Organizational models of medical school relationships to the clinical enterprise

Abstract

The authors analyzed existing relationships between medical schools and clinical enterprises in order to develop models of these relationships. The conceptual framework for the models uses three variables to assess the nature of the relationships: (1) high academic control-high clinical enterprise control; (2) high academic influence-low academic influence; and (3) self-contained system-open system (i.e., the extent to which the resources needed for clinical education are provided by the relationship between the clinical enterprise and the medical school). The authors present four conceptual models of the relationship between the medical school and the clinical enterprise: (1) The "single ownership; owned integrated system" is characterized by a closed clinical delivery system owned or controlled by the academic institution. (2) The "general partner" organization emphasizes an open clinical environment in which the medical school forms alliances with clinical entities, and the school is a dominant partner. (3) The "limited partner" organization operates with an open clinical delivery system that the school relates to through affiliations and contractual relationships, and the school is a less dominant partner. (4) The "wholly owned, subsidiary" organization operates in a controlled clinical environment in which the medical school is a subsidiary of the larger integrated delivery system. Each model is presented in its pure organizational form, then augmented with descriptions of the different ways that the medical school and other components may relate to each other. Also, the advantages and disadvantages of each model for the medical school are discussed. The authors emphasize that no model is superior to the others; instead, the best choice for a medical school depends on the history, local circumstances, and leadership of the school and other organizations. The authors' intent is to assist the leaders of medical schools as they design strategies for the future relationships of their institutions.

The Evolution of the Medical School Deanship: From Patriarch to CEO to System Dean

“…7 Research-oriented schools have strategies different from those of community-based institutions, often with competing priorities even within governing boards. 8 Schools founded to serve particular populations or demographic groups have had patterns of development different from those with more general charters. 8 Therefore, it might seem presumptuous to posit a general pattern for medical school leadership and administration.…”

“…8 Schools founded to serve particular populations or demographic groups have had patterns of development different from those with more general charters. 8 Therefore, it might seem presumptuous to posit a general pattern for medical school leadership and administration. It is our intent to identify common developmental patterns in the evolution of medical school deanship that may be used as a model for future study and analysis of this pivotal role.…”

The Health Sciences University as a Different Macro Organizational Model in Education

“…It is a union of all three structures at a low level (20,21) When the UHS macro-organizational model is examined, it is seen that it differs from other structures. Because it involves a very large area and hospital, it is similar to the structure of the coalition leader (Type 5), but although none of the hospitals that it covers are low-level institutions, they are education and research hospitals.…”

The functional relationships of medical schools and health services

“…This is not unusual in academic medical centres in the United States. 5,6,17 Such centres do not consistently provide a wide range of services or equity of access to comprehensive health care for large populations. Nevertheless, enlargement of this capacity would increase the ability of medical schools to embark on development of innovative health services.…”