MANAGING THE INTERFACE BETWEEN MEDICAL-SCHOOLS, HOSPITALS, AND CLINICAL RESEARCH

Objective.-To review how academic health centers are coping with the c hanging environment of health care delivery with special emphasis on t he impact of the changing health care system on clinical research. Des ign.-In response to Health and Human Services Secretary Donna Shalala' s 1995 mandated review of the National Institutes of Health (NIH) Warr en Grant Magnuson Clinical Center, an NIH review team visited 30 healt h facilities and government-owned organizations throughout the country . The review team determined what strategies are used by academic heal th centers to survive and thrive in the changing health care marketpla ce. The findings have implications for the NIH Clinical Center as well as academic health centers. Conclusions.-Management strategies in suc cessful academic health centers include streamlined governance structu res whereby small groups of highly empowered group leaders allow insti tutions to move quickly and decisively; an active strategic planning p rocess; close integration of hospital and medical school management; h eavy investment in information systems; and new structures for patient care delivery. Successful centers are initiating discussions with thi rd-party payers and are implementing new initiatives, such as establis hing their own managed care organizations, purchasing physician practi ces, or owning hospitals. Other approaches include establishing revenu e-generating centers for clinical research and new relations with indu stry. Attention to the infrastructure required to support the training and conduct of clinical research is essential for the future vitality of medical schools.