MIKÄ ON YLIOPISTOSAIRAALA ?
• Omasta mielestäni yliopistosairaalan tunnusmerkkejä
ovat ainakin seuraavat: (1) muodollinen (juridinen) status
yliopistosairaalana, (2) yliopiston osallistuminen
sairaalan hallintoon, (3) viralliset ja monipuoliset sidokset
sairaalan ja yliopiston välillä, (4) runsaasti yhteisiä
virkoja (periaatteessa kaikilla erikoisaloilla), (5) laajaa
tieteellistä tutkimustoimintaa, (6) yhteisiä opetuksen ja
tutkimuksen infrastruktuuriyksiköitä, (7) yhteinen
strategia tai yhteisiä toimintapolitiikoita, -suunnitelmia ja
–ohjelmia.
ESITYKSENI VALMISTELU
• Kysyin sähköpostitse n. 20 sellaiselta henkilöltä, joilla
tiesin olevan kokemusta työskentelystä yliopistollisessa
sairaalassa, näkemyksiä ja kokemuksia otsikon aiheesta
eli ”Mikä/millainen on yliopistollinen sairaala ?”. Puolet
vastasi, kolme henkilöä erittäin perusteellisesti – kiitokset
heille.
• Lisäksi ”googlasin” itse eräiden sairaaloiden rakenteita ja
vuosiraportteja + tutustuin uudelleen FinnPron toimesta
laadittuun ”maailman johtavien sairaaloiden”
selvitykseen, jonka HUS teetätti kaksi vuotta sitten
• Lisäksi ”olin utelias ja kyselin” ”urbi et orbi”
• Referoin ja esitän johtopäätöksiä. Viimeistely jäi
”kalkkiviivoille” – panostetaan keskusteluun.
JOHTOPÄÄTÖKSIÄ 1
• Koko aineistossa, johon tutustuin, suuri enemmistö
yliopistollisista sairaaloista oli KAHDEN ERI
ORGANISAATION eli sairaalan ja yliopiston yhteistyöorganisaatioita. Esim. Irlannissa kahden eri ministeriön
(Terveys ja Opetus) alainen valtiollinen toiminta ”kohtaa”
yliopistollisessa sairaalassa, jolle on säädetty selkeä
muodollinen yhteinen toimintamalli- ja organisaatio.
Norjan ja Tanskan malli on samantapainen.
• UK:ssa esim. ”Sheffield Teaching Hospital” on korkealle
rankattu sairaalayhtymä, jolla on yhteistyösopimus 2-4
yliopiston/korkeakoulun kanssa. Sama ”toisinpäin”:
UCSF
UCSF Medical Center + muut sairaalat.
JOHTOPÄÄTÖKSIÄ 2
• On myös ”kokonaan yliopiston hallitsemia” sairaaloita,
esim. Berliinin Charite, ja toisaalta ”kokonaan sairaalan
hallitsemia” tiedekuntia tai Medical schooleja,
ymmärtääkseni esim. Cleveland Clinic
• Hampurissa kaupungin (!) aikanaan omistama
yliopistollinen sairaala on yksityistetty ja opetuksen ja
tutkimuksen järjestäminen on osoittautunut hankalaksi.
• (Sivuhyppäys: Ranskassa on myös sairaaloiden
johtamisen ”Grand Ecole” Rennesissä, nelivuotinen
korkeakoulu jo yhden tutkinnon suorittaneille, sisäänotto
60 vuodessa, V-Sshp:llä ja sitä ennen PPshp:llä oli
yhteyksiä siihen.)
”TAPAUSSELOSTUKSIA”
KÖLNIN YLIOPISTO SAKSA. TIEDOT ANTOI PROFESSORI KLAUS BROCKMEIER:
We have a 'split' budget - one is the income from patient care and there is only scientific activity in terms
of clinical studies (new drugs etc). The revenue belongs to the department in charge (overhead is 510%).
Second is the budget from the government for teaching and science that is distributed
by a key that is related to proportion of personel and activity. This 110 MEuros p/a are also used for the
salaries of all people / material working in the preclinic medical school, maintenance, buildings etc.
