Getting on to ‘the factory floor’

In a personal view article, Michael Hanna explores whether Academic Health Systems would work in the Irish context.

Health services and third level education institutions are in the middle of enormous challenges and there is no let up in sight.  Academic Health Centres or as I shall call them here, Academic Health Systems (AHSs), have often been born out of situations of extreme adversity – and they have worked. Could they work for Ireland?

Michael Hanna
Michael Hanna

In Health, delivery, education and research are all intimately connected. Quality health education builds a quality workforce. An innovative health service provides increased opportunities for R & D. A well run hospital offering reputational advancement will attract the best staff. Articulate patients will provide critical feedback for institutional improvement. In corporate terms health, education and delivery are businesses with a good fit.

If this is valid, then why have we been so slow to explore new corporate structures in Ireland? The AHS model is not a panacea and on occasion things have gone wrong (mainly in the US) – maybe that is part of the reason – but in such cases, the positives have been so strong that problems have been worked through and solutions found. Europe has been slower into the field and has learnt from the US experience so risks are less.

In Ireland we have six medical schools, each associated with other health profession schools and each with one or more acute hospital groups. Heads of these professional schools meet regularly. R.C.S.I. has a successful track record in running health and education facilities overseas. UCD and RCSI  have been involved in Penang Medical College, Malaysia for over 10 years. NUI Galway and UCC will this year admit the first cohort of Malaysian students to a similar twinning programme. Heads of the Dublin medical schools are leading discussions on developing AHC structures with their voluntary hospital partners. In Cork, Professor John Higgins, Head of UCC’s College of Medicine and Health, has spent the last two years conducting a detailed review of health services in Cork and Kerry (the Reconfiguration Roadmap). Quacquarelli Symonds Limited 1994-2011 (QS) rankings for Irish medicine place three of our universities in the top 200.  I would argue that in our university sector, clinical leadership is delivering.

Our government is committed to radical health reform. Their legislative programme should include the universities as potential partners in proposed hospital trusts. The message this sends to our universities would be clear. The time has come to roll up your sleeves and work with your hospitals, your clinical colleagues and policymakers and thrash out the most suitable models, timelines and milestones, financial structures, agreed outcomes and measures of success.

Their legislative programme should include the universities as potential partners in proposed hospital trusts

The scale of the challenges would require fundamental thinking from potential partners. What are some of these challenges?

To deliver integrated care, consultants must operate in specialty teams working from identifiable regional centres – The Reconfiguration Roadmap already maps out how and from where these teams would operate in Cork and Kerry. Delivering effective clinical teams will require strong leadership combining clinical knowledge, management authority and political will. To deliver robust clinical governance will necessitate agreement on detailed protocols and follow through on implementation. Leaders must forge a new relationship with service users and make them partners in learning and reform. Clinical leaders will need to be strong enough to press ahead and wise enough to know when to stop and listen.

Management challenges will also abound. Consolidating back office functions will be a major task. Efficiencies in procurement, stock control, transport and communication systems call for innovative solutions.  Redeployment and role extension will require thinking outside the box. New partnerships will need new models of budgetary allocation and financial control. Performance management must drive quality improvement. Management and leadership training must be provided to ensure smooth succession planning. Reinvigorated management will release funding for innovation from industry and philanthropy.

The university has challenges peculiarly its own. Its traditional posture is critical detachment. In an AHS, it must ‘get onto the factory floor’ and provide tailored courses in role extension to specific groups; it must deliver these courses in workforce friendly ways that allow advancement in education as far as motivation and ability will allow. It must look to its own internal structures to ensure these do not prevent the broadest possible support for the AHS, utilising appropriate disciplines in arts, science, business, law and social sciences. All this will involve new thinking and changes in traditional attitudes on the role of the university in society.

I think the debate should now move from “Should we?” to “How might we?”

Michael Hanna, College of Medicine and Health, University College Cork.

Michael Hanna has worked for over 30 years in Faculty Administration in Science and Health Sciences in Trinity College Dublin and University College Cork. In the last two years, he has worked with Professor John Higgins on the Reconfiguration Roadmap for Cork and Kerry. His work has involved all the health professions and for a number of years he provided administrative support for the Council of Deans of Faculties with Medical Schools in Ireland (CDFMSI).