Academic Health Center Leaders Research Articles

Defining the Learning Health Care System: An International Health System Leadership Perspective.

Over the past 2 decades, many academic health centers (AHCs) have implemented learning health systems (LHSs). However, the LHS has been defined with limited input from AHC leaders. This has implications because these individuals play a critical role in LHS implementation and sustainability. This study aims to demonstrate how an international group of AHC leaders defines the LHS, and to identify key considerations they would pose to their leadership teams to implement and sustain the LHS. A semistructured survey was developed and administered in 2022 to members of the Association of Academic Health Centers President's Council on the Learning Health System to explore how AHC leaders define the LHS in relation to their leadership roles. The authors then conducted a focus group, informed by the survey, with these leaders. The focus group was structured using the nominal group technique to facilitate consensus on an LHS definition and key considerations. The authors mapped the findings to an existing LHS framework, which includes 7 components: organizational, performance, ethics and security, scientific, information technology, data, and patient outcomes. Thirteen AHC leaders (100%) completed the survey and 10 participated in the focus group. The AHC leaders developed the following LHS definition: "A learning health system is a health care system in which clinical and care-related data are systematically integrated to catalyze discovery and implementation of new knowledge that benefits patients, the community, and the organization through improved outcomes." The key considerations mapped to all LHS framework components, but participants also described as important the ability to communicate the LHS concept and be able to rapidly adjust to unforeseen circumstances. The LHS definition and considerations developed in this study provide a shared foundation and road map for future discussions among leaders of AHCs interested in implementing and sustaining an LHS.

Cybersecurity Challenges and the Academic Health Center: An Interactive Tabletop Simulation for Executives.

Academic health centers (AHCs) face cybersecurity vulnerabilities that have potential costs to an institution's finances, reputation, and ability to deliver care. Yet many AHC executives may not have sufficient knowledge of the potential impact of cyberattacks on institutional missions such as clinical care, research, and education. Improved cybersecurity awareness and education are areas of opportunity for many AHCs. The authors developed and facilitated a tabletop cybersecurity simulation at an international conference for AHC leaders in September 2019 to raise awareness of cybersecurity issues and threats and to provide a forum for discussions of concerns specific to CEOs and C-suite-level executives. The 3.5-hour interactive simulation used an evolving, 3-phase case study describing a hypothetical cyberattack on an AHC with a ransomware demand. The approximately 70 participants, from AHCs spanning 25 states and 11 countries, worked in teams and discussed how they would react if they held roles similar to their real-life positions. The authors provide the full scenario as a resource. The exercise was well received by the participants. In the postsession debrief, many participants noted that cybersecurity preparedness had not received the level of institutional attention given to threats such as epidemics or natural disasters. Significant variance in teams' courses of action during the simulation highlighted a lack of consensus with regard to foundational decisions. Participants identified this as an area that could be remedied by the development of guidelines or protocols. As health care cybersecurity challenges persist or grow in magnitude, AHCs will have increased opportunities to lead in the development of best practices for preparedness and response. AHCs are well positioned to work with clinicians, security professionals, regulators, law enforcement, and other stakeholders to develop tools and protocols to improve health care cybersecurity and better protect patients.

Socially Accountable Academic Health Centers: Pursuing a Quadripartite Mission.

Academic health centers (AHCs) in the United States have had a leading role in educating the medical workforce, generating new biomedical knowledge, and providing tertiary and quaternary clinical care. Yet the health status of the U.S. population lags behind almost every other developed world economy. One reason is that the health care system is not organized optimally to address the major driver of health status, the social determinants of health (SDOH). The United States' overall poor health status is a reflection of dramatic disparities in health that exist between communities and population groups, and these are associated with variations in the underlying SDOH. Improving health status in the United States thus requires a fundamental reengineering of the health delivery system to address SDOH more explicitly and systematically. AHCs' tripartite mission, which has served so well in the past, is no longer sufficient to position AHCs to lead and resolve the intractable drivers of poor health status, such as unfair and unjust health disparities, health inequities, or differences in a population's SDOH.AHCs enjoy broad public support and have an opportunity-and an obligation-to lead in improving the nation's health. This Perspective proposes a new framework for AHCs to expand on their traditional tripartite mission of education, research, and clinical care to include explicitly a fourth mission of social accountability. Through this fourth mission, comprehensive community engagement can be undertaken, addressing SDOH and measuring the health impact of interventions by using a deliberate structure and process, yielding defined outcomes.

