HSMC in collaboration with the Department of Health Policy and Management at the University of Maryland (UMD), USA, along with University College Dublin, has established a new Health Research Exchange (HREx) to identify comparative projects and foster links among PhD and early career researchers (ECRs). I was delighted to be selected to join the first in-person meet-up of everyone who has been involved so far, including project leads Professor Mark Exworthy of HSMC and Associate Clinical Professor Negin Fouladi, UMD.
A full programme of events and discussions was organised in advance via Zoom so there was plenty of time to prepare presentations and buy some summery tops for the anticipated warmer weather. Before I knew it, I was on a flight for my first ever trip to the United States…
Comparing health systems: University of Maryland Medical Center
Our first full day saw us taken by bus to the University of Maryland Medical Center (UMMC) in Baltimore to meet with a range of senior leaders and practitioners keen to share with us the opportunities and challenges of working in the Maryland system. UMMC operates under a “Total Cost of Care Model,” unique to the State of Maryland. This model ensures that all payers (private, commercial, Medicare, Medicaid, self-pay) are charged the same rate for the same service at the same hospital. Costs are managed within a set budget with each hospital directly accountable for delivering on the three pillars of the model: Equity, Community and Value.
I was especially struck by the success of the Advanced Practice Providers programme in terms of nursing staff retention as well as the strong commitment to develop a ‘Just Culture’. Yet there are also many challenges, some only too familiar (staff wellbeing post-Covid-19) and some less so within the UK context (failure of timely payments from insurers resulting in delayed discharge and financial penalties for the hospital).
HREx Symposium Panel Talk
Day two took us to the School of Public Health building on the extensive and attractive UMD campus. Negin and her team had organised a two-day symposium with the first day providing each nation opportunity to present on key health system challenges in the US, UK, Ireland and Canada. As the UK contingent we introduced some of the difficulties of operating within a global health budget, challenges in managing population health, issues around equity of access and outcomes, and the current workforce crisis in terms of recruitment, retention and staff wellbeing. To drill down in to the latter, we talked to two case studies in detail: 1. The Impact of COVID-19 on England’s NHS and its Workforce and 2. The Impact of COVID-19 on the Dental workforce in Scotland.
As the morning progressed it became increasingly clear that despite differences in structure and funding models all the nations involved in the symposium were facing similar issues and grappling with how to address these. Suddenly the need to share knowledge, across borders, of what works and when, as well as what doesn’t and why, became an obvious and necessary step in attempting to address these complex and multiple issues. One key question which pervaded every topic was around how do we locally, nationally, globally take advantage of all the positive things we learned during Covid, such as how to actualise rapid system-wide change, and as researcher and practitioners not end up falling into the trap of ‘analysis paralysis’?
PhD & Early Career Researcher Panel and Special Topic Seminar
The second day of the symposium provided the PhD students and ECRs from each nation chance to come together as a panel and talk to their experiences, as well as answer questions from an audience of students and prospective PhD candidates. This was a really enjoyable session, not least because some audience members approached us afterwards to say that the panel had inspired them to look at undertaking doctoral level study. On a personal level it was reassuring to hear all about the PhD journeys of my peers and to take note that we all face many similar challenges. The importance of keeping well and building in time off from study was a key message and one I shall continue to be mindful of as I enter the writing-up stages of my own research.
Another highlight of the day was the special topic seminar delivered on Health Equity in the U.K. Health System by Professor Mark Exworthy. Mark encouraged attendees to reflect upon the necessary conditions and alignments required for policy change to be enacted to address health inequities.
Next steps: Collaborative research projects and teaching opportunities
Another component of the visit involved meeting with various UMD departments to explore possibilities for collaborative projects for researchers and potential teaching opportunities, including the aspiration to develop joint PhD and/or Master’s programmes. Having had the initial discussions this work shall continue apace over the next 12 months. In September this year the UMD team shall fly over to the UK and spend a week in Birmingham where we plan to mirror and build upon the fantastic experiences we shared in Maryland.
Being involved in this exchange has so far proved to be a highly educational and professionally beneficial experience. While there is a definite place for technology in facilitating meeting online and collaborating remotely, the opportunity to immerse oneself in the culture and context within which a health care system operates and to develop relationships in-person is simply invaluable. I am greatly looking forward to continuing to be involved in the U21 Health Research Exchange
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