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Going with the flow: A systems approach to how an academic health science centre creates value through collaboration

Authors:
Ng, I., Parry, G., Davies, S. and Lim, W. M. (2012) Going with
the flow: A systems approach to how an academic health science
centre creates value through collaboration. Executive briefing. ISSN
9781906087449 Available from: http://eprints.uwe.ac.uk/16557
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executive briefing
Going with
the flow
A systems approach to how an Academic Health
Science Centre creates value through collaboration
RESEARCH
Advanced Institute of
Management Research
www.aimresearch.org
Written by:
Professor Irene Ng, Professor of Marketing and Service Systems, WMG,
University of Warwick; AIM Services Fellow; ESRC/NIHR Placement Fellow
Dr Glenn Parry, Associate Professor, Strategy and Operations Management,
University of the West of England
Stephen M Davies, Chief Operating Officer, Cambridge University Health Partners
Dr Wai Mun Lim, Associate Professor, University of Plymouth;
AIM Associate Fellow
2
AIM – the UK’s research initiative on management
Written by:
Professor Irene Ng, Professor of Marketing and Service Systems, WMG,
University of Warwick; AIM Services Fellow; ESRC/NIHR Placement Fellow
Dr Glenn Parry, Associate Professor, Strategy and Operations Management,
University of the West of England
Stephen M Davies, Chief Operating Officer, Cambridge University Health Partners
Dr Wai Mun Lim, Associate Professor, University of Plymouth;
AIM Associate Fellow
The Advanced Institute of Management Research
(AIM) develops UK-based world-class management
research. AIM seeks to identify ways to enhance
the competitiveness of the UK economy and its
infrastructure through research into management
and organisational performance in both the private
and public sectors.
about AIM
contents
AIM consists of:
Over 300 AIM Fellows and Scholars – all leading academics in their fields…
Working in cooperation with leading international academics and specialists
as well as UK policymakers and business leaders…
Undertaking a wide range of collaborative research projects on management…
Disseminating ideas and shared learning through publications, reports,
workshops and events…
Fostering new ways of working more effectively with managers and policymakers…
To enhance UK competitiveness and productivity.
AIM’s Objectives
Our mission is to significantly increase the contribution of and future capacity
for world class UK management research.
Our more specific objectives are to:
Conduct research that will identify actions to enhance the UK’s international
competitiveness
Raise the quality and international standing of UK research on management
Expand the size and capacity of the active UK research base on management
Engage with practitioners and other users of research within and beyond the
UK as co-producers of knowledge about management
AIM – the UK’s research initiative on management 2
About AIM 3
AIM research themes 4
Executive summary 5
Introduction 6
Methodology and a value-based systems approach 7
Key findings 8
The AHSC flow framework as the value of partnership 11
Improving the AHSC 16
Conclusion 18
3
AIM research themes
Current AIM research projects focus on:
UK productivity and performance for the 21st century.
How can UK policymakers evaluate and address concerns surrounding the UK’s
performance in relation to other countries?
National productivity has been the concern of economists, government policymakers,
and corporate decision-makers for some time. Further research by scholars from a
range of disciplines is bringing new voices to the debates about how the productivity
gap can be measured, and what the UK can do to improve the effectiveness of UK
industry and its supporting public services.
Sustaining innovation to achieve competitive advantage
and high quality public services.
How can UK managers capture the benefits of innovation while meeting other
demands of a competitive and social environment?
Innovation is a key source of competitive advantage and public value through new
strategies, products, services and organisational processes. The UK has outstanding
exemplars of innovative private and public sector organisations and is investing
significantly in its science and skills base to underpin future innovative capacity.
Adapting promising practices to enhance performance
across varied organisational contexts.
How can UK managers disseminate their experience whilst learning from others?
Improved management practices are identified as important for enhancing
productivity and performance. The main focus is on how evidence behind good or
promising practices can be systematically assessed, creatively adapted, successfully
implemented and knowledge diffused to other organisations that will benefit.
4
5
executive summary
An AHSC is
a partnership
between one or
more universities
and healthcare
providers
focusing on the
tripartite mission
of research,
clinical care
and teaching.
This briefing looks at the case of Cambridge University Health Partners, the
management organisation of the Cambridge Academic Health Science Centre (AHSC).
An AHSC is a partnership between one or more universities and healthcare providers
focusing on the tripartite mission of research, clinical care and teaching. AHSCs work
on the principle that the collaboration between university and healthcare providers
creates greater value than their operating alone. Our briefing reports on the nature
and characteristic of one such partnership, and how such outcomes are achieved
collaboratively.