Aligning Education With Health Care Transformation: Identifying a Shared Mental Model of "New" Faculty Competencies for Academic Faculty.

To develop a potential competency framework for faculty development programs aligned with the needs of faculty in academic health centers (AHCs). In 2014 and 2015, the authors interviewed 23 health system leaders and analyzed transcripts using constant comparative analysis and thematic analysis. They coded competencies and curricular concepts into subcategories. Lead investigators reviewed drafts of the categorization themes and subthemes related to gaps in faculty knowledge and skills, collapsed and combined competency domains, and resolved disagreements via discussion. Through analysis, the authors identified four themes. The first was core functional competencies and curricular domains for conceptual learning, including patient-centered care, health care processes, clinical informatics, population and public health, policy and payment, value-based care, and health system improvement. The second was the need for foundational competency domains, including systems thinking, change agency/management, teaming, and leadership. The third theme was paradigm shifts in how academic faculty should approach health care, categorized into four areas: delivery, transformation, provider characteristics and skills, and education. The fourth theme was the need for faculty to be aware of challenges in the culture of AHCs as an influential context for change. This broad competency framework for faculty development programs expands existing curricula by including a comprehensive scope of health systems science content and skills. AHC leaders can use these results to better align faculty education with the real-time needs of their health systems. Future work should focus on optimal prioritization and methods for teaching.

The Role of Academic Health Centers and Their Partners in Reconfiguring and Retooling the Existing Workforce to Practice in a Transformed Health System

Inspired by the Affordable Care Act and health care payment models that reward value over volume, health care delivery systems are redefining the work of the health professionals they employ. Existing workers are taking on new roles, new types of health professionals are emerging, and the health workforce is shifting from practicing in higher-cost acute settings to lower-cost community settings, including patients' homes. The authors believe that although the pace of health system transformation has accelerated, a shortage of workers trained to function in the new models of care is hampering progress. In this Perspective, they argue that urgent attention must be paid to retraining the 18 million workers already employed in the system who will actually implement system change.Their view is shaped by work they have conducted in helping practices transform care, by extensive consultations with stakeholders attempting to understand the workforce implications of health system redesign, and by a thorough review of the peer-reviewed and gray literature. Through this work, the authors have become increasingly convinced that academic health centers (AHCs)-organizations at the forefront of innovations in health care delivery and health workforce training-are uniquely situated to proactively lead efforts to retrain the existing workforce. They recommend a set of specific actions (i.e., discovering and disseminating best practices; developing new partnerships; focusing on systems engineering approaches; planning for sustainability; and revising credentialing, accreditation, and continuing education) that AHC leaders can undertake to develop a more coherent workforce development strategy that supports practice transformation.

Interprofessional Academic Health Center Leadership Development: The Case of the University of Alabama at Birmingham’s Healthcare Leadership Academy

AimThe study describes the genesis of the University of Alabama at Birmingham’s Healthcare Leadership Academy (HLA), highlights the HLA’s outcomes, discloses how the HLA has changed, and delineates future directions for academic health center (AHC) interprofessional leadership training. BackgroundWhile interprofessional training is recognized as an important component of the professional education for health professionals, AHCs have not focused on interprofessional leadership training to prepare future AHC leaders. As professional bureaucracies, AHCs require leadership distributed across different professions; these leaders not only should be technical experts, but also skilled at interprofessional teamwork and collaborative governance. MethodsThe HLA is examined using the case method, which is supplemented with a descriptive analysis of program evaluation data and outcomes. ResultsThe HLA has created a networked community of AHC leaders; the HLA’s interprofessional team projects foster innovative problem solving. ConclusionsInterprofessional leadership training expands individuals’ networks and has multiple organizational benefits.

