Parent University Research Articles

Selling teaching hospitals and practice plans

The financial and organizational upheavals that have beset academic medical centers in recent decades have been analyzed by John A. Kastor in a series of books, of which Selling teaching hospitals and practice plans: George Washington and Georgetown Universities is the fourth. Previous volumes dealt with such issues as crises in governance and mergers of academic medical centers. This latest volume details the financial and management strains that led to the sale of the aforementioned institutions’ teaching hospitals. Kastor’s analyses are valuable not only because of his own experiences as a former chair of a department of medicine in an academic medical center, but also because of the candor he provokes in his interviews with hundreds of physicians, administrators, and hospital and university leaders. The first chapter examines some unique features of the social and medical environment in Washington, DC. Subsequent chapters provide a detailed analysis of events at George Washington University prior to the sale, followed by chapters dealing with the selling of the hospital and the faculty practice plan at Georgetown University. There are three useful appendices: Appendix A examines the current status of universities with teaching hospitals owned by for-profit companies; B details Kastor’s proposed solutions for reducing deficits and controlling finances at institutions that still own their hospitals; and C lists the 335 individuals he interviewed. In the DC area, many choices for medical care are available to more affluent citizens at the major government medical institutions, such as the National Naval Medical Center and the Walter Reed Army Medical Center, as well as the nearby Johns Hopkins Medical Center. In contrast, Kastor notes the high percentage of low-income and often uninsured individuals living in the area. These circumstances posed significant financial problems for both George Washington and Georgetown University hospitals as demand for services to the indigent rose and reimbursement fell. Kastor documents the deteriorating financial situation at each institution during the 1990s and the inevitable interpersonal struggles among leaders that ensued, involving millions of dollars in annual losses. At George Washington, there was only a limited endowment available to cover the losses; lack of capital prevented improvement of the facilities. Similar problems beset Georgetown, but Kastor outlines some distinctive issues there. The Jesuit leadership, in the opinion of those interviewed, was not always comfortable with its obligations to the medical school, hospital, or physicians. On the other hand, the medical center, during earlier times of financial security, was required to provide significant subsidies to the university, which were used to support other departments such as the humanities. Kastor describes the often bitter disputes that arose in the last decade as successive leaders strove to reduce losses, deal with pressures from the parent universities, and cope with growing dissent from the increasingly embattled faculty. The personalities involved and their struggles are richly drawn, enlivening the narrative. The two institutions became particularly vulnerable to rising operational deficits in a competitive environment, receiving little or no government subsidy for care of indigent patients and no significant philanthropic contributions, corporate or personal. Officials at both George Washington and Georgetown were simply unable to come up with effective solutions other than to sell the hospitals and practice plans. George Washington University Hospital was sold in 1995 to a for-profit healthcare corporation, Universal Health Services Inc., and Georgetown University Hospital to a not-for-profit local group, MedStar Health, in 2000. Significant upgrades to the facilities followed. Kastor notes that research normally fuels innovation and recognition, yet both institutions lack broad research programs (in 2005, Georgetown and George Washington Universities ranked 60th and 90th, respectively, among 121 universities in the amount of NIH funding received). Healthcare corporations that acquire clinical practices and academic hospitals do not regard the educational and research functions of the medical school as essential, particularly if they are for-profit. How these vital missions of the schools can be achieved or even sustained under these circumstances remains a critical question. Kastor attempts to distill some general principles that might help medical centers that still own their practice plans to avoid the separation of an institution’s clinical care arm from its teaching and research programs. What gives credibility to his proposals is the care with which he has developed them in consultation with leaders at other institutions. He avoids broad generalizations that sound impressive but may fail to apply to a specific institution’s distinctive history and environment. Medical centers may be in for much more upheaval. Perhaps recently evolved management models will prove to be more durable; however, it is likely that further reorganization will occur. Kastor’s documentation of how the current era evolved should be helpful in understanding such change. This volume should be essential reading for leaders of academic medical centers, particularly at institutions threatened with loss of control of their practice plans and/or hospitals.