This briefing identifies the value of partnerships in an AHSC, the scope of an AHSC
management organisation (AHSCMO), measures that can be taken to improve AHSC
performance through a systems approach, as well as interventions that can improve
the collaboration between the different parties.
To do this we used a value creating systems approach. The approach looks at value
creation within the system, managing and supporting value creating activities and any
barriers that exist, as well as how to measure performance. We apply systems theory
to the AHSC, which involves looking at the whole as well as the parts, considering
the interactions within the system, emergent outcomes, and in particular the way
that individuals interact to effect change and achieve outputs.
The research identified the characteristics of the AHSC system as well as numerous
challenges to and enablers of collaboration. Importantly the findings reveal that it is
the linkages between the care, teaching, research, tripartite mission that are crucial
to the successful creation of value. It is in these interactive flows that collaboration
maximises value, achieving outcomes over and above what is possible when the
three elements are operating alone.
As such we propose that the role of the AHSCMO is to focus on and make sure that
these flows are optimal.This is the outcome that the AHSCMO should be assessed
on – as opposed to the underlying but separate missions: research, teaching and care.
It is also important not to attempt to impose pre-determined linear pathways
upon the system in order to try to manage or improve performance outcomes.
Instead the briefing offers a number of flow framework models that can be used
to map current interactions and activities onto the model and assess how specific
interventions could increase the system effectiveness, while at the same time
monitoring consequences elsewhere.
Finally, we also offer three categories of interventions and measures that can
be applied to improve collaboration and so obtain greater value from partnering
within the system.
6
It is suggested
that AHSCs
have the
potential
to lead ‘the
transformation
of medicine
through the
development of
a discovery-care
continuum’…
introduction
1Dzau, V.J., Ackerly, D.C., Sutton-Wallace, P., Merson, M.H., Williams, R.S., Krishnan, K.R., et al (2010).
The role of academic health science systems in the transformation of medicine, Lancet 375:949-953.
Academic Health Science Centres (AHSC) explained
An AHSC is a partnership between one or more universities and healthcare providers
focusing on the tripartite mission of research, clinical care and teaching. AHSCs work
on the principle that the collaboration between university and healthcare providers
would enhance all missions in such a way that the whole is greater than the sum
of its parts. In 2005, the top sixteen ranked hospitals in the US were all AHSCs.
AHSCs in the UK were borne out of Professor Lord Darzi’s report in 2007, as part
of his review of healthcare in London. As the report stated:
London needs to explore the model of Academic Health Science Centres being
followed by other large cities if it wants to be at the cutting-edge of research and
clinical excellence… A new form of university/hospital partnership is needed to
maintain the UK’s academic institutions at the forefront of the global marketplace
where they compete for grants, recognition and staff.
Since then, five partnerships in the UK have been designated as an AHSC and all
but one, as of 2011, have formalised the management of their AHSC through the
creation of an entity – the AHSC Management Organisation (AHSCMO). Despite
some differences of detail and emphasis, these broadly follow a single model,
being not-for-profits with an intermediary role.
Typically the AHSCMO’s mission is to formalise and strengthen the collaboration
between academic institution(s) and its principal NHS partners through the promotion
of excellence in the tripartite mission of health care, education and research,
to promote innovation and to communicate positive economic impact.
The aim is to improve the following outcomes for both sectors:
improved patient care and population health
excellence in health research and education
more rapid translation of research into new products or processes
It is suggested that AHSCs have the potential to lead ‘the transformation of medicine
through the development of a discovery-care continuum’ (p.950, Dzau et. al. 20101)
and the AHSC model is well established in the United States, Canada, Singapore,
Sweden and the Netherlands. The research literature relating to AHSCs is mostly
North American and is focused on institutional issues, such structure and governance,
or on aspects of the individual missions. It is also mostly atheoretical. Our approach
is novel in that we bring systems theory to bear on this organisational category.
This executive briefing summarises the following:
aarticulating the value of partnerships in an AHSC and the scope of an AHSC
management organisation (AHSCMO)
brecommending how to improve on the performance of the AHSC through
a systems approach
Critically, what do individual institutions have to gain through the collaboration
afforded by being part of an AHSC, that they would otherwise not be able to achieve?
7
This briefing
describes the
key interactions
and issues
encountered
by members
of the tripartite
mission in
the pursuit
of academic,
research and
or clinical
excellence.
methodology and a value-based systems approach
This executive briefing draws on the findings from a project involving Cambridge
University Health Partners, an AHSCMO set up to manage the Cambridge AHSC.
