Academic Medical Centres
Academic Health Centres An Academic Health Centre (AHC) consists of a medical school or university, one or more other health professional schools or programmes (such as allied health, dentistry, graduate, nursing, pharmacy, public health), and one or more teaching hospitals or health systems. The underlying objective of the AHC concept is to improve the health of people by advancing the leadership of academic health centres in health care delivery, health professions education and biomedical and health services research.
In an AMC the School of Medicine, with its responsibility for the initial training of physicians and for scientific research, is merged with the teaching Hospital, with its responsibility for tertiary care and clinical research and innovation.
In the US, Canada and Australia academic medical centres are the norm Established centres of excellence in patient care, education and research. In Europe, many internationally recognised medical and teaching centres have developed into academic health centres, or are in the process of doing so, to capitalise on the potential benefits to patient care, education and research The Netherlands took perhaps the most revolutionary step when they created University s by placing eight hospitals under the arm of the local universities in 1996.
The way in which academic health centres are organised varies considerably. However, they all encompass the three core functions of any academic health centre (patient care, education and research). If you have seen one academic health centre, you have seen one academic health centre!" Victor Dzau MD, chancellor for health affairs at Duke University and president and CEO of Duke University Health System
Organization of academic medical centres Multiple models Partnership or unitary management structure University owned, university managed or university shared governance Key leadership positions jointly decided Clinical leadership always within a university-led hierarchial framework and with a very clear leadership/governance structure Tripartite mission always central
The model Uniquely integrated leadership and management throughout Research and education embedded with clinical services Patient Care Joint appointments and programmes Education Research Integrated strategic, operational and capital planning
Irish Government policy Consolidate acute services and specialties around a limited number of major acute teaching hospitals for reasons of patient safety, quality assurance and economic use of specialist resources and high cost equipment. This is evidenced by a number of recent policy and strategy documents including Children s Health First (2006), Strategy for Cancer Control (2006), Report of the National Task Force on Medical Staffing (2003) develop a small number of centres of world significance in translational health research as emphasised by the recent government Strategy for Science, Technology & Innovation 2006-2013 establish clear and transparent governance structures between teaching hospitals and their associated university, underpinned by clear and explicit legal agreements Fottrell report on medical education be competitive for available research funding from a range of Government agencies (SFI, HRB, etc.) and to be able to demonstrate value for money incentivise hospital-university interaction and the integration of research and clinical practice
Strategy for Cancer Control, 2006 there are some consistent trends in evidence that show that most countries are now seeking to develop cancer control programmes that enable care to take place in centres characterised by high caseload, earlier access to care, multidisciplinary care, integration of care delivery, availability of sub-specialty expertise, availability of support services (e.g. intensive care, specialist nurses, specialist therapy services, support services), availability and quality of technology, and the existence of training and research facilities.
Are academic medical centres relevant to Government policy? Towards better health: achieving a step change in Health Research in Ireland, 2006 The report of the Advisory Council for Science, Technology and Innovation, clearly points to the need for further hospital-university integration. For Ireland to optimise the social and economic returns from research, the council believes that clearer governance structures need to be developed between hospitals and universities, and that incentives should be offered to reward hospitaluniversity interaction and the integration of research and clinical practice.
Strategy for Science, Technology & Innovation 2006-2013 The Strategy for Science, Technology & Innovation 2006-2013 stipulates that a strong research culture is vital if the health service is to offer a world-class standard of care to patients and retain professionals of the highest quality The system also needs to harness research to find better ways of improving the health of the population and delivering more efficient and effective healthcare. SSTI sets out the Government s commitment to: Develop a small number of centres of world significance in translational health research, each with strong foundations in both academia and the health services
Delivering translational medicine What is translational Medicine? Most specific definition: "bench-to-bedside" research wherein a basic laboratory discovery becomes applicable to the diagnosis, treatment or prevention of a specific disease is brought forth by either a physicianscientist who works at the interface between the research laboratory and patient care or by a team of basic and clinical science investigators. Wider definition: spectrum of patient-oriented research that embraces innovations in technology and biomedical devices as well as the study of new therapies in clinical trials. It also includes epidemiological and health-outcomes research and behavioral studies that can be brought to the bedside or ambulatory setting.
