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4 - Pursuing organizational and cultural change
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- By Michael A. Geheb, Professor of Medicine and Vice President Institutional Advancement at Oregon Health & Science University, Mark L. Penkhus, Senior Vice President and Chief Development Officer Sheridan Healthcorp, Peter O. Kohler, President Oregon Health & Science University, Arthur Garson, Vice President and Dean of the School of Medicine University of Virginia, Jonathan F. Saxton, Health Policy Analyst Emory University, Michael M. E. Johns, Executive Vice President Health Affairs at Emory University; Chief Executive Officer Robert W. Woodruff Health Sciences Center, George F. Sheldon, Professor of Surgery and Social Medicine and former Chair of Surgery University of North Carolina
- Edited by Don Detmer, University of Virginia, Elaine Steen, University of Virginia
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- Book:
- The Academic Health Center
- Published online:
- 12 November 2009
- Print publication:
- 12 May 2005, pp 119-187
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Summary
Introduction
The academic physician, academic medicine, and the health professions in general are in the midst of an extended period of organizational and professional turbulence. Beginning with the explosive growth of managed care in the 1980s, the relatively closed, professionally self-regulated health services sector has been pushed into a more classically competitive marketplace. The 1990s brought additional impetus for change with shifting public policy, changing demographics, increasing consumerism, and the growing influence of information technologies. Further, the turn of the century brought renewed public concern with deficiencies and inconsistencies in the quality of health care services.
The health care sector is clearly laboring under the strains of this changing and demanding environment. The new marketplace is squeezing the financial resources and compensation available to health professionals and organizations. Societal needs, expectations, and aspirations for the health care system have changed and are growing. Academic health centers (AHCs), in particular, continue to face great challenges in adapting their multiple service and academic missions to changing societal, financial, and service requirements.
Academic health centers have adopted measures to improve service, cut costs, and increase productivity. They are learning how to do more with less. They have also worked to develop new capabilities and revenue streams in an attempt to shore-up strained academic and clinical resources. These efforts increase the service and performance expectations for faculty and staff who find it increasingly difficult to pursue research and teaching goals.
2 - A health system for the twenty-first century
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- By Ron J. Anderson, President and Chief Executive Officer Parkland Health and Hospital System, Sue Pickens, Director of Strategic Planning and Population Medicine Parkland Health and Hospital System, Enriqueta C. Bond, President The Burroughs Wellcome Fund, Peter O. Kohler, President Oregon Health & Science University, Robert Galvin, Director Global Healthcare at General Electric Company
- Edited by Don Detmer, University of Virginia, Elaine Steen, University of Virginia
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- Book:
- The Academic Health Center
- Published online:
- 12 November 2009
- Print publication:
- 12 May 2005, pp 26-72
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Summary
Introduction
Health care spending in the United States is massive and on the rise. We do not, however, spend our health care dollars wisely. Despite the importance of health and health care to individual, community, and national productivity, we have not designed a health system that assiduously leverages its resources to maximize health. Rather, we continue to support a health care system that does not provide access to basic care for all citizens and does not fully exploit either established knowledge or technologies proven to improve health.
Our health care spending and policy is heavily skewed towards treating rather than preventing illness (leading to higher treatment costs). We overemphasize the care of individuals to the detriment of the health of populations. We do not organize our practice systems to manage chronic illnesses as well as we could. Quality and safety of care are highly variable; both over-treatment and under-treatment are commonplace. Such practices waste dollars and patient time and expose patients to unnecessary risk. Typically, incentives are not aligned with desired behaviors of patients and health professionals. Further, administrative costs are high and regulations are often beside the mark. In short, we must make substantial reforms.
The Blue Ridge Academic Health Group (Blue Ridge Group) believes that it is both possible and essential for the United States to spend its health care dollars much more rationally and effectively. We can build a true health system that is capable of maximizing the health of individuals and populations.