With a few notable exceptions, the majority of top-performing
medical schools in the U.S. are academic health centers associated
with broader universities—evidence that such structural organizations
are beneficial to the overall institution.
Yet, the potential that exists for advantageous synergy among the
component parts—undergraduate and graduate/professional schools,
health science and non-health science colleges and departments, the
clinical enterprise, the research function, clinical and non-clinical
faculty and administration—is, in many institutions, not fully realized.
Significant differences in culture, mission, and financial structure drive
separation and siloing; these are trends that institutional leaders must
consciously and deliberately counter with strategies for cross-institutional
alignment to achieve the greatest possible success.
This imperative is even greater in today’s increasingly difficult higher
education and healthcare environments. Multiple pressures resulting
from increased demand for accountability, a rapidly evolving regulatory
landscape, a greater need to demonstrate value, and the drive to increase
size and efficiency in an environment of decreasing state support, mean
the siloing with which many of these organizations have existed is simply
no longer tenable.
Thus, there is a great need to better educate university and academic
health center leadership and faculty regarding what each of these
constituents can bring to the table and how to leverage their unique
skills, talents, and abilities to the betterment of the institution as a whole.
And, all parties need to become convinced of the mutual benefits of
For example, many institutional leaders do not fully appreciate the
energy, perspective, and tools that academic health faculty and
leadership can contribute to the overall university. Because they operate
in significant part as revenue generators, these personnel typically are
able to inject a greater entrepreneurial perspective and bring related
skills—such as effective project and change management—as well as
business tools, such as lean process improvement. And, to quote Galileo,
healthcare leaders’ willingness, ability, and experience to “measure what
can be measured, and make measurable what cannot be measured” can
be applied advantageously to further a wide range of institutional goals.
MD, MBA, MPH
Georgia Regents University
Georgia Regents Health System Georgia Regents University
Looking back on my 30-year career in academic medicine
administration, I realize that every position I held offered lessons
applicable to leadership, personal character, communication skills,
responsibility, authority, and accountability. However, building
strong relationships with those with whom I worked—whether peers,
subordinates, or superiors— was the bedrock foundation of this journey.
Cultivating relationships that were based on shared values enabled
successful management and implementation of strategy and operations.
In instances when things did not work out well, I could usually find
disruption of relationship as one of the root causes.
The leader of the academic health system is required to have a clear
understanding of the health system’s mission relevant to the academic
mission of the university. That includes training of health professionals,
supporting discovery, and transforming care-models. As safety-net
institutions, academic health systems have a moral obligation to serve our
communities and the healthcare needs of our patients.
In addition, academic health system leaders need to broaden their vision
and commitment to community engagement beyond the traditional
care-delivery mission. We must advocate for, engage with, and
champion community and business development activities; foster positive
interactions with local, state, and federal government officials; and not be
afraid to speak out for social justice.
As academic health systems face significant economic challenges in
the second decade of the 21st Century and beyond, we must become
much more strategic with investments. We should not expect to see
unlimited growth and diversification moving forward. These are complex
institutions, and changing priorities and direction can be difficult. But
change is inevitable and is best guided by sound strategy that is aligned
with the mission and values of the organization. In short, we must adapt
to our changing environments.
Leaders should understand their governance, management, and
organizational structures within the context of the larger university, and
they must also embrace the university’s vision and mission. At the highest
levels of administration, the chemistry and relationship between the
university president and academic health science leader is vital. If that
positive working relationship does not exist, then the two parties need to
seek rapprochement to achieve an effective working relationship. Failure
to do this, in my opinion, requires the health system leader to move on; in
the end, the university community is not well served by conflict between
Christopher C. Colenda,
President and Chief Executive Officer
West Virginia United Health System
Former Chancellor for Health Sciences
Robert C. Byrd Health Science Center
West Virginia University