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Bismantara H, Ahern S, Teede HJ, Liew D. Academic health science centre models across the developing countries and lessons for implementation in Indonesia: a scoping review. BMJ Open 2022; 12:e051937. [PMID: 36691121 PMCID: PMC9453943 DOI: 10.1136/bmjopen-2021-051937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/10/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To describe models of academic health science centres (AHSCs) across developing countries, in order to inform AHSC development in Indonesia. DESIGN Scoping review with systematic methods. DATA SOURCES Ovid MEDLINE, ProQuest Central, Wiley online library, Scopus and Web of Sciences were searched for relevant publications from 1 January 2015 to 1 December 2020. 'Grey literature' was hand searched by targeted website searches, Google searches, as well as personal communication held with stakeholders in Indonesia specifically. Relevant articles regarding AHSCs in developing countries are included. The review would be synthesised to focus on the purpose, structure and core activities of AHSCs. Strategies for success were also considered. RESULTS Twenty-six recognised AHSCs in developing countries were identified, located in Asia (n=13), Europe (n=1), South America (n=7) and Africa (n=5). Innovation, health system improvement and enhancement in academic capacity were the common visions. Most centres are functionally integrated and university-led. Most AHSCs include community health services to complement primary stakeholders such as academic institutions and hospitals. Limited information was identified regarding patient and public involvement and workforce capacity building. Five AHSCs have been piloted in Indonesia since 2018, integrating universities, academic hospitals and provincial health offices. However, information regarding their core activities and successes is limited. CONCLUSIONS The review suggests that limited published data are available on AHSC models in developing countries, but they still provide important insight into AHSC development in Indonesia. Innovation and health systems strengthening are the common visions. Functional integration with university leadership is the most common model of governance. Other than universities and hospitals, community health centres, research centres and regional health offices are common partners. There is a little description of community engagement and workforce capacity building.
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Affiliation(s)
- Haryo Bismantara
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Helena J Teede
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash Partners Academic Health Science Centre, Melbourne, Victoria, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Chari R, O'Hanlon C, Chen P, Leuschner K, Nelson C. Governing Academic Medical Center Systems: Evaluating and Choosing Among Alternative Governance Approaches. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:192-198. [PMID: 28906263 DOI: 10.1097/acm.0000000000001903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The ability of academic medical centers (AMCs) to fulfill their triple mission of patient care, medical education, and research is increasingly being threatened by rising financial pressures and resource constraints. Many AMCs are, therefore, looking to expand into academic medical systems, increasing their scale through consolidation or affiliation with other health care systems. As clinical operations grow, though, the need for effective governance becomes even more critical to ensure that the business of patient care does not compromise the rest of the triple mission. Multi-AMC systems, a model in which multiple AMCs are governed by a single body, pose a particular challenge in balancing unity with the needs of component AMCs, and therefore offer lessons for designing AMC governance approaches. This article describes the development and application of a set of criteria to evaluate governance options for one multi-AMC system-the University of California (UC) and its five AMCs. Based on a literature review and key informant interviews, the authors identified criteria for evaluating governance approaches (structures and processes), assessed current governance approaches using the criteria, identified alternative governance options, and assessed each option using the identified criteria. The assessment aided UC in streamlining governance operations to enhance their ability to respond efficiently to change and to act collectively. Although designed for UC and a multi-AMC model, the criteria may provide a systematic way for any AMC to assess the strengths and weaknesses of its governance approaches.
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Affiliation(s)
- Ramya Chari
- R. Chari is policy researcher, RAND Corporation, Arlington, Virginia; ORCID: http://orcid.org/0000-0002-6805-0974. C. O'Hanlon is assistant policy researcher, RAND Corporation, and a doctoral candidate, Pardee RAND Graduate School, Santa Monica, California; ORCID: http://orcid.org/0000-0001-6398-5845. P. Chen is physician policy researcher, RAND Corporation, Santa Monica, California. K. Leuschner is research communications analyst, RAND Corporation, Santa Monica, California. C. Nelson is senior political scientist, RAND Corporation, and professor of policy analysis, Pardee RAND Graduate School, Santa Monica, California
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Sanfilippo F, Burns KH, Borowitz MJ, Jackson JB, Hruban RH. The Johns Hopkins Department of Pathology Novel Organizational Model: A 25-Year-Old Ongoing Experiment. Acad Pathol 2018; 5:2374289518811145. [PMID: 30456297 PMCID: PMC6238201 DOI: 10.1177/2374289518811145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/27/2018] [Accepted: 09/24/2018] [Indexed: 11/30/2022] Open
Abstract
In 1993, the present Department of Pathology at Johns Hopkins was established with the leadership of a new chair (ie, referred to as department director at Hopkins) and upon the integration of 3 separate and independent departments at the Johns Hopkins School of Medicine (Pathology) and the Johns Hopkins Hospital (Pathology, Laboratory Medicine). This new department was organized into 17 divisions, each of which was expected to develop and maintain significant clinical, educational, and research programs of excellence. To facilitate performance and alignment across missions and parent organizations, a novel professional and administrative structure was created. Professionally, vice-chairs (ie, deputy directors) for research, teaching, and patient care were appointed to oversee and coordinate these activities across all units of the department. Likewise, to focus and enhance expertise, individual administrators were appointed for academic, clinical, and business affairs. A departmental executive committee was created consisting of the vice-chairs and administrators, which was presided over by the chair. Simultaneously, substantial effort was put into measuring and improving the organizational culture using evidence-based methods. Significant improvements were documented by the year 2000 in departmental performance in research, education, clinical service, culture, and finances. Under 2 successive leaders, the department has maintained its eminence across missions and financial performance. This 25-year experience supports the tenet that innovative and strategic organizational structures and functional alignments can provide sustainable competitive advantages in performance.
