Managing the interface between medical schools, hospitals, and clinical research
J. I. Gallin and H. L. Smits
Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892-1504, USA.
OBJECTIVE: To review how academic health centers are coping with the
changing environment of health care delivery with special emphasis on the
impact of the changing health care system on clinical research. DESIGN: In
response to Health and Human Services Secretary Donna Shalala's 1995
mandated review of the National Institutes of Health (NIH) Warren Grant
Magnuson Clinical Center, an NIH review team visited 30 health facilities
and government-owned organizations throughout the country. The review team
determined what strategies are used by academic health centers to survive
and thrive in the changing health care marketplace. The findings have
implications for the NIH Clinical Center as well as academic health
centers. CONCLUSIONS: Management strategies in successful academic health
centers include streamlined governance structures whereby small groups of
highly empowered group leaders allow institutions to move quickly and
decisively; an active strategic planning process; close integration of
hospital and medical school management; heavy investment in information
systems; and new structures for patient care delivery. Successful centers
are initiating discussions with third-party payers and are implementing new
initiatives, such as establishing their own managed care organizations,
purchasing physician practices, or owning hospitals. Other approaches
include establishing revenue-generating centers for clinical research and
new relations with industry. Attention to the infrastructure required to
support the training and conduct of clinical research is essential for the
future vitality of medical schools.
