Single academic medical centre means better, more efficient care
THERE is an immediate need for all Tasmanian patients to receive better, safer and more efficient care from highly competent health professionals using existing knowledge and resources.
This responsibility needs to be shared between health administrators, frontline health professionals and academic teachers and researchers. We need a new learning institution.
I suggest Tasmania needs one statewide Academic Medical Centre (AMC), the University of Tasmania Medical Centre (with three
Bryan Walpole
statewide campuses), because the Royal Hobart Hospital has been superseded. Royal is an anachronism because the RHH treats far more than Hobartians, it’s a statewide institution and has a wider role than a hospital, with its outreach and ambulatory services. There is an urgent need to bring institutions (academic, learning and clinical) under one administration, and make the four hospitals complementary.
There is no universally agreed definition of an AMC, but most are alliances of geographically co-located entities. All AMCs are committed to a tripartite mission of advancing research, education and patient care.
The British National Health Service has mandated such unions, without any extra funding, but to achieve economies of scale, and an early evaluation has been positive. In the US, some universities own their own hospitals, and all successful institutions are a union of academic, clinical and teaching arms into an AMC.
The Australian Government-commissioned McKeon review this year directed there be up to six such institutions nationally.
Tasmania is ideally placed to establish such a body, with one university, partially unified hospital system, two research institutions, and now Primary Health, representing community health, all within a day’s drive, and linked by the NBN. Menzies, the UTAS southern medical school and RHH are within sight, but not formally united, and staff are independently appointed, rather than having a joint appointment to all three.
Clinicians, academics, teachers and administrators need to work together, with academics in leadership roles, because through research they are aware of trends and quality. Doing what works, promptly, first time saves money, and drives quality.
The current state health efficiency measurements, waiting list times, waiting times in emergency and surgical throughput, are measures of comfort and timeliness, but are hardly related to quality care.
Mr Justice Garling noted, in his report on NSW Health, all the failing hospitals had good records for throughput yet poor care. He identified the major fault as a schism between management and clinicians, just as we have here.
Australia has several highly fruitful AMC models: Royal Melbourne Hospital, Walter
and Eliza Hall Institute, and University of Melbourne, and Alfred, Monash, with Baker ID Institute, to name two outstanding successes.
At an AMC, clinical discourse centres on quality, but here it’s mostly budget. Quality, which is primarily driven by research, only occasionally gets a look-in at hospitals.
The success of centres to promote quality learning health systems requires structural alignment and integration of research, education and clinical service delivery. Accountability for these elements, which are currently held by different agencies, needs to be brought together under one health framework with a single CEO and board. This will not be easy. It requires bottom-up leadership by academic and clinical leaders and top-down leadership from government departments, statutory bodies and health service administrations.
Trust is missing here as past attempts have failed, leaving only an MOU in place, with no coercive power and only limited influence.
An issue in the past is that universities and research institutes are concerned research funding may be diverted to health service delivery, while services have concerns the reverse could occur, especially given the scope of clinical and health services research required to drive evidence implementation and innovation across the system.
This uncertainty impedes a concerted effort to bring applied clinical and health services research into both mainstream academia and service delivery, yet it is this that will provide the cost efficiencies, because academics know what works, so healthcare becomes better, less expensive and more efficient with time.
It’s time for a new look for Tasmanian health, with the UTAS Medical Centre. Dr Bryan Walpole, an emergency physician, has been the director of Emergency at RHH and co-director Department of Medicine, Senior Lecturer Emergency Medicine UTAS, AMA state president, and vice president Australian College for Emergency Medicine.