Introduction to the theory of research hospitals (series 6): discipline construction in research hospitals
Review Article

Introduction to the theory of research hospitals (series 6): discipline construction in research hospitals

Jun Yao1, Tian Gao2

1Chinese Research Hospital Association, Beijing 100039, China; 2