1. Managing of academic health centers
a. Definition
i. Must be either owned or closely affiliated with a university or medical school
ii. Must at least have one other graduate health professional program
iii. Must be actively engaged in undergraduate medical education, biomedical research and delivery of patient care
b. Operation
i. Look for innovative solutions
ii. Look at the long term implications of the strategies
iii. Make decisions based on results
iv. Management information system
v. Center of excellence
vi. Cultural attributes
1. Acute care culture
2. Specialty oriented culture
vii. Financial sustainability
1. Lower the operating budget
2. Improve financial efficiency
a. Hire business people to run the business
3. Funding sources
4. Costs
a. Costs in order to develop the ability to treat difficult and complex illnesses
b. Educational costs
c. Technology costs
5. Compensations
6. Revenues
a. Tuition
b. Government grants
c. Private grants
d. European Community Research Programs
e. From clinical services
viii. Structure
1. Governance structure
2. Operational structure
a. Organogram
ix. Administration
x. Productivity 
1. Increase clinical productivity
a. Balanced score cards
i. Align the goals of…
1. Financial health
2. customer satisfaction
3. internal business procedures
4. employee satisfaction
2. New information systems
3. Improve quality
4. Improve accountability
xi. Performance
xii. Quality of services
c. Missions
i. Social mission
1. Poor people
2. Need for highly specialized care not available by others
3. Need for complex care not available by others
4. Need for innovative care not available by others
ii. Teaching mission
1. Train future physicians
2. Provide graduate medical education
iii. Research mission
iv. Clinical service mission
d. Strategy
i. Future strategy
1. Change the mission
2. Evolve into new type of organization
ii. Vision of the future
iii. Communication of mutual benefits
iv. Identification of change champions
v. Training systems that reflect the change
vi. Incentive systems that reflect the change
vii. Linkage strategies
1. Mergers
2. Alliances
3. Build referral networks
a. Community based health care system
b. Primary care practices
c. Referrals by affiliated practitioners
i. Salaried employee
1. Decreased productivity
d. Outcome:
i. Financial disaster
ii. Network agreements do not produce community physician referrals
4. Build integrated delivery health systems
a. Integrative network strategy
b. Increase of market share
c. Improve the power to negotiate
5. Affiliated physicians
6. Ensure economies of scale
a. Difficult due to cultural and organizational complexity
7. Consolidate markets
8. Increase market share
9. Decrease competition
10. Provide the critical mass needed to sustain world class research and educational activities
11. Create new opportunities for cost reduction
12. Create new opportunities for improved efficiencies
13. Develop market power in order to deal with local competitive pressures
14. Operational integration issues
15. Cultural integration issues
16. Clinical integration
17. Administrative integration
18. Brand recognition
viii. Managerial strategies
1. Need for operational flexibility
2. Need for entrepreneurial flexibility
3. Need for rapid decision making
4. Need for mobilization of organizational resources necessary for implementing strategies
5. Structural reform
a. Consolidate research, education and service missions
6. Governance
a. Traditional structure is central
ix. Product/Market strategies
1. Research product/market strategies
a. Commercialize research
b. Expedite in technology transfers
c. Threats of research mission
d. Opportunities of research mission
e. Difficult to do both research and provide clinical services
f. Alternative sources of research funds
g. Incentives system for faculty research grants
h. Technology development program
i. Technology transfer program
j. Create a clinical trials network
i. Academic researchers 
ii. Community based physicians
k. Support for patents
l. Partnerships with research parks
m. Development of incubators
n. Development of centers of excellence
2. Clinical services product/market strategies
a. Exploitation of market niches
i. Community is viewed as a source of opportunity or a niche
ii. Identify health and services needs of communities
iii. Differentiation
1. in quality
2. in perceived value
3. in reputation
4. organizational structure
b. Establish and manage its own managed care insurance operations
i. Establish a HMO
ii. Insurance packages
iii. Complete failure
1. Due to lack of business skills
2. Due to lack of finances
x. Operating efficiency strategies
e. Environment
i. Location
1. Location opportunities
2. Location resources
ii. Competition
1. Managed care organizations
iii. Policy makers
iv. Legislation
v. Market
1. Market location
f. Services 
i. Research
ii. Teaching
1. Reduces clinical productivity
2. Need to order tests for didactic reasons
3. Need to offer a broad range of services
iii. Evidence based care
iv. Managed care
1. High costs are inconsistent with managed care
v. Health system (holistic medicine health system)
g. Resources
i. Human resources
1. Researchers
2. Practitioners
ii. Infrastructure - Facilities
1. Hospitals
2. Teaching facilities
3. Laboratories
iii. Knowledge resources
iv. Relationship resources
1. Referral network