DISCOVERING STRATEGY: A KEY CHALLENGE FOR ACADEMIC HEALTH CENTERS.

The health care marketplace is increasingly being driven by competition on value for patients -- that is, meeting their needs as efficiently as possible. Academic medical centers must adapt to this shift through the development of true strategies aimed at creating value, as opposed to trying to deflect the pressures of competition through tactics such as merging with competitors. True strategies require clarity on what the organization is trying to do for whom, and how the organization is going to be different from its competitors. Six key questions are described and discussed: 1) What is our goal? 2) What businesses are we in? 3) What set of conditions shall we compete in? 4) How will we be different? 5) What synergies can be created across our sites? and 6) What is our appropriate density and scope? Academic medical centers have been the crown jewel of health care for the United States and, indeed, the rest of the world. Their research, teaching, and patient care missions all command respect, and their halls are filled with representatives of industry interested in scientific advances; trainees seeking expertise; and patients hoping for relief of their suffering -- or at least peace of mind that all opportunities for improvement of health have been exhausted. Despite obvious "demand" for what academic medical centers have to "sell," the evolving health care marketplace poses existential threats to academic medical centers, causing many such organizations to wonder what their role should be -- or if they will even be in existence. The threats are indeed real, and they cannot be overcome by reminding the public of the noble missions of academic medical centers. Instead, academic medical centers need to rediscover the meaning of strategy, which always requires choices that are politically challenging. But organizations that can develop a true strategy and make those difficult choices have an excellent chance of thriving in the new marketplace -- because, in fact, academic medical centers have some advantages that their competitors lack in the struggle for market-share. [ABSTRACT FROM AUTHOR]