Governance of academic medical centres in changing healthcare systems: An international comparison

Cardinaal, Ester; Dubas‐Jakóbczyk, Katarzyna; Behmane, Daiga; Bryndová, Lucie; Cascini, Fidelia; Duighuisen, Heleen; Davidovitch, Nadav; Waitzberg, Ruth; Jeurissen, Patrick

doi:10.1016/j.healthpol.2022.04.011

Cited by 7 publications

(7 citation statements)

References 16 publications

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“…It has been found that there is still little scientific literature available on the governance of academic medical centres ( 55 ). At the same time, it is known that the governance problems of European AMCs are perceived as similar ( 56 ). Therefore, this study may be of interest to countries in similar circumstances that want to start a discussion about a change.…”

Section: Discussionmentioning

confidence: 99%

Academic medical centres in the Netherlands: muddling through or radical change?

Cardinaal,

Tjan,

Jeurissen

et al. 2024

Front. Public Health

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IntroductionAcademic medical centres (AMCs) are designed to perform multiple tasks within a single organisation. This institutional complexity gives rise to intricate governance challenges and promotes incrementalism and muddling.MethodIn this study, we hypothesised that radical change could provide a solution to the current incrementalism and we explored the conditions under which such changes could or could not be achieved.ResultsWe conducted unstructured interviews with various high-level stakeholders and identified issues that negatively affected the governance of Dutch AMCs, which include: 1) negative undercurrents and unspoken issues due to conflicts of interests, 2) organisational complexity due to relationships with a university and academic medical specialists, 3) lack of sufficient government direction, 4) competition between AMCs due to perverse systemic incentives, 5) different interests, focus, and organisational culture, 6) concentration of care, which does not always lead to enhanced quality and efficiency as the provision of less complex care is of utmost importance for education and research, 7) the infeasibility of public and regional functions of an AMC, 8) the inefficiency of managing three core tasks within the same organisation and, 9) healthcare market regulation.DiscussionOur hypothesis that radical change offers a solution to the current incrementalism in AMCs could not be adequately explored. Indeed, our exploration of the conditions under which radical change could potentially take place revealed that there are factors currently at play that make a substantive conversation between stakeholders about radical change difficult, if not impossible. The results also show that the government is in a position to take the lead and create conditions that foster mutual trust and common interests among AMCs, as well as between AMCs and other hospitals.

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Section: Discussionmentioning

confidence: 99%

Academic medical centres in the Netherlands: muddling through or radical change?

Cardinaal,

Tjan,

Jeurissen

et al. 2024

Front. Public Health

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“…В динамично меняющихся условиях современного мира существует насущная необходимость повышения эффективности процесса практикоориентированного обучения медицинских кадров, повышения эффективности освоения постоянно обновляющихся медицинских технологий в ходе додипломной и последипломной подготовки медицинских специалистов. В качестве оптимальной модели для реализации перечисленных задач во многих странах мира нашли свое место университетские клиники [4,5].…”

Section: Introductionunclassified

The Experience of the Pilot Project “Grodno University Clinic” Implementation Regarding the Efficiency of Practice-Oriented Training of Medical Staff

Zhuk,

Lazarevich,

Mahiliavets

et al. 2024

Journal GrGMU

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The training of highly professional medical staff with minimal need in their further workplace adjustment is an important current problem facing health care and medical higher education institutions authorities. To a large extent, existing clinical healthcare organizations, which are an example of cooperative relationships are serving this purpose. At the same time, the existing practice of their functioning indicates an insufficient degree of integration of the academic environment and practical healthcare. The purpose of this publication is to summarize the experience of the pilot project “Grodno University Clinic” implementation regarding the efficiency of practice-oriented training of medical staff. The integration of academic medicine and practical healthcare in a university clinic allows solving a number of important problems. Maximum involvement of teaching staff in medical activities allows maintaining and improvement of their professional competencies. The logical consequence of this process is the improvement of the quality of practice-oriented undergraduate and postgraduate training of medical specialists. Participation of the students in the diagnostic and treatment process as both active observers and direct participants to an even greater extent contributes to a quality learning experience and a conscious approach to choosing their future specialization.

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“…Academic medical centres (AMCs) are large hospital organisations that combine highly complex patient care, biomedical research, and training and education [1]. An international comparison showed that European AMCs face significant challenges, including staff shortages and ongoing internal tensions regarding the allocation of financial resources between patient care, research and education [2]. The literature increasingly points to the added value of business models to address such challenges [3].…”

Section: Introductionmentioning

confidence: 99%

Use of business model potential in Dutch academic medical centres—A case study

Cardinaal,

Truijens,

Jeurissen

et al. 2024

PLoS ONE

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Academic Medical Centres (AMCs) are large organisations with a complex structure due to various intertwined missions and (public) roles that can be conflicting. This complexity makes it difficult to adapt to changing circumstances. The literature points to the use of business models to address such challenges. A business model describes the resources, processes, and cost assumptions that an organisation makes in order to the delivery of a unique value proposition to a customer/patient. Do AMC business operations managers actually use business models to address challenges and operate in a way that enables AMCs to adapt to changing circumstances? This study explored whether the use of a business model is a starting point for bringing about change in AMC operations. A case study design was considered appropriate to explore the knowledge and experience of business models among business operations managers of Dutch AMCs. Through purposive sampling, participants were invited to participate in a questionnaire to provide in-depth and detailed information about the use of business models in AMCs. Our research showed that a business model can support the complex organisation of an AMC, but the design and use of business models varies. In general, respondents attribute more potential to the use of a business model than they experience in daily practice. The majority consider a business model to be suitable for bringing about change, but see it only sparingly used in their own AMC. This is the first study to provide some initial insights into the use of business models in Dutch AMCs. We can assume that improvements are possible in order to optimise the change potential of business models in AMCs worldwide. In order to successfully implement an innovative business model, the interpretation of the concept of a business model and the creation of a framework of preconditions should be taken into account. Healthcare providers, policy makers or researchers should explicitly identify the environment in which the model will operate. In particular, by identifying the level of readiness for change readiness at all levels of the organisation.

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Governance of academic medical centres in changing healthcare systems: An international comparison

Cited by 7 publications

References 16 publications

Academic medical centres in the Netherlands: muddling through or radical change?

Academic medical centres in the Netherlands: muddling through or radical change?

The Experience of the Pilot Project “Grodno University Clinic” Implementation Regarding the Efficiency of Practice-Oriented Training of Medical Staff

Use of business model potential in Dutch academic medical centres—A case study

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