C
American Journal of Transplantation
Wiley Periodicals Inc.
Copyright 2012 The American Society of Transplantation
and the American Society of Transplant Surgeons
doi: 10.1111/j.1600-6143.2012.04189.x
Personal Viewpoint
Transplant Organizational Structures: Viewpoints
From Established Centers
M. Abouljouda,b, *, G. Klintmalmc
and S. Whitehoused
a
Henry Ford Transplant Institute, Detroit, MI
Division of Transplant and Hepatobiliary Surgery, Henry
Ford Hospital, Detroit, MI
c
Baylor Simmons Regional Transplant Institute, Dallas, TX
d
Office of Clinical Quality and Safety, Henry Ford Health
System, Detroit, MI
*Corresponding author: Marwan Abouljoud,
maboulj5@hfhs.org
b
This personal viewpoint report summarizes the responses of a survey targeting established transplant
programs with a structured framework, such as center, institute, or department, and stability of leadership to assure valuable experiential observations. The
18-item survey was sent to 20 US institutions that
met inclusion criteria. The response rate was 100%.
Seventeen institutions had a distinct transplant governance structure. A majority of respondents perceived
that their type of transplant structure was associated with enhanced recognition within their institution
(85%), improved regulatory compliance (85%), transplant volume growth (75%), improved quality outcomes (75%) and increased funding for transplantrelated research (75%). The prevailing themes in
respondents’ remarks were the perceived need for autonomy of the transplant entity, alignment among services and finances and alignment of authority with
responsibility. Many respondents suggested that a dialogue be opened about effective transplant infrastructure that overcomes the boundaries of traditional
academic department silos.
Key words: Institutes,
centers
service
lines,
transplant
Abbreviations: CEO, Chief Executive Officer; CFO,
Chief Financial Officer; COO, Chief Operating Officer.
Received 26 October 2011, revised 25 May 2012 and
accepted for publication 02 June 2012
35 organ transplant programs at 15 top-performing transplant centers; their selection criteria were based on high
volume, high growth, low graft failure and low mortality.
The Collaborative’s study served to establish best practices
in an effort to increase transplant volumes by 50% over
5 years (2). Common factors for transplant growth were
identified as institutional commitment, dedicated transplant teams, patient- and family-centered care, aggressive
evidence-based clinical practice and sound finances (2).
It is our opinion that the level of institutional commitment
toward integrated transplant services accounts for a significant component of the variation seen in transplant organizational structures. We developed a survey for established
transplant centers in the United States to assess experiences and perceptions regarding the nature of transplant
structures. We summarize the opinions and experiences
revealed in the survey responses and express our perspectives on forming integrated transplant structures. Our aim
is to provide a springboard for a national dialogue on how
to improve operational frameworks of transplant entities
that allows for stable functions and sustainable growth.
Opinion Survey Summary
Using Kaneku and Terasaki’s annual transplant program list
(3) and our personal knowledge of the field, we identified
institutions with a stable multiorgan transplant structure
and presence in the US market for at least 5 years. Stable
transplant structure was defined as same physician (medical or surgical) transplant director for at least 5 years and
steady or growing volume of transplants. Twenty institutions met these criteria.
The 18-item survey included multiple choice and
open-ended questions with opportunity for comments
(Appendix). The survey was delivered to the 20 transplant
R
(Palo Alto, CA, USA) in
directors using SurveyMonkey
October 2010. Responses were blinded.
Survey response was 100%, and all questions were answered by every respondent. The following responses correlate with the questions of the survey.
Introduction
The United States had nearly 250 transplant centers in
2011, although variation continues to exist in transplant
organizational structures, volumes and outcomes (1). The
Transplant Growth and Management Collaborative studied
Transplant structure nomenclature
Of the 20 institutions, 9 have transplant centers, 8 transplant institutes, 1 transplant department, 1 transplant
service line and 1 transplant center with an organspecific institute.
Abouljoud et al.
Perceived differences between the center and institute
Seven respondents perceived no difference between a
transplant center and transplant institute, one said not
applicable, one said not sure. Of the nine respondents
who perceived a difference, most identified the institute
structure as more autonomous: “one corporate/business
structure”, “greater level of commitment/scope”, “more financial autonomy and authority”, “independent structure
from department of medicine and department of surgery”.
The transplant center was perceived as “many corporations coming together”, “collaborative”, “a hospital entity”,
“more virtual”, as well as “perceived by the public as a
more comprehensive set-up”.