In fact there is a complex interaction between the faculty of medicine and the university hospital of
Cologne. Last year the hospital had a positive balance of 4 MEuros and the faculty a negative of 1 ME.
The dean is now providing a plan of how to stabilize the budget - rather successful. Important feature of
Cologne University is the close co-operation with the
faculty of math/natural sciences. There are several new facilities for research/labs and two graduate
schools.
New directors/ full profs are selected by a team of experts of the faculty. However, both directors of the
hospital ( economic&medical) have a vote in the final decision making (also proportions of students and
MDs without a professorship).
Aki Linden, toimitusjohtaja
6
PADOVAN YLIOPISTO (EUROOPAN VANHIN LÄÄKETIETEELLINEN YLIOPISTO, GALILEO
GALILEIN OPPITUOLI SIJAITSEE TÄÄLLÄ). TIETOJEN ANTAJA PROFESSORI ORNELLA
MILANESI
Our Hospital is an University Medical Institution, functioning as a tertiary pediatric care center for the
entire Veneto Region, providing teaching and training opportunities at the pre- and post graduate level
and conducting
clinical and laboratory research. The personnel working in the hospital has or a university (named
Professor) or hospital (Doctor) appointmentOnly people with university appointment can chair a class in the pre and post graduation courses ,
while people with a hospital appointment can cooperate with the university professor, but not chair.
The duties of a university professor are three: taking care of patients, teaching and doing research,
while the duty of a physician with medical appointment is to take care of patients. However most of
them do an excellent research.
Research projects can be funded by the University (Ministry of Education) and just University
professors can apply to them, or by the Veneto Region (Ministry of Health) or by private companies,
like banks (Cassa di Risparmio is a no profit bank) and both professors and doctors can apply to them.
The Faculty of Medicine and Surgery of Padua is made of 8.
University Departments, all with a separate budget, provided by the Ministry of Education through the
Central Administration of the University. Our Department is the Department of Women and Children's
health and comprises Pediatrics, Obstetrics and Gynecology Pediatric Surgery. The chair of the
Department is a full professor, elected between
the chairs of the three different disciplines by all the
Aki Linden, toimitusjohtaja
7
University do.
PADOVAN YLIOPISTO (EUROOPAN VANHIN LÄÄKETIETEELLINEN
YLIOPISTO, GALILEO GALILEIN OPPITUOLI SIJAITSEE TÄÄLLÄ).
TIETOJEN ANTAJA PROFESSORI ORNELLA MILANESI
Overlapped to this University Department there is the Women and Children's Hospital, with a director,
who can be a Professor or a Doctor, depending on and referring to the General Director of the Hospital
Medical Institution. He is elected between all the directors of a Complex Unit (Pediatrics, Pediatric
Cardiology, Psychiatrics, Obstetrics and Gynecology, Pediatric Cardiac Surgery, Pediatric Surgery,
Metabolic Diseases are the Complex Unit) by all the people working in the Hospital.
In the case of my department the chair of the University department and of the hospital is the same
person, Giorgio Perilongo that you met when you came to Padova. The director of the Hospital Medical
Institution, depending from the Minestry of Health and without any teaching duty or activity, is designed in
agreement by the Rector of the University and the President and the Veneto region. At the moment there
is no a parallel position in the University hierarchy, all the University Departments have their different
administration, and their chair. The president of the school of medicine, elected between the full
professors of medicine and supported by representative of the 8 Departmets, has the duty to outline
the strategy of the faculty of medicine and allied faculties. The Director of the hospital medical Institution,
is totally independent from the University in deciding the strategies of the hospital (employment of
MD and other personnel, opening or closings of divisions etc) . In the last months I've participated in a
commission aiming at outlining a more tight cooperation between the University and the hospital authority,
as far as the decisions concerning the strategy of development, and the regional health policy.
Aki Linden, toimitusjohtaja
8
UK, ST EVELYN HOSPITAL/KINGS COLLEGE. TIETOJEN ANTAJA PROFESSORI GURLEEN SHARLAND
Our hospital is linked with King's College London. Another large hospital, King's College Hospital, is
also linked to King's College the university. The hospitals and university work together under the
umbrella of King's Health Partners.
