Hospital-Based Integrative Medicine

Hospital-Based Integrative Medicine: A Case Study of the Barriers and Factors Facilitating the Creation of a Center

Ian D. Coulter
Marcia A. Ellison
Lara Hilton
Hilary J. Rhodes
Gery Ryan
Copyright Date: 2008
Edition: 1
Published by: RAND Corporation
Pages: 192
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  • Book Info
    Hospital-Based Integrative Medicine
    Book Description:

    This study tracks the establishment of a single hospital-based integrative medicine center. Although some factors clearly worked in favor of the center, the hospital had few models to guide it and no experience in creating such a clinic. Thus, it made many decisions in the areas of administration, finance, and legal issues that created barriers to the center's success, and the center was ultimately closed.

    eISBN: 978-0-8330-4819-6
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-x)
  4. Figures
    (pp. xi-xii)
  5. Tables
    (pp. xiii-xiv)
  6. Summary
    (pp. xv-xviii)
  7. Acknowledgments
    (pp. xix-xx)
  8. CHAPTER ONE Introduction
    (pp. 1-14)

    The overall goal of this in-depth case study was to document the barriers to and facilitators of integrating biomedicine and complementary and alternative medicine (CAM) in a hospital-based integrative medicine (IM) center. The process of establishing an IM center in a hospital brought to the forefront long-standing tensions and changing attitudes of biomedical and CAM practitioners, and highlighted the factors that impede or facilitate integration. An IM center represents two distinct medical systems and philosophies. Biomedicine, with its disease focus and fairly homogeneous, vertically organized hierarchy of specialists and generalists, traces its philosophical roots and practices to rationalistic, quantitative western...

  9. CHAPTER TWO The Study
    (pp. 15-34)

    The emergence of centers of integrative medicine is well documented in the literature. Several points remain unclear, however. What is a center of integrative medicine? To what extent is it integrated with mainstream medicine? What factors are likely to facilitate or inhibit such integration? Although no in-depth independent analysis has been done of any single functioning center, we can study an integrated center by considering it a service delivery component embedded in a larger health system. Such systems can further be represented as a network of individuals (or stakeholders), and we can study how they interact with each other in...

  10. CHAPTER THREE Creation and Development
    (pp. 35-52)

    We tell our story chronologically in three phases: first the creation, then the operation, and finally the demise of the center. Like any complex story, this one has twists and turns, and resists reduction to a simple plot. This is not a story of either success or failure but one of successes and failures. It is a story from many perspectives—people who have quite different interpretations of events. It is a personal story, one that could be told as a story of individuals. It is also a partial story: No research methodology can hope to capture the whole story...

  11. CHAPTER FOUR Implementation and Operation
    (pp. 53-82)

    In this chapter, we describe the implementation of the chosen model and present a profile of the center at the peak of its operations, between 1998 and 2001.

    The center’s administrative structure is shown in Figure 4.1. The center was located in a foundation that existed in the hospital. The foundation (originally modeled after the Howard Hughes Medical Research Foundation and the Gladstone Foundation) was instituted by the board to give programs more flexibility. It provides an umbrella for two local but geographically noncontiguous medical groups and offers shelter from the Stark regulations¹ by housing hospital-affiliated programs as physician-owned professional...

  12. CHAPTER FIVE The Demise of the Center
    (pp. 83-90)

    Two years into the center’s existence, the financial losses were such that the hospital administration began the process of shutting down the center and the corporation. The program was restructured within the Department of Medicine in 2001 and ceased to exist as an independent center at that time.

    Despite the board’s insistence that loss-leader programs can be supported if they meet a perceived community need, programs that fail to contribute to overhead are more likely to be eliminated, especially given the hospital’s current financial shortfall. In 2000, the first step in attempting to turn the center around financially was to...

  13. CHAPTER SIX Evaluation
    (pp. 91-140)

    In Chapter Three, we told the story of the planning for the integrative medicine center (IM center); in Chapter Four, we described the implementation and operation of the center; and in Chapter Five, we told of the center’s ultimate closing. These chapters were intended to be primarily narrative and descriptive. In this chapter, we present an evaluative discussion of the results of our stakeholder analysis. We assess outcomes and the impact of the decisions and forces that shaped the center’s creation, operations, and eventual demise. These results form the basis for our conclusions in Chapter Seven.

    Legal issues were responsible...

  14. CHAPTER SEVEN Conclusions: Facilitators and Barriers
    (pp. 141-150)

    The distinction is blurred between facilitators of and barriers to the center’s success. Over the evolution of the IM center, factors that helped make it an attractive concept ultimately hindered its sustainability. To appreciate this paradox, we summarize the facilitators and barriers.

    Some factors clearly worked in favor of the IM center. The first was the perception of strong support from the board of directors, although support was, in fact, limited. The sense that the program was a board initiative heightened its acceptability in the hospital community. A second factor that aided success was the hospital’s reputation. Another attractive characteristic...

  15. APPENDIX A Expert Panel
    (pp. 151-160)
  16. APPENDIX B Brief Time Line
    (pp. 161-162)
  17. References
    (pp. 163-172)