Science at the Interstices: An Evolution in the Academy

Biomedical science is at an evolutionary turning point. Many of the rate-limiting steps to realizing the next generation of personalized, highly targeted diagnostics and therapeutics rest at the interstices between biomedical science and the classic, university-based disciplines, such as physics, mathematics, computational science, engineering, social sciences, business, and law. Institutes, centers, or other entities created to foster interdisciplinary science are rapidly forming to tackle these formidable challenges, but they are plagued with substantive barriers, born of traditions, processes, and culture, which impede scientific progress and endanger success. Without a more seamless interdisciplinary framework, academic health centers will struggle to move transformative advances in technology into the foundation of biomedical science, and the equally challenging advancement of models that effectively integrate new molecular diagnostics and therapies into the business and social fabric of our population will be similarly hampered. At the same time, excess attention on rankings tied to competition for National Institutes of Health and other federal funds adversely encourages academic medical centers (AMCs) and universities to hoard, rather than share, resources effectively and efficiently. To fully realize their discovery potential, AMCs must consider a substantive realignment relative to one another, as well as with their associated universities, as the academy looks toward innovative approaches to provide a more supportive foundation for the emergent biomedical research enterprise. The authors discuss potential models that could serve to lower barriers to interdisciplinary science, promoting a new synergy between AMCs and their parent universities.

Challenges in Science and Academic-Industry Interactions

Challenges in Science and Academic-Industry Interactions

Redefining Competition Constructively

In the United States, the relationship between state governments and public colleges and universities is being redefined with new notions of autonomy and accountability, and with funding policies that are highly market-driven (often referred to as “privatisation”) as the centrepieces. Situations and institutional strategies unthinkable only a few years ago are becoming increasingly commonplace. For instance, a few business and law schools at public institutions are moving toward privatisation, distancing themselves from both the states and their parent universities. While American higher education has traditionally been competitive and market driven, emerging state market-based policies, which will clearly benefit some types of institutions over others, are further intensifying the competition with a variety of effects at the institutional and sector levels. Entrepreneurial or commercial activities may provide the additional resources individual institutions need to fulfil their public purpose. However, when all institutions pursue the same set of competitive strategies, no one gains an advantage. Institutions run harder to stay in place. The cumulative effect of competition may also work against important social objectives such as affordability and access. This paper explores the challenges that the current competitive environment creates for institutional leaders in the United States. It acknowledges that the competitive environment will not abate and suggests that by competing in different ways, over different objectives, with different purposes, US higher education might better meet its social objectives of increased access, lower cost and enhanced quality.

Sitios webs de centros universitarios de estudios de las mujeres en españa: selección y evaluación

Tras presentar de manera sucinta el nivel de desarrollo de los Estudios de las Mujeres en España y de enumerar los centros universitarios que los generan y difunden, se evalúan los sitios web que tienen como titular a institutos, seminarios o aulas de género, utilizando como punto de vista la usabilidad, con el objetivo de que los resultados puedan servir para mejorar el uso y consulta de las páginas existentes y, sobre todo, como modelo para las que se creen en el futuro dentro de dicho ámbito.

The Benefits and Challenges of Research Centers and Institutes in Academic Medicine: Findings from Six Universities and Their Medical Schools

To understand the benefits and challenges of using centers and institutes in the academic research enterprise, and to explore institutional strategies that capitalize on the strengths and ameliorate the weaknesses of the center/institute structure. Using a qualitative research design, the author and associates interviewed over 150 faculty members and administrators at six medical schools and their parent universities in 2004. Interview data were transcribed, coded, and analyzed using a grounded theory approach. This methodology generated rich descriptions and explanations of the six institutions, which can produce extrapolations to, but not necessarily findings that are generalizable to, other institutions and settings. Centers and institutes offer a number of benefits to academic institutions. Centers can aid in faculty recruitment and retention, facilitate collaboration in research, secure research resources, offer a sense of community and promote continued learning, afford organizational flexibility, and focus on societal problems and raise funds. Despite their many benefits, centers can also create tensions and present management challenges to institutional leaders. Centers can compete with departments over resources, complicate faculty recruitment, contribute to a fragmented mission, resist effective evaluation, pose governance problems, and impede junior faculty development. Institutional leaders might capitalize on the strengths of centers through three strategies: (1) reward leaders who embrace a collaborative point of view and develop a culture that frowns upon empire building; (2) distinguish among the many entities that share the "center" or "institute" labels; and (3) acknowledge that departments must maintain their place in the organizational milieu.

