How one academic health center is successfully facing the future.

The author maintains that the academic health centers (AHCs) that successfully weather the current vast changes in the health care environment will be stronger institutions. But to survive and prosper in the future, AHCs must come to terms with their entrenched cultures and create new forms of organization that are more flexible, more adaptive, and more agile. Even though each center confronts unique circumstances requiring unique solutions the author describes the changes made during the last six years at his center--the Allegheny Health, Education and Research Foundation (AHERF), in Pittsburgh, Pennsylvania--to show how one AHC is successfully facing change. The central problem facing AHERF (and all AHCs) is that revenues from all traditional sources are declining significantly. AHERF is dealing with the problem in part by actively seeking philanthropic and public funding for research and education. But such funding cannot be relied upon, and for AHERF to stay true to its mission, it must practice the "Three Rs" of modern academic medicine. First, the center is cultivating a more responsive organization. The author describes the organizational structure of the center; the emphasis on providing an environment that unleashes the creativity and productive potential of each employee and fosters teamwork; goals, objectives, and incentives; the way decisions are made; and the way revenue is allocated. Second, productivity must be improved through re-engineering. For example, AHERF oversaw the consolidation of two medical schools into one. The author describes the organizational changes that made the management of the resulting institution possible and cost-effective, and discusses changes in workflow, support functions, the use of information systems, and innovative supplier arrangements. Third, the revenue base must be secured. The author describes four of the main ways this is being done (e.g., the expansion of the center's large network of primary care physicians). The author provides a variety of statistics of AHERF's successes so far (e.g., patient revenues have gone from $500 million in 1989 to $1.3 billion in 1994). He concludes by emphasizing that AHCs cannot wait for outside help but must take their futures into their own hands, beginning now.

Comparing selection criteria of residency directors and physicians' employers.

In 1993, the Medical College of Pennsylvania (MCP), mindful of the rapidly changing environments of health care delivery, created three surveys to gather information from outside the school that would help the faculty plan how the curriculum and advising system could better prepare students and residents for the demands of twenty-first-century medicine. The first survey focused on the MCP seniors graduating that year and asked about their perceptions of their medical education and their specialty and residency choices. The second survey, directed to 40 medical residency program directors in family medicine, internal medicine, pediatrics, and surgery, sought to identify the characteristics of applicants that these directors valued when selecting entrants to their programs. The third survey, of 30 employers of physicians representing four practice environments (private practice, hospitals/other health systems, academic medical centers, and health maintenance organizations), sought information on hiring and recruitment practices and the skills, competencies, and attitudes these employers valued most when hiring recently graduated physicians. The responses showed several differences and/or misperceptions among the views held by the three groups surveyed and suggest that medical educators have not adapted as rapidly as have employers to changes in the health care environment. Academic health centers must broaden their missions and make changes in their own institutional cultures, both to maintain their own viability and to train physicians who have the balance between scientific and technical competency and essential personal characteristics (such as empathy) that the next century's practice will probably demand.