The academic-medical centre model is new to Ireland, but one that is needed to keep up with the times, writes Claire O'Connell
Two of Ireland's largest medical schools and four major teaching hospitals in Dublin are undergoing radical changes of governance in a bid to improve patient care. In moves they hope will boost specialist areas and offer patients a wider range of expertise, Trinity College Dublin (TCD) is joining forces with St James's and Tallaght hospitals to form the Trinity Academic Medical Centre (TAMC), while the medical school at University College Dublin (UCD) will operate with St Vincent's and the Mater Misericordiae Hospitals as Dublin Academic Health Care (DAHC).
Currently, teaching hospitals are linked to universities through agreement, but the development of academic-medical centres will see clinical staff become part of the formal academic structure, according to Prof Dermot Kelleher, head of Trinity's medical school. "It's a big change," he says. "The concept is that we would move towards a single governance model incorporating the university and the teaching hospitals."
The academic-medical model is common in large institutions in the US and Europe, but a new concept for the UK and Ireland, says Kelleher, and one that's needed to keep up with the times. "Medicine is going to change radically over the next 10 years. There are going to be new ways of treating diseases and people have to be kept at the cutting edge of that."
Specialist areas such as cancer, diabetes, inflammatory disease and age-related conditions stand to gain from the improved links between research and clinical practice at the TAMC, says Kelleher.
"Those are where the expertise within the university is going to allow, we hope, delivery of improvement in patient care. So rather than everybody thinking of their own little area, there's some focus on what the whole thing is going to deliver."
He also hopes that clinical trials will benefit: "If you look at cancer, participation in clinical trials is a key element in how you assess the quality of cancer care. If there's a lot of participation in clinical trials it tends to be good cancer care.
"And we definitely need joined-up thinking between the university and the hospital in the clinical trials area."
The Trinity partnership aims to "resolve issues around the new governance structure within a 12-18 month timeframe," according to Trinity's Kelleher.
But hammering out agreement between rival institutions isn't always straightforward, and the TAMC has faced its hurdles, he adds. "It's certainly a challenge and we have worked quite hard to come to this point, at which people agree," he says. "But I think we all have to be aware of our common goal and that is to produce something at a world class standard that we can all be proud of."
Similarly for the DAHC collaboration through UCD, "friendly rivals" St Vincent's and the Mater had to bury a few hatchets for the common cause, according to Prof Bill Powderly, head of UCD's school of medicine and medical science. "But there's a tremendous enthusiasm among the medical staff about this because of the potential that can be tapped," he notes.
Realising that potential will have a "strong impact" on patient care, he believes. Teams from the two hospitals will work together in single departments, providing greater resources for patients.
"So where you have four lung specialists in St Vincent's and four in the Mater, you now have a department that has eight, and you can start to develop areas of specialty within that where you have even more expertise," he explains, adding that the majority of patients will not have to travel between the two hospital sites to access care.
Powderly also believes that creating an academic-medical model similar to those seen overseas should make Dublin an attractive option for international staff.
"When we look to bringing in people who have been trained in the US, what they want is a system like the one they have already been working in. Doing this makes us more likely to be able to attract and retain the best," he adds.
In particular he would like to see more medical scientists, to help develop scientific discoveries into improved patient care. "If we are really serious about being competitive in biomedical research - and that's a government policy - we have to be able to recruit high-quality medical scientists, and to compete with the Harvards and the Hopkins and the UCLAs of the world you have to have an environment where they are going to say I am likely to be successful in Dublin," he says.
Many of the senior physicians here have already experienced the academic-medical model from their specialist training overseas, notes Powderly. So even before Government reports recommended the combined approach last year, the will was there to implement the change, he says. "We felt if we wanted to bring Irish medicine to the next level, this was the way to go."
The DAHC board will meet next month and integration of the new governance will take about 18-24 months, says Powderly. And they will be monitoring indicators of patient care as the new approach takes root.
"We want to be able to show that patients who come in with, say, pneumonia or a heart attack receive the best practice as rapidly as possible," says Powderly.
"We want to show that the quality of care that people get in an academic-medical centre such as this is as good as the care they could get anywhere else in the world."