Stark Law as issues will vary depending on the employment model and specific contractual arrangements within
the institution.)
Types of transplants
Twenty institutions provided liver and pancreas transplants,
18 provided kidney, 14 heart, 12 lung, 6 small intestine and
6 bone marrow/stem cell transplants.
Reporting structure
Respondents noted that several types of physicians report to them: abdominal transplant surgeons (common to
90% of respondents), hepatologists (70%), nephrologists
(65%), thoracic transplant surgeons (40%), cardiologists
(40%), pulmonologists (40%) and other (40%). “Other”
was varied and included transplant infectious disease specialists, transplant psychiatrists, transplant intensivists, cardiac surgeons, as well as midlevel providers, pharmacists,
researchers and administrative staff. Four respondents
noted that their reporting structure was “loose”, “matrix”, or
partial. Of reporting structures for the transplant directors,
40% report to the board of trustees/directors, 40% report
to CEO/other chief executive, 35% report to the medical
school dean and 20% report to the chair of surgery. Several
respondents noted that a matrix reporting existed, such as
Board of Directors and Dean or CEO and chair of surgery.
Perceived benefits attributed to transplant structure
Of 18 respondents who listed at least one benefit, types
of benefits perceived included “recognized status within
the institution”, “unified approach in working with the
hospital and medical school”, “better alignment with the
hospital administration”, “academic growth”, “one unified
reporting structure”, “integrated budgeting”, “effective
multidisciplinary care delivery”, “integrated practice information”, “core support groups”, “one-stop shopping”,
“better control and management of contracting”, “better research integration”, “more resource allocation” and
“better marketing”. One respondent said “maybe” benefits included marketing and enhanced resources. One respondent “cannot see any advantage of the current system since it creates many conflicts of interest among
departments/sections”.
Perceived key factors to success
Institutional leadership support (45% [9/20]) and transplant
financial strength (45%) were the two most common factors noted by respondents to be critical in the formation and
success of the transplant enterprise. Other factors mentioned included aggressive contracting, strong customer
service marketing and outreach, quality improvement, clinical outcomes and research.
Challenges to overcome
When starting the transplant enterprise and/or continuing today, the more common challenges reported by respondents included overcoming boundaries/“politics” and
achieving/maintaining autonomy (55% [11/20]), and financial issues/competition for resources (45%). Other issues mentioned included contracting, marketing, outreach,
competition, research and Stark Law. (Fairly complex, in
general the Stark Law prohibits physician self-referral of
patients to an entity that the same physician has a financial relationship with. In our opinion, each transplant entity
ought to engage health law counsel in matters related to
Relation of transplant enterprise formation to
improvements
For survey items on how the formation of the transplant
structure related to specific benefits, responses were favorable in all categories: transplant growth (75%), improved quality monitoring/outcomes (75%), improved regulatory compliance (85%), positive impact on transplant
research (75%) and increased recognition within the institution (85%).
Capital/staffing resources
Source(s) for allocation of resources noted by respondents
were the transplant entity (80%), hospital (80%), department of surgery (10%), or other (20%), which was noted to
include a foundation, university, executive-level committee
and/or a mix of these.
Governance structure
Most (85%) respondents reported having a governance
structure for the transplant enterprise, most commonly
governance by committee (i.e. board of directors, executive committee, advisory board, institute board, steering
committee). Committees comprised institutional executives (CEO, dean, chancellor), department chairs (medicine,
surgery), operational and/or financial executives (COO,
CFO), as well as transplant directors, transplant program
leaders, administrators, etc.
Profit-sharing model related to transplant outcome
measures
Only 30% of respondents reported having a profit-sharing
model with the institution and/or transplant outcome measures. A total of 15% explained they did not have a profitsharing model but had some type of financial bonus or
incentive system.
American Journal of Transplantation
doi: 10.1111/j.1600-6143.2012.04189.x
Transplant Structures
Change for improvement
When asked what to do differently to improve operations,
40% (8/20) cited their preference for a freestanding or independent, autonomous structure. Control of finances and
new positions, alignment of payment and accountabilities
and improved allocation of discretionary funds were examples cited. Seven respondents reported that they would do
nothing differently.
