Improving accountability through alignment: the role of academic health science centres and networks in England

BMC Health Services Research

Alastair M Buchan²  Ara Darzi⁵  Gary A Ford³  Glenn Wells²  Stephen M Davies¹  Pauline Allen⁴  Axel Heitmueller⁶  Pavel V Ovseiko⁷ 

[1]Addenbrooke’s Charitable Trust, Cambridge, UK

[2]Oxford University Hospitals NHS Trust, Oxford, UK

[3]University of Oxford, Oxford, UK

[4]London School of Hygiene and Tropical Medicine, London, UK

[5]Imperial College Healthcare NHS Trust, London, UK

[6]Imperial College Health Partners, London, UK

[7]Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK

关键词: Academic Health Science Network (AHSN);    Academic Health Science Centre (AHSC);    Tripartite mission;    Academic-clinical relationships;    Teaching hospital;    University medical school;    Partnership;    Collaboration;    Alignment;    Accountability;   

Others  :  1134315
DOI  :  10.1186/1472-6963-14-24

 received in 2013-08-27, accepted in 2014-01-17,  发布年份 2014

【 摘 要 】

Background

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.

Discussion

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.

Summary

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.

【 授权许可】

   
2014 Ovseiko et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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