_-- Public Policy Network - Posting to PUBPOL-L --_


Lately I have encountered the top management of university health systems
simultaneously occupying the following positions with combined mammoth
portfolios - not necessary in the order of importance:=20

- University Executive Vice President for Health Affairs
- Dean of the Medical School
- CEO of the Health System
- Medical Director of the hospitals and clinics
- Professor of Medicine
- Responsibility for research centers and technology transfer enterprises
- Responsibility for Development and Relations

Another problem is the major research universities have a Vice President =
or
Vice Provost for Research (including grants administration and technology
transfer) while the Health czars control health research. A similar situa=
tion
exists with university development versus medical/health development.

In the past some of the justification for having such an arrangement was =
to
spread as much as possible of the administrative overhead among third par=
ty
payers. However now that that is ending as Government is correctly and
gradually eliminating as much of medical education and research as possib=
le
from the health car bills, the justification for having such czars contin=
ue
is disappearing too.  In fact their existence may be counter productive t=
o
the universities as well as the medical schools and the public. The situa=
tion
also runs contrary to leading paradigms of management and organization.

In my recent attempts to organize industry and health system consortia to
apply for ATP/NIST funding for health infrastructure (previous postings) =
that
will dramatically change the way medical services and health care are
provided in the next decade, the biggest obstacle was the lack of time of=
 the
health czar to give to the projects. Since the lower management=92s did n=
ot
dare move a step without the czar's involvement and blessing every inch o=
f
the way.

Needless to say in at least 2 major cases I can attest to, despite the hi=
gh
interest in the projects as well as the need for funding that that would
result, the existence of the Czars prevented the management teams from mo=
ving
forward on the projects in the time frame necessary to meet deadlines. In=
 one
case, I estimate that from $10 to $20 million in funds was lost. In anoth=
er
case at least $1 to $2 million was lost.=20

A far more persuasive case can be made for breaking up the portfolios to =
have
different individuals occupy each of the aforementioned functions with
appropriate line authority and responsibility and have all of them come u=
nder
the portfolio of a university executive vice president for health and
science. In such an arrangement, there will be the integration of researc=
h,
technology transfer/enterprise, and development.=20

I am very interested in hearing the reactions and comments of the group
members. Since this list is not for discussions, please address comments =
to
me at=20

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Thank you

Stephen Miles Sacks PhD


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