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Affiliation(s)
- Fred Sanfilippo
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Kathleen H. Burns
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J. Borowitz
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J. Brooks Jackson
- Department of Pathology, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Ralph H. Hruban
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Koslov S, Trowbridge E, Kamnetz S, Kraft S, Grossman J, Pandhi N. Across the divide: "Primary care departments working together to redesign care to achieve the Triple Aim". HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2016; 4:200-6. [PMID: 27637827 DOI: 10.1016/j.hjdsi.2015.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 11/10/2015] [Accepted: 12/08/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary care is considered the foundation of an effective health care system. However, primary care departments at academic health centers have numerous challenges to overcome when trying to achieve the Triple Aim. METHODS As part of an organizational initiative to redesign primary care at a large academic health center, departments of internal medicine, general pediatrics and adolescent medicine, and family medicine worked together to comprehensively redesign primary care. This article describes the process of aligning these three primary care departments: defining panel size, developing a common primary care job description, redesigning the primary care compensation plan, redesigning the care model, and developing standardized staffing. RESULTS Prior to the initiative, the rate of patient satisfaction was 85%, anticoagulation measurement 65%, pneumococcal vaccination 85%, breast cancer screening 79%, and colorectal cancer screening 69%. These rates all improved to 87%, 75%, 88%, 80%, and 80% respectively. Themes around key challenges to departmental integration are identified: (1) implementing effective communication strategies; (2) addressing specialty differences in primary care delivery; (3) working within resource limitations; and (4) developing long-term sustainability. CONCLUSIONS Primary care in this large academic health center was transformed through developing a united primary care leadership team that bridged individual departments to create and adopt a common vision and solutions to shared problems. Our collaboration has achieved improvements across patient satisfaction, clinical safety metrics, and publicly-reported preventive care outcomes. IMPLICATIONS The description of this experience may be useful for other academic health centers or other non-integrated delivery systems undertaking primary care practice transformation.
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Affiliation(s)
- Steven Koslov
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, United States; Primary Care Academics Transforming Healthcare Collaborative, UW Health, United States
| | - Elizabeth Trowbridge
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, United States; Primary Care Academics Transforming Healthcare Collaborative, UW Health, United States
| | - Sandra Kamnetz
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, United States; Primary Care Academics Transforming Healthcare Collaborative, UW Health, United States
| | - Sally Kraft
- Dartmouth Institute for Health Policy and Clinical Practice, United States; Primary Care Academics Transforming Healthcare Collaborative, UW Health, United States
| | - Jeffrey Grossman
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, United States; University of Wisconsin Medical Foundation, United States
| | - Nancy Pandhi
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, United States; Primary Care Academics Transforming Healthcare Collaborative, UW Health, United States.
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Taylor N, Clay-Williams R, Hogden E, Braithwaite J, Groene O. High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement. BMC Health Serv Res 2015; 15:244. [PMID: 26104760 PMCID: PMC4478709 DOI: 10.1186/s12913-015-0879-z] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 05/19/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND High performing hospitals attain excellence across multiple measures of performance and multiple departments. Studying high performing hospitals can be valuable if factors associated with high performance can be identified and applied. Factors leading to high performance are complex and an exclusive quantitative approach may fail to identify richly descriptive or relevant contextual factors. The objective of this study was to undertake a systematic review of qualitative literature to identify methods used to identify high performing hospitals, the factors associated with high performers, and practical strategies for improvement. METHODS Methods used to collect and summarise the evidence contributing to this review followed the 'enhancing transparency in reporting the synthesis of qualitative research' protocol. Peer reviewed studies were identified through Medline, Embase and Cinahl (Jan 2000-Feb 2014) using specified key words, subject terms, and medical subject headings. Eligible studies required the use of a quantitative method to identify high performing hospitals, and qualitative methods or tools to identify factors associated with high performing hospitals or hospital departments. Title, abstract, and full text screening was undertaken by four reviewers, and inter-rater reliability statistics were calculated for each review phase. Risk of bias was assessed. Following data extraction, thematic syntheses identified contextual factors important for explaining success. Practical strategies for achieving high performance were then mapped against the identified themes. RESULTS A total of 19 studies from a possible 11,428 were included in the review. A range of process, output, outcome and other indicators were used to identify high performing hospitals. Seven themes representing factors associated with high performance (and 25 sub-themes) emerged from the thematic syntheses: positive organisational culture, senior management support, effective performance monitoring, building and maintaining a proficient workforce, effective leaders across the organisation, expertise-driven practice, and interdisciplinary teamwork. Fifty six practical strategies for achieving high performance were catalogued. CONCLUSIONS This review provides insights into methods used to identify high performing hospitals, and yields ideas about the factors important for success. It highlights the need to advance approaches for understanding what constitutes high performance and how to harness factors associated with high performance.
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Affiliation(s)
- Natalie Taylor
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, North Ryde, Sydney, NSW, 2109, Australia.
| | - Robyn Clay-Williams
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, North Ryde, Sydney, NSW, 2109, Australia.
| | - Emily Hogden
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, North Ryde, Sydney, NSW, 2109, Australia.
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, North Ryde, Sydney, NSW, 2109, Australia.
| | - Oliver Groene
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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