ...
Knowledge management has clear clinical applications, ensuring that staff has access to all the types of information and knowledge needed to conduct their work, as they conduct their work (The Blue Ridge Academic Health Group, 2000)
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From page 131... ...
AHCs will need to become more aware of and involved in knowledge management given the expanding knowledge base in health, the potential for genomics research to foster individualized care processes, the expectations of more informed and engaged patients, and demands on them for significant improvements in quality and safety. To date, the use of information technology at AHCs has focused primarily on meeting institutional needs, driven mainly by clinical operations (The Blue Ridge Academic Health Group, 2000)
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From page 132... ...
To accomplish the recommendations set forth in this report, AHCs will need to establish measurable goals at the level of the overall AHC. AHCs will need to look across their entire enterprise to align programmatic and financial management, understand the flow of funds, and reorient internal planning and financing arrangements to improve coordination across clinical departments and institutions.
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From page 133... ...
Department chairs raise funds for research, direct budgets, control faculty promotion, design curriculum in the residency programs, direct the undergraduate medical education process, and are the main source of information and communication between the faculty and the administration (Bulger, 1988)
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From page 134... ...
Although an organizational structure along departmental lines has historically enabled AHCs to achieve success in their activities in research, education, and patient care, the question remains of whether it is the best structure to meet the needs of the 21st century. Their organizational complexity poses a serious challenge to AHCs in developing a vision for the overall AHC enterprise.
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From page 135... ...
In recent years, performance measurement has moved toward the use of more standardized measures because they make it pos BOX 8-1 Examples of AHC Performance Measures from the Blue Ridge Academic Health Group (1998a) Productivity Quality Innovation Societal Value Patient Cost per case Health-related Savings from Improvements Care outcomes new clinical in community protocols health markers Research Direct grant Publications Reduction in Cost impact of revenue per per faculty grant new diagnostic faculty FTE preparation or treatment full-time time capabilities equivalent (FTE)
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From page 136... ...
For example, a recently announced effort by the Association of American Medical Colleges, the American Hospital Association, and the Federation of American Hospitals is aimed at establishing quality measures for hospital patient care (Association of American Medical Colleges, 2002)
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From page 137... ...
having each department house one or more research programs so that interdisciplinary research and training programs are administered by individual departments as a resource for all departments (The Blue Ridge Academic Health Group, 2001)
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From page 138... ...
Although many people believe that initiating change requires a cultural transformation, this framework suggests that cultural change comes at the end of the process, after people's behaviors have changed, and there is a connection between the new actions and improved performance. The new behaviors shape the culture, rather than the reverse.
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From page 139... ...
Although the process results in a balanced set of performance measures, its aim is to clarify the vision or strategy of top leaders and translate that strategy into operational terms, focusing the entire organization on making the changes that will ensure future success, rather than simply documenting past performance. The above approaches suggest that strategic change occurs through a linear process.
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From page 140... ...
During times of major change, an enduring vision enables leadership and staff to stay focused on a clear and consistently stated mission (Simone, 1999) and allows leaders to make strategic decisions that are understood by staff and external supporters.
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From page 141... ...
One study of 22 medical school deans found that faculty had been promoted on the basis of individual achievement and that the commitment to collective goals had generally not been rewarded. The Commonwealth Fund Task Force on Academic Health Centers (2000a)
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From page 142... ...
For example, the Association for Academic Health Centers (2002) has undertaken a major campaign to call attention to the uninsured.
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From page 143... ...
And as noted, beyond leading change within their own organizations, AHCs must lead change to improve health for all people. To meet the challenges of the 21st century, AHCs will need public policy support; however, AHCs must also embark on a period of critical self-evaluation and direct the enormous intellectual energy they house toward leading the changes required.
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