Briefing Note 7.4
Advancing a National Recognition Program for Academic Health Sciences Centres
DRAFT Indicators to help Identify Academic Health Science Centres
PURPOSE:
The purpose of this briefing note is to provide an update on the progress of our ongoing project to
identify indicators of academic centres in Canada.
BACKGROUND:
The ability to identify academic centres or those having a special role in research and innovation has
been identified in several reports. These include the Action Plan for the Sustainability of Health
Research (2014) and An Action Plan to Help Attract More Clinical Trials to Canada (2010), as well as a
request from the HealthCareCAN Transitional and Founding Boards of Directors.
Over time, such indicators could form the basis of a national recognition program for AHSCs (i.e. to
help government identify these organizations) and/or a proposal for use within HealthCareCAN (i.e.
anticipating the growth of membership to include more community hospitals and/or non-academic
RHAs). This initial set of indicators was developed in the following manner:
1. A preliminary, scoping review of the literature and environmental was conducted.
2. A series of reports produced by the Hay Group and CIHI, up to and including 2009, contained
indicators that were compared between what they referred to as “teaching hospitals” and what they
referred to as “large (similar size) community hospitals”.
o It should be noted that while the term “teaching hospital,” is considered outdated, the
operational definition of “teaching hospital” used in these reports maintains the integrity of
the tripartite mandate and considers sites within RHAs. By comparing the metrics in these
reports for the “teaching vs same size non-teaching” sites, a few items stand out as
“differentiators”.
3. HealthCareCAN requested advice from CIHI staff on how to go about this exercise.
o It should be noted that at one point, CIHI considered membership in the former ACAHO as
part of the technical definition of a “teaching hospital”. Since its dissolution, this is no longer
an option. CIHI now asks the provinces to identify their “teaching hospitals”. The resulting
designations may be as much a response to political considerations as practical ones. As a
membership driven organization, HealthCareCAN may be positioned to undertake this
exercise nationally.
4. Based on the above, draft indicators were proposed and circulated for comment to the Vice
Presidents of Health Research and to the Founding Board for initial comment and the indicators
were revised to include system-level indicators per the Board’s recommendation.
5. The draft indicators have been sent to all member CEOs and to the Association of Faculties of
Medicine for advice on the best ways to engage with the Faculties of Medicine.
CONSIDERATIONS
There are two groups of considerations for this initiative. The first relates to the indicators themselves
and the second relates to their feasibility. They include the following questions:
VPR Meeting October 22, 2015 – Indicators for Academic Centres
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Is there “readiness” for the introduction of such indicators or are there anti-bodies to them?
Are the indicators correct, complete and feasible? How many of the indicators would have to be met
as the threshold for being identified as an academic centre (It could be 1, 5, all, etc.).
Can the indicators be used by multi-site organizations, RHAs, and single site hospitals alike?
Are the indicators collectable, useful and meaningful, do they distinguish more academic from less
academic healthcare facilities?
How do we engage in dissemination across the sector and then broader dissemination across
policy audiences?
To address these issues, we have taken a three-pronged approach:
1. We have sent the indicators (attached) to all HealthCareCAN members prior to undertaking a
pilot so that we have “feel out” any major issues before we go too far down this path. There
have been few responses, no negative responses, and the few comments received have
indicated (a) the initiative is timely and important (b) whether the indicators should be
“weighted” and (c) queried the number of indicators that an organization should meet.
2. We have an MSc student (Mr. Charles Thompson) who is interested in this area and who will
develop a protocol for and conduct a pilot test using research-based methods which will allow
for an objective analysis of the indicators.
3. We are in communication with CIHI and AFMC to discuss the initiative with them. We have also
applied for a dissemination grant from CIHR to help disseminate the findings.
DISCUSSION AND DECISION
It is recommended that the membership now be advised of the intention to pursue the pilot, with a final
invitation for comments and that the pilot be pursued.
Prepared by:
Bill Tholl, President & CEO, HealthCareCAN
Tina Saryeddine, Executive Director Research & Innovation,
HealthCareCAN in consultation with representatives from the VPR
Roundtable.
Charles Thompson, MSc Candidate Telfer School of Management
and HealthCareCAN Research Intern.
Date: October 26, 2015
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TABLE 1: DRAFT SET OF INDICATORS FOR IDENTIFYING ACADEMIC CENTRES
Corporate
1. Mandate:
Does your
facility have a
publicly stated
tripartite
mandate of
patient care,
training, and
research?
[Yes/No]
2. Vice
President of
Health
Research or
Equivalent:
Does your
most senior
leadership
team (for an
RHA at the
RHA level)
include a Vice
President of
Health
Research (or
equivalent)?
[Yes/No]
3. National
Role: Does
your
organization
hold
membership in
national
associations
engaged in
academic
health
sciences?
[Yes/No]
Clinical
4. Rare and/or
complex care
and/or special
population: In the
past year, has your
organization
provided care to
patients in any of 8
rare or complex
patient case mix
groups OR does
your organization
focus solely on a
specialized
population (eg.
Elderly, children,
mental health, etc.)
