MANAGEMENT ROLE. As the Vice Dean for ALF issues, Christina Jern seeks to highlight ALF issues and strengthen collaboration with Sahlgrenska University Hospital and the Västra Götaland region.
‘We must collaborate and pull together to achieve a good showing in the national quality evaluation that will form the basis for distribution of ALF funds between seats of learning,’ she says.
The agreement concerning medical education and research in health and medical care (ALF agreement) regulates, among other things, government compensation for the costs incurred by the County Council in connection with clinical research and the training of doctors. It concerns large sums of money – this year alone ALF operations amounted to SEK 432 million in Gothenburg. Of this amount, around SEK 350 million will go to clinical research and around SEK 80 million to the training of doctors.
Entirely new conditions
The fact that the Sahlgrenska Academy now has its very first Vice Dean with special responsibility for ALF issues stems from the new ALF agreement that entails entirely new conditions and challenges for ALF collaboration at the national and regional levels. Our performance and ability to collaborate between healthcare and the academy will in fact translate directly into how much money will be placed at our disposal in future ALF rounds.
‘If we are to achieve the intentions of the new agreement – and conduct high-quality clinical research and basic training for our medical students – then a major part of the faculty must get involved in ALF issues, not just the members of Medi-sam och Hälso-sam. We need a broad platform for collaboration on these issues,’ says Christina Jern.
As the Vice Dean for AFL issues, Christina will be the faculty’s equivalent of the University Hospital’s head of research. She will be one of the representatives in the Medi-sam body for research issues, and in line with other vice deans, she will report to the Dean and the Academy Board.
Motivating collaboration
When the first ALF agreement was signed in 1989, the funds were split between six principles (Uppsala, Umeå, Stockholm, Gothenburg, Lund and Linköping). These days Örebro is also included in the SEK 2.3 billion allocated by the government for clinical research and medical training every year.
Previously, Gothenburg received a fixed sum every year, but starting next year, part of the ALF research funds will be reallocated among the seats of learning. Thus while Gothenburg has the opportunity to get more funds, it also risks getting less than before.
‘I interpret this to mean that the government seeks to encourage better collaboration between the nation’s university hospitals and universities. Exposing part of the funds to ‘competition’ is also an attempt to improve the quality of research and training,’ says Christina Jern.
The proportion of ALF funds allocated to research based on performance will gradually increase. During 2016 and 2017, 10% will be distributed based on a bibliometric evaluation of clinical research, and this will increase to 15% in 2018. In 2019, 20% will be reallocated.
Creating an allocation model
The new ALF agreement will also entail the introduction of a resource allocation model in 2019. While the precise form the allocation model will take has not yet been decided, it is clear that one fifth of government funding will be covered by the reallocation. The joint national steering committee for ALF will be presented shortly in a proposal. The model will probably be based on bibliometrics and also take into consideration the conditions and clinical significance of the research. Counties where clinical researchers have good prospects may thus receive more funds than counties where such prospects are not as good.
A new term has been introduced into the ALS agreement, namely university health care, which is healthcare of a type that requires collaboration with the university. The national steering committee has been tasked with presenting proposals for the criteria used to define university healthcare. The steering committee must also provide guidelines as to how the quality of university healthcare should be monitored.
Stable 2016
The ALF funds for allocation to Gothenburg next year are already fixed. Initially, the redistribution model will have no major significance for Gothenburg; in 2016 we will receive roughly the same as before, neither more nor less.
‘We received a neutral outcome, and there are prospects for our improving this. We have long enjoyed a good climate of collaboration in ALF issues in Gothenburg, and both parties are willing to compromise whenever necessary. This is something we can build on for the future,’ says Christina Jern, and continues:
‘Good collaboration within Sahlgrenska Academy is very important to increase the potential of translational research and new research constellations.’
New reporting requirements in connection with the reallocation of ALF funds according to performance also necessitates increased administrative cooperation between the Sahlgrenska Academy and the University hospital.
More funds for positions
The generation shift in clinical research is an important issue concerning the preservation of Gothenburg’s competitiveness, according to Christina Jern. For many years it has been difficult to recruit doctors to research, and we are now facing large-scale retirements. In order to expand the research recruitment base, Sahlgrenska Academy and Sahlgrenska University Hospital have set ALF funds aside for the teaching assistant program for medical students, intern- researcher positions and ‘try-it-and-see research months’ for medical interns. A new type of ALF medical position has also been established at doctoral and post-doctoral levels, which means such positions are no longer locked to specialist levels. To bridge the career gap between post-doctoral and academic levels for combined research and healthcare positions, higher ALF medical positions were also introduced recently.
‘We now have the whole chain, from teaching assistants to the level immediately below combined research and healthcare,’ says Christina Jern, who is pleased with the threefold increase in the number of applicants:
‘When we announced the ALF specialist positions a few years ago, we had around 25 applicants, but last time we had more than 80 applicants for ALF medical positions. Hälso-sam has now decided to raise the proportion of ALF research funds allocated to this type of program and position from 8% in 2015 to 13% in 2016. For me, this is one of the very best investments we could make.’
‘Compared to many other universities, the University of Gothenburg uses a major part of its ALF a location to ALF project funds distributed in open competition.’
‘We use around 65% of the ALF budget for project funds, and it might be possible for us to increase this proportion,’ says Christina Jern.
Research as a complement to training
The new regional ALF agreement has also led to the division of Medi-sam into two bodies – one for research and one for training. As the vice dean for ALF issues, Christina Jern will be one of Sahlgrenska Academy’s representatives in the research body, and also a representative in the joint meetings of the two bodies.
In Gothenburg, SEK 80 million of ALF funds are set aside for medical student internships in healthcare (previously known as clinical training [VFU], but now referred to as integrated training, [VIL]). ALF funds not only finance integrated training at SU, but also at other hospitals in the region.
High quality medical training requires total educational environments with clinical research in every discipline. The close link between learning and research is reflected in the strategic investment of ALF funds.
‘Just as we are able to further strengthen extremely competitive research environments, we can provide research opportunities to high quality clinical activities that are poorly researched where this is important from an educational standpoint, says Christina Jern.
Many previous management assignments
As a Professor of Neurology with a focus on vascular illnesses and vascular genetics, Christina Jern conducts broad research into strokes and their genetic links. She has extensive experience of management assignments both within the university and collaborative bodies between universities and healthcare. She was a member of the Sahlgrenska Academy’s Faculty Board for many years and has in recent years alternated as chairman of Medi-sam with Head of Research, Lars Grip. She was also Head of Practice for Clinical Genetics at Sahlgrenska University Hospital.
Click here to read about the regional ALS agreement, which came into force on May 1, 2015: https://gubox.box.com/s/t8so35oer8sy9f2g23b8lier2fsp6amh
Click here to read about the national ALS agreement upon which the regional agreement is based: https://gubox.box.com/s/qevf9b46kymzsuje46dpwlbb5p5h6lnq
