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Karolinska unlocks collaboration between hospital and research

Trapped in silos, European university hospitals and their twinned research institutes are exploring better ways of working together. Karolinska Institute and the Karolinska University Hospital have created a new 50/50 joint venture PMCK – Precision Medicine Center Karolinska. We talk to PMCK’s acting director Anna Wedell about how this will unlock profound collaboration.

The aim of the new venture is to enable research scientists and physicians to work together much more closely. It is also a way of unlocking resources which would otherwise be siloed.

In many ways it looks like a small step. PMCK today is a small, virtual organisation and almost all its staff are likely to be employed directly by either the institute or the hospital for the foreseeable future. So why all the fuss?

PMCK grew out of Wedell and her colleagues’ experience at the Centre for Inherited Metabolic Diseases (CIMD) at Karolinska University Hospital. Working in a cross-clinic collaboration, the genomes of 10,000 patients have been analysed: “We created tools that enable us to ask very specific questions and give verified diagnoses. We have diagnosed hundreds of patients, in some cases saving lives and preventing handicaps, and we have discovered a load of completely new diseases. All this was only possible by creating multi-disciplinary teams that straddled medical departments and academic disciplines.” As a scientist she sees this as “proof of concept”.

All well and good.

But Wedell says the experience also highlighted the challenges thrown up by the separation of academic institute and hospital. For instance, as a hospital department, CIMD is measured monthly and quarterly on KPIs which do not reflect the value of achievements such as early diagnosis and treatment.

Nor does it have direct access to the sort of budgets that establishing infrastructure for whole genome sequencing at scale cost. Those resources sat within the research institute. Finally, staff were measured by individual KPIs related to their speciality departments, whether at the hospital or in research. This makes teamwork much harder.

Separate IT systems pose further challenges.

She says that PMCK is the first long-term initiative she knows of in Sweden to fix these issues once and for all. As director, she reports to both the vice chancellor of the Karolinska Institute and to the CEO of Karolinska University Hospital. Upstream further, PMCK has got buy-in from Stockholm region. With buy-in from senior management, PMCK can now start to systematically deal with barriers to collaboration.

She says: “the idea is not to create a separate centre, but to enable the present healthcare to work differently.” That means enabling legal contracts that will allow people to work across both organisations. Whilst that is possible today, it tends to be executed on a case-by-case basis. A more seamless approach should also make it much easier to train staff across the two organisations.

Within the hospital itself, she is keen to bring together people from different specialities so they can focus on disease areas. “It is crucial that we do this and unite lab and clinical medicine. So we are identifying pilot projects. In the long-run, we need to create a governance system that measures the right things and that isn’t siloed.”

And PMCK is also all about cultural change. “Academic medicine can be very competitive and individualistic. But we have seen what teamwork can achieve. We know people find it a relief when they can collaborate in teams. As we change KPIs, so this will happen.”

All of this fits, of course, into a broader narrative. Professor Phillip A. Sharp at MIT put it like this to us: “It is now clear that the effectiveness of future healthcare systems will depend on big data and its integration at all levels. That calls for deep cooperation across departments.” Big European university hospitals and their twinned institutes are all in the same race to establish large-scale hubs which mirror what has been achieved in Boston – a new industrial revolution in which academia and hospitals work closely with external investors and life science companies around big data sets.

Wedell acknowledges all this but before Stockholm can effectively build such a hub it needs to integrate better.

Talking to Wedell you can sense her excitement. She and her team have tasted freedom, they know what is possible. And now they have the green light. Watch this space.

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