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The Costs of Decentralization

Two recent Cornell news items recently crossed my news feed, and I think both really stress the need to 'reimagine' Cornell beyond simple cost-cutting and streamlined procurement procedures to centralize a lot of the academic units at Cornell. Coincidentally, they both deal with issues of healthcare and health policy, another subject matter that needs more centralization as opposed to an overly bureaucratic, de-centralized system.

The first is in regards to an ILR-sponsored conference on health care policy reform and the Affordable Care Act. President Skorton spoke:

"I do think it's a very important time for ILR and Cornell to step up," Skorton said. "The world of work is superimposable on health care. ILR is very well suited to ask the questions, to listen to others ... to develop and test hypotheses and move forward" as the nation grapples with improving the ways health care is delivered.

Successful reform demands listening to each other and to workers in the midst of delivering care, he said. "It's very important to listen to frontline workers ... they have the knowledge, experience and chance to be responsive" to patients.

As a land-grant university, Cornell is ideally suited to facilitate health care reform by blending academic research and day-to-day applicability, Skorton said.

Sessions on patient safety, electronic medical records, the role of unions in improving patient care and other issues were also held at the conference, co-sponsored by Cornell's Clinical and Translational Science Center, the Business and Labor Coalition of New York, Cornell University Cooperative Extension New York City and Weill Cornell Medical College. Funders included ILR's Pierce Memorial Fund and Cornell University's Institute for the Social Sciences.

And the second pertains to a recent announcement that the Hotel School is planning on developing an institute to study the long-term care arrangements of our nation's elderly:

Cornell University is developing plans for a major new project on Route 96 that could include senior housing, offices, small-scale commercial, and an institute for its hotel school.

Cornell owns 35.86 acres on Route 96 between Overlook apartments and the West Hill fire station. Though plans are still preliminary, Cornell is looking to partner with developers Conifer LLC to build 72 senior living apartments and 60 assisted-living units for low-income seniors, Town Supervisor Herb Engman said.

Cornell Real Estate Director Tom LiVigne said the hotel school has not yet been decided on the exact size and shape of a new institute building, but it would study issues related to seniors in terms of food service and housing, and likely interact with the on-site senior housing.

What's striking is that Human Ecology's Policy Analysis and Management Department, complete with experts in health economics, and its complementary Sloan Program offering a Masters in Health Administration are nowhere to be found in either news clipping. It's odd, of course, because you would think that the nature of these program would make them want to be part of the discussion. And likewise, you would think that ILR and Hotel would want them to be as well:

(The MHA) degree prepares future leaders in health management with the knowledge and skills in management, health care organization, policy and public health to manage health care organizations and promote quality, access, efficiency and innovation in health care delivery and financing.

I know I'm starting to sound like a broken record, and I wrote about this last year, but the sooner Cornell reorganizes its applied social science departments into broader business/management and public policy/public health units and unites them with cross-disciplinary centers and institutes, the stronger Cornell will be as a university.

Late Update: Reader AF writes in to point out that Dartmouth College is implementing a cross-disciplinary center studying the modalities of health care delivery. From Inside Higher Education:

Today (Dartmouth President) Kim launches the Dartmouth Center for Health Care Delivery Science, which will serve as a hub of instruction, research and advocacy on the college’s Hanover, N.H., campus. “We think that health care is one of the greatest issues and is something that our students should learn about,” he said. “It’s also one of the really large problems we at Dartmouth have the capacity to tackle.”

The center's courses, research and advocacy work will include students and faculty from Dartmouth Medical School, the Thayer School of Engineering, the Tuck School of Business, the Dartmouth Institute for Health Policy and Clinical Practice, and the college’s arts and sciences division. It’s funded by a $35 million gift from an anonymous donor, who Kim described as “a health care consumer like the rest of us who understood the great problems in health care delivery and shares with us our sense of urgency.”

It's striking because Dartmouth's new center purposefully unites all of its different academic units together for a common good.

Matthew Nagowski | Posted on May 16, 2010 (#)

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