This comprises the University of Cambridge and its three principal National Health
Service affiliates. The project used a value-based systems approach to analyse the
AHSC. A value-based approach focuses on value that is co-created between partners
of a system to discover:
the value to be created by participants in the system
the key value transformations within the system
an understanding of where barriers may exist in collaboration
an understanding of how the system could be managed, and supported
to create the value
how performance could be assessed
Concurrently, we also employ a systems approach towards our analysis,
which allows us to understand:
the whole as well as the parts
the dynamism of the whole and how various decisions could impact
on different outcomes
how various elements interact with one another
how core transformations are effected by various agents in a system
how agents interact within a system to achieve outputs and emergent outcomes
inputs, outputs and the role of interventions to achieve various outcomes
performance evaluation based on the value co-created by the whole,
rather than the parts
Our working hypothesis is that the overall performance of this system depends on
the ways in which individual clinicians/researchers/educators are able to work across
organisational boundaries, both through collaboration at an individual level and through
their ability to engage in organisational politics and processes.
This briefing describes the key interactions and issues encountered by members of
the tripartite mission in the pursuit of academic, research and or clinical excellence.
The documentation, understanding and analysis of these key interactions and the
nature of value co-creation between the relevant parties at an abstract level is
critical as it will allow the knowledge to be transferred across contexts.
8
key findings
The AHSC
analysed
is a multi-
organisational
collaborative
system with
a number
of distinct
features.
Distinctive features of the Cambridge AHSC
The AHSC analysed is a multi-organisational collaborative system with a number
of distinct features. This is true of the system as whole and the individuals within it.
The system
The system was designated as an AHSC by the UK government in 2009. However,
the AHSC system pre-existed and would continue to exist and continue to achieve
collaborative outcomes with or without the AHSC label or the intervention of the
AHSCMO as a vehicle for formal governance.
Thus, any attempted management of the system in an attempt to improve the
system’s effectiveness must be careful not to disrupt the existing system’s
achievements, which are based upon long-standing dynamics. The governance
body has to consider how it remains viable, and at the same time can improve
on the AHSC rather than reducing its effectiveness.
9
The system outcomes are currently achieved by many autonomous individuals.
Putting in place mechanisms that are deterministic, rigid, or too controlling, may
compromise the creativity and entrepreneurialism of individuals, even though the
same mechanisms may spur others to collaborate. As a result, maintaining system
stability and sustainability to consistently deliver good outcomes is a challenge.
Since the AHSC has a tripartite mission, it is important to take care not to compromise
any of the missions when attempting to improve the whole, or at least not to do so
without the specific knowledge and consent of the partner organisations.
As a complex collaborative system, system outcomes and behaviours cannot be
deterministically designed in a reductionistic manner – where a problem is broken
down into its component parts to be optimised separately before piecing them
together again. Reducing the system into a sub-system (predesigning the research-
to-care route, for example) may lead to unintended consequences elsewhere.
The system exhibits the complex emergent property of a knowledge community.
Being a member of a knowledge community will have an impact on the behaviours of
individuals within the system, particularly in motivating individuals to achieve excellence
Individuals in the system
The individuals within the system also have certain characteristics.
There are, for example, various degrees of autonomy amongst individuals (agents),
with some individuals, such as academics, being much more autonomous than others.
This implies that governance, policies and organisation processes may have different
degrees of influence on different individuals.
Autonomous agents within the system have shown some extraordinary
entrepreneurial creativity in working across boundaries. This creativity is sometimes
because of these boundaries and sometimes in spite of the boundaries.
Many individuals work for more than one organisation within the system. A person
may work for the hospital as clinician, and for the university as a researcher or lecturer,
for example.The organisational layer, therefore, sits above a complex social layer of
mixed incentives, motivations, skills and job descriptions.
On a daily basis, individuals will assume and cope with multiple roles and therefore
identities. For example, they may negotiate between teacher, researcher, and clinician,
all within the day.
On a daily basis
individuals
will assume
and cope with
multiple roles
and therefore
identities.