Personal Reflections
This opinion survey of 20 established transplant centers
presents leaders’ views on their transplant organizational
structure. Academic medical centers have been instituting
multidisciplinary care primarily using the horizontal clinical
integration model in which department structures remain
intact (4–7), and few examples of transplant departments
exist in the United States. Of our survey respondents,
one identified the structure as “a department [that] is a
service line [with] all hospital, ancillary and professional
revenue and cost under one business plan’ and another
identified the structure as a service line. Although institutes and centers were the majority, one transplant center
also had an organ-specific transplant institute. Nomenclature alone cannot distinguish horizontal, vertical, or mixed
types of structures, and we did not provide definitions for
program, department, center, institute, or service line. Nevertheless, that 40% of respondents cited the preference
for increased organizational independence/autonomy suggests that complete integration does not exist among all of
the established entities surveyed. Clearly, transplant organizational structure remains a topic of interest for discussion and an opportunity for further improvement.
We elected to survey only established transplant entities
in the United States with at least 5 years of the same
physician transplant director as a means to identify obstacles to and benefits from developing and maintaining
such entities. Most survey respondents felt that formation of their transplant structure was associated, in their
opinion, with improved regulatory compliance (17/20), improved stature within the institution (17/20), growth in
transplant volumes (15/20), improved quality monitoring
(15/20) and increased research support (15/20). In our own
experience, we have found that disease-specific transplant
programs do not always benefit equally from a more integrated structure. Perhaps benefit may be a function of
alignment and coordination between the transplant entity
and divisional/department leaders and certainly their ability to recruit and retain talented staff. Furthermore, the
need for additional resources is only part of the challenge
in smaller programs that do not command economies of
scale. Matching the resource needs with a collaborative
engagement of the organization in terms of effective and
focused recruitment and accountabilities to outcomes is
critical. We believe that it is generally poorly understood
that while a transplant program depends on physicians for
American Journal of Transplantation
doi: 10.1111/j.1600-6143.2012.04189.x
guidance and management, who in turn report to division
and department chiefs, the accountabilities for center outcomes and finance as well as majority of resources relate
to the institution/hospital and its leadership. This duality
ought to be reconciled for better alignment and greater
chances at success.
In its most specialized and differentiated state, transplantation falls within the silos of traditional divisions and departments. The clinical and operational imperatives of transplantation have shown that significant coordination and
collaboration are necessary and critical to success. In between the single specialty (least integrated) and service
line (presumably most integrated) structure lies a spectrum of structures, such as the creation of service integrators (program managers), formation of teams and matrix
frameworks (Figure 1) (8).
Transplant integration may present a challenge to lead up
and down the hierarchy and across silos. Integration in incremental steps has been suggested as a more amenable
strategy to institutions (9). The initiation of change in an
institution leading to the formation of an integrated transplant structure/entity requires substantial effort and leadership with engagement of all stakeholders. In our opinion,
for matrix or horizontal type structures, leadership engagement and relationship building is a continued effort, as the
transplant structure elements with its historical benefits
may not be evident to newcomers to the organization;
such individuals were not involved in the original deliberations and discovery, do not possess institutional memory,
and may come with “new” ideas of how things ought to
run and potentially dismantle work previously done, leading to serious dysfunctions and adverse outcomes. As one
survey respondent stated, “Every time a division chief or
chair changes, same problems [occur] all over again with
buy-ins”. In our perspective, the issues that specialty division chiefs face with recruitment and affiliations of their
transplant staff are not to be underestimated. A heart failure cardiologist may perceive a duality between affiliation
with a heart failure program, a transplant program/institute,
or both. This matrix may apply to other subspecialists as
well. Therefore, collaborations, alignment and integration
efforts should take these issues into consideration and not
present divisions and specialists with conflicting dualities
that cannot be reconciled.
As a process for change, Kotter (10) outlined eight steps:
establishing a sense of purpose and urgency for needed
change, forming a powerful and guiding coalition, creating
a vision, communicating the vision, empowering others to
act, planning for short-term wins, consolidating improvements and introducing more change and institutionalizing
new approaches. Kotter’s report on change management
would be a valuable read for any leader in the transplant
enterprise where change is a recurring theme. At the core
of introducing change is the leadership talent required
from physicians and administrators alike. In parallel with
Abouljoud et al.
Figure 1: Continuum of the organization structure toward service line
integration. (Adapted with permission
from Ref. 8.)
institutional commitment, probably the single most important factor for the successful formation of an integrated
medical and administrative transplant center, institute, or
service line is a leader who has developed and maintained
the respect and trust of all stakeholders. The physician
leader must be clinically accomplished to achieve respect
from the departments and administration.