The Financial Management of Research Centers and Institutes at U.S. Medical Schools: Findings from Six Institutions

To explore three questions surrounding the financial management of research centers and institutes at U.S. medical schools: How do medical schools allocate institutional funds to centers and institutes? How and by whom are those decisions made? What are the implications of these decision-making models on the future of the academic biomedical research enterprise? Using a qualitative research design, the author and associates interviewed over 150 faculty members and administrators at six medical schools and their parent universities in 2004. Interview data were transcribed, coded, and analyzed using a grounded theory approach. This methodology generated rich descriptions and explanations of the six medical schools, which can produce extrapolations to, but not necessarily generalizable findings to, other institutions and settings. An examination of four dimensions of financial decision-making-funding timing, process, structure, and culture-produces two essential models of how medical schools approach the financial management of research centers. In the first, a "charity" model, center directors make hat-in-hand appeals directly to the dean, the result of which may depend on individual negotiation skills and personal relationships. In the second, a "planned-giving" model, the process for obtaining and renewing funds is institutionalized, agreed upon, and monitored. The ways in which deans, administrators, department chairs, and center directors attend to, decide upon, and carry out financial decisions can influence how people throughout the medical school think about interdisciplinary and collaborative activities marshalled though centers and institutes.

Building a High Quality Global E-Learning Network: Lessons, Pitfalls and Opportunities from Universitas 21 Global

Universitas 21 Global was formed by 16 internationally focused research universities to provide a laboratory for online learning and to provide the highest quality learning to underserved populations globally. Accordingly, the paper will provide the background and history for the U21 Global collaborative experiment in online learning. It will also cover lessons learned during the four years that U21 Global has been operation including what we have learned about strategies to support a common platform for ‘internationalising’ education in the online medium. Both progress and pitfalls will be discussed as are our processes and criteria vis-a-vis quality assurance and benchmarking and some of the innovative frameworks that have been developed at U21 Global for managing quality processes in our open online learning environment. The paper also touches on issues of democracy, student-centred approaches to learning, and international collaboration and cooperation in the e-learning space that U21 Global has experienced. Also explored in the paper are opportunities for the future to enhance online learning and expand its scope and scale internationally. A major focus of the paper will be the importance of cooperation between and among U21 Global and its parent universities, which has provided U21 Global with unique and powerful opportunities to bring very high quality graduate program learning experiences to learners globally. The experience suggests that focusing on and committing to deep cooperation and quality are key elements differentiating U21 Global and underpin its successes to date. The paper concludes with new paths and ideas that build on successes and overcome problem areas that have been identified during the past four years. These paths largely rest upon increasingly numerous and creative links with U21 universities.

A Look at Circulation Statistics

ABSTRACT Nearly all academic libraries keep circulation statistics which are often shared with their parent university, library consortia, and national organizations. This study attempted to discover what goes into circulation statistics by surveying Southeastern research libraries. Libraries were asked what they count in their circulation statistics and what their circulation policies are to identify differences across libraries. The results of the survey indicate that there is no set formula for counting circulation statistics.

Research Centers and Institutes in U.S. Medical Schools: A Descriptive Analysis

Research centers and institutes are a common mechanism to organize and facilitate biomedical research at medical schools and universities. The authors report the results of a study on the size, scope, and range of activities of 604 research centers and institutes at research-intensive U.S. medical schools and their parent universities. Centers and institutes with primary missions of patient care, education, or outreach were not included. The findings indicate that, in addition to research, centers and institutes are involved in a range of activities, including education, service, and technology transfer. The centers and institutes the authors studied were more interdisciplinary than those included in previous studies on this topic. Most research centers and institutes did not have authority comparable to academic departments. Only 22% of centers directly appointed faculty members, and most center directors reported to a medical school dean or a department chair. A small group of centers and institutes ("power centers"), however, reported to a university president or provost, and may have considerable power and influence in academic decision making and resource allocation. Two main types of centers and institutes emerge from this research. The first type, which includes the vast of majority of centers, is modest in its scope and marginal in its influence. The second type--with greater amounts of funding, larger staffs, and direct access to institutional decisionmakers--may have a more significant role in the organization and governance of the medical school and university and in the ways that researchers interact within and across academic divisions.

