Table 1.

Initial steps of Integration

Steps	Recommendations
Introspection	Identify all of the academic leaders amongst its contributing (or potentially contributing) departments and divisions. Each of these leaders should evaluate their own academic programs from both budgetary and productivity standpoints. Performance of SWOT analyses for each program may be particularly helpful.
Outreach	Each academic program evaluation should be shared amongst the group of academic leaders within the CCO. Identify potential areas of collaboration. Perform a local analysis of how integration of various programs may affect cost or productivity.
Collaboration	A detailed plan of integration should be developed by the group of academic leaders. The goal of this integration should be to create a shared identity as intensivists. It is important that this collaboration be done in good faith and ultimately create a relationship of trust between the members of the new CCO. It will not always be possible to integrate all programs completely; however the academic leadership should work to find as many areas to integrate as possible.
Communication	Identify key stakeholders who are primary decision makers from an approval, organizational, and funding standpoint (e.g. hospital president, Medical School Dean, Chief Medical Officer, Department Chairs, governmental funding agencies). Stakeholders may be interested in different parts of the academic CCO. Medical school officials may be more interested in research and professional development of faculty, whereas hospital and government officials may be particularly concerned with patient care quality, efficiency, and overall cost. Close communication with this group regarding the plan and progress of integration is essential. Patient care/quality and academic aspects, financial support structure, organizational leadership, and expectations regarding accountability should be presented together. Create a comprehensive plan and present it all at once. This will allow the group of stakeholders to evaluate the entire integration plan in context.