The hospital and university work as separate institutions with separate funding and separate
managerial staff running things. All staff working in the hospital have to provide teaching for medical
students as part of their contract.
Clinicians that do some academic work can apply for paid sessions with the university and get an
honorary contract with university. Usually nowadays one has to generate grant income to get these
sessions paid for. One can also get an honorary contract with the university if one is involved
in alot of teaching for the university.
Clinical academics who do mainly academic work and generate alot of grant income will have their
main contract with university, but can get an honorary contract with hospital for any clinical work.
Funding for research projects has to be applied for through grants. Most consultants that are not
academics will have only 1 hour a week allocated for research which is nothing really.
Professors and academics posts are selected by the university. The hospital can support applications
but the university makes the final decision.
Aki Linden, toimitusjohtaja
9
LUNDIN/MALMÖN YLIOPISTOLLINEN SAIRAALA/SKÅNE UNIVERSITY RUOTSI. TIETOJEN ANTAJA KATARINA
HANSÉUS (HÄN TUNTEE HELSINGIN JÄRJESTELMÄÄ):
We have (had) the same system. In reality research and clinical work is rather
mixed. Since the fusion of Malmö and Lund hospital to Skane University Hospital
the administrations are trying to cooperate more and have a bilateral exchange
system with one rep in all boards from Faculty-hospital board
Medicinska fakulteten – divisionen Avdelning för pediatrik verksamhetsledningen.
A good initiative and I think it has helped at least somewhat to bridge the gaps.
Aki Linden, toimitusjohtaja
10
ZÜRICHIN YLIOPISTO/YLIOPISTOLLINEN SAIRAALA SVEITSI. TIETOJEN
ANTAJA PROFESSORI EMMANUELA VALSANGIAMO-BÜCHEL
Here some information about the relationship Pediatric Hospital and University in Zurich:
Academic activity: lectures and bedside courses in Pediatrics, tutorials and repetitoriums. Our academic staffs can
participate to different working groups and initiatives of the University - this is happening more on an
individual iniative
The Hospital has a total of 7 Chairs (who are official paid by the University). The highest chair is the Chair of Pediatrics,
position coupled with the position of medical director of the Hospital. Other chairs in the different specialities: Infectiology,
Neuroloy, Immunology, Oncology, Cardiology= , Endocrinology
All chairs are member of the Faculty of Medicine of the University Zurich, which have regular meetings during the year
The chair of Pediatric has direct contact and exchanges with the dean and other important persons within the University.
He does not currently have any higher position within the board of the University
There are not any direct representatives of the university in the hospital’s governing body
The University give to the Children's Hospital a certain money budget /year which is then redistributed among the different
chairs. This money can be used for academic activities and research - the amount is usually enough
for travel expenses, ethical fees, small other expenses. Not enough for financing a full research project
- research is financed with grants from the university (application is separate) and from the national (Swiss national found
for research) as well as from grants from private foundations
The professors who have a university chair are elected by an election committee of the University; however the medical
and administrative directors of the Hospital are in the committee ex-officio and have a large influence
Aki Linden, toimitusjohtaja
11
on the choice of the candidate.
