Aligning Delivery System and Training Missions in Academic Medical Centers to Promote High-Value Care

Acad Med. 2019 Sep;94(9):1289-1292. doi: 10.1097/ACM.0000000000002573.


Academic medical centers (AMCs) are transforming to improve their care delivery and learning environments so that they build a culture that fosters high-value care. However, AMCs struggle to create learning environments where trainees are part of the reason for institutional success and their initiatives have high impact and are sustainable. The authors believe that AMCs can reach these goals if they codevelop strategic priorities and provide infrastructure to support alignment between the missions of health delivery systems and graduate medical education (GME).They outline four steps for AMCs and policy makers to create an infrastructure that supports this alignment to deliver value-based care. First, AMCs can align strategic priorities between delivery systems and educators by creating a common understanding of why initiatives require priorities within the health care system. Second, AMCs can support alignment with data from multiple sources that are reliable, valid, and actionable for trainees. Third, resident initiatives can create sustained impact by linking trainees to the institutional staff and infrastructure supporting value improvement efforts. Fourth, incentive payment programs through medical education could augment current system incentives to propel further alignment between education and delivery systems. The authors support their recommendations with concrete examples from emerging models created by GME and health delivery system leaders at AMCs across the country.

MeSH terms

  • Academic Medical Centers / organization & administration*
  • Adult
  • Education, Medical, Graduate / organization & administration*
  • Female
  • Humans
  • Internship and Residency / organization & administration*
  • Intersectoral Collaboration*
  • Male
  • Middle Aged
  • Organizational Objectives*
  • Quality of Health Care / organization & administration*
  • United States
  • Young Adult