Tobacco Industry Links to Faculties of Medicine in Canada

The tobacco industry uses various strategies to promote itself as a socially responsible, ethical industry, including establishing links with health institutions and medical research. The purpose of this study was to identify the relationships between the tobacco industry and Canadian faculties of medicine, specifically research funding and donations from tobacco industry sources, and faculty-specific policies regarding the acceptance of tobacco industry funds. Information about policies and practices regarding research funding and donations from 1996-1999 was requested from the 16 Canadian faculties of medicine and their parent universities, as part of a larger cross-sectional survey-centred study that examined links between the tobacco industry and Canadian universities. All 16 faculties of medicine (100%) reported on research funding and 11/16 (70%) reported on donations from the tobacco industry. Twenty-five percent (4/16) of the faculties received research funding from the tobacco industry and 27% (3/11) received donations. No Canadian medical school had a policy that banned tobacco industry research funding or donations. The tobacco industry have made donations and given research funding to faculties of medicine in Canada. This may present major conflicts of interest that undermine public health and have implications for the scientific integrity of the medical research enterprise. Faculties of medicine should consider developing policies that prohibit tobacco industry research funding and donations, with the intent of preventing conflicts and precluding ethical dilemmas arising from links with the tobacco industry. They should also encourage parent universities to establish similar policies at an institutional level.

Improved Hypothermic Preservation of Human Renal Cells Through Suppression of Both Apoptosis and Necrosis

A new platform of hypothermic solutions, the HypoThermosol® (HTS) series, has been developed for the improved hypothermic storage of cells, tissues, and organs. Cells and tissues cold-stored in HTS-FRS demonstrate improved viability when returned to normothermic temperatures in comparison with the parent solution, HTS-BASE, or University of Wisconsin (UW) solution (UW-ViaSpan®). While our group and others have implicated apoptosis as a major player in cell death initiated by extended hypothermic storage, it has been unclear if the improved performance of HTS-FRS as a hypothermic storage solution is due to its ability to inhibit apoptosis. Data reported herein show that human renal cells hypothermically stored in renal cell culture medium, HTS-FRS, HTS-BASE, or UW solution demonstrated improved survival in HTS-FRS. Following 5 days of hypothermic preservation and 1 day of recovery at 37°C, cells preserved in HTS-FRS exhibit 75% metabolic activity, whereas cells stored in HTS-BASE, UW, or culture media demonstrate 32%, 17%, and 6% recovery, respectively. In addition, cells stored in HTS-BASE supplemented with caspase inhibitor exhibit increased cell numbers in comparison to cells stored in HTS-BASE (72% vs. 30% after 7 days of cold storage and 2 days of recovery). Experiments with annexin and propidium iodide as well as assessment of caspase activities suggest that the improved performance of HTS-FRS as a preservation solution may be due to its ability to inhibit both apoptosis and necrosis.

3.1 Scholarship and the university.

Universities now exist in an environment of increasing accountability for their academic performance, both in teaching and research. Dental schools are expected to meet the academic expectations of their parent university and, in addition, to contribute to the health-care needs of the community. Individual staff members must achieve collectively the performance targets required of their school and individually must develop skills and expertise in their academic and clinical activities to merit tenure and promotion. This discussion examines the issues which impact on current problems of recruitment and retention of academic staff in dental schools internationally. The essential issue is career development in a manner which maintains the values that will ensure the credibility of dentistry as a scientifically based discipline and profession, while balancing the achievable academic needs with the added demands of achieving specialist clinical skills. Central to this balance is recognition that scholarship, which provides the bridge between research and teaching, can be broadly defined and that different individuals can be scholarly in a range of ways. Increasingly, schools are recognizing the importance of providing structured opportunities and guidance for career development of younger staff and of the need for flexibility in their criteria for tenure and promotion, recognizing that a diversity of individual strengths and teamworking are necessary both for the collective performance of the institution and the morale and development of the individual.

Effects of socioeconomic status on presentation with acute lower respiratory tract disease in children in Salvador, Northeast Brazil.