10
Individual (micro-level) collaboration in the system: challenges and enablers
Challenges to Collaboration
There are several challenges associated in achieving the linkages necessary
for collaboration. These include:
incentives of parties not being well-aligned
under-investment in interfaces
inter-organisational boundaries impede collaboration
outcomes that are uncertain and attempts to collaborate not always productive
collaboration requiring trust and time with risky payback
cumbersome inter-organisational processes
a lack of physical spaces to promote serendipity, opportunities
and collaborative culture
collaboration being a multi-layered (e.g. warming to each another, relationship
building, actual work scoping, sharing data, writing grants etc.), requiring different
skills and capabilities in each layer
and collaboration being unstructured
Enablers of collaboration
Despite these challenges, respondents have also reported times when
collaboration was enabled by an individual. Enablers of collaboration include:
parties focusing on opportunities (e.g. ‘could see what was possible’)
providing Rewards and Incentives as motivators
understanding characteristics of people who are more inclined
towards collaboration
individuals with mixed identities and mixed contracts who can see
different perspectives and recognise challenges spur collaboration
ambition (that spurs collaboration)
starting with a smaller role to get into the culture of collaboration
learning the system; developing familiarity with the system and the
language of others
developing a social network before collaborating
having a strong vision and conviction for a particular research
co-location of research institute with clinicians promotes serendipity
and relationship building
having a champion, as the initiator or catalyst for collaboration
being ‘problem’ or ‘needs’ focused
discovering complementarity between research ideas and problems
11
The value of
partnerships lies
in the practice
linkages
between the
three functional
missions and
the emergence
of knowledge
flows between
them.
the AHSC flow framework as the value of partnership
Our findings reveal that the concept of knowledge flows is fundamentally important
in creating value through collaboration. Knowledge flows focus on the practices
that result in the acquisition of knowledge, and encouraging such flows encourages
practices to promote, motivate, encourage, and nurture the way ‘knowing’ is
achieved. It privileges the relationship between the knowledge and the knower
through dynamic practice, rather than removing the knower by trying to capture or
distribute knowledge. Focusing on knowledge flows, therefore, means enabling the
development of learning communities. The value of partnerships lies in the practice
linkages between the three functional missions and the emergence of knowledge
flows between them.
Thus, for an AHSC to be viable, it has to focus on enabling research, teaching and care
flows as a macro-level property of the system i.e. the linkages between the tripartite
missions and the performance of emergent knowledge flows are in themselves the
outcome of which the AHSCMO should be assessed on. In other words, we propose
that it is not research, teaching, or care, that is the focus of the AHSCMO, but
research-informed-care practices (and vice versa), teaching-informed-care practices
(and vice versa) and research-informed-teaching practices (and vice versa).
By focusing on, and enabling such flows, we recommend that AHSCMO takes
ownership of the practices embedded in the linkages, creating a complementary
effect of the organisation’s role to that of its partner organisations.
Interactions between individuals within and across boundaries are the unit of analysis
to catalyse micro level collaboration to achieve macro level flows. However, partner
organisations and the AHSCMO serve a crucial role of governing, incentivising and
intervening in the environment within which such individuals operate.
The AHSC Knowledge Flow Framework:
articulating the value of the AHSC partnership
Care Flows
Care Flows emerge from how research or teaching informs care. These flows could
emerge from more direct interactions from research to care (or teaching to care), or
through indirect interactions i.e. research informing teaching, which then informs care.
For example, academics could be conveying the latest research to their PhD students
(research informed teaching) who then graduate and develop new curriculum for
clinicians (teaching informed care).The types of Care Flows are presented in Figure 1.
From Figure 1, our findings, together with literature from previous studies, show that
research informs care through four interactive practice channels labelled as RC1, RC2,
RC3 and RC4. Teaching informs care through TC1-TC4. It is also possible for teaching
to inform care through research (RT1-RT3) and for research to inform care through
teaching (RT1-RT3).
12
Figure 1: Care Flows of the AHSC System Model – for better care outcomes
External
Bodies
T
C
R
aftercare
grants
trials
papers
assessment
accreditation
diagnose
treatment
feedback
Indirect flows
Direct flows
Directflows
Care Outcomes
Enablechange
TC1
Educatingclinicaluse oftechnologiestoclinicians/doctors
TC2
Educatingclinical practical processesto clinicians/doctors
TC3
Educatingclinical knowledgeto clinicians/doctors
TC4
Curriculumdevelopment(content)
RT1
Evidence-basedpolicyclinicaleducationregulation
RT2
Pedogogy(tokeepuptodate)
RT3
Reflexivityofteaching
TR1
Interrogationandcontestationofcontent
TR2
Evidence-based policy clinical care (NICE) RC1
Drugs and patents industry commercialisation
RC2
Changing technologies of care (comparative studies)
RC3
Changing processes and care RC4
Indirect flows
Direct flows
Directflows
Reflexivityofteaching
TR1
Interrogationandcontestationofcontent
TR2
Enablechange
TC1
Educatingclinicaluseoftechnologiestoclinicians/doctors
TC2
Educatingclinicalpracticalprocessestoclinicians/doctors
TC3
Educatingclinicalknowledgetoclinicians/doctors
TC4
Industry
(simulation)
Creatingbetterteachingprocesses
CT1
Practicingknowledge(people)
CT2
Creatingcontent(cases+examples)
CT3
C
R
aftercare
grants
trials
papers
Invoking need/motivation to do research (people)
CR1
Informs research questions (content)
CR2
Informing different ways of doing research (processes)
CR3
Inform different knowledge bases for own research technologies
CR4
diagnose
treatment
Tassessment
accreditation
feedback
Research Flows
Similarly Research Flows emerge from how care or teaching informs research. These
flows could emerge from more direct interactions from care to research (or teaching
to research), or through indirect interactions i.e. care informing teaching which then
informs research.The types of Research Flows are presented in Figure 2.
