Open Access Highly Accessed Debate

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

Pavel V Ovseiko1, Axel Heitmueller2, Pauline Allen3, Stephen M Davies34, Glenn Wells5, Gary A Ford567, Ara Darzi89 and Alastair M Buchan15*

Author Affiliations

1 Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK

2 Imperial College Health Partners, London, UK

3 London School of Hygiene and Tropical Medicine, London, UK

4 Addenbrooke’s Charitable Trust, Cambridge, UK

5 Oxford University Hospitals NHS Trust, Oxford, UK

6 Oxford Academic Health Science Network, Oxford, UK

7 University of Oxford, Oxford, UK

8 Imperial College London, London, UK

9 Imperial College Healthcare NHS Trust, London, UK

For all author emails, please log on.

BMC Health Services Research 2014, 14:24  doi:10.1186/1472-6963-14-24

Published: 20 January 2014

Abstract

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.

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