Two different socioeconomic groups of children with pneumonia were studied, and their clinical and demographic aspects were evaluated. The diagnosis of pneumonia was based on findings of cough and tachypnea, or on crackles on auscultation or on radiologically confirmed infiltrate. This was a prospective cross-sectional study conducted at the Professor Hosannah de Oliveira Pediatric Center, which cares for children of lower socioeconomic status (PHOPC), and at one private hospital which cares for children from middle to high socioeconomic status (Aliança Hospital, AH). Demographics and clinical differences were assessed by the Pearson chi-square test or Fisher's exact test as appropriate; means of continuous variables were compared by Mann-Whitney U-test. In a 26-month period, 3,431 cases were recruited. The 2,476 cases identified at the PHOPC were younger than the 955 identified at AH (2.2 +/- 2.3 vs. 4.5 +/- 3.1 years, P < 0.0001) and had higher scores for severity (3.5 +/- 1.5 vs. 2.7 +/- 1.7, P < 0.0001), duration of hospitalization (days) (10.9 +/- 12.1 vs. 6.2 +/- 7, P < 0.0001), frequency of tobacco smoker in the household (48% vs. 31%, P < 0.0001), cardiopathy (15.3% vs. 5.9%, P = 0.003), fever (44.4% vs. 36.3%, P = 0.0001), tachypnea (67.6% vs. 32.3%, P < 0.0001), crackles (69.5% vs. 64.9%, P = 0.02), somnolence (19.9% vs. 10.4%, P < 0.0001), malnutrition (13.7% vs. 5%, P < 0.0001), hospitalization rate (27.4% vs. 22.5%, P = 0.003), and death (0.9% vs. 0.1%, P = 0.009). However, other features were more frequent among AH cases: parent's university level of education (38.2% vs. 1.0%, P < 0.0001), underlying chronic illness (40.6% vs. 28.5%, P < 0.0001), asthma (62.7% vs. 50.8%, P = 0.01), rhinitis (9.2% vs. 0.4%, P < 0.0001), previous use of antibiotics (34.3% vs. 27.1%, P = 0.001), and wheezing (53.1% vs. 42.2%, P < 0.0001). Children of lower socioeconomic status have more serious lower respiratory tract disease, whereas children with pneumonia of middle to high socioeconomic status have more allergic diseases (rhinitis, asthma) and wheezing.

Real-time Internet connections: implications for surgical decision making in laparoscopy.

To determine whether a low-bandwidth Internet connection can provide adequate image quality to support remote real-time surgical consultation. Telemedicine has been used to support care at a distance through the use of expensive equipment and broadband communication links. In the past, the operating room has been an isolated environment that has been relatively inaccessible for real-time consultation. Recent technological advances have permitted videoconferencing over low-bandwidth, inexpensive Internet connections. If these connections are shown to provide adequate video quality for surgical applications, low-bandwidth telemedicine will open the operating room environment to remote real-time surgical consultation. Surgeons performing a laparoscopic cholecystectomy in Ecuador or the Dominican Republic shared real-time laparoscopic images with a panel of surgeons at the parent university through a dial-up Internet account. The connection permitted video and audio teleconferencing to support real-time consultation as well as the transmission of real-time images and store-and-forward images for observation by the consultant panel. A total of six live consultations were analyzed. In addition, paired local and remote images were "grabbed" from the video feed during these laparoscopic cholecystectomies. Nine of these paired images were then placed into a Web-based tool designed to evaluate the effect of transmission on image quality. The authors showed for the first time the ability to identify critical anatomic structures in laparoscopy over a low-bandwidth connection via the Internet. The consultant panel of surgeons correctly remotely identified biliary and arterial anatomy during six laparoscopic cholecystectomies. Within the Web-based questionnaire, 15 surgeons could not blindly distinguish the quality of local and remote laparoscopic images. Low-bandwidth, Internet-based telemedicine is inexpensive, effective, and almost ubiquitous. Use of these inexpensive, portable technologies will allow sharing of surgical procedures and decisions regardless of location. Internet telemedicine consistently supported real-time intraoperative consultation in laparoscopic surgery. The implications are broad with respect to quality improvement and diffusion of knowledge as well as for basic consultation.

The effects of a changing environment on relationships between medical schools and their parent universities.

