Adapting health care institutions and medical schools to societies' needs.

Although societies and the priorities of stakeholders within them differ, four universal values regarding health care exist: quality, equity, relevance, and cost-effectiveness. The first two of these values can be viewed as poles of "the dream axis" and the second two as poles of "the reality axis." Medical schools and other stakeholders can pursue optimal patterns of health care most effectively through partnerships with one another. With regard to improving the health care system, medical schools can be characterized as neutral, reactive, or proactive. A socially responsible medical school perceives the needs of society and reacts accordingly, and a socially accountable school also consults society about priorities and provides evidence of impact of its deeds. A grid for assessing the social accountability of medical schools has been developed. With this grid, a school's activities in education, research, and service are evaluated relative to the four universal values of quality, equity, relevance, and cost-effectiveness of health care; activities also are characterized as "planning," "doing," or "impacting." Assessment can promote greater social accountability of medical schools.