A WAY TO APPROACH THE STRATEGIC DECISIONS FACING ACADEMIC HEALTH CENTERS

Rapid changes taking place in the various markets served by academic h ealth centers (AHCs) are forcing these institutions to make difficult strategic decisions that may change AHCs' historic priorities. The aut hors present an approach that can help AHCs visualize possible new con figurations of their traditional serc ices of research, education, and clinical care. This approach is based on successful strategic managem ent methods from the private sector and involves a three-dimensional ' 'topography of services'' encompassing all possible configurations of AHCs' services. From among the many possible configurations, the autho rs discuss three in detail. The historic one, which they call the trad itional model, is characteristic of AHCs that give high priority to bi omedical and clinical research, have broad medical education activitie s, and deliver comprehensive,, high-quality clinical care. In the futu re, this configuration will be rare, and two others are likely to pred ominate, First is the ''revised'' traditional model, which would offer ''boutique'' clinical services, biomedical research, and medical educ ation for MD-PhD students, residents, and fellows seeking tertiary car e or academic careers. The patient care required for undergraduate med ical education and clinical research would be provided by partnerships with community-based providers. Second is the academic services model , which would focus on competitive primary and secondary clinical serv ices, health services and operations research, and primary care medica l education. The authors discuss the implications of these models for AHCs' organizational structures and faculty incentives, They conclude that the clarity with which AHCs' strategic decisions are made and com municated to faculties and the incentive systems that are selected to motivate faculty and to provide the selected services may ultimately d etermine which institutions survive.