UNIVERSITY MEDICAL CENTERS
IN THE NETHERLANDS: WHY AND HOW
Prof.dr. G.H. Blijham
Chairman of the board
UMC Utrecht
Chairman of the Dutch Federation of UMCs (NFU)
THE UNIVERSITY SYSTEM IN THE
NETHERLANDS
• 13 semipublic universities
• 8 with a faculty of medicine
• Faculty of medicine:
– ± 20% of university budget
– ± 25% of the professors
– undergraduate (bio)medical teaching
– preclinical and clinical research
THE HEALTHCARE SYSTEM IN THE
NETHERLANDS
• Private providers (not-for-profit)
• Private insurers (not-for-profit)
• Tight regulation of:
– Patient selection
– Premium
– Budgets
• Currently changes in insurance and budget
system aiming at more competition
HOSPITALS IN THE NETHERLANDS
• 100 hospitals
(16 million inhabitants)
• 20 ‘large’ hospitals
(>500 beds, teaching facilities)
• 8 academic hospitals
(associated with university)
• Few ‘commercial’ out-patient clinics
(<5% of care)
Ministry of Education
University
Academic Hospital
Board of trustees
Board of trustees
Executive board
Executive board
Faculties (deans)
Departments (chiefs)
– students
– teachers
– researchers
–
–
–
–
students
teachers
researchers
patients
Ministry of Education
University
Academic Hospital
Board of trustees
Board of trustees
Executive board
accountability Executive board
for R&E
Dean medical faculty
Medical faculty
membership
Departments
merger
UNIVERSITY MEDICAL CENTERS:
ACCOUNTABILITY
• Various models depending on local
situations
• Allocation of money for research, teaching
and patient care to divisions/departments
• Integration of money flow at the
division/department level
• Contract model with departments based
on performance
• Integrated annual budget and report
UNIVERSITY MEDICAL CENTERS:
INTERNAL ORGANIZATION
• Various models depending on local
situations
• Integration of research, teaching and
patient care in divisions/departments
• Management team of division/department
is responsible for all functions
• 60% of executive board members of
UMCs has a background as professor
UNIVERSITY MEDICAL CENTER UTRECHT:
ORGANIZATION
• Executive Board: 3 members
(prof. of medicine, prof. of neurosciences, economist)
• Central facilities (HRM, Finances, ICT)
• 12 Divisions lead by 1 or 2 professors, 1 nursing
and 1 operating manager.
• Clinical departments, research groups etc with
integrated budget responsibility
University Medical Centers
in the Netherlands
• Mergers of academic hospitals and
medical faculties
• New organisations in 7 of 8 locations
• 60.000 employees,
• Total budget 4.400 x 106
• Integration of care, education and
research at all levels
UNIVERSITY MEDICAL CENTERS:
IS 8 ENOUGH?
• 340 first year medical students per UMC: that´s a lot
• For teaching each UMC needs 5-10 other hospitals
• Geographic spread for specialized and tertiary care is
needed
• Less UMCs than in the USA or Switzerland on
population basis
• Competition fosters quality, in particular in research
• Increased awareness of the necessity to concentrate
some functions
8 UMCs in the Netherlands:
research and development
• 7.500 papers in peer-reviewed scientific journals
per year
• One-third of total scientific output of the country
• 100.000 citations per year, 40% over world average
• High quality of clinical research
• Strong national and international cooperation
• 2000 new clinical research protocols per year
• Active human technology assessment departments
8 UMCs in the Netherlands:
teaching and education
• Medical students (15.000)
• Bachelor and master programs in biomedical
and health sciences (1500 students)
• Ph.D. programs (3500 students)
• Training for medical specialist (2500 residents)
• Training for specialized nursing (3000 students)
• New professionals: physician assistants en nurse
practitioners
• Postgraduate teaching
8 UMCs in the Netherlands:
patient care
• 800.000 new patients/year
• 60% tertiary/licensed care
• 80% of tertiary and 50% of licensed specialized care in the
country
• 10% of secondary care in the country
8 UMCs in the Netherlands:
health care funding
•
•
•
•
Regular budget
€ 1.900
licensed specialized care € 400
Last resort tertiary care € 400
Healthcare R&D
€ 200
€ 2.900 x 106
8 UMCs in the Netherlands:
