Navigating and Rebuilding Academic Health Systems (AHS)

Abstract

Academic medical centers (AMC) also known as academic health systems (AHS) have become major and complex healthcare and business enterprises in the USA and around the world. The AHS also have the unique imperative to provide a complex mission of evidence-based clinical quality care, relevant teaching, and innovative research. To ensure completion of this mission, accomplished AHS have combined its teaching hospital(s) with teaching and research programs affiliated with medical schools and other colleges/universities, clinical faculty, and in some cases affiliated community physicians, or the AHS may own community physician group practices. In previous decades, healthcare organizations operated within fragmented governance and financial and clinical practices accounted for the overuse of care and unnecessary costs. Clinical care structures were set up and performed in silos with hospitals in most cases completely separate from the medical schools and universities. The governance of the teaching hospital(s) from the medical schools and universities was unaligned, which led to duplicative clinical practices – hence, reimbursements were based on volumes. In some cases the clinical care objectives were in conflict with the teaching and research objectives. Hospitals funded teaching programs through traditional revenue streams, and research was funded through federal or nonprofit grants and traditional revenue streams. In this chapter, we will explore a number of aspects that will be required in the rebuilding process, always starting with the vison and strategy and ensuring that human capacities and all intricacies are met to achieve excellence in healthcare.