KI News special report: vice-chancellor of KI meets the new hospital director Melvin Samsom

The one has been vice-chancellor of KI for two years, the other CEO of Karolinska University Hospital for just four months. Here in an interview they talk about the challenges they share and about integrating research and education with academic healthcare and innovation.

What are the main challenges facing the partnership between KI and the university hospital?

Anders Hamsten: In general, it’s about how we’re to integrate the university and the university hospital more effectively. This is our main challenge, and one that can be broken down into different parts. One important part is the issue of leadership. In both organisations we talk a great deal about the importance of good leadership, academic leadership for knowledge-intensive, complex organisations. It’s also important to nurture a common leadership that works in both environments. Another part of the challenge is organisational: to harmonise our respective structures so that they dovetail better. And then, of course, we have the issues of financing all our joint activities, and to work together to improve the quality of academic healthcare.

Another part of the challenge is organisational: to harmonise our respective structures so that they dovetail better.

Melvin Samsom: I’d prefer to start at the other end: what are the options and possibilities available to us? KI and the university hospital together are uniquely endowed: such a renowned university next to such a large university hospital on two campuses. If we can coordinate our strategies, we will be in a strong position to drive the development of future healthcare systems, amongst other things. We both agree that our partnership is not operating at its optimum, and there is much to be gained by improving it. Resources will always be in short supply, but there is a lot we can improve using what we currently have at our disposal. One example is to take the areas in which KI excels and make them areas in which the university hospital also excels, so that we can benefit more from each other. Another important issue is the brand. To much of the world, both our organisations are “Karolinska”. It’s a powerful brand that we should take great of.

In which areas should the two organisations integrate more?

Anders Hamsten: In all core operations. As I see it, there are four areas: research, education, academic healthcare and, as the fourth point, innovation, implementation and knowledge dissemination. But to achieve this, we need to work with a fifth area: a common infrastructure. This is now being built up at both KI and the university hospital, and it’s something of a challenge to make sure that it’s designed in a way that favours our collaboration.

What else does the infrastructure include?

Melvin Samsom: It’s easy to think of material investments, but most of all I want to emphasise the importance of soft infrastructure: the people. The new environments being built are, of course, important, and we have a desperate need for new IT systems, but it’s still more important to find the right people – people who are in sync with us and how we’re changing. This has been one of the pivotal questions of our conversations: how can we get the right people in the right place? The ones who can tackle the four areas that Anders mentioned: academic healthcare, research, education and innovation. I know that this hasn’t always been the case at the hospital and that healthcare has been our main focus. This, however, will change over the coming years.

What will happen to your education programmes?

Anders Hamsten: One interesting question is to identify the most suitable clinical learning environments for our students: how relevant they are to our different programmes, what highly specialised care is done there, what the mix of the major disease categories looks like, what supervisory resources are available, and so on. Since the patient flow changes quite quickly, this will be a challenge.

Melvin Samsom: We need to look at it from the students’ vantage point. The educational world is changing rapidly, and it’s now possible to study at universities in different countries by distance. Young people don’t want an education that assumes they’ll stay working in the same field until they retire. Do we offer the flexibility they’re looking for? Another question is: do we have the right patient groups at the university hospital for their education? What other caregivers need to be engaged to give the students proper clinical experience?

Is it harder now to combine healthcare production with education and research?

Melvin Samsom: I’d say it is. It’s more expensive to treat patients at a university hospital than in other places, and since we’re publicly financed, we need to justify why this is the case and why a patient has to be treated at this higher cost instead of somewhere else. Sometimes it’s because we’re the only ones with the competence. It can also be because the treatment of that patient group is closely linked to education or research. Uncertainty about the magnitude of this extra cost and what we get for it easily causes problems when healthcare is to be combined with education and research.

Anders Hamsten: And to that I’d like to add the question of leadership. Not only the leadership of our respective organisations, whereby we both want to reinforce the academic leadership, but also political leadership, which must help to ensure that the university hospital receives the resources it needs. Without them, both healthcare and the education of the next generation of medical staff will suffer. Our political leaders must be explicit in making it clear that the university hospital plays a special role amongst all the hospitals and specialist clinics in the Stockholm region.

KI and the university hospital must remain mutually critical, in a constructive sense.

Melvin Samsom: Patient flows are changing, and the university hospital will be changing its patient mix. We will be focusing on more complex, academic healthcare that we have had, the kind of healthcare that demands close collaboration with research and education. We need to look critically at which patients require treatment at the university hospital and which can be treated more cheaply elsewhere. Because of this we have to cooperate in a more organised way with a network of other caregivers operating around us.

You seem to agree on most things. Is there anything you don’t see eye to eye on?

Melvin Samsom: It’s true that we’ve found much common ground. The fact that we have similar backgrounds – we’re both clinicians, researchers and managers – has no doubt helped to make it easy for us to agree. I think we have very similar ideas about our common goal. But of course then, when the job has to get done, lots of questions will crop up along the way that we’ll have different opinions about. Which is good. KI and the university hospital must remain mutually critical, in a constructive sense. It’s through such criticism that academic environments advance.

Text: Anders Nilsson

Photo: Gustav Mårtensson