Medical schools differ from other university graduate schools in that community settings, hospitals, and ambulatory care facilities are required for medical education, and most of these settings are either owned by or closely affiliated with the university. Thus, the extraordinary changes in recent years in the organization, delivery, and financing of health care have required the attention not only of the leadership of academic medical centers (i.e., medical schools and their owned or closely affiliated teaching hospitals) but also of the administrators and boards of their parent universities. Many university-wide structures and policies that previously served the medical school well in accomplishing these missions may now be viewed as inflexible by the faculty and administration of the school. Conversely, the historically distant governance and administrative oversight of the medical school has become a concern for some at the university, given the huge budgets of the school, its faculty practice, and its affiliated hospital(s). From information derived mainly from annual visits to 14 medical schools from 1996 through June 2000, the authors review the issues between medical schools and their parent universities and the strategies being used to resolve them. These strategies include changes in the governance, organization, and management of the medical school, such as unified authority for health affairs, reengineered administrative systems, and increased autonomy in decision making. The authors conclude that these strategies appear to be working on behalf of not only the medical school but, in some instances, the university at large. They also comment on possible negative implications of the greater separation of the medical school from its parent university.

Information literacy co-ordination: two dynamic approaches

The libraries of the University of Melbourne and Queensland University of Technology have two different approaches to co-ordinating information literacy. During 1999, each library reviewed various aspects of their coordination processes, the result of which was the implementation of innovative approaches to managing their education and training programs. Although the libraries service the needs of parent universities with distinct educational agendas, they share a common focus concerning Information Literacy objectives and issues. Each library has an extensive teaching and learning tradition and demonstrates a strong commitment to student learning outcomes. Furthermore, as multi-campus institutions, the development, co-ordination and management of their education and training programs presents similar opportunities and challenges. However, each library has adopted distinctly different operational models. This paper presents an overview of the co-ordination models adopted by each library and analyses their individual rationales, within the context of their organisations, for applying these models. It summarises the redevelopment and implementation processes undertaken, including operational initiatives, managerial strategies, staffing and resourcing issues and evaluation and feedback methodologies, and analyses the success or otherwise of each model. It provides a critique of both approaches in terms of achievements, challenges and issues born as a result of each process. It also seeks to identify future trends and improvements to be undertaken in subsequent reviews.

Scholarship in the Medical Faculty from the University Perspective

Academic medicine and research universities have enjoyed a close relationship that has strengthened both, spawning an era of discovery and scholarship in medicine that has earned the U.S. academic medical enterprise a high level of public trust and a deserved leadership position in the world. However, changes in the financing of medical care and in the organization of health care delivery have dramatically affected the medical school-university partnership. The growing emphasis on delivery of clinical services and the concomitant decrease in time for tenured and clinician-educator faculty to teach and do scholarly work jeopardizes both the potential for continued discovery and the education of the next generation of medical scholars. The background of the medical school-university relationship and the factors leading to the development of clinician-educator faculty tracks are reviewed, and recent trends that impact faculty scholarship are discussed. Both tenure-track and clinician-educator medical faculty, as members of the broader university community, should expect from their university colleagues a continued demand for scholarship and educational activity that reflects the underlying philosophy of the parent university. As a corollary, the university, through its medical school, must provide these faculty the time and the financial support necessary to fulfill their academic mission. The size of the clinician-educator faculty should be determined by the academic needs of the medical school rather than by the service demands of its associated health care delivery system. To accomplish this, academic medical centers will have to develop cadres of associated or clinical faculty whose primary focus is on the practice of medicine.

Branding B-Schools: Reputation Management for MBA Programs

Increasingly, business schools are finding that they need to focus on building reputation — even more so than their parent universities. However, in-house, public relations and publications offices are ill-equipped to take on this responsibility. Some schools, like the University of Chicago, have hired marketers and others have used consulting firms, like McKinsey & Co., to analyze this problem, but none are immune from the phenomenon, and few seem to understand the need to focus on reputation.

Why is it that management academics rarely advise on the management of their own institutions?

Since academics in business schools teach others about management it might be expected that these schools and their parent universities would make considerable use of this in-house expertise in managing their own activities. There is little evidence that this takes place. This paper examines why this might be so - putting forward nine hypotheses. While some of the hypotheses seem to have limited explanatory power, others, principally those concerned with the motivational structures within universities, seem to provide more plausible explanations.