In the absence of translational and patientoriented clinical research, delivery of medical care would remain stagnant and uninformed by the tremendous progress now taking place in biomedical science. Thus, translational medicine represents a unique aspect of academic medical centers the prospect of improving current health care through state-of-the-art translational research and medicine
The Gap We have high quality research-intensive Universities Internationally ranked Leaders in innovation We have high quality teaching hospitals with internationally qualified specialty care This has not translated into Improved health care outcomes Significant commercial growth in biomedical industries
Closing the gap Our goal is to improve patient care by closing the gap in the pathway between research/education and clinical services. The Academic delivers A culture of inquiry that emphasizes quality at every point translation of new medical advances into everyday practice translation of basic and clinical research into ideas and products
Dublin Academic Medical A formal Partnership between UCD School of Medicine, Mater Misericordiae University Hospital and St. Vincent s Hospital Group to create a academic health centre focused on delivering excellence in patient care, research and education. Centre Education Patient Care Research
Development of DAMC July 2006 to February 2007, the concept of an AMC for Mater Misericordiae University Hospital, St Vincent s Hospital Group and UCD School of Medicine and Medical Science (UCD SMMS) was formally examined by a representative Working Group. Proposal reviewed and accepted by Boards of both hospitals and GA of University Memorandum of agreement signed by chairs of hospitals and President of UCD in Sept 2007. DAMC incorporated as legal entity (Company limited by guarantee) in May 2008 CAO appointed
Why Dublin Academic Medical centre? Teaching hospitals that seek to excel and lead in delivering quality patient care, must take a holistic and encompassing view of their core activities patient care, education and research. Hospitals that want to provide excellent, leading edge patient care must be involved in research and education. They need to be able to harness the latest knowledge in medical science and the most appropriate and up to date treatments and techniques, and apply them to patient care.
Forming Dublin Academic facilitates more effective strategic planning in relation to patient care, education and research; the strategic deployment of resources and the development of shared services should increase access to, and the quality of, patient care. Increased collaboration, specialisation and sub-specialisation within the framework of DAHC will contribute to superior patient service and outcomes. Critical mass of consultant skills Greater use of multidisciplinary teams
A centre for specialist care, diffusing excellence through clinical networks There is strong evidence that specialist units performing larger numbers of cases achieve better health outcomes, particularly with more complex work. We aim to provide leading specialist care, while continuing to serve our community with a range of services These specialist areas will include those where UCD has a leading research presence, such as pulmonary diseases, diabetes and obesity, cardiovascular disease, chronic inflammation including musculoskeletal disorders, and infectious diseases.
Research The formation of Dublin Academic Healthcare will facilitate a strong research culture, provide a critical mass in research programmes, and facilitate rapid and effective transfer of research ideas into clinical practice.
Education Educating world class doctors and other healthcare professionals requires access to a wide range of medical specialties, services and patients, and to internationally recognised academic clinicians. Functional AHCs generate a culture of enquiry Unwilling to accept good enough Facilitates critical self-review and audit Develops evidence based medicine as the basis of practice Allows the AHC to generate the evidence
Delivering Patient Quality and Safety Successful AMCs focus on the patient experience Provide robust clinical governance structures Provide the research culture to selfanalyse research and trial new approaches and technologies to reduce human error and improve patient care Develop and publish the benchmarks for patient outcome in all areas
Delivering innovation Results of research taken to next level Collaborative studies with industry Patents, spin out companies or other forms of validation of scientific discovery Innovation in clinical therapeutics or diagnostics However AMC s can also produce innovations in the process of care delivery, Hospital setting, primary care or nursing home care. Innovations can be thoroughly evaluated before becoming standard practice and their value in improving outcomes for patients or in reducing costs can be critically assessed. AMCs function as the R&D arm of the Health care system.
Phased development Establishment of an entity such as DAMC involves very substantial changes in staffing, operational practice and structures. A phased development was determined would enable the three founding institutions to establish DAMC in a short timeframe in order to respond to the immediate developments in the sector. Phase 1 DAMC would assume responsibility for medical education, research and establishing joint medical departments for each specialty, with clear clinical governance guidelines. Phase 2 Once DAMC is well established, its role and functions would be expanded to encompass all clinical care and clinical service. All departments would become joint clinical departments (i.e. including nursing staff and other health professionals).
