An element common to successful health science centers (HSCs) and schools of medicine (SOMs) is effective administrative infrastructure at all levels of the organization. This infrastructure supports not only the groundbreaking achievements of faculty members but also the high-quality education provided to students in a cost-conscious manner. Recent changes in the financial underpinning of Academic Medical Centers (AMCs) have compelled HSCs and SOMs to reconsider their administrative models. The effects of greater integration within the clinical enterprise of an AMC, including the realignment of and heightened focus on clinical revenues and expenses, have naturally led to an examination of the investment of clinical funds in the academic mission. Given the multimillion-dollar significance of this funds flow, HSCs and SOMs want to demonstrate that administrative functions are provided effectively and efficiently. This is combined with the pressure of obtaining traditional academic funding streams (e.g., state funds, tuition, F&A) externally and internally and the complexity of managing the core HSC and SOM functions. All together, these considerations are causing organizational leaders to explore new models for delivering administrative services, particularly in the academic departments that serve faculty and students on a daily basis.
CHALLENGES WITH HISTORICAL MODEL
In the traditional, department-based administrative model, an administrator within each department directs support staff who provide a host of functions such as clerical, financial, research administration, educational program administration, and human resources. Under this framework, resource levels are typically determined by each department, and interactions with SOM- and/or HSC-level support functions may vary. Although this model is common and simple in structure, it has several shortcomings in the evolving AMC environment:
- Possible redundancies in work effort
- Inconsistencies in support processes and access to key services, quality, and expertise
- Potential coverage issues
- Limited succession planning and career growth opportunities
- Minimal identification and dissemination of best practices
- Incongruence with the increased focus on collaboration/interprofessionalism across disciplines within HSCs and SOMs
- Insufficient access to the sophisticated management skills and deeper expertise required for the ever-increasing complexity within AMCs
While certain services may prove to be most effective when oriented within individual departments, serious consideration should be given to models that allow for key functions and resources to be shared across multiple departments or fully centralize a given function at the SOM/HSC level. These types of frameworks are often more effective in promoting the quality and performance sought by SOMs, HSCs, and their clinical partners.