What does it mean to be an academic health organization?
As an academic health organization, London Health Sciences Centre (LHSC) has a care, teaching and research mandate to fulfill. We provide acute care for the sickest patients and those requiring highly specialized treatment; we train more than 3,600 students each year - including student doctors, nurses, and health professionals such as social workers, speech language pathologists, psychologists and physiotherapists; and, through our research institute, we conduct leading edge research to advance knowledge and care now and in the future. To achieve its academic mandate, LHSC and Lawson Health Research Institute – the research institute of LHSC and St. Joseph’s Health Care London - work in partnership with Western University and other institutions of higher learning. inside LHSC talked to five leaders from LHSC, Lawson and Western to get their perspectives on our shared academic mandate and where we’re heading in the future.
Dr. David Hill, Integrated Vice President of Research and Scientific Director of Lawson Health Research Institute
“As an academic centre it’s not enough to practice current standards of care. LHSC has a mandate to discover the next level of care, so it has a key role in innovation which is interwoven with the responsibility of delivering tertiary - or highly specialized - levels of care. As an academic teaching hospital we do the most difficult medical and surgical procedures. The most qualified medical and allied health staff expect to be involved in research to develop the next level of care, and to attract them you need to provide a vibrant research environment.”
Q: Where does the research start?
It often starts at the point of care. Research questions generally come out of a frustration at the bedside. Clinicians notice a challenge and envision a way to solve it through research. What are the options of producing a better outcome for the patient – is it the system, is it the drug, is it the procedure? For example, how can we make that joint replacement last longer?
Q: What is the goal?
At Lawson, all of our research is entered into with the desire and passion to continually improve the outcomes for patients, whether that is in London, across Canada or around the world. This comes from the front line clinical teams at LHSC and St. Joseph’s that are not only treating patients but also thinking about how we can make improvements. The emphasis is always on what we can do for patients and families.
Q: How does Western University factor in?
Our researchers also have faculty appointments at Western, so they have responsibilities teaching health providers and scientists. Obviously we have strong linkages with medicine and dentistry, nursing and health sciences, and we also have links with engineering, social sciences and computer science. This alignment promotes the sharing of knowledge, resources and capabilities between different and highly specialized research teams across the city, and strengthens London’s ability to deliver on ground-breaking health research results. We also have streamlined processes and shared administrative support that help our researchers dedicate more time to their work.
Q: Does Lawson also train students in conducting research?
Yes, we train about 140 graduate students and 60 postgraduate fellows each year.They are trained in everything from laboratory-based techniques to epidemiology (the study of the distribution and determinants of health and diseases in defined populations), clinical trial design, analysis, and qualitative as well as quantitative research – basically the skills you need to conduct all aspects of research. It puts us in a unique position because the skills are being taught within a multidisciplinary hospital setting. This fosters collaboration and discussions between different groups that may not otherwise work together. This is when the innovative sparks fly.
Q: Where is the future of hospital research heading?
For an academic health centre as large as LHSC, our researchers aspire to be international leaders, and indeed we have a long history of innovating for the world. We are leaders in orthopaedics, movement disorders, cardiology, personalized medicine, transplantation, mental health, cancer treatment and many other areas of research including a specialized children’s program. We’re harnessing new technology, such as research into 3D printing of artificial implants and joint replacements which are directly based on the individual characteristics of the patient’s anatomy. In essence, the research is looking at tailor-making an implant which will ideally last a lifetime. And, a whole field is opening up in terms of data and setting up a direct linkage with the provincial health database, so we can do research at LHSC and compare it with data across the province. Those are just two examples of where research, and care, is heading.
Dr. James Calvin, LHSC Cardiologist and Chair/Chief of Medicine, Interim Chief Medical Officer
“Many physicians are looking to practice within an academic health sciences environment. It’s about pursuing personal goals as they relate to research and education, in addition to caring for your patients. There’s a high level of commitment. We attract good people and we offer them our best so they can find their best.”
Q: How does LHSC coordinate the overlapping work of the physicians with Lawson and Western?
The physicians have a contract with Schulich School of Medicine & Dentistry, Western University, for designated roles such as clinician-teacher, clinician-scientist, or researcher-teacher, and the expectation on time spent on clinic and teaching work varies according to their contract.
Q: How do you see LHSC’s role as a teaching hospital unfold day-to-day?
The young students are very bright and they are learning to think like doctors. They communicate differently now than say 30 or 40 years ago, and they access information in a different way so their ability to get into a problem is significantly enhanced. Sometimes they’re teaching us as much as we are teaching them. The way to prepare them is to learn from them ourselves.
Beyond the technical skills, there is still a place for teaching humanism, incorporating empathy for their patients and also for their colleagues. Empathy in anything you do is extremely important as a physician. Difficulties are often related to communication and not seeing things the same way.
Q: So how do you integrate the teaching of empathy with in-the-moment care?
Students observe how you interact and respond in the moment, whether it is with a patient, a family member, or a colleague.
In our teaching we are asking students to reflect on how patients might cope with the stress they are experiencing as part of their illness, we are asking them to meet patients on their own terms. Those kinds of discussions are important to have with the students.