research and education funding
• Bachelor and master programs
€ 400
(tax money)
• Post initial medical & nursing training € 200
(insurers)
• (Bio) medical research
€ 400
(tax money)
• Third party money
€ 1.500 x 106
€ 500
University Medical Centers:
merging academic hospital and
faculty of medicine
PROs
•
•
•
•
Strategic synergy
Bench-to-bedside alignment
Improved accountability
Less bureaucracy
University Medical Centers:
merging academic hospital and
faculty of medicine
CONs
• “Research will suffer, patient care will
dominate”
• “Patient care will pay for preclinical
research”
• Loss of interaction with other academic
disciplines
• A step toward separate medical universities
Complexity
Phenomenology of hospital care
Tertiary care
Elective highly
specialized care
Basic general
care
Elective simple
care
Predictability
Complexity
University
Medical Centres
UMC’s and large
general hospitals
Community
hospitals
Focussed
factories
Predictability
University
Complexity
R&D
T&E
Disease
oriented
Process
oriented
Symptom
oriented
Process
oriented
Chain
Primary
care
Self-care
Predictability
R&D
T&E
Access for
R&D and T&E
UMC’s and large
general hospitals
Community
hospitals
Focussed
factories
UMCs: ambitions
• The motor of research and development in health, disease and
healthcare
• The breeding site of the health care work force
• The provider of tertiary care in the health care system
UMCs: challenges
• How to maintain research and
development (R&D)
• How to provide teaching and
education (T&E)
• How to guarantee tertiary care for
complex and ‘orphan’ patients (TC)
in a money- market- driven system
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COLLEGE OF MEDICINE AT QATAR UNIVERSITY MAKING HMC THE QATAR UNIVERSITY HOSPITAL
DISCUSSION PAPER AND
WORKING DOCUMENT
23rd of March, 2015
BUILDING UPON THE EXPERIENCE OF HMC, THE COLLABORATION WILL BRING
ALONG SUBSTANTIAL ADVANTAGES FOR BOTH PARTIES
Previous education and research
achievements of HMC
• Originator of Qatar’s academic health system
(AHS) initiative with 8 health education and
research partners, 2011
• Establishment of comprehensive teaching activities
for medical students in collaboration with
– Qatar University Health Sciences and
Pharmacy
– WCMC-Q
– Calgary nursing
• As only 2nd healthcare provider outside the US,
HMC received US accreditation (ACGME I) for 7
residency programs
• High commitment to and profound experiences in
research activities
– During 2013, research investigators at Hamad
received 11 grants
– In 2013, more than QR 3,000,000 was
awarded through internal research grants
for 143 research proposals
Mutual advantages of the
collaboration
Advantages for CMED
• Comprehensive service scope with a
wide range of specialties
• Health care provider with joint interests
in education and research
• Profound teaching experience
including existing infrastructure and
staff
• Access to research infrastructure and
staff
Advantages for HMC
• University status as catalyzer for future
development strengthening research
and educational activities
TODAY’S MEETING FOLLOWS A FOUR STEP APPROACH
Task
Focus of today’s meeting:
1
2
Definition of
affiliation
archetype
•
Scope
Benchmarking of
university
hospital
requirements
•
Establishment of a
long-term
collaboration
towards shared
education and
research objectives
Ensuring a
collaboration model
on ‘equal footage’
•
•
Assessment of
international
examples for
structural criteria of
a university hospital
Derivation of
responsibilities of
both parties
3
Proposed
university
hospital
framework
•
•
Proposed criteria
catalogue for HMC
University Hospital
Proposed
governance
structure
4
Proposed
roadmap
•
Derivation of action
plan to implement
the CMED-HMC
affiliation and
•
derivation of
timelines towards
the formal affiliation
THE FRAMEWORK FOR BECOMING THE CMED UNIVERSITY HOSPITAL
NEEDS TO DEFINE CRITERIA ON FIVE MAIN AREAS
Strategy
•
•
Agreement on core collaboration areas and joint branding
Full strategic alignment of core areas including
development of a long-term education and research
strategy
Universit
y
hospitals
Teaching
hospitals
Teaching
Research
• Min. department
size / max.
