Getting off the bandwagon: An academic health center takes a different strategic path

Focusing on one state university academic health center (AHC) located in a rural setting in the southeastern United States, this case study investigat es the strategic response to the increasingly turbulent and competitive env ironment in the healthcare industry. The qualitative research reported here : involved a review of pertinent documents and archival data and interviews with key informants including AHC executives and staff, community leaders, and others. Additional information was obtained from published sources, in cluding a literature review that covers a five-year period ending in 1997 a nd searches conducted using the key words "academic medical or health cente r." The AHC in this case study demonstrates how it is possible to respond proac tively to changes in the environment without sacrificing the multiple missi ons of the institution. This AHC implemented strategies that ensure access for both inner city and rural underserved populations while providing venue s for primary care training and educational programs. In addition, the AHC positioned itself to compete more effectively by implementing a continuous quality improvement program that is aimed at maximizing quality while contr olling costs. Administrators in not only AHCs but also other healthcare org anizations, such as community hospitals and competing systems, should consi der the findings from this case study useful in evaluating existing strateg ies and possible alternatives. In particular, the use of an affiliation str ategy for growth in a resource-poor environment may encourage organizations located in rural areas to consider innovative expansion strategies to deve lop integrated systems of care.