Governance of Dublin Academic Medical Centre DAMC will have: a Board (consisting of representatives from each of the 3 institutions, and independent Board members) responsible for developing DAMC to its full potential a Chief Academic Officer (CAO), recruited by and reporting to the Board of DAMC, responsible for clinical and academic leadership, and oversight of the joint medical departments clinical and academic leaders for each joint medical department a joint Medical Committee chaired by the CAO and consisting of clinical and academic leaders from each joint medical department
University Hospital Dublin Academic Academic Council Governing Authority President & SMT College Principal Hospital Board(s) Head of School & School Executive Medical Executive CEO Academic Governance Division Department Subject Centre Operations Management Clinical Governance Clinical Department Clinical Department Clinical Department Clinical Department Operations Management
Clinical Governance The objective of DAMC Phase 1 is to create joint clinical departments across the two hospitals and the university. These Departments will be subject to (i) clinical governance through a joint medical board and the CAO (ii) academic governance and management through the UCD School of Medicine and the CAO (iii) healthcare operational management through the hospital management structures and the CEOs
Medical Governance DAMC will also integrate medical (consultant and NCHD) staffing across MMUH and SVHG to: develop sub-specialisation within each speciality establish joint medical departments across MMUH and SVHG, with both clinical and academic missions as appropriate, appoint consultant staff with sessions across DAMC affiliated hospital sites as appropriate, rotate NCHDs across the different sites for training purposes establish clear clinical governance guidelines
Academic Council Governing Authority President DAMC Phase 1 DAMC Board Chief Academic Officer Board CEO Joint Medical Board Board CEO Head of School Operations Operations Joint Clinical Department Joint Clinical Department Joint Clinical Department Preclinical Sections Clinical Sections
UCD President & Governing Authority MMUH Board of Directors SVHG Board of Directors DAMC Board of Directors August 2007 College Principal Chief Academic Officer September 2007 Head of School & School Executive MMUH Medical Executive SVHG Medical Executive DAMC Medical Executive March 2008 Division Joint Clinical Academic Department Departments / Directorates Department Ongoing Division Department Department Division Department Department Division Department Department DAMC Governance Structures
Additional Considerations in developing governance Balance Clinical Care, Research & Education priorities Effective communication across all sites Clarity on internal and external relationships Alignment with UCD Structures Future proof for Phase II (Nursing et al, Other hospitals) Recognise HSE strategy (e.g. Clinical Directors, Primary Care Strategy, Cancer strategy)
Research and Education DAMC will manage medical educational activities within the two hospitals undergraduate, intern and postgraduate including the development of postgraduate fellowship programmes. All NCHD posts will be DAMC DAMC will manage, develop and advance translational research infrastructure and translational research programmes for the three partners. Appointment of two existing consultants to a dedicated commitment as Director of Translational Medicine and Director of Medical Education.
Cancer Both MMUH and SVUH designated as cancer centres in national Strategy DAMC goal of a single Comprehensive Cancer Center across the campuses Establish a single governance structure and a single strategy Engage with NCCP as a single organizational unit with uniform policies and procedures Preparing to consolidate certain services along strategic lines Opportunity for recruiting, education and research
Improving health in Dublin Preventative and Interventional Public Health Develop close links with Primary Care Centres Leading role in clinical networks in diabetes and obesity, vascular disease and stroke, pulmonary disease, musculoskeletal disease Research opportunities in Health Innovation and prevention
DAMC phase 2 Once DAMC is well established, its role and functions should be expanded to encompass all clinical care and clinical services All departments will become joint clinical departments (i.e. including nursing staff and other health professionals).
Structural challenges in Irish context Evolution from multi-purpose institutions to Centres of Excellence Size of Ireland such that there will be a limited number of centres of excellence Likely to organized around diseases/disease activity E.g. Cancer, Cardiovascular Disease, Inflammatory diseases, Neurosciences, mental health Institutions will need to make strategic decisions
Medical challenges in 2020 Ageing population Cancer Degenerative diseases Disability New technologies Changing expectations Public less willing to accept good enough Best possible care/close to home/ in community Different regulatory environment Re-emergence of infectious diseases Antimicrobial resistance Globalization
Predicting the future Ireland will reorganize its Health Service increasingly along the lines recommended for over 30 years (starting with Fitzgerald report) Centres of excellence built around research based Medical Schools 3 AHCs in Dublin Cork Galway
Predicting the future Everything that will be invented has been EF Pender 1898 director of US Patent office recommending its closure to Congress No one s going to pay to hear actors talk Harry Cohn, Chairman Warner Bros Studios 1928 Predictions are difficult, especially when they involve the future Attributed to Dan Quayle, US VP 1988-1992
Questions? Comments?
DAMC Mission To improve the health of patients and the population, and provide excellent training to healthcare professionals, by purposefully linking treatment, teaching and research capability Our hospitals have distinguished traditions in healthcare delivery to their local communities, the Dublin region and throughout Ireland. UCD is the largest educator of medicine, nursing, radiography and physiotherapy students in Ireland. We will consistently pursue excellence and innovation in the education of health professionals; the discovery, dissemination and utilization of new knowledge; the provision of highest quality patient care; and the promotion of health.