Figure 2: Research Flows of the AHSC System Model – for better research outputs
13
T
eaching Flows
Finally, teaching flows emerge from how research or care informs teaching. These
flows could also emerge from more direct interactions from care to teaching (or
research to teaching), or it could be through indirect interactions i.e. care informing
research which then informs teaching. The types of Teaching Flows are presented
in Figure 3. It is worth noting that incentivisation of teaching flows by an AHSCMO
could generate better teaching outcomes.
Figure 3: Teaching Flows of theAHSC System Model – for better teaching outcomes
Indirect flows
Directflows
Directflows
T
C
R
aftercare
grants
trials
papers
Evidence-based policy clinical care (NICE) RC1
Drugs and patents industry commercialisation
RC2
Changing technologies of care (comparative studies)
RC3
Changing processes and care
RC4
Invoking need/motivation to do research (people)
CR1
Informs research questions (content)
CR2
Informing different ways of doing research (processes)
CR3
Inform different knowledge bases for own research technologies
CR4
Industry
(simulation)
Creatingbetterteachingprocesses
CT1
Practicingknowledge(people)
CT2
Creatingcontent(cases+examples)
CT3
Curriculumdevelopment(content)
RT1
Evidence-basedpolicyclinicaleducationregulation
RT2
Pedogogy(tokeepuptodate)
RT3
assessment
accreditation
External
Bodies
diagnose
treatment
feedback
Value to be generated by an AHSCMO
Although the diagrams depict flows as linear, they are not. Knowledge flows are
an emergent property at a macro level that is the result of hundreds and thousands
of micro-level interactions between individuals collaborating, engaging in knowledge
practices and exchanging resources where such interactions are often iterative,
non-linear, non-structured and messy. It is important to note that the emergent
knowledge flows are non-deterministic and is a property of the system, rather
than directed or controlled in some way.
It is therefore important to understand that since knowledge flows are emergent,
effort to direct or control can only be achieved through interventions, rather than direct
determinism. While direct control and management is possible, complexity may be
created as unintended consequences and systemic disruptions may occur elsewhere.
14
From our framework, we also note that the emphasis of policy towards AHSCs, and
of AHSC’s own advocacy, has generally been on the research to care flows. Previous
studies have suggested that AHSCs are transformative through their facilitation of
the speed and quality of the discovery to care continuum. Sir David Cooksey’s 2006
report, ‘A Review of UK Health Research Funding’ also stresses the pathway for
translation of health research into healthcare improvement. Yet, our findings show
that the process of translational health research in healthcare improvement should
be regarded systemically as an emergent property and treated as such, as it is highly
dependent on the micro-level interactions within the system. Consequently, top-down
operate/manage/control system may not be the most prudent way to improve the
performance of the system.
The reality of translation is that it is achieved through various systemic interactions,
sometimes through direct but unstructured individual interactions between research
to care, sometimes through indirect interactions through teaching and often resulting
in other interactions. In addition, the interactions resulting in flows from care back
to research and through teaching also impact on resources that enable direct and
indirect research to care flows.
We propose that viewing translational health research as a linear pathway diminishes
the more complex and critical individual micro-level interactions that have resulted
in that pathway. Describing it as such also results in the failure to appreciate the
emergent nature of translational health research, hence privileging a reductionistic
command-and-control governance structure, rather than a more systemic
interventionistic governance structure.
15
At the extreme, due to the reductionistic nature of such designs, mechanisms
to pre-design such a pathway could result in unintended consequences elsewhere
and may impede the very purpose of predesigning. From a systems-view, the
so-called ‘gaps in translation’ outlined in the Cooksey report may be a consequence
of not understanding the system interactions that have achieved the translation.
Recommendations regarding flow
Our findings lead us to make a number of recommendations.