[Yes/No]
5. Regional centre:
Does your
organization/site
serve as a regional
centre for
specialized care
(eg. Paediatrics,
trauma, etc.) and/or
accept transfers
from other acute
care facilities.
[Yes/No]
Research
7. Research
budget: Does
your organization
have a dedicated
budget for
research?
[Yes/No]
Training
10. Faculty of
Medicine:
Does your
organization
have a
formalized
relationship
with a
faculty of
medicine
and does it
offer training
of physician
specialists
or clinician
scientists?
[Yes/No]
System
13. Network
Formation:
Has your
organization
engaged in
efforts to build
a network with
others over
the past year?
[Yes/No
followed by
three examples]
8. Patents or
licenses: Does
your organization
have income from
patents, licenses,
spinoffs, or other
commercialization
activities?
[Yes/No]
14. Population
health or
community
outreach:
Has your
organization
led or played
a major role in
population
health or
community
outreach
activities in
the past year?
[Yes/No
followed by
three examples]
6. Flagged
conditions: In the
past year, has your
organization (or if
an RHA, a site
within your
organization) had
more than 10% of
patients with
flagged conditions
OR more than 50%
in the two highest
plx groups (% to be
discussed with
CIHI) [Yes/No]
9. Private sector:
Does your
organization have
research related
contracts with the
private sector?
[Yes/No]
11. Health
Profession
faculties
and
colleges:
Does your
organization
have formal
relationships
with other
departments
or faculties
that
influence
how
students are
trained?
[Yes/No]
12. Post docs
and
fellows:
Does your
organization
provide
research
and/pr
clinical
training to
post-docs
and/or
fellows?
[Yes/No]
VPR Meeting October 22, 2015 – Indicators for Academic Centres
15. Health
transformati
on: Has your
organization
led or played
a major role in
health system
transformation
activities over
the past year?
[Yes/No
followed by
three examples]
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Notes for each proposed indicator:
1. Mandate: This indicator may be ascertained by looking for evidence of the tripartite mandate in the
mission, vision, or strategic goals of the organization.
2. Vice President of Health Research (or equivalent): The emphasis of this recommendation is not
on the title of the position, but on the fact that this individual is on the senior leadership team. The
role may be shared with an Assistant Dean or Vice President of Care/Quality role or equivalent.
3. National role: This indicator harkens back to the CIHI technical definition of teaching hospital which
as late as 2013 was defined as follows in the Canadian Hospital Reporting Project Technical Notes:
“Teaching hospital are defined as hospitals with full membership in ACAHO” (see page 9
http://publications.gc.ca/collections/collection_2013/icis-cihi/H118-86-1-2013-eng.pdf). This
indicator also acknowledges that some organizations make a financial and strategic
investment/commitment to developing their national role and contribution in this peer group.
4. Rare and complex care/specialized population: This indicator includes either the focus of the
entire organization on a speciality population (like mental health) or the performance of one or more
of 9 conditions that are considered rare and costly including: fetal surgery; heart or lung transplant;
treatment of concurrent hip fracture and head injury; treatment of concurrent spinal cord, chest
and/or abdominal injury; any of the neonatal infant catastrophic diagnoses (Birth weight 10002500g); treatment of concurrent spinal cord injury and head injury; other musculoskeletal infections;
non-extensive burn with wound procedures. http://www.healthcarecan.ca/wpcontent/uploads/2014/11/05.30-NTF-EN-FINAL.pdf
5. Regional centre role: As would be expected for centres that are able to provide complex acute or
specialty care, academic centres usually have a higher proportion of transfer cases as a percentage
of inpatient days and as a percentage of total cases. “The costs of hospital stays: why costs vary” ”.
CIHI, Ottawa, 2008.
6. Flagged interventions: Flagged interventions refer to fourteen procedures which have been
identified by CIHI to be associated with higher costs of stay even though the intervention itself may
not be costly. A greater proportion of patients at “teaching hospitals” (11%) have “flagged
interventions” than at community hospitals (6%). “The costs of hospital stays: what makes a hospital
day more expensive”. CIHI, Ottawa, 2008.
7. Dedicated budget for research: This is the traditional indicator identifying academic centres. The
assumption here is that the amount is significant, but at this point no threshold is offered.
8. Spinoffs and world firsts and/or patents/license income: For this indicator, the idea would be to
identify spinoffs and world firsts over the past 5-10 years and/or to identify whether the organization
has had income from patents/licenses over the last 1 year.
9. Private sector: Private sector funding is an indicator of the research role of the organization. Over
time a threshold would need to be determined.
10. Faculty of medicine: An arrangement with a faculty of medicine is a fundamental prerequisite for
academic centres.
11. Health professions: There may be relationships with a faculty of nursing, allied health and various
health professions. This could be an “intensity measure” i.e. number of relationships.
12. Postdoctoral students and fellows: This indicator represents the ability of the organization to
offer advanced training opportunities.
13. 13-15. System impacts: In this set of indicators, academic centres are asked for examples of their
roles in network formation, system transformation, population health/community outreach.
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