The Metro Firm System: meeting the challenges of a changing health care environment

Changes in the health care system and especially in reimbursement systems are creating new challenges for all hospitals. These challenges are particularly critical for academic medical centers. The traditional (inpatient) teaching base is threatened by changes in the case mix of patients entering hospitals and by the associated decreasing lengths of stay. The effects of the new financial pressures are intensified in academic centers which have been shown to be less efficient and more costly than community hospitals. This paper describes the formation and evolution of the Metro Firm System, an organizational structure which is adapting to the changing demands placed on an academic medical center. Inherent in its structure is the ability to evaluate easily and rigorously changes that have been suggested in the system prior to implementing them. Operational details essential for understanding functions of and interrelationships within the system are included.