The knowledge flows emerge from micro-level resource exchanges and value
co-created by individuals and organisations within the system that are tasked
to perform research, care and teaching functions (within one individual, as they
may fulfil other functions as well).
From our case research, our recommendations are that:
The key transformation and responsibility of the AHSCMO should be to enable
such flows, and not to achieve research, teaching or care outcomes itself.
Understanding and intervening at a micro-level implies enabling the interactions
that contribute to the emergence of such flows.These flows should therefore
be the unit of focus, owned by the AHSCMO and excellent flows would be
the result of better collaboration and micro-level interactions.
The improvement in flows is the value generated by the AHSCMO, and
it emerges from improvements in the way the AHSCMO has enabled the
interactions and collaborations between multiple individuals within the partner
organisations. Clearly, the better the flows the better the tripartite mission
outcomes.
However, it is important to note that achieving the tripartite outcomes are
the primary tasks of the partner organisations (research/teaching outcomes
for university, care outcomes for trusts) and not the AHSCMO. The role of the
AHSCMO is to assist in those tasks through enabling interactions that result
in better flows, and not to be tasked to assist the tripartite missions directly.
This would ensure minimal conflict of purpose and policy between AHSCMO
and partner organisations, as well as focusing on where the AHSCMO truly
enable added value to be created.
More importantly, the performance of the AHSCMO should be assessed on
the value of the partnership (i.e. achieving better flows) and how that impacts
on partner organisations within an AHSC.
Furthermore, we would recommend that the AHSC management organisation takes
a systems approach towards interventions to improve the effectiveness of an AHSC,
rather than a pre-designed deterministic approach towards translation. Based on
the flow framework proposed the management organisation can actively locate
current interactions and activities onto the model and assess how specific micro-level
interventions could increase macro-level knowledge flows and the system’s
overall effectiveness, while at the same time monitoring consequences elsewhere.
This would also preserve the autonomy of agents in the system which underpinned
previous successes, while intervening where it is most effective.
…we would
recommend
that AHSC
management
organisation
takes a systems
approach
towards
interventions
to improve the
effectiveness
of an AHSC…
16
improving the AHSC
Interventions for better collaboration and greater value from partnering
Since effective collaboration is integral to emerge knowledge flows in the tripartite
system and thus creating value, we also considered what interventions could be
made to improve that collaboration.
Interventions by AHSCMO as the AHSC’s governing body
Behavioural studies have shown that the process towards a particular collaborative
behaviour is influenced by personal as well as social characteristics. Our findings
suggest that there are three types of micro interventions that can potentially improve
collaborations, as illustrated in Figure 4. Such micro-level interventions at individual
levels could then emerge to achieve macro level knowledge flows as presented above.
Agent Resource Interventions
These interventions involve providing resources to individuals (agents) within
the AHSC system that would allow them to collaborate. These include:
grants and other monetary resources
freeing of time (through grants or other means)
providing equipment
better transferability of equipment and materials
better access rights to resources not owned by themselves
training on skills to collaborate
Such interventions would be basic drivers towards improved individuals’ propensity
to collaborate.
Agent Psycho-Social Interventions
These interventions involve improving individuals beliefs, attitudes and intentions
towards collaboration. Our findings show that some individuals are more inclined
towards collaboration and these are embedded in their belief and attitudinal structure.
In addition, ambition, developing a vision and conviction all serve to enable
collaboration. The AHSCMO could directly intervene through mindset change
or motivational programmes. Rewards and incentives can also change individuals
beliefs and attitudes towards what is possible.
17
Socio-Environmental Interventions
Interventions are about catalysing and enabling collaborations to happen.
Social-environmental interventions can include:
provision of space for brainstorming and for serendipitous and creative
collaborative learning, and these spaces could be physical or virtual, for example
through co-location, sharing spaces for research and work posters, etc.
having individuals with experience to catalyse collaborations
developing processes and mechanisms for entering into a collaborative
space so that individuals find sharing of ideas to be less threatening
having champions or catalysts to assist individuals to begin their journey
towards collaboration
getting individuals collaborating to start with a smaller role in learning the system
getting them to develop familiarity with the system and the language of others
through networking
working towards reducing barriers to collaboration, particularly around alignment
of partner organisations towards achieving collaborative goals
proactively developing the community as an intervention for better performance;
individuals within the system have described a sense of community they feel
as part of Cambridge AHSC, which have spurred much of the entrepreneurial
and collaborative spirit amongst individuals
Figure 4: Individual (autonomous agents) motivations (and their respective
interventions) for enabling collaboration
Interventions
are about
catalysing
and enabling
collaborations
to happen.
