Multiple Strategies of Change

To the Editor: A reader of our article "Reengineering Clinical Psychiatry in Academic Medical Centers: Processes and Models of Change" in the January issue (1) contacted us about his concern that it painted too simple a picture of the strategies used at certain medical centers. The article describes seven models of change that have been used by academic departments of psychiatry to adapt to the rapidly evolving health care environment.

In our article we cited departments that have employed each model. However, we think it is important to clarify that most of these departments have used more than one approach. For example, multiple strategies have been used in the departments of psychiatry at the Medical College of Wisconsin, the University of Cincinnati, the University of Illinois at Chicago School of Medicine, Montefiore Medical Center and the Albert Einstein School of Medicine, Dartmouth College, the University of Connecticut, Wake Forest University, and Yale University. These departments are only a few of those that could be cited.

The combination of strategies selected by a specific department is influenced by many factors, including the interests of department leadership and faculty, the characteristics of the host medical school and university, and the nature of the state and local health system. Readers who wish to learn how the various models of change have been combined should consult the case studies cited in our article or contact the faculty members who have been reengineering clinical psychiatry at these and other departments across the country.