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AAMC Reporter: October 2009
A Word from the President: Is Your Academic Medical Center "Aligned"?
When we began our AAMC strategic thinking and planning process
in 2006, alignment was one of three cross-cutting factors identified—along
with collaboration and leadership—as key to the continued effectiveness
of the AAMC and its members. As part of this ongoing process, last
year we put into place a new governance structure to help align
the association as a "whole," while at the same time ensuring that
the voices of our component "parts" would be heard. Today— based
on informal discussions with members as well as a recent series
of meetings focused on the topic—it has become clear that we need
to take the next step and ask, "What does alignment mean in practice
for our members and for academic medicine?" How does it relate to
our ongoing culture change, and how do we actually implement changes
to maximize alignment and advance the work in our mission areas
of education, research, and patient care?
In mid-September, during several fascinating meetings with our
leadership and constituents, the need to foster better alignment
in academic medicine was a recurrent theme. These gatherings included
a joint meeting of the administrative boards of our councils and
organizations with our board of directors as well as a discussion
the day before about integrative leadership with a cross section
of deans, health system and hospital CEOs, and practice plan leaders
to share ideas about integrative leadership.
Interestingly, everyone seemed to agree about what is not aligned
in our institutions. They noted, for example, fragmented decision
making, departments working at cross purposes with one another financially
or programmatically, and lack of continuity in leadership. As the
various discussions proceeded, the focus turned to what an aligned
academic medical center would look like. The "core properties of
alignment" they identified essentially mirrored the key cultural
changes many of us have been saying we need to move forward, e.g.,
achieving greater shared accountability, transparency, collaboration,
and patientcenteredness.
In fact, I believe it is fair to say that there is tremendous agreement
exists within our community about the desirability of these properties
as well as the recognition that, in many ways, we fall short of
exemplifying them. The practical issue with which many of the September
meeting participants grappled, however, was how their respective
institutions could progress from their current state to being more
productively aligned.
The good news is that, as participants described their own institutional
experiences, it became evident that many already are using certain
tools to promote these qualities. For example, many of our members
take an "open books" and "all funds budgeting" approach to create
transparency and a sense of shared accountability in the use of
financial resources. Some academic medical centers have worked to
create transparency in funds flow among medical school, teaching
hospital, and practice plan, and some are utilizing tightly coordinated
strategic planning among these three entities. Several are developing
the tools of succession planning and centralized recruitment processes
to create more coherence in leadership recruitment. Still others
are starting to create "matrixed" positions where an individual
may have dual reporting responsibilities to both the medical school
and health system to ensure alignment within and among mission areas.
The conclusion I reached was that we already have a fairly well-equipped
toolbox at our disposal that could be used to move our institutions
in the right direction. What the AAMC needs to do is become much
more purposeful and explicit in describing what these tools are,
when and how they can be applied to the greatest effect, and provide
case examples from members to help create learning communities of
"change agents" focused on alignment.
Having the right tools is simply a starting point. Attaining alignment
will not be easy, and I certainly appreciate the magnitude of the
work to be done. At an individual institutional level, our academic
medical centers face unique challenges that other institutions do
not, including their mission to provide a critical safety net for
the uninsured and underinsured. At the community level, we are making
progress in changing our culture, but still on our journey from
good to great. Further, attaining alignment will require understanding
the complex inter-relationships among all three mission areas. For
example, while we currently are focused on health care reform, it
is important to note that achieving alignment is much broader and
goes far beyond redesigning our clinical services to embrace all
our missions.
Every challenge we face—financial crises, disruptive technology,
leadership turnover—presents an opportunity to work toward greater
alignment, and the academic medical centers that approach challenges
from this perspective will be the strongest. These are the institutions
that realize they need to strive for alignment not only within all
three missions, but among all three missions.
Finally, achieving the properties of alignment will require leaders
with vision and courage. They will be the "Level 5" leaders Jim
Collins has described, and that I discussed in my column three years
ago. We need leaders who will focus on the long term, and who ensure
that the right decisions "happen," no matter how difficult, unpopular,
and even personally risky these decisions may be. This is not a
task for someone who wants to "preside" in an academic medical center,
but for the individual who wants to work collaboratively with a
team to improve it. This is the nature of integrative leadership
in academic medicine. The time has arrived for all of us, in a most
fundamental and honest way, to ask ourselves, "Is my academic medical
center truly aligned?"
Darrell G. Kirch, M.D., AAMC President and CEO
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