Strategies for University Hospitals
Interview: Prof Hans Romijn, CEO, Amsterdam UMC
Prof Hans Romijn was faced with the task of merging Amsterdam’s two university hospitals, the Academic Medical Center (AMC) and the VU University Medical Center (VUmc), which had fiercely competed for decades. Out of the eight university hospitals in the Netherlands, the duo were both in the smallest three. Yet the newly-merged organisation is now the largest in the Netherlands with an enviable high-ranking position for research output in Europe, in terms of citations.
So how did he do it and what did he learn along the way?
First, the journey wasn’t easy. “It took ten years to get permission to merge,” he recalls.
He likens the merger process to a zipper: “We started the merger with a zipper and we zipped the organisations from the top to the bottom.”
The two boards of directors were merged in June 2018. Both institutions were organised in January 2019 into 10 divisions with each division being an exact mirror of the similar division in the other institution. The management boards of the similar divisions of both sides were merged into a single management.
Next step was to put each department under one chairman. “It took 14 months to select a single person to chair each department.” The departments themselves will be merged in the autumn of 2021.
“It was initially assumed by some that there would be a 20-minute meeting with the two chairmen to decide who would be the chairman and who would step down. However, the process was designed and guided by several one-hour sessions one-on-one and together with board members. This worked well and by the end of the second or third hour many of the chairmen would come to us together, having reached a mutual agreement.”
He said to make the process work he insisted that there should be no cuts in salary for the person who stepped down. At the same time all staff across both university hospitals are employed on the same terms by the same employer. Some 18 years ago, the Academic Medical Centre had pioneered a move to ban all employees from doing any private practice.
He says: “Previously there were discrepancies in pay and employment and many physicians had small private practices on the side. They were even sometimes treating their private patients in our hospital! All this created a lot of resentment and friction.”
At the same time Romijn and the board has started setting research priorities for the group.” Just five years ago professors had complete freedom in research. Now we agree in advance a plan and we think about where we want to be as an institution.”
This meant taking some tough decisions. Amsterdam no longer does many standard procedures such as hip replacements. “Ten years ago, if a patient came to us, we would treat them whatever disease they had. That is not true now. We know what research we want to do and that determines the patients we treat and vice versa. Our patients and our research are aligned.”
He says that the leadership team also needs that level of clarity: “Too often, in university hospitals management is not clear about their function and what they do. Ally that to terms of employment which enable freelance work and you end up with big problems.”
Structure of a university hospital can be simple. “We have a board of directors which controls 10 divisions under which are 70 departments. The board makes a decision, and this is transmitted to the chairman of the division and then to the medical departments. They control HR, budgets and investments. It is a very solid line and very simple and everyone understands it.”
The patient will make a journey with the contribution of specialists from say 2-3 departments. “If a patient has pancreatic cancer, he/she is treated in a highly coordinated way managed by case managers by dedicated specialized teams consisting of radiotherapists, medical oncologists and surgeons.”
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