Abstract
Background
Debates continue regarding optimal structures for governance and administration between
medical schools and their teaching hospitals.
Methods
Structural integration (SI) for 85 academic health centers was characterized as high
(single leader or fiduciary) or low (multiple leaders or fiduciaries). Functional
alignment (FA) was estimated from questionnaire responses by teaching hospitals' chief
executive officers, and an index was calculated quantifying organizational collaboration
across several functional areas. SI and FA were examined for their association with
global performance measures in teaching, research, clinical care, finance, and efficiency.
Results
AHCs with high SI had significantly higher FA, though overlap between high-SI and
low-SI institutions was considerable. SI was not significantly associated with any
performance measure. In contrast, FA was significantly associated with higher performance
in teaching, research, and finance but not clinical care and efficiency.
Conclusions
FA between medical schools and their primary teaching hospitals more strongly predicts
academic health centers' performance than does SI. As demands for greater collaboration
increase under health reform, emphasis should be placed on increasing FA rather than
SI.
Keywords
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Article info
Publication history
Published online: June 30, 2011
Received in revised form:
May 16,
2011
Received:
April 2,
2011
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
