The Tall Order of the Modern Hospital: Balancing Patient Care with Economics and Academic Missions – Administrators’ Perspective

  • Ronald C. MerrellEmail author


The Academic Health Center must maintain a successful balance between potentially conflicting missions of patient care of the highest quality and perception, dynamic interaction with the needs of the health-care work force, and the economics of a highly competitive business in an increasingly challenging market. The administrator is the lynchpin to coordinate these missions. The players and payers are clearly the patients, the trainees, the faculty, the regulators, and the payers. Thus far the centers have been enormously successful being consistently named the leaders of American medicine in national surveys. Issues at hand include technology, changing venues of health care to include the home and workplace, conflicts of the missions when one regulator imposes a requirement incompatible with the other players, intense competition, and staffing to include the administrator. Emerging solutions include leadership skills, creative contracting, simulation and team building, opportunities for discovery, patient education involvement and communication, telemedicine and e-health, and efficiency. The task is daunting, but the centers must and will prevail. The coordination and tie-breaking administrator can achieve the necessary balance. The success is not so much that of the apical leaders as the conductor of an orchestra which understands the composition and achieves the necessary harmony.


Hospital administration Academic Health Centers Medical education Faculty development Medical leadership development Patient-centered care Medical economics 


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryVirginia Commonwealth UniversityRichmondUSA

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