Pattullo Lecture 2006. Crossing the educational chasm: preparing healthcare leaders for interprofessional practice.

Despite marked differences in training and professional interests, physicians and hospital administrators face similar problems: failure of reimbursement to keep pace with rising costs, new therapeutic modalities, critical workforce shortages, increasing government and managed care regulation, heightened consumerism, & an aging patient population. In the face of these mounting challenges, both physicians and hospital administrators could benefit significantly from a climate of collaboration and interdependence to optimize interprofessional practice. Teaching people to work with other healthcare professionals who play key roles in healthcare delivery is an important educational mission for the Association of University Programs in Health Administration (AUPHA) and for society in general.

Making hospital-physician collaboration work.

Hospital-physician collaboration can reduce costs, alleviate unproductive competition, increase revenue, and foster productive working relationships. Using structured dialogue can improve communications. A hospital medical advisory panel of physicians can champion collaboration. A three-stage framework of proactivity, collaborative conflict, and containment can help resolve physician-hospital competition.

Overview of physician-hospital ventures.

An ongoing environment of reimbursement lagging behind escalating expenses has led physicians to explore new sources of revenue. The goal of physician-hospital ventures is to create a valuable entity that benefits patients, physicians, and the hospital. Physicians may choose to invest in healthcare facilities to improve patient care and obtain increased control over daily operations. If so, they should seek counsel to avoid violating Stark laws and anti-kickback laws. Modalities for investing in physician-hospital ventures are joint equity (stock) ventures, participating bond transactions (PBTs), and contractual integration, a new method to align the goals of specialists and hospital management without using joint equity ventures. Physicians and management should invest time in developing a shared vision of the future before beginning contract negotiations. Successful partnering requires transparency and stepwise building of trust. The greatest gain in joint ventures arises when both sides become active owners, rather than passive investors.

Gaining hospital administrators' attention: ways to improve physician-hospital management dialogue.

BACKGROUND: Despite marked differences in training and professional interests, physicians and hospital managers face similar problems stemming from the unprecedented rate of change in the health care delivery system: failure of reimbursement to keep pace with rising costs, new therapeutic modalities, increasing government and managed care regulations, heightened consumerism, and an aging patient population. In the face of these mounting challenges, both physicians and hospital managers could benefit significantly from a climate of collaboration and interdependence. METHODS: This article presents a "case report" of a community teaching hospital in which practicing physicians and hospital administrators collaborated to develop an operating plan for the next 3 years to improve the practice environment. RESULTS: The physicians recommended new clinical priorities to enhance service to patients and families, to improve physician-physician communication, to develop clinical protocols, and to build coordinated diagnostic treatment centers, which the administration has implemented. SIGNIFICANCE: Physicians and hospital managers can no longer pass on cost increases at will to patients and third-party payers. Nor can physicians and managers ignore the heightened power of patients and third-party payers. Effective dialogue and collaboration are in all parties' interests to optimize patient care and to develop innovative services. Despite the tensions created by competition and rapid change, transformation from a blaming to a learning environment may be a key strategic advantage in today's health care marketplace.

The necessity for physician involvement in strategic planning in healthcare organizations.

Strategic planning is necessary in health care organizations to meet the constraints of a lean economy, rapidly changing technologies, and an unprecedented need to provide quality services at affordable prices. It offers a structure for assessing core strengths and environmental conditions and an innovative approach to enhance revenue and minimize costs. During the planning process, organizations define their mission, identify direction, develop a unified approach, prioritize long- and short-term goals, assign accountability, and allocate financial resources. Effective strategic planning is a continuous process and becomes an integral part of an organization's culture. Implementation is a part of strategy formulation, because future insights arise from current operating experiences. Success depends on buy-in from stakeholders, including physicians, nurses, and managers. The invested effort can offer the rewards of management that is proactive rather than crisis driven.

Balance between activation and inhibition of matrix metalloproteinase-2 (MMP-2) is altered in colorectal tumors compared to normal colonic epithelium.

Matrix metalloproteinase-2 (MMP-2) is overexpressed in human cancers and facilitates tumor growth and metastasis. It is synthesized as an inactive proenzyme that is activated by membrane-type matrix metalloproteinase-1 (MT1-MMP) and inhibited by tissue inhibitor of metalloproteinase-2 (TIMP-2). We hypothesized that there is an imbalance between the expression of TIMP-2 and the expression of MMP-2 and MT1-MMP that favors activation of MMP-2 in malignant colon tumors compared to normal colonic tissue. Specimens of colon tumors and of adjacent normal mucosa were obtained from 22 patients at the time of surgical resection. MMP-2, MT1-MMP, and TIMP-2 RNA transcripts were measured in each sample using a quantitative reverse transcriptase polymerase chain reaction assay. We observed that MMP-2 RNA levels were significantly elevated in tumors compared to normal tissue (P = 0.039). In addition, the TIMP-2:MMP-2 ratio was twofold lower (P = 0.001) and the TIMP-2:MT1-MMP ratio was 1.5-fold lower (P = 0.003) in tumors compared to normal mucosa. These results suggest that the balance between genes that activate and inhibit MMP-2 is shifted toward activation in colon tumors. The abnormal expression of gene products that regulate MMP-2 activity may be an important early step in the malignant transformation of colon cancer and may provide a useful target for new chemoprevention and adjuvant treatment strategies.

Business plan writing for physicians.

Physicians are practicing in an era in which they are often expected to write business plans in order to acquire, develop, and implement new technology or programs. This task is yet another reminder of the importance of business principles in providing quality patient care amid allocation of increasingly scarce resources. Unfortunately, few physicians receive training during medical school, residencies, or fellowships in performing such tasks. The process of writing business plans follows an established format similar to writing a consultation, in which the risks, benefits, and alternatives to a treatment option are presented. Although administrative assistance may be available in compiling business plans, it is important for physicians to understand the rationale, process, and pitfalls of business planning. Writing a business plan will serve to focus, clarify, and justify a request for scarce resources, and thus, increase its chance of success, both in terms of funding and implementation. A well-written business plan offers a plausible, coherent story of an uncertain future. Therefore, a business plan is not merely an exercise to obtain funding but also a rationale for investment that can help physicians reestablish leadership in health care.