Linking University Medical School with Teaching Hospitals and Health Care Centres – A Framework

1. Linking University Medical School with Teaching Hospitals and Health Care Centres – A Framework Ilkka Välimäki University of Turku, Finland

2. ”Among the objects of human enterprise… none higher or nobler can be named than that which is contemplated in the erection of university” Cardinal J.H. Newman in National Universityof Ireland (see M.Shattock 2003)

3. Contents:Interests of four parties 1. University: research and teaching 2. Academic hospital(AMC): top level medical care and research/development 3. Health care centre: economical primary health care 4. Community i.e. patients: optimal care and cure  significant political passions

4. Two dramatic milestones in history of medicine • 13th century: Artof medicine medical Science • 21st century: advanced medical R&D and new turbulent university climate Economic changes and financial crises in health care

5. university medicine born patients got involved with medical science Arabic medicine fertilized western medical practice licensing of medical practice was started Milestone I: High Middle Ages

6. Milestone II: Evidence based medicine and new University climate in the 21st century 1) pax antibiotica 2) major breakthroughs in • cellular pathology • molecular medicine and genetics • biomedical engineering 3) increasingly limited economic resources 4) increasing academic competition

7. Traditions vs.modern needs of ”New University Climate” • ’medieval’ autonomy, top-down hierarchy • corporation of scholars, slow reactivity • roadmap strategy and fixed budgeting • changing competitive environment, need of fast reactivity and flexibility • competition of ambitious staff and students • no more unlimited resources  diversification of income sources

8. systematic curriculum ambitious successful research impact but faculty of medicine is expensive govermental support does not any more cover the increasing costs of E&R Features of the Medical School in a multi-faculty University

9. Features of Academic Medical Centres (University Hospitals) • offer high quality health-care ”products” • increasing costs economic burden • contribute to clinical research and education • research may not support health care • research often not understandable to decision makers and politicians • patients too selected for basic education(?), need of additional training sites Will current AMC’s be operationally and financially viable?

10. costs of drugs and hospital supplies costs of labour costs of equipment ’very sick’ patients policies in social security and health insurance inefficient economy bad management inability to constrain expenditures, even by legislation etc. Reasons for financial crises in AMC’s

11. Key features of Health Care Centres • HCC maintained by community for the benefit of the inhabitants; it has a key role in management of health care costs! • ”outpatient care is most economical” - is it? only if managed and monitored well • the role of HCC becoming crucially important in teaching of medicine • thus HCC is an important partner of AMC

12. AMC & other health care costs/person in 10 Finnish communities in 2005(Nordic Healthcare Group report 2007)

13. Linking Medical School, AMC and HCCentre, how is it done? • appreciate partnership (overall contribution >> sum of the parts!) • set common goals • use ”new” strategies (broad objectives instead of detailed planning) • use joint managing bodies • apply bottom-up managing, major ideas are bubbling up from practical level!

14. Linking Medical School, AMC, HCC, how is it done? (cont.) • sharing responsibilities is essential • transparent regimes are associated with fairness and production of relevant source data for further operations • collegial, determined management • diversified funding, control of resources development of ”entrepreneurial medical school and AMC culture”

15. A case study How the linking process is carried out between the Medical School and health services in Turku

16. Åbo Lazarett 250 years old • the current Turku University Hospital was established by King Adolf Fredrik of Sweden on the 17th of December 1756 • the 3rd hospital in Nordic countries after Uppsala (1708) and Copenhagen (1756)

17. Law of University Hospitals (1956) • § 45: The university is authorized to make use of the university hospital for teaching and research. • § 46: The university hospital owners have to provide facilities and equipment necessary for teaching and research as well as offices and social space for the teaching staff and students of medicine. • Compensation of extra costs caused by medical education and clinical research to the University Hospital owners is provided through a specified governmental transfer (SGT) by the Ministry of Social Affairs and Health • until 1994 SGT equalled 12% of Hospital budget

18. Turku University medical school makes use of • the AMC (actual University Hospital plus 6 other units of the Hospital Federation of SW Finland) • the Central Hospital in Pori; annex of the Medical School • the HCCentre of Turku city and 25 others in smaller communities

19. The Medical School and AMC have jointly established e.g. • Education Centre for Clinical Skills • Clinical Research Centre (in 2006): ”single counter coordination” and support for clinical scientists, also provides training in GCP • Common ”Science and Research Strategy for 2007-2015”

20. Administration of linking in Turku Med School - AMC • University Joint Venture Board, meeting twice a year (official agreements) • Medical School – AMC Collaboration Board, meeting monthly, chair: Dean • Dean is a consulting member of the Administrative Board of University Hospital, meeting weekly • dedicated committees

21. Medical School 50% Ministry of Education 50% non-governmental Turku University Foundation Acad Med Centre basic financing from public communities owning the hospital Spec.Governmental Transfer 7% from Ministry of Health (E&R support) Turku AMC Fund Funding of Turku Med School and Academic Medical Centre

22. Specified Governmental Transfer and statistics of 5 AMS’s indexed for 1994

23. Remedies for survival of University Medicine? • regular negotiations between university, hospital and communities • partnership! • pragmatic, fast decision-making • entrepreneurial strategies without sacrificing academic values • try to overcome resistance to change, gently...