Inter-organizational relationships of seven veterans affairs medical centers and their affiliated medical schools: Results of a multiple-case-study investigation

Purpose. This study describes the costs and and value added to Veterans Aff airs Medical Centers (VAMCs) through their affiliations with medical school s. The study also creates a conceptual framework for evaluating the critica l dimensions across which these affiliations vary. Method. Case studies of seven VAMCs' affiliations with medical schools, ran ging from two highly affiliated VAMCs to one with only one funded residency position, were conducted in 1997 and 1998 using a survey and in-depth inte rviews with 78 key individuals at the institutions. The qualitative data we re then used to develop a conceptual framework for evaluating these affilia tions. Results. The results are reported in two stages. In stage one, three organi zing themes emerged from the data that formed the conceptual framework for evaluating affiliations: (1) the characteristics of each VAMC and its envir onment, (2) the characteristics of the relationships between each VAMC and its medical school affiliates, and (3) the costs and value that medical sch ool affiliations add to VAMCs. The affiliations that were most beneficial t o VAMCs were characterized by a relationship of trust, extensively shared e ducation and research programs, and a high degree of physician interaction. The achievement of these characteristics is influenced by the distance bet ween the VAMCs and their affiliated medical schools, the VAMCs' levels of o rganizational complexity, the degree of managed care penetration, and the c ontinuity and academic orientation of leadership at the VAMCs. In stage two , study data were used to create a conceptual framework to evaluate the cha racteristics of VAMCs and their affiliations with medical schools. Conclusions. The study supplied data to construct a conceptual, framework t hat describes many of the relationships among the different affiliations in the study. The framework offers a tool for evaluating the dimensions acros s which affiliations vary and how these differences influence the costs and value of medical school affiliations to VAMCs.