Socio-environmental
Intervention
Agent Psycho-social
Intervention
Agent Resource
Intervention
Resources
Beliefs
Attitude
Intention
Collaboration
18
conclusion
The application of systems theory to AHSCs is a new development and the findings
of this study challenge two commonplace assumptions in the institutional literature.
The first assumption is that overall AHSC performance can be improved by focusing
on management of the individual strands of the tripartite mission in isolation: clinical
care, health-related research and the education of the healthcare workforce. Our
study suggests that not only is this reductionistic approach inappropriate, it creates
unnecessary complexity and greater barriers to collaboration. Closely related to
this is the notion that measuring performance for each strand in isolation will provide
an adequate assessment of the performance of an AHSC as a system, and of the
AHSCMO as the manager of that system. This approach is flawed as it measures
the aggregated ‘parts’ only and fails to measure how the value created by the ‘whole’
system is greater than the sum of such parts. Our study suggests that the knowledge
flows, i.e. the connections rather than the outputs, should be the unit of focus
for assessing the performance of both the AHSC system and the AHSCMO.
The second assumption is that the processes that improves an AHSC are linear and
that management of these processes will be predictable. As our study has found,
the mindset to manage a complex collaborative system of autonomous individuals
should be that of creating systemic platforms for enabling, empowering, intervening
and incentivising rather than top-down control, determine and direct.
For institutional management, our findings present a challenge: conceptually and
practically it is easier to take a reductionist approach and focus on the individual
strands of management both in terms of management interventions and performance
assessment. Our study suggests that such an approach is really missing the point,
which is to focus on how to nurture and sustain the flows in the system. The task
of management may, therefore, be to cultivate particular properties in the AHSC as
a system and to focus on identifying and addressing blockers and enablers of flow.
This will not be easily explained to those not versed in system approaches and the
complexity of collaborative university/health system partnerships.
…conceptually
and practically
it is easier
to take a
reductionist
approach and
focus on the
individual
strands of
management…
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ISBN 978-1-906087-44-9
© Professor Irene Ng, Dr Glenn Parry, Stephen M Davies and Dr Wai Mun Lim 2012
... In aggregate, these developments are expected to facilitate establishing the AHSs of the future [12]. Within this context, which constitutes both a challenge and an opportunity for healthcare leaders, exploring and realizing the latent potential in building system-wide partnerships become of utmost importance [15]. In fact, the leadership and governance of AHSs tend to be committed to ful lling the tripartite mission through an effective academic partnership between a university and health care related division(s) [4,16]. ...
... Successes of such a liations, within the context of AHSs, have been reported [17]. The mindset shifts from the individual institution competitiveness to the synergy and catalytic effect that multiple institutions can achieve together to improve their community's health and economic gain [15]. To the best of the authors' knowledge, there is paucity in the literature around such a liations, especially those relating to public private partnerships. ...
... Moreover, the academic culture that is at best student-centric and involves a high degree of independence needs to shift to a patient-centric model. This all calls for a culture of collaboration [15] with tighter alignment between AHSs' clinical, academic, and research missions based on an interprofessional model of care and education [47] designed to achieve better outcomes at lower cost [7]. The current study sheds light on the latent potential in public private partnerships, within the context of AHSs, and on a means of leveraging action research [48] to go about forming such an a liation. ...
Preprint
Full-text available
In an Academic Health System model where university and clinical care institutions are separate entities, robust agreements are needed for effective working relationships among the involved institutions. There is paucity in the literature around reports of such affiliations, especially those relating to public private partnerships. Accordingly, the overall purpose of this study is to explore the perception of key opinion leaders about the development of a values-driven affiliation between a public medical school and a private healthcare provider in an Academic Health System in Dubai, United Arab Emirates. The process of developing the respective affiliation was based on the principles of action research. It involved ongoing cycles of planning, acting, observing, and reflecting. This study relied on a qualitative phenomenological research design, where 18 primary stakeholders, who played an active role in making the affiliation, were given the option of providing their feedback either in writing, using a tailor-made questionnaire, or in the form of a semi-structured interview. Constructivist epistemology constituted the basis of the entailed interpretive qualitative analysis, which followed the six-step analysis approach initially introduced by Braun and Clarke (2006). The qualitative analysis led, as per this study’s conceptual framework: ‘Public Private Affiliation Journey’, to two interconnected themes, namely: Key Milestones and Driving Forces. Within Key Milestones, seven sequential categories were identified: Observing a triggering need, Finding a good match, Seizing the opportunity, Arriving at a common ground, Looking ahead, Venturing for the right reasons, and Reaping the benefits. Within the second theme: Driving Forces, the following three categories were identified: Aspiring for success, Leveraging human qualities, and Doing things the right way. This study showed that there is a latent potential in forming public private partnerships that can enable the formation and development of Academic Health Systems. It also showcased how the guidelines of action research can be set as the basis of the process of partnership formation, and how following those guidelines in such an endeavor maximizes value for all. Lastly, this study introduced the ‘Public Private Affiliation Journey’ conceptual framework, which can be deployed in ‘federated’ Academic Health Systems worldwide to increase the chances of success of public private partnerships and to maximize the value attained through them.
