The leadership and management of academic health centers are increasingly in the spotlight during these uncertain times at the dawn of the 21st century. Many business leaders and management experts have openly recognized the more complex array of challenges that face chief executive officers of academic health centers (AHCs) compared with those faced by the average corporate leader. It has been repeatedly shown to be exceedingly difficult to implement standard business management strategies within the environment that has evolved from the deeply rooted culture of American university-based AHCs.

Great leaders are often depicted as shepherds, but great shepherds lead flocks of sheep or cows, accustomed to work together in going where the shepherd leads. Great shepherds do not shepherd cats, but herding cats is in fact one over-simplified way of describing the leadership and management challenge facing AHCs. We need leaders and management tools that can get cats to work as a team for institutional goals. AHC leaders need to create an organizational culture with incentives sufficient to sustain required integration. The culture must foster coordination and collaboration not only among individual cats, but also among the several species of cats composing the various silos typical of our academic centers. How to herd academic health center cats is one of the themes this book addresses.

Clearly, many changes have occurred and much progress has been made over the past decade in re-shaping our academic organizations to meet their challenges. We must not lose sight of that.