Volume 194 - Issue 9
Academic health science centres in Australia: let’s get competitive
Authors: Michael K Morgan and Janet D Greeley
Med J Aust 2011; 194 (9): 487-488. || doi: 10.5694/j.1326-5377.2011.tb03073.x
Published online: 2 May 2011
Published online: 2 May 2011
To the Editor: Eight Australian medical deans recently called for academic health science centres (AHSCs) —
where a leading university joins with a major tertiary health care provider in a tripartite mission of excellence in clinical service, research and education.1
However, there are obstacles to their proposal due to the misalignment in purpose of universities and teaching hospitals.
Why do they call for change, given that many of our public hospitals are already affiliated with universities, have academic units of the university, and are funded by governments to educate doctors? Many private hospitals are also involved in university and college education.
The Garling report was commissioned in response to a crisis in the quality of acute care offered in New South Wales public hospitals.2 However, none of its 139 recommendations refer to striving to achieve excellence. While excellence must be the aim of our public hospitals, their immediate response should be patient-centred, ensuring an acceptable minimum standard of care. Other targets, such as research and concentrating limited resources on aiming for excellence in specified areas, could prove to be a distraction from this core purpose.
Education was mentioned in the Garling report but in no sense was achieving excellence in clinical service or research implied to be its purpose, unless excellence is to be understood to mean the minimally acceptable level of care. Medical education and research need to fit within a public hospital system that has funding limits and is struggling to deliver its core goal of clinical care. Given the current misalignment of purpose between hospitals and universities, it is no surprise that the combined deans have expressed a tone of dissatisfaction.
Mayo Clinic in the United States has a logo of three interlocking shields,3 representing a “tripartite mission of excellence in clinical service, research and education”. Mayo Clinic’s key to achieving excellence — the aspirational aim of the deans’ “world-class AHSCs” — is alignment of purpose of the hospital and the academic institution.
Similarly, in Australia, the barriers highlighted by the deans1 were dealt with in the planning of Macquarie University’s medical school and hospital. A common purpose and a greenfield site, where a new culture could be introduced, were a core part of Macquarie’s approach.4 As Macquarie’s Vice Chancellor, Professor Schwartz, was reported to say in 2010: “By owning and running the hospital we can ensure that we put medical teaching and research at the forefront”.5 Macquarie knows that simply owning and running its own hospital does not necessarily assure success, but it is an important step.
References
- Fisk NM, Wesselingh SL, Beilby JJ, et al. Academic health science centres in Australia: let’s get competitive [editorial]. Med J Aust 2011; 194: 59-60.
- Garling P. Final report of the Special Commission of Inquiry: Acute Care Services in NSW Public Hospitals. Sydney: NSW Government, 27 November 2008. 0_i1095851
- Mayo Clinic [website]. http://www.mayoclinic.com (accessed Mar 2011).
- Clarke R, Morgan MK. Education programs at the new Australian School of Advanced Medicine at Macquarie University. Med J Aust 2007; 187: 685-687. 0_i1095855
- Gilmore H. Macquarie to be first uni to open private hospital. Sydney Morning Herald 2010; 18 Apr. http://www.smh.com.au/nsw/macquarie-to-be-first-uni-to-open-private-hospital-20100417-sli1.html (accessed Mar 2011).