 In Spring of 2011, NCHL developed a joint operating agreement with Rush University Medical Center and the Griffith Leadership Center of the University of Michigan School of Public Health.The agreement was pursued in recognition of changing healthcare leadership development needs associated with the implementation of the Patient Protection and Affordable Care Act.In 2013, NCHL's programs were expanded to include the US Cooperative for International Patient Programs, an organizational membership program with a mission to expand global access to US expertise in high-quality healthcare.