Commentary

Academic health centers are traditionally dependent on extramural agencies like the National Institutes of Health to fund medical research. The still-struggling U.S. economy has kept federal paylines stagnant in recent years even as research costs climb. Academic health center leaders need to find new funding sources to ensure that critical medical research continues. Myers and colleagues, in their report in this issue of Academic Medicine, found that scientific research funding by philanthropic nonprofit organizations rose 26% from 2006 to 2008. Even though the time frame for their study precedes the recent economic recession, their findings provide hope and guidance to academic health centers. Stable research portfolios should include a variety of sources, and Myers and colleagues suggest that partnership opportunities exist between federal and not-for-profit funding sources to focus on key disease areas. Seeking broader research funding may benefit at-risk groups like junior investigators, as the average age of a first-time NIH grant recipient in 2008 was 42 years old. To foster the new discoveries and ideas that come from young scientists, academic health centers need to diversify their research funding sources.It is encouraging that high-visibility philanthropic organizations enhanced funding by 26% from 2006 to 2008. However, between 2008 and 2010, overall grant support from foundations declined 2.3%. Should federal and private funding continue to fall, there is an eminent threat of losing a generation of investigators. Thus, creative solutions and partnerships are needed to fund more high-priority research to cure disease and create the future of medicine.

The Evolving Academic Health Center: Challenges and Opportunities for Psychiatry

Regardless of the outcome of current efforts at healthcare reform, the resources that academic health centers need-to provide care for increasingly complex patient populations, support clinical innovation, grow the clinical enterprise, and carry out their research and teaching missions-are in jeopardy. This article examines the value proposition for psychiatry. The authors describe areas where academic departments of psychiatry have opportunities to help shape the future of academic health centers in a rapidly-changing healthcare environment and share their experience in leadership roles in academic psychiatry and in consulting to academic health center leaders. Many academic health centers are reexamining both their mission and their use of available resources. Some are questioning their ability to sustain traditionally low-margin clinical specialties like internal medicine, pediatrics, and psychiatry, where, all too often, clinical revenues alone are insufficient to cover the full cost of caring for the patients they serve. Academic departments of psychiatry must continually demonstrate their value to the academic health centers' clinical and academic mission.

Perspective: Paying Physicians to Be On Call: A Challenge for Academic Medicine

Paying physicians for on-call services is an emerging national trend. It is fueled by the growing demand for specialty services during nighttime, weekend, and holiday hours, coupled with the changing attitude of physicians, many of whom no longer view being on call as an obligation. Academic health centers (AHCs) serve as stewards of the public's health and are the primary educators for most health care workers. AHCs' policies, including their on-call practices, have significant influence on health care trends and the practice of medicine, but AHC leaders have not reached consensus on whether being on call should be a voluntary or paid responsibility. Graduate medical education programs at AHCs, which insist that trainees adhere to work hours restrictions, are teaching tomorrow's physicians that working fewer hours and getting enough sleep will help reduce medical errors. The unintended consequence is an increasing shortage of physicians who are willing to be on call. Faculty at AHCs need to critically evaluate the multiple factors creating on-call shortages, then formulate and implement practical solutions. Simply offering payment as an incentive for on-call services has not guaranteed the availability of specialty care around the clock and has not addressed the on-call burden for physicians.

Burnout and Psychological Stress among Deans of Colleges of Medicine: A National Study

Psychological burnout may inhibit the ability of deans of colleges of medicine to effectively lead their organizations during periods of rapid change. The objective of this study was measure the prevalence and intensity of the psychological components of burnout and their correlates among deans of U.S. colleges of medicine. To do so, questionnaires that burnout, job stressors, personal support systems and job satisfaction were sent to deans of all U. S. colleges of medicine, and selected deans of nursing schools, and other academic health center leaders. Medical school deans exhibited a high prevalence of depersonalization (42.9% of respondents), emotional exhaustion (25.4%), and reduced personal accomplishment (27.0%). High levels of these subdomains and of overall burnout intensity significantly correlated with high levels of personal, job, and environmental stress; low levels of support or coping resources; high prevalence of physical and behavioral symptoms; and reduced job satisfaction. Deans of colleges of medicine frequently exhibit characteristics of burnout that may impede effective leadership. These characteristics are likely to intensify unless specific interventions are devised and implemented.