program size
• Staff qualification
• Protected time for
teaching
•
Research is not a
priority (for staff
hiring or for
promotion)
• Crossrepresentation
• Installation of
teaching
coordinators and
mentors
• Significant
teaching
commitment, e.g.:
• Appointments
• Evaluation
• Academic
teaching
• Min. research
output for new
appointments
• Protected time for
research
• Joint committees
and decision
making
• Installment of
research
coordinators
• Crossappointments
best
practice
High quality of patient care based in international
•
•
Organization &
governance
HMC to be responsible to ensure highest quality of patient care and continuous improvements
HMC to provide transparency about quality of care in terms of standardized external evaluation processes
WITHIN THIS FRAMEWORK, CMED AND HMC AGREE ON A JOINT
STRATEGY FOR THE UNIVERSITY HOSPITAL WHILE REMAINING
AUTONOMOUS IN THEIR PARTICULAR CORE COMPETENCIES
Joint areas of the University Hospital
CMED
•
•
Full responsibility for
development of the
curriculum
Full responsibility for
academics (incl. e.g.,
staffing, operational
requirements at the
medical faculty)
•
Development of a joint long-term
vision
•
Agreement on a joint branding /
name of the affiliate
•
Full responsibility for
clinical care at HMC
•
Development of a clinical
education and research strategy
•
Full responsibility for
high quality of patient
care
•
Responsibility for
formulation of proposed
clinical education
program in line with
curriculum
•
Agreement on clinical
education program
•
Joint application for
3rd party funding
•
Joint decision making regarding
operational requirements of the
education and research program
(incl. e.g., teaching and research
staff, investments)
HMC
INTERNATIONAL AFFILIATION AGREEMENTS CONTAIN DETAILED
PREMISES REGARDING TEACHING QUALITY AND FACILITIES
Criteria:
German
y
Requirements:
Department size:
•
•
> 4 full-time specialists per department, < 0.5 student placements per full-time specialist
10-15 beds per student placement, > 60 inpatient beds in internal medicine / surgery
Staff qualification:
•
•
PhD of Department Head, higher education qualification of staff members
> 1 central teaching coordinator by faculty
•
Formulated teaching curriculum incl. > 90 min classes / week, demonstrations, case
conferences
Compliance with Logbook and formulated structured evaluation of teaching success
Clinical teaching plan:
•
•
Staff qualification:
•
Austria
•
Clinical teaching plan: •
•
Staff qualification:
UK
Impact
on
CMED HMC
•
Clinical teaching plan:•
•
•
•
•
Provision of a teaching coordinator at the hospital and subject coordinator on specialty
level
Minimum qualification: specialists, participation at training programs of the medical faculty
obligate
Provision of case conferences and radiological demonstrations as well as further trainings
Nomination of mentors on departmental level
Biweekly assessments, feedback sessions at the end of each block, support of the final
examination
Significant teaching commitment, defined as the installment of a non-executive director
appointed from a university with medical / dental school
> 1 practice placement per department
Minimum department size in alignment with expected student numbers?
Higher education of all teaching staff, each department / specialty to be headed by PhD?
Implementation of shared appointment at CMED for all teaching staff members?
Minimum guidance for HMC to formulate a clinical teaching plan?
SOURCES: CMED team; German Society of Medical Education: Quality management of clinical-practice instruction, 2014 / Medizinsche
Universität Wien: Kriterien für die Akkreditierun als Lehr-Krankenhaus der MedUni Wien, 2013 / Association of UK University
Hospitals – University Hospital Trusts, 2014; NHS Act 2006 – Definition of University Hospital Status
AFFILIATIONS INSTITUTIONS ADDITIONALLY REQUIRE TO SHOW
EVIDENCE OF SIGNIFICANT RESEARCH ACTIVITY WITHIN THE
HOSPITAL
Criteria:
UK
Impact
on
CMED HMC
Requirements:
Staff requirements:
•
A core number of university principal investigators (minimum of ten university staff) to be
based on site
Research output:
•
Research output to be Research Excellence Framework
•
•
•
1)
returnable
Minimum number and qualification of research staff?
Definition of share of protected time for research?
Research output:
•
Definition of minimum quantitative output per research staff and year?
•
Definition of minimum qualitative output (e.g., impact, number of citations)?