... As in many countries around the world, there are high expectations on academic health science centres and networks in England to provide high-quality care, innovative research, and world-class education, while also supporting wealth creation and economic growth [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. An academic health science centre (AHSC), also known in different countries as an academic health centre (AHC), academic medical centre (AMC), or university medical centre (UMC) is not a single institution, but "a constellation of functions and organizations committed to improving the health of patients and populations through the integration of their roles in research, education, and patient care" [17]. ...
... The most common model has been the intermediate organisation, straddling the boundary between universities and NHS institutions. There has been, as yet, no systematic evaluation of the effect of these innovations, but there is growing evidence based on expert opinion and case studies of new and fruitful dynamics in some cases [4,7,8,13,15,23]. ...
Article
Full-text available
As in many countries around the world, there are high expectations on academic health science centres and networks in England to provide high-quality care, innovative research, and world-class education, while also supporting wealth creation and economic growth. Meeting these expectations increasingly depends on partnership working between university medical schools and teaching hospitals, as well as other healthcare providers. However, academic-clinical relationships in England are still characterised by the "unlinked partners" model, whereby universities and their partner teaching hospitals are neither fiscally nor structurally linked, creating bifurcating accountabilities to various government and public agencies. This article focuses on accountability relationships in universities and teaching hospitals, as well as other healthcare providers that form core constituent parts of academic health science centres and networks. The authors analyse accountability for the tripartite mission of patient care, research, and education, using a four-fold typology of accountability relationships, which distinguishes between hierarchical (bureaucratic) accountability, legal accountability, professional accountability, and political accountability. Examples from North West London suggest that a number of mechanisms can be used to improve accountability for the tripartite mission through alignment, but that the simple creation of academic health science centres and networks is probably not sufficient. At the heart of the challenge for academic health science centres and networks is the separation of accountabilities for patient care, research, and education in different government departments. Given that a fundamental top-down system redesign is now extremely unlikely, local academic and clinical leaders face the challenge of aligning their institutions as a matter of priority in order to improve accountability for the tripartite mission from the bottom up. It remains to be seen which alignment mechanisms are most effective, and whether they are strong enough to counter the separation of accountabilities for the tripartite mission at the national level, the on-going structural fragmentation of the health system in England, and the unprecedented financial challenges that it faces. Future research should focus on determining the comparative effectiveness of different alignment mechanisms, developing standardised metrics and key performance indicators, evaluating and assessing academic health science centres and networks, and empirically addressing leadership issues.
Article
Full-text available
Introduction Academic health centers are poised to improve health through their clinical, education, and research missions. However, these missions often operate in silos. The authors explored stakeholder perspectives at diverse institutions to understand challenges and identify alignment strategies. Methods Authors used an exploratory qualitative design and thematic analysis approach with data obtained from electronic surveys sent to participants at five U.S. academic health centers (2017‐18), with four different types of medical school/health system partnerships. Participants included educators, researchers, system leaders, administrators, clinical providers, resident/fellow physicians, and students. Investigators coded data using constant comparative analysis, met regularly to reconcile uncertainties, and collapsed/combined categories. Results Of 175 participants invited, 113 completed the survey (65%). Three results categories were identified. First, five higher‐order themes emerged related to aligning missions, including (a) shared vision and strategies, (b) alignment of strategy with community needs, (c) tension of economic drivers, (d) coproduction of knowledge, and (e) unifying set of concepts spanning all missions. Second, strategies for each mission were identified, including education (new competencies, instructional methods, recruitment), research (shifting agenda, developing partnerships, operations), and clinical operations (delivery models, focus on patient factors/needs, value‐based care, well‐being). Lastly, strategies for integrating each dyadic mission pair, including research‐education, clinical operations education, and research‐clinical operations, were identified. Conclusions Academic health centers are at a crossroads in regard to identity and alignment across the tripartite missions. The study's results provide pragmatic strategies to advance the tripartite missions and lead necessary change for improved patient health.
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