Dr. Emrick's Books and Articles
The Crucial Role of Academic Medicine
In the final
part of a 3 part series on Academic Medicine, I examined several key strategies
that illustrate how clinician-led changes can lead to enhanced performance. One
academic center undertook a concerted effort to reduce its hospital length of
stay, which had been higher than that of its peers. By engaging clinical teams
in identifying bottlenecks and implementing solutions (from quick wins, such as
adding weekend discharge services, to more comprehensive workflow redesigns,
like co-locating multidisciplinary teams), the hospital reduced the average
length of stay by 13%, which freed up capacity to increase admissions by 10%.
Notably, these improvements were achieved while improving clinician
satisfaction – for example, co-locating care teams saved some physicians nearly
an hour on daily rounds, reducing burnout. In another case, a large AMC focused
on outpatient productivity. Rather than simply pushing physicians to “work
harder,” leaders empowered clinicians to redesign clinic workflows and add
support (e.g., hire scribes, optimize staffing) so that doctors could work at
the top of their license. The result: faculty physician productivity increased
by roughly 25% over two years, reaching benchmark levels, and patient waiting
times for appointments dropped significantly. Crucially, this initiative was
clinician-led – departments set their own efficiency plans and business cases,
which overcame prior resistance and ensured the changes were implemented. These
successes share common themes. Research by McKinsey and others has identified
several key strategies for effective clinician-led transformation in academic
health centers:
I.
Make the case patient-centric: Frame efficiency
improvements in terms of patient care benefits (expanded access, shorter wait
times, improved outcomes) rather than solely financial goals. A compelling
patient-centered rationale helps align clinicians with the effort. (For
example, the productivity initiative above was messaged as reducing patient
wait times, not merely boosting physician output.)
II.
Empower clinical leaders: Enlist physicians,
nurses, and other providers to co-lead improvement efforts. Front-line
clinicians are best positioned to spot inefficiencies and design workable
solutions. Hospitals that form clinician-led working groups and committees for
key initiatives see faster buy-in and more sustainable change. In contrast,
purely top-down mandates often falter.
III.
Use data to target impact: Take an analytical
approach to identify the highest-yield opportunities. Rather than hundreds of
scattershot projects, focus on the few changes that will move the needle most
(which may differ by department or site). Rigorous upfront diagnostics – for
example, analyzing drivers of prolonged length of stay at each hospital –
ensure that effort is invested where it matters most.
IV.
Redesign workflows to help clinicians: When
asking clinicians to change practices, leaders should also make everyday work
easier. Successful AMCs often redesign care models to eliminate frustrations
and wasted effort for staff. For instance, reorganizing inpatient units so that
each attending physician’s patients are on one floor can save physicians a
significant amount of walking and coordination time. By improving the work
environment (not just demanding more output), hospitals can achieve efficiency
and enhance morale.
V.
Willingness to invest in support: Counterintuitively,
cutting costs may require investing in new resources. Many care teams lack the necessary
tools and staff to operate at maximum efficiency. Strategic investments – in
technology, additional clinical support staff, equipment, and facility upgrades
– can yield a positive return on investment by boosting productivity and
patient throughput. For example, one AMC hired more clinical assistants to free
up physicians’ time and subsequently saw net margins rise as those doctors were
able to see more patients. Leadership should be prepared to invest in
cost-effective solutions, guided by thorough business cases that provide a
clear understanding of the benefits and risks.
VI.
Strengthen accountability and transparency:
Large academic health systems are complex, so any change program needs transparent
governance and accountability structures. High-performing centers set up
transparent tracking of initiatives (with defined owners, timelines, and
metrics) and regular oversight by leadership to remove barriers. Data
transparency – such as dashboards that compare performance across departments –
creates peer pressure and fosters a shared responsibility for improvement.
VII.
Align incentives and recognition: AMCs should
examine how to align incentives with operational excellence. This may include
revising compensation models, offering department-level rewards for efficiency
gains, or simply publishing performance metrics so that no clinician wants to
be an outlier. Financial rewards are not the only motivator; in fact, many AMC
leaders report that peer comparison and transparency are among the most
effective tools to drive clinician engagement. Ensuring that promotions and
prestige within the institution value clinical innovation (not just research
accomplishments) is another way to encourage clinician-investment in efficiency
efforts.
So, what does the future hold for
AMCs? It's hard to say, but picture a teaching hospital where every clinic
visit contributes to a learning-health system, residents switch between bedside
rounds and VR simulations, and research funding comes from a mix of
mission-driven donors, competitive start-up accelerators, and carefully vetted
industry partners; that vision is quickly becoming reality as extended Medicare
telehealth waivers keep virtual training sites operational, artificial
intelligence platforms integrate genomic and social data into care plans, and
new curricula combine data science with ethics so graduates can challenge
algorithms as confidently as they interpret X-rays. In this evolving landscape,
the academic medical center sheds its ivory-tower boundaries. It reappears as a
borderless laboratory—testing discoveries in real-time, addressing workforce
shortages through community pipelines, and sharing expertise far beyond campus
walls—proving that when innovation and public mission come together, the impact
on health and knowledge multiplies.
Levine,
E., Malani, R., Odden, A., & Schulz, J. (2024, April 4). Ensuring the
financial sustainability of academic medical centers. McKinsey & Company. https://www.mckinsey.com/industries/healthcare/our-insights/ensuring-the-financial-sustainability-of-academic-medical-centers
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