1) The Research Excellence Framework is a process of expert review assessing the quality of research in the UK;
Criteria are output (in terms of originality, significance, rigor), impact (in terms of effect on / change of economy, society, culture or health), and
environment (in terms of strategy, resources and infrastructure that supports research)
SOURCES: Association of UK University Hospitals – University Hospital Trusts, 2014; NHS Act 2006 – Definition of University Hospital
Status
ENSURES SUCCESSFUL AND SUSTAINABLE IMPLEMENTATION OF AN
AF THE JOINT GOVERNANCE STRUCTURE AND ORGANIZATION
MODEL FILIATION MODEL
Criteria:
Organization:
Austria
UK
Impact
on
CMED HMC
Requirements:
•
Nomination of a teaching and subject coordinators at the hospital by the medical school
•
Governance structure:
•
•
Joint evaluation of teaching success, e.g. through joint final examination at the medical
faculty
Participation of teaching staff of the hospital at teaching programs of the medical faculty
Feedback sessions between staff of the medical faculty and mentors at the hospital
Organization
Shared appointments of researchers at the university hospital and the medical faculty
•
•
Governance structure:
•
•
•
•
•
University representation on hospital boards (e.g., Trust’s Local Awards Committee,
Trust’s Advisory Appointments Committees
Nomination of teaching and research coordinators at the hospital by the medical school?
Appointment of clerkship directors involved in clinical services and supporting clinical students?
Definition of joint committees (incl. chairs, attendees, meeting cycle and responsibilities) and proposed
cross-representation on committee level of partner entity?
Definition of reporting and decision making processes?
Definition of publication guidelines including definition of intellectual property?
SOURCES: Medizinsche Universität Wien: Kriterien für die Akkreditierun als Lehr-Krankenhaus der MedUni Wien, 2013 / Association of
UK University Hospitals – University Hospital Trusts, 2014; NHS Act 2006 – Definition of University Hospital Status
BASED ON INTERNATIONAL STANDARDS, AN INITIAL FRAMEWORK
HAS BEEN DEVELOPED TO BUILD BASE FOR THE COLLABORATION
CMED – HMC (1/2)
Responsibilities of HMC
Category
Criteria
Comment
Strategy
• Aligned strategic plans in core areas (except patient care) and agreement on
KPIs
• Joint responsibility for KPIs
• Alignment about types of academic accreditation sought (e.g., ACGME standards
shared between MD and postgraduate programs)
• HMC needs to have postgraduate training programs
Based on internal
discussions
Teaching
• Minimum department size:
• 4 full-time specialists per department, maximum of 0.5 student placement per
full-time specialist
• Provision of adequate number of workstations
• Provision of access to clinic infrastructure (e.g. staff changing)
• Access to library and internet
• Shared training facilities (e.g. skills lab)
• Minimum staff qualification:
• Higher graduating level within each specialty: e.g, min. of 1 professor
• Joint professional development activities
• Graduating level of teaching staff members: M.D.
• Teaching staff ideally appointed as adjunct lecturer / faculty at CMED
• Teaching program:
• Formulated teaching program based on the CMED curriculum and rotation
program
• Monthly demonstrations in pathology and case conferences
• Minimum of 90 min structured classes per week
Based on
international
benchmarks,
selected most
detailed criteria
SOURCE: CMED team
BASED ON INTERNATIONAL STANDARDS, AN INITIAL FRAMEWORK
HAS BEEN DEVELOPED TO BUILD BASE FOR THE COLLABORATION
CMED – HMC (2/2)
Responsibilities of HMC
Category
Criteria
Comment
Research
• Minimum number of researchers on site and minimum staff qualification
• Minimum qualification for new appointments (e.g. Academic Medical Center
Helsinki: minimum of 20 publications as first, second, second last or last
publisher)
• Reasonable research output (to be frequently assessed by Joint Steering
Committee)
• Publications to be marked as affiliated with QU CMED (ideally all papers)
• Joint PhD program
• Joint research projects
• Joint application for 3rd party funding
• Shared research facilities (e.g. biostatistics)
Based on UK
benchmark and
discussion with Dr.