The process of selecting leaders is sometimes faulty. This
has been outlined by Epstein and Bard (11), who studied the process of leader selection in service lines. They
stated that directives given to service-line leaders were often misaligned with institutional strategic goals, resulting
in the inability to obtain proper resources as well as poor
execution. Leaders were frequently entrenched in matrix
structures that thwarted their ability to secure resources,
manage budgets, hire and promote staff and set enforceable quality and productivity expectations. This resulted in
a scenario of responsibility without authority, which makes
leaders much less effective (11).
Responsibility without authority may explain some crises
within transplant programs that have failed after an initial period of success. In our opinion, leaders needed to
be granted significant organizational currency to succeed
in their roles. In addition, leaders frequently would benefit
from formal leadership training. The lack of leadership training has been recognized by the American Society of Transplant Surgeons, which is being addressed with a primer
in leadership held yearly in collaboration with the Kellogg
School of Management (12).
We find the insight shared by survey respondents valuable
for further discussion at a national level. “Politics” was a
common challenge cited: “we still do not have complete
physician buy-in from [the department] of Medicine”; “opposition from departments”; “animosity and lack of trust
between medical and surgical leaders”; “silo mentality”.
As one respondent shared:
“I was surprised with how divisive formation of an Institute
can be and how rewarding it can be as well. This effort requires a high level of astute leadership and statesmanship
to succeed. It is continuous maintenance. I still believe
that transplant is hospital based and chairs of departments
need to finally accept this fact”.
The academic medical center’s traditional use of the authoritative department structure often presents barriers to
the development of integrated multidisciplinary patientfocused care. Specifically, awarding medical, administrative and financial authority to a transplant entity that is not
a department or freestanding business unit, in our opinion,
appears to threaten other institutional leaders, which may
be the greatest challenge for a new organizational model.
Nevertheless, such barriers can become steps in the process toward change by understanding an institution’s culture and assimilating top-level leadership in the journey
toward change. Engaging departmental leaders in critical
decision making and a transparent process may serve to
encourage participation from all parties.
Transplant medicine by nature is multidisciplinary and
will call upon our skills for collaboration, cooperation and
continued focus on patient-centered care and program
success. Institutional commitment to the formation of a
more vertically integrated transplantation service, such
as a transplant department, usually requires bold executive/committee decisions for integration. This should be
based on clinical excellence and care coordination, service
line financial metrics, funding for dedicated transplant personnel and other resources, and active participation of the
institution’s executive, financial, clinical, operational and administrative leaders to implement the integrated transplant
entity successfully.
As one respondent stated: “Challenges now are the same
as any department, financial mostly—contracts, competition from other centers, reimbursement decreases, salary
American Journal of Transplantation
doi: 10.1111/j.1600-6143.2012.04189.x
Transplant Structures
increases, institutional overhead, competing hospital
priorities”.
This discourse is limited by including only our perspectives
and the opinions from leaders of established transplant
programs. Affiliations included medical school, group practice and private practice, which may add dynamics not addressed by the survey. There may be confounding variables
and simultaneous initiatives leading to success; thus, complete attribution of success to transplant integration efforts
may be limited.
For many transplant structures currently in operation, we
leaders ought to face such challenges with both the responsibility and the authority to affect positive change.
Acknowledgments
M.A. is supported by the Benson Ford Endowment in Transplantation.
Disclosure
The manuscript was not prepared in any part by a commercial organization.
Conflict of Interest
The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of
Transplantation.
References
1. Organ Procurement and Transplant Network. Transplant Center
Members. Available at: http://optn.transplant.hrsa.gov/members.
Accessed May 24, 2012.
2. HRSA Transplant Center Growth and Management Collaborative: Best Practices Evaluation. Final Report. Rockville,
MD: Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation. Available at:
ftp://ftp.hrsa.gov/organdonor/transplantctrgrowth_and_mangmtco
llaborbestpracticesreport.pdf. Accessed May 24, 2012.
3. Kaneku H, Teraski PI. Clinical Transplants. Los Angeles: Terasaki
Foundation Laboratory, 2010.
4. Howard RJ, Kaplan B. The time is now: Formation of true transplant
centers. Am J Transplant 2008; 8: 2225–2229.
5. Levin SA, Saxton JWF, Johns MME. Developing integrated clinical
programs: It’s what academic health centers should do better than
anyone. So why don’t they? Acad Med 2008; 83: 59–65.
