Governance of the academic health center: striking the balance between service and scholarship.

Academic health centers (AHCs) rank among the most complex organizations. Spanning the domains of university, clinical practice, hospital, and research, AHCs encompass a range of strikingly different business models, each with its own economic potential. The ability to bring these diverse enterprises actively working together has been the unique strength of the AHC as a vehicle of patient care, education, and discovery. Unfortunately, the AHC has also proved at times to be a frustrating organizational matrix of indecision wrought by different aims and distributed influence, presenting substantial challenges to the success of these institutions. The question of how best to organize the fiduciary and executive management structures of the AHC continues to be the subject of much interest to those trustees responsible for these complex institutions. Although the question of what is the best governance model for an AHC is sometimes approached in simple terms of "one leader, or multiple," success is more likely defined by how well other critical factors are organized and managed. These include considerations of governance, including selection and education of key trustees, their ability to access key data for their specific institution and the AHC as a whole, performance evaluation of the operating executives with respect to both specific institutional criteria and those for the AHC as a whole, and management oversight by boards across the AHC. When more than one governing body is involved, joint participation of boards and key executives is recommended for selected aspects of these processes.