Anne
Organization
& governance
• Representation of HMC in CMED Steering Committee
• Collaboration with teaching respectively research coordinator through CMED
Based on
international
benchmarks,
selected most
detailed criteria
SOURCE: CMED team
ADDITIONALLY, CMED WILL PROVIDE THE ADMINISTRATIVE
SUPPORT TO ENSURE HIGH QUALITY OF CLINICAL EDUCATION
Responsibilities of CMED
Category
Criteria
Strategy
• Development of an overarching strategic plan for CMED as baseline for joint
activities with the University Hospital
Teaching
• Appointment of clerkship directors involved in clinical services and supporting
clinical students (12-15 in total)
• At least one clerkship director for each phase of clinical clerkships (10
clerkships planned)
• 20%-50% patient care
• 50% teaching
• 0-30% research involvement
• Establishment of master programs for developing clinical staff at HMC
Research
• Nomination of at least one research coordinators per major department in the
hospital (12-15 in total)
• Research support group within the hospital to support development of research
projects, connect with researchers at QU, and provide methodological support
(e.g. statistics)
Organization
&
governance
• Establishment of a Joint Steering Committee
• Representation of the CMED on HMC board level
• Abdullatif appointment
SOURCE: CMED team
Comment
Based on input
management
team meeting
FIRST PRIORITY IS TO INSTALL THE COLLABORATION ON RESEARCH
ACTIVITIES WHILE IMPLEMENTING THE TEACHING FACILITIES
Today
Teaching Agreement on
activities affiliation model
Assessment
of current
state
To be
defined
Implementation of criteria for
teaching hospitals
Development of
research
program
Research
activities
Milestones
Winter
2015
Start of
implementatio
n process
SOURCE: CMED team
Gap analysis
and
implementatio
n plan
HMC to
become
designated
university
hospital of
CMED
Feb. 2019
To be
defined
Start of clinical education/ Final
implementation of teaching
requirements
Start of joint
research activities
First batch of
students to
start
clerkship
Re-assessment
of university
status in “steady
state” after 3 – 5
years
NEXT STEPS
•
•
•
•
Internal discussion of criteria catalogue and incorporation of feedback
– Review trough management team, meeting planned on Monday, 23rd of March 2015
Alignment with EMC
Discussion and alignment with HMC
Preparation of assessment of current status
CLEVELAND CLINIC
22.6.2015
78
CLEVELAND CLINIC
22.6.2015
79
CLEVELAND CLINIC
22.6.2015
80
STRATEGINEN ALLIANSSI
•
•
•
•
Strateginen allianssi tarkoittaa molempien (tai useampien)
osapuolten tärkeänä pitämää yhteenliittymää, joka perustuu
yhteiseen strategiseen näkemykseen ja ainakin osin yhteisiin
rakenteisiinkin.
HUS-näkökulma: olemme jo strategisessa allianssissa HY:n ja sen
lääketieteellisen tiedekunnan kanssa, mutta meidän pitää mennä
yhdessä eteenpäin: yhteinen toimintasuunnitelma (tutkimusstrategia on hyvä, mutta ei riittävä), ja lisää yhteisiä rakenteita.
Nostettava vakavasti esille UMS –vaihtoehto !
Tiedostettava myös haasteet: yliopistosairaalalla on kalliimpi drgpisteen hinta kuin muilla sairaaloilla ! HYKS 741 €, Muut HUSsairaalat 618 € - 671 €. Myös THL:n Benchmarkig osoittaa tämän.
VALTAKUNNALLINEN YHTEISTYÖ UUDELLE TASOLLE !
•
•
Vaikka kilpailu potilaista ja tertiääritason keskuksista on todellista,
ovat yliopistosairaaloiden yhteiset intressit suuremmat. Yhteistyö
tulee nostaa uudelle tasolle. Muutamia vuosia sitten oli puhetta
yhteisestä organisaatiosta/resurssista, tähän tulisi palata.
Sote-lain tämän hetkinen valmistelu osoittaa, että
yliopistosairaaloiden asemaa ei ymmärretä ja ne nähdään jopa
”mustina aukkoina”, jotka edustavat hallitsematonta
medikalisaatiota. On toki itsekin oltava kriittinen omaan toimintaan
nähden, mutta väärät uskomukset on päättäväisesti korjattava ja
lisättävä lobbausta ja tiedonvälitystä kaikilla tasoilla.