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Commentary: Change We Must: Putting Patients First With the Institute Model of Academic Health Center Organization

Young, James B. MD; Cosgrove, Delos M. MD

doi: 10.1097/ACM.0b013e31824d5960

In the traditional department-based organizational structure of an academic health center, patients can be neglected as a result of fragmented systems of care. Specialty-driven, provider-oriented, economically influenced organizations dominated by research and education missions might, paradoxically, promote too little concern for the patient. All three components (education, research, and patient care) of academic health centers’ tripartite mission are sacred, but times have changed. Academic health centers must rethink their traditional approach to achieving their mission. The authors describe the evolution at the Cleveland Clinic of a unique, institute-based reorganization that is focused on integrated disease- and organ-system-based patient care, research, and education. The authors argue that this model better focuses on the patient as well as on the institution’s academic charge. It is a concept that should be more widely adopted with deference to individual institutional culture and history.

Dr. Young is professor of medicine and executive dean, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, and George and Linda Kaufman Chair, Cleveland Clinic, Cleveland, Ohio.

Dr. Cosgrove is president, chief executive officer, and Rich Family Chief Executive Chair, Cleveland Clinic, Cleveland, Ohio.

Editor’s Note: This is a commentary on Kastor JA. The Cleveland Clinic institute system is the right structure for academic health centers in the 21st century. Acad Med. 2012;87:558; and Kastor JA. The traditional departmental model is the right structure for academic health centers in the 21st century. Acad Med. 2012;87:559.

Correspondence should be addressed to Dr. Young, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave. NA21, Cleveland, OH 44195; telephone: (216) 444-2333; fax: (216) 445-3516; e-mail:

© 2012 Association of American Medical Colleges