We are an academic medical center with a three-part mission: research, teaching, and clinical care. While the academic portion (research and teaching) is core to the university’s mission, excellence in the clinical practice of medicine is inextricably intertwined with and essential for success in the other parts in the mission of an academic medical center. Without that academic component, there is no reason for us to have a clinical enterprise.

Stanford Medicine aspires to the same level of excellence as the rest of the university, and whenever possible, follows the university tradition of avoiding activities and programs where the institution will not be world-class. The dean and senior leaders in the School of Medicine, in consultation with the CEOs, have primary responsibility for articulating and prioritizing strategies for preeminence that cut across all Stanford Medicine entities.

Excellence in an academic institution flows first and foremost from the faculty (whose excellence in all aspects of their activities is the primary concern of the dean), but must be accompanied in clinical settings by broad excellence among hospital staff (a chief responsibility of the CEOs). Because of these responsibilities and the imperative that excellence in all facets of Stanford Medicine is of paramount importance, it follows that the dean and those faculty designated by the dean must have the primary responsibility for oversight of selection and quality of all physicians employed by medical groups contracted with University HealthCare Alliance (UHA) or Packard Children’s Health Alliance (PCHA), as well as physicians employed by the School of Medicine. To effect this oversight, the dean and department chairs will be fully consulted at an early stage concerning medical groups that UHA or PCHA are seriously considering for an affiliation and will be involved in an ongoing fashion in ensuring quality.

Stanford Medicine is comprised of entities that are strategically, operationally and financially interdependent.  The dean and the two hospital CEOs lead this partnership and it must work well for us to be successful. The CEOs of the hospitals have primary responsibility for the operations of the hospitals and clinics. The dean has primary responsibility for the faculty and physicians (including their selection and compensation) as well as the research and teaching that the faculty members undertake (including the training of residents and clinical fellows). 

A high degree of coordination and transparency is required among the dean and CEOs. In accord with the nature of this partnership, the dean and senior leaders in the School of Medicine will be fully consulted early in the development of significant strategic initiatives that involve any component of Stanford Medicine, and they must concur with the decision to embark on any major initiative. At the same time, with a rapidly changing health care market, decision-making and execution cannot be inhibited by the often slow and cumbersome decision cycles of the academy. To ensure that this does not happen, the school will need to designate small groups of representative leaders who are fully prepared to commit their time to reviewing any new initiatives.

Communications regarding strategic decisions and opportunities should come from Stanford Medicine (statements from the dean as well as from the CEO of the relevant hospital).

We recognize that the health care market is changing and evolving rapidly and that consolidation may pose significant threats to the viability of the clinical mission. Addressing these challenges will likely require bold and creative approaches, but should not force us to diverge from our core academic mission.

The revenue flows between the hospitals and the School of Medicine are critical to the survival of the School and to the engagement of the departments and faculty. These revenue flows need to be negotiated in good will with a strong appreciation of the goals of the dean and other leaders in the School of Medicine.