Academic health science centres in Australia: let’s get competitive

To the Editor: The editorial on academic health science centres (AHSCs) in Australia by the deans of medicine in all eight research-intensive universities1 is an important platform for discussing fundamental issues to be considered in developing these centres.

The essential basis of an AHSC is a combination of two major initiatives:

• Seamlessly integrating research done in laboratories and clinical trials with multidisciplinary patient care.

• Building a centre of innovation where questions are asked based on actual clinical problems and can be resolved by the collective efforts of on-site “knowledge workers”.

It is timely and necessary to investigate this option of health care delivery, as politicians negotiate at state and federal levels on appropriate models, and is in keeping with the National Health and Medical Research Council’s objectives in its latest strategic plan for broadening and building Australia’s capacity for research.2

It is crucial that any AHSCs created justify their status. They could be national centres of excellence, funded by an agreed federal and state government contribution model, together with endowments and competitive research funds. They should not merely be cosmetic makeovers for current university hospitals, with their idiosyncratic selection of staff and clinical practice models. Their governance needs to be standardised, based on agreed principles. A competitive national selection process should include identifying submissions that define employment of specific personnel and implementation of interventions to address the challenges of health care delivery in a timely and efficient manner.3

A suggested list of required attributes of staff employed in AHSCs is shown in the Box. A single academic chief executive officer who is a proven educator and researcher and cognisant of local and regional issues of health care delivery can facilitate the development of the centre, with the assistance of similar professionals on the board of management. The knowledge workers in an AHSC should include knowledge leaders (who incorporate knowledge into clinical protocols and management plans), creators (who generate new knowledge from research data), users (clinicians and researchers who incorporate therapies and skills into the clinical arena) and learners (students training to be health professionals and researchers).

Direct interaction between the financial regulators and leading researchers and clinicians in an AHSC can lead to implementation of state-of the-art clinical practice, with patient care consistently being evaluated so that clinical and financial inefficiencies can be eliminated. The interaction of knowledge workers within the AHSC can result in sharing innovative and ethical translational research with bedside clinical practice.