Carol Young-Ritchie, Chief Nurse Executive, and Vice President of Medicine, Family Medicine, Critical Care and Professional Practice
“Typically we think of nurses and health-care professionals in hospitals spending all their time providing direct patient care. Uniquely within an academic health science centre, many nurses, as well as health professionals from numerous disciplines (for example, pharmacists, physiotherapists, social workers, psychologists, occupational therapists, speech-language pathologists, and dieticians) support learning and research, with many holding academic appointments within colleges and universities as adjunct faculty. As direct care patient needs continue to increase, it can be challenging to fulfill our education and research mandate. However, the strength of our health system in the future will rely on today’s education and research, and LHSC is fully committed to continuing its legacy of teaching tomorrow’s care providers and innovating through research.”
Q: What is involved in teaching nursing and health discipline students at LHSC?
Each year, we have well over 1,200 allied health and nursing students in clinical placements at the diploma, undergraduate and the graduate level. The curriculum is set to provincial standards and we are evaluated on the experience we provide our students. I am proud that some of our preceptors - skilled practitioners who supervise students in a clinical setting to allow practical experience with patients -have won awards for their excellence in teaching and mentoring, and have been recognized provincially. In addition to their clinical learning, many students also do small research projects or quality improvement projects as part of their education at LHSC.
Q: How are nurses and allied health professionals involved in research?
Within an academic centre, nurses and members of the health disciplines can be immersed in research in a number of ways. For some practitioners with advanced degrees this may be developing research questions and leading research studies. Many nurses and health professionals are also members of research teams, contributing unique perspectives in their area of expertise with a multidisciplinary focus. Most importantly, all the health professionals rely on research to help inform best practice. From this perspective many of our clinicians translate research findings into frontline practice. In everything we do we use evidence to provide optimal patient care.
Q: What are the challenges that our students face now and into the future?
We need to appreciate that the foundational knowledge nurses and members of the health disciplines receive with their education is just the beginning of growing as health care professionals. Hospitals such as LHSC are very specialized as we care for the most medically complex and severely ill patients. Our challenge - and our commitment - is to support lifelong learning with continuous inquiry throughout the career span.
Dr. Michael Strong, LHSC Neurologist and Dean of Schulich School of Medicine & Dentistry, Western University
“In terms of teaching, across the country there are 17 medical schools and they are responsible for 100 per cent of the physician training in Canada. On the clinical side, LHSC and Schulich Medicine & Dentistry are absolutely inseparable. Physicians’ time is spent in the hospital setting and also as faculty at the university. The hospital provides the hands-on experience with patients, families and other health-care providers.”
Q: How does university prepare students for the hospital training experience?
It starts in year one working with simulated patients. Students learn how to take a medical history and how to examine a patient. Surgical residents first train in a surgical simulation environment - so starting with surrogate patients long before they take training in the hospital. Our simulation education in London is a real strength, providing entry-level to very advanced surgical simulation learning environments.
Q: How do the academic partners coordinate the research aspect of their respective mandates?
It’s quite variable. In some programs we are very tightly integrated among all three, working as a single unit. Other programs are driven intrinsically by the hospital and Lawson. Some of the clinical trial work going on at the hospital, for example, the university input may be limited to the ethics-review component. It’s a mix and match, but it all comes together well.
Q: Looking ahead, how are the academic partners planning for future regional system needs?
In short-term planning we are very good at working together and looking at what the needs are here - do we have the right specialties covered for future population needs? Do we have the researchers, do we have the resources? Longer term we will be looking at planning for our region. The decisions we make today have an impact 15 to 20 years down the road. That is fascinating.
Dr. Paul Woods, LHSC President and CEO
“Academic hospitals have a role as connector and partner with others in the system. In the Southwestern Ontario health-care ecosystem we ask ourselves how we can reach a new level of relationship and shared accountability. It has to be intentional. There is the tyranny of the urgent, the need to tend to the current crisis, and my challenge is to still look forward. As a new CEO, it is important to me to make personal connections and interact with peers in London and the region. It is important to come to the table with humility - ask how we can help and how you can help. We have much we can learn from one another.”
Q: What do you see as our role as an academic teaching hospital?
We are at a key stage in defining LHSC’s go-forward strategic plan which will define our priority areas of focus. In turn, this clarity will help guide the way we shape and deliver our care, teaching and research mandates. Today, we provide a clinical teaching setting and a clinical research setting, and we cover a large selection of specialties. I believe that by being more intentional in our strategic focus, we can strengthen these efforts.
Q: What are the challenges of being an acute care academic health organization?
From a patient care perspective, we see the most medically complex and critically ill patients in the region. When other regional hospitals are overwhelmed by patient volumes, or patients require more complex care than can be delivered locally, patients come to LHSC. This brings the obvious challenges that we face in terms of wait times in the Emergency Department and shortage of beds. This is a system-wide challenge playing out across major academic centres in Ontario as population health-care needs continue to grow. Improving access and flow remains a key area of focus for LHSC and all regional partners.
From a teaching perspective, providing quality training across the hospital is an important component of our work and represents a significant undertaking each year to ensure we prepare the care providers of tomorrow.
In terms of attracting and retaining top clinicians, we have to make sure we are supporting their clinical and research work, have the resources in place, and have the courage to partner in new approaches to be successful.
Q: How are we planning for our future with our research and teaching partners?
Together with our academic partners we are moving toward being much more integrated in our collective strategic planning to be sure we are doing everything we need toward a shared vision of sustained care, teaching and research excellence in London and the region. To this end, we will be getting together to assess opportunities and ensure plan alignment and compatibility. This will be important work and a benefit for everyone involved.