This report identifies and assesses potential models of organization to help achieve the goals of Zhejiang University's academic medical center (AMC). The university, the Yuhang District Government, and donors have invested resources in the development of this new AMC to integrate the university's health-related research, teaching, and care activities; and to build a world-class comprehensive biomedical and clinical research infrastructure.

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Supporting the Development of a Vision and Strategic Plan for Zhejiang University's Academic Medical Center

by Rafiq Dossani, Peggy G. Chen, Christopher Nelson

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Research Questions

  1. How will officials know whether the organizational model selected and implemented is working for the academic medical center (AMC)?
  2. How should the government, private donors, the university, and the affiliated hospitals collaborate to establish the AMC?
  3. What are the factors most likely to influence success?
  4. How should the implementation of the selected organizational model be monitored and evaluated?

Zhejiang University (ZJU) is a nationally ranked (in the top five) comprehensive university in China, with strengths in earth sciences, natural sciences, applied sciences, information sciences, medicine, and engineering. The university, the Yuhang District Government, and donors have invested resources for the development of a new academic medical center (AMC) with the intention of integrating the university's health-related research, teaching, and care activities; and building world-class comprehensive biomedical and clinical research infrastructure to provide vital patient care, support public health initiatives, conduct cutting-edge biomedical and clinical research, and educate the country's future health care workforce.

This report identifies and assesses potential models of organization to help the AMC achieve its goals. The authors conducted four case studies of AMCs in the United States to illustrate and assess potential models for the organizational structure of ZJU's AMC. The findings were used to develop recommendations for the future development of the AMC. The report emphasizes that there is no out-of-the-box solution, but that the model ultimately chosen for the Zhejiang University AMC will require ongoing monitoring and adjustments to ensure its optimal performance for meeting stated goals.

Key Findings

Potential models of organization vary

  • The key domains of an AMC organizational structure that have the potential to distinguish AMCs from one another are ownership and identity, governance and operations, and finances.
  • Four models were identified with variations in these domains that could reasonably be considered by ZJU for governance of the new AMC.
  • In all four models, ownership is divided between the university and the hospital (while governance is shared), but the models differ in where their identity lies and who holds operational control.

Two models stood out as having the most potential

  • The university-led model would achieve the highest level of performance on attributes that measure progress toward the ZJU AMC goals.
  • The AMC-led model also achieves the desirable attributes of the university-led system but primarily within the AMC.
  • Both models entail significant start-up costs and time commitments compared with some of the other models considered.
  • The two models also entail a certain organizational vision that recognizes that ownership may be separate from governance, which in turn may be separate from operations control.
  • A key aspect of organizational vision is the importance of a unified identity: the university.

Support from the government and private donors is crucial to the AMC's success

  • The government's role will be necessary at different levels — provincial, municipal, and district. Government support is needed to ensure that costs are met and to fulfill the vision of a unified health system under the university's identity.
  • Donors add to the hospitals' main sources of revenue.

Recommendations

  • The two recommended models are: a university-led model, in which the AMC adopts the identity of the university and is operated by the university; and an autonomous model (or AMC-led model), in which the AMC adopts the identity of the university but operates independently.
  • We do not recommend consideration of a hospital-led model, in which the AMC adopts the identity of the hospital and is operated by the hospital; or of a shared model, in which the AMC adopts the identity of the university and is operated jointly by the hospital and the university.
  • Ongoing monitoring and measurement are key to the success of the ZJU AMC, and they should be initiated in parallel with the initiation of implementation plans for the new model.
  • Monitoring the progress of a selected organizational model should be systematic, utilize different types of data and data sources, and focus on both long-term goals and short- and mid-term goals.
  • No matter which governance model is ultimately selected, there are likely to be unanticipated barriers that will require adjustments to the model even as progress continues.
  • Together, all these factors will ensure the presence of learning and feedback loops that can guide ZJU in making midcourse corrections.

Table of Contents

  • Chapter One

    Background and Objectives

  • Chapter Two

    Evaluation Criteria and Approach

  • Chapter Three

    Case Studies

  • Chapter Four

    Organizational Model Development

  • Chapter Five

    Assessment of Organizational System Models and Recommendations

  • Chapter Six

    Pathways, Monitoring, and Evaluation

  • Chapter Seven

    Conclusion

  • Appendix A

    Models of Organizational Structure

  • Appendix B

    Case Study Selection

Research conducted by

The research described in this report was sponsored by Zhejiang University and conducted by RAND Health Care and RAND Education and Labor.

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