6. Barrett DJ. The evolving organizational structure of academic
health centers: The case of the University of Florida. Acad Med
2008; 83: 804–808.
7. Onaca N, Golstein RM, Levy MF, Klintmalm GB. Baylor Regional
Transplant Institute: An update on liver, kidney, and pancreas transplantation. Proc (Bayl Univ Med Cent) 2003; 16: 297–301.
8. Charns MP, Young GJ. Organization design and coordination. In
Shortell and Kaluzny’s Healthcare Management: Organization, Design, and Behavior (6th ed.). Clifton Park, NY: Delmar Publishing,
2010, pp. 64–90.
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9. Axelrod DA, Lentine K, Salvaggio P, Schnitzler M. The promise and
pitfalls of transplant centers. Am J Transplant 2008; 8: 2179–2180.
10. Kotter JP. Leading change: Why transformation efforts fail. HBR
2007; January:1–9.
11. Epstein AL, Bard MA. Selecting physician leaders for clinical service lines: Critical success factors. Acad Med 2008; 83: 226–234.
12. American Society of Transplant Surgeons. ASTS leadership development program. Available at: http://www.asts.org/Meetings/
LeadershipDevProgram.aspx. Accessed May 24, 2012.
Appendix
Transplant Survey Questions
1. Is your Transplant Program designated as a:
• Transplant Center
• Transplant Institute
• Transplant Department
• Other (please describe)
2. Does your Institution consider there is a difference between
a Center and an Institute designation? Please describe.
3. The following organs are included in your Transplant entity
(check all that apply):
• Liver
• Kidney
• Pancreas
• Small Intestine
• Heart
• Lung
• Bone Marrow/Stem Cell
4. List experienced/perceived benefits attributed to your Transplant structure.
5. Please list key factors and/or steps that you feel were/are
critical to the formation and success of the transplant enterprise in your Institution.
6. List challenges you had to overcome when starting your
Transplant Center/Institute, and/or continue to face now.
7. Did the formation of a Center/Institute support/spur transplant growth at your institution?
• Yes
• No
8. Did the formation of a Center/Institute improve quality monitoring/outcome?
• Yes
• No
9. Did the formation of a Transplant Center/Institute improve
regulatory compliance?
• Yes
• No
10. Did the formation of a Transplant Center/Institute have a
positive impact on transplant research (funding, trials, and
publications)?
• Yes
• No
11. Did the formation of a Transplant Center have a positive
impact on the recognition/standing within the Institution?
• Yes
• No
12. As Director of your Transplant Center/Institute, do any of the
following report to you? Please check all that apply.
• Abdominal Transplant Surgeons
• Thoracic Transplant Surgeons
Abouljoud et al.
13.
14.
15.
16.
17.
18.
• Nephrologists
• Hepatologists
• Cardiologists
• Pulmonologists
• Other (please specify)
As Director of your Transplant Center/Institute, do you report
to any of the following? (check all that apply)
• Chair of Surgery
• Dean of Medical School
• Board of Trustees/Directors
• Other
When resources are required (staffing, capital), would they
be allocated from:
• Transplant Center/Institute
• Department of Surgery
• Hospital
• Other
Do you have a Transplant Center/Institute Governance structure:
• Yes
• No
Do you have a profit sharing model with the Institution from
transplant revenue and/or transplant outcome measures?
• Yes
• No
• Other
What would you do differently if you could change things for
better operations?
Additional comments/opinions.
Selection of Respondent Comments
On “Institute versus Center”:
•
•
•
•
•
•
•
•
•
•
An institute should be under one corporate/business
structure. A center may be many corporations coming
together to deliver an integrated product.
Although “center” is a warmer, more welcoming name,
“institution” connotes a greater level of commitment and
expertise, and a broader scope.
Institute implies more financial autonomy and authority
over the personnel.
Institute has its governing structure, while Center is collaborative. However, Transplant Center does have its own
budget and administration.
At our institution an institute has formal participation from
multiple schools (Medicine, Nursing, Public Health, the
College).
An institute connotes something larger than a center, but
no definite definition what that is.
Institute is a separate financial entity and has autonomy
over departments in recruiting, hiring and firing. Our institute is a partnership between university and hospital.
An institute is an independent structure from either the
department of surgery or medicine, the structure and infrastructure are directly budgeted by the hospital, and the
director reports directly to the Dean/CEO of the health
care system.
Transplant Center is a hospital entity which is run by the
faculty from the medical school.
Initially [institute] was seen as a designation of a more
comprehensive set up. Today it is more what is the public
perception—we are going to change to a Center designation after focus groups of professionals and lay people.
•
Institution feels Institute is more encompassing and suggests formation of a working unique and that Center is
more virtual.
On “perceived benefits of structure”:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Shared resources and expertise.
Contracting benefits.
All hospital, ancillary and professional revenue and cost
under one business plan.
Expanded healthcare services throughout hospital. Survival strategy for hospital competing with newer community hospitals. Financial marketing/PR/reputation. Increased level of ancillary services within hospital (lab,
ICU, OR, billing, EMR, radiology).
Unified approach in working with the hospital, med
school.
It has created better alignment with the hospital administration.
Allows point accountability and leadership over all organ
transplant systems to share best practices and support
across the enterprise.
Our center allows each physician to continue to be an
academic and clinical member of their respective departments (i.e. Medicine, Surgery, etc.) yet fiscally be supported without retribution by the center and not be a cost
burden to their department.
Core support groups, such as biostats, informatics, coordinator support, contracting, quality ancillary personnel
(social workers, case managers, etc).
Academic growth.
Effective multidisciplinary care delivery, integrated budgeting, better faculty time management, effective resource allocation from the hospital, better research integration.
Separate cost center, with ability to incentivize surgeons, nephrologists, hepatologists, internists, PAs, clinical nurse specialists . . . great team attitude between surgeons and medical specialists since they are part of the
same organizational program. Shared interest in marketing and coordinated patient care, since sink or swim together . . . . Have high ratings by surgery residents on service, provide medical teaching for medical fellows that
they couldn’t afford otherwise. Made it much easier to
negotiate with hospitals for support as a cohesive program.
All specialties involved housed in one area with one unified reporting structure. All specialists report to Transplant only. For example, Transplant surgeons report to
Chair of Transplant, not Chair of Surgery. All data, both
costs and reimbursement analyzed in Department. Also
use integrated practice information which tracks all costs
and revenue by patient. Therefore capture the true picture of Transplant impact.
Protection of program from supporting less productive
services; ability to reinvest in transplant program; retaining surgeons.
Revenue sharing and autonomy transcending academic
structure.
Cost-efficient, effective communication with the referring medical community, successful contract negotiation,
educational benefits for participants, successful cross organ NIH center grants.
American Journal of Transplantation
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Transplant Structures
•
Marketing (maybe); enhanced institutional resources
(maybe).
• UNOS and CMS compliance, contracting.
• It is a complex system where physicians and surgeons
have their academic appointments from their corresponding departments while they are working in the
Transplant Center. I cannot see any advantage of the
current system since it creates many conflict of interest among departments/sections in regards to revenue
share, power struggle, philosophy and culture.
• One stop-shopping with multidisciplinary team.
• Recognized status within the institution, more than just
a division, now on par with a department.
• More resource allocation. Better control and management of contracting. Better marketing. Presence at the
“table” where major decisions are made. Growth of activities. More administrative support.
On “What would you do differently to improve operations:”
• Laws prevent us from being more efficient. Duplication of
services on hospital vs professional side could be improved
if laws allowed us.
• Increase our independence from hospital governance system
more, such that operations are not hindered by red tape
of various approval committees within the hospital settings
(position control, for example).
• Independent transplant Institute governing all staff working
for it.
American Journal of Transplantation
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•
•
•
•
•
•
•
•
•
•
•
Align authority with responsibility, have more financial autonomy.
We would do better if we had some discretionary funds
for research and clinical needs that we could independently direct rather than only institutionally. Also, more
independent control over marketing for transplant and
outreach.
Allocate discretionary funds.
Profit sharing isn’t quite the right term, but we do want to
expand our financial integration with the Health System. We
have a reasonable model, but it needs to continue to evolve.
We are working on creating a virtual hospital where reporting is up through the transplant program and not matrixed
through other parts of the system.
Form a separate business entity within the institution.
Not sure . . . we have a complicated system with many
“side deals” already in place. These exist within the Department of Surgery and Department of Medicine, and
these compete (and potential support) faculty in both
Departments.
Be a Transplant Department.
Development of “department of transplantation”.
Include all organs.
Become a free-standing department with buy-in from medical team who can make it or break it. Assure payment and
accountabilities are aligned. Assure incentives for transplant
focus on relevant outcomes.