Chair's Column: We're Better Together

This place is pretty darn impressive. As we will hear more about over the next few years, this is the home of one of the most astounding examples of translational research – the discovery of insulin and its subsequent revolution of diabetes care. We are rather uniquely linked by ONE medical school that trains the largest number of specialists in internal medicine – clinicians, teachers, quality improvers, scientists, educators, and leaders – anywhere. We have world-class teaching hospitals (nine fully-affiliated and 25 community-affiliated hospitals and sites), each with its own particular strengths and focus. There truly is a Toronto Advantage. This is why, back in the era of hospital restructuring in the early 1990’s, the Toronto Academic Health Science Council (now the Toronto Academic Health Science Network [TAHSN]) was created by Dean Arnie Aberman. TAHSN’s mission was and is to, “Serve as a leader in Canadian health care by developing collaborative initiatives that optimize, advance, and sustain a shared academic mission of high quality patient care delivery, education, knowledge transfer, and research innovation.” Here's the  history.

In the past year or so, we have undertaken external reviews of a number of our departmental divisions (cardiology, rheumatology, neurology, dermatology, medical oncology, and occupational medicine). Put simply, the reviewers have been blown away by YOU and by what we have here at U of T. But where they feel we could do better – achieve even greater impact – is in implementing city-wide approaches to catalyze opportunities for clinical care, research, teaching and quality improvement. There is a collective belief that leveraging our unique strengths with a common purpose will benefit everyone.

They have pointed out that better coordination of care, capitalizing on pockets of clinical expertise, and fostering cross discipline resource allocation and planning has potential to reduce fragmentation and duplication of efforts and costs. Specifically, a division-wide clinical (recruitment) and research strategy has been recommended by all external review teams to, “help balance the various academic roles with clinical demands,” address clinical needs, and help, “fulfill the research mission.”

Formal measurement of adherence to current guidelines for clinical care across our sites was noted as lacking in several divisional reviews. Reviewers noted, “University of Toronto…is uniquely positioned to lead in development of formal mechanisms and measures to assure quality care at their affiliates.” One review commented that, “giving world leading experts in quality of care an opportunity to use the U of T clinical organization as their ‘laboratory’…will vault their careers into the next level.” And while our training programs are strong, reviewers have noted that we are inadequately capitalizing on the, “…diverse and large patient population,” that our hospitals care for. They note that, “…greater presence of faculty and trainees at some sites would enhance the learning experience and broaden residents’ training.”

Donors also understand that leveraging the collective that is U of T has value. They’re happy to support an excellent program or institute at hospital X, but they are well aware that if hospital X were to work collaboratively with hospitals Y and Z, even more could be achieved. Case in point is the Roger’s gift to  University Health Network (UHN),  SickKids and Faculty of Medicine and the Medical Psychiatry Alliance gift to Trillium, CAMH, SickKids and U of T Faculty of Medicine. Our external reviewers recognized this. One review team noted, “Philanthropy is changing – the traditional ‘grateful patient’ still exists to support an individual’s research, but large scale philanthropy has become more outcome, and results based. The term ‘venture-philanthropy’ has been coined to denote the active engagement of large donors in shepherding projects to success. There is an opportunity for the division to take the lead across the siloed hospitals to develop division or U of T wide projects.” They called for strategies to leverage the multiple hospital foundation resources in a unifying vision. This is starting to happen – with St. Michael’s Hospital (SMH), we have just successfully recruited an international star as our next departmental division director for neurology. This feat required a true partnership between advancement in the Faculty of Medicine with the SMH Foundation. A similar partnership is underway between Women’s College Hospital and the University to recruit our next departmental division director for dermatology

We know full well that it is an enormous challenge to work in such a highly complex multi-institutional structure, with the many barriers to collaboration that exist, including complicated systems for inter-institutional agreements and electronic records that cannot be shared between sites. But this complexity is also our unique strength. As physicians and leaders, we need to reach out to one another across our institutional silos to do what’s best for our patients. At the end of the day, if by working together we can bring more resources to the table to conduct research, teach and care for our patients, isn’t that good for us all? In this edition of DoM Matters, we wish to highlight some amazing examples of exactly how we’re better together. These examples set a precedent within the U of T system and are ripe for others to emulate.