Sc. Schimpff et Mi. Rapoport, OWNERSHIP AND GOVERNANCE OF UNIVERSITY TEACHING HOSPITALS - LET FORM FOLLOW FUNCTION, Academic medicine, 72(7), 1997, pp. 576-588
Citations number
15
Categorie Soggetti
Medicine, General & Internal","Education, Scientific Disciplines","Medical Informatics
Under the best of circumstances, the complex decisionmaking and resour
ce-allocation processes of a state university (and often of a variety
of state agencies important to the university) significantly hinder th
e ability of the university-owned hospital to make changes critical to
its financial and, hence, its programmatic success. At worst, as was
the case for the University of Maryland Hospital a decade ago, the hos
pital can become capital-starved and operationally deficient under the
bureaucratic mantle of the state and university and find itself unabl
e to respond to the fast changing market, placing its viability in jeo
pardy. To remedy this situation at the University of Maryland Hospital
, in 1984 the state created a separate not-for-profit corporation, the
University of Maryland Medical System (''the Medical System''), gover
ned by its own board of directors, with a mandate to assure sound busi
ness practices, outstanding patient care, access to patients from acro
ss the state for tertiary care, access for the local disadvantaged com
munity for comprehensive care, and attention to the academic mission o
f the university and its school of medicine, The results include stron
g financial performance, the ability to recapitalize outmoded faciliti
es and technology, growth of strong programs, and the recruitment of e
xcellent chairs and faculty, The Medical System's success suggests tha
t university teaching hospitals, which necessarily depend on patient c
are revenues, may best be starved by (1) removing them from university
governance, thus allowing them to give primacy to their mission of pa
tient care, and (2) removing them from state ownership, thus allowing
them to use sound business kinetics in the competitive health care env
ironment. The challenge under this arrangement is to ensure that the t
eaching hospitals can still support the educational and research progr
ams that distinguish them. By establishing its independent, actively i
nvolved board of directors, the Medical System has successfully respon
ded to this challenge.