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Blog: Twinning isn’t good enough

Historically, university hospitals in Europe have been paired with research institutes in a separate twinned relationship. The harsh truth is this doesn’t work well. If Europe is to emulate the success of Boston’s biotech hub we need unified structures where scientists and physicians work side-by-side for the same employer. Here we look at attempts in Berlin and Stockholm to do just that.

We do actually know what successful hospital/research hubs will look like a decade or two. Professor Phillip A Sharp at MIT told us that scientists and physicians will work shoulder-to-shoulder using big data platforms interrogated by AI that can dig deep into disease causation and cure. It is interesting to note that this is an uncontroversial claim – we can’t predict future healthcare science but the structures that can best deliver it are perfectly obvious. All this calls for far larger organisations with decade long investment projects. This is coming. In Paris l’Assistance Publique Hôpitaux de Paris, APHP, has a cumulative revenue of over €7,5bn, in London, the Kings Health Partners hub is at £4.5bn. OK, so they are still dwarved by US counterparts with 5-8 times their revenue, but it is a start. Expect more mergers soon.

But size is not enough. The twinned historic relationship between university hospitals and research institutes is not fit for purpose. It is only when scientists and physicians can work together to shared KPIs from shared budgets and with a single employer that Europeans can seriously expect to compete in the new era. This is being recognised in brave projects in Stockholm where the CEO of Karolinska University Hospital and the Karolinska Institute have created a new virtual organisation, Precision Medicine Center Karolinska (PMCK), which will effectively provide a single platform. In Berlin, Professor Nikolaus Rajewsky has created the Cell Hospital with a similar goal in mind. 

Why are unified structures needed? There are several answers to that. If scientists are siloed off working on academic research, they may well focus on abstract papers which have little or no impact on patient outcomes. Meanwhile, the hospital physicians focus on complex care for patients and may have little time for innovation. And there can be immense gaps. Rajesky points out that in Berlin it is illegal to train physicians or researchers in their partner organisations! That shows how deep the barriers are. And it is not hard to find departmental heads in hospitals who are deeply frustrated by monthly and quarterly KPIs which focus on medical activities and do not reward innovation and discovery in any way.

Dig deeper and you can find horror stories. We know of a German university hospital which had to close state of the art children’s wards because the research team and the physicians constantly countermanded each others’ orders. The end result? The demoralised nurses quit in droves and the wards were mothballed.

Of course, it is possible to build strong partnerships between research institutes and hospitals and you can engage in persuasion and cultural change as per this Spanish example, but in a twinned model there will always be fractures and a constant, and wearing, need to build bridges. Note that there is one European country, the Netherlands, which has moved to a unified structure already in the last two decades. We interview the outgoing CEO of Amsterdam MC Prof Romijn here.

Note that in America there has been a general move towards unitary structures. University of Utah Health is the ultimate owner of both the research institute and the hospital. Mass General in Boston works closely with Harvard University but also incorporates a $1bn research institute which it owns. Unless you have a strong, unitary organisation we do not see how Europeans can successfully build massive data platforms and work to the time horizons they need to if they are to compete long-term with their far larger and better funded American counterparts.

All this is also true because there is another step Europeans need to take if they are to compete. That is engaging with start ups, investors and big medtech and pharma to create a new industrial revolution, a virtuous funding circle. We think unitary structures will find that much easier that twins.




We would welcome your thoughts on this story. Email your views to Max Hotopf or call 0207 183 3779.