The Evolving Organizational Structure of Academic Health Centers: The Case of the University of Florida

Abstract

The organizational structures of academic health centers (AHCs) vary widely, but they all exist along a continuum of integration--that is, the degree to which the academic and clinical missions operate under a single administrative and governance structure. This author provides a brief overview of the topic of AHC integration, including the pros and cons of more integrated or less integrated models. He then traces the evolution of the University of Florida (UF) Health Science Center, which was created in the 1950s as a fully integrated AHC and which now operates under a more distributed management and governance model. Starting as a completely integrated AHC, UF's Health Science Center reached a time of maximal nonintegration (or dys-integration) in the late 1990s and at the beginning of this decade. Circumstances are now pushing the expanding clinical and academic enterprises to be more together as they face the challenges of market competition, federal research budget constraints, and reengineering clinical operations to reduce costs, enhance access, and improve quality and patient safety. Although formal organizational integration may not be possible or appropriate for any number of legal or political reasons, the author suggests that AHCs should strive for "functional integration" to be successful in the current turbulent environment.

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

“…This structure mainly describes the formal and informal relationship and affiliation among the healthcare institutions. Medical faculty, clinical and practical applications, education programs, research and development activities, and education and research hospitals comprise the main structure of this affiliation and relationship (15). The matter is which organizational structure should be chosen here.…”

“…When the literature is reviewed, the organizational structure of tertiary healthcare services under the name of Academic Health Science Centers is seen in developed countries, especially in the USA and England (14)(15)(16). This structure mainly describes the formal and informal relationship and affiliation among the healthcare institutions.…”

“…It is a more flexible affiliated model in which each of university academic activities, faculty of medicine, and the activities in affiliated hospitals are managed by different leaders and separate and independent boards ( Figure 4) (13,15,17).…”

The international spread of Academic Health Science Centres: A scoping review and the case of policy transfer to England

“…At the other end is a more loosely affiliated model in which the university academic activities, medical school physician practices and teaching hospital operations are each managed by different leaders and governed by different boards [46]. Under this model, integration is more functional than structural with the different parts of the AHSC remaining distinct legal entities but sharing strategic planning.…”

“…Several papers use conceptual frameworks and descriptive case studies to consider how to optimally arrange AHSCs. There is a range of AHSC structures characterised by the extent to which the academic and clinical missions operate under a single administrative and governance framework [46], and no "one size fits all" model.…”