In order to continue meeting their missions, academic health centers must make bold transformative changes. They must extensively reform their systems for care delivery and financing, improve the productivity of research, and reduce the cost of medical education. And they must foster innovation that yields “disruptive” technologies and approaches that can reduce costs and/ or increase revenues. This chapter discusses how the changing healthcare landscape cannot be escaped, with the authors challenging academic health centers to transform enterprise-wide.

Future Directions

Obviously, we are seeing a rapid change of the healthcare delivery system in the United States, and academic health centers must transform in order to continue to excel in the new environment. Academic health centers will always excel if we understand what we are best at.

Planning within academic health centers must engage all the different aspects of the institution because research, education, and clinical care are highly interdependent. Collective decision-making must be embraced, and silos must be eliminated. Our institutions must understand their fundamental strengths and raison d’être. Academic health centers differentiate themselves from other healthcare providers in several ways, but notably through the capacity for discovery and excellence in specialty care. We must not surrender those strengths, and we should continue to be leaders in those areas, but we also cannot be an Ivory Tower. Academic health centers must become vertically integrated organizations that address population health, the continuum of care, and the fundamental design of healthcare delivery itself. Cost is going to be a significant area of emphasis, and we need to deliver the best outcomes to the populations we serve at the lowest possible cost.

The advantage of the academic health center is that we can leverage tools that no other system can. We can convene leaders from business, economics, and the behavioral sciences to work with us to create a new continuum of care. We can bring together a wide range of expertise and talent from within the academic environment and apply it to all aspects of patient care. Very few institutions have access to this tremendous resource. Of course this can help in research and discovery, but other disciplines can also help us redesign the way we educate and deliver care.

For example, big data and informatics will play an increasingly important We must challenge our existing paradigm because the world is changing. role in the way we design and deliver care. Our best chance of success is to continue to adapt. The world will not be the same forever, and so we must be resilient and embrace change.

There are always challenges and opportunities. It’s natural for people to expect business as usual, or that if the present paradigm changes, disaster will follow. This is why our leaders must be analytic and visionary. They must have the ability to see the road ahead and to engage their organizations in comprehensive conversations in order to transform education, research, and care delivery. They must mobilize stakeholders at all levels of the institution.

Victor J. Dzau, MD
President, Institute of Medicine
Chancellor Emeritus,
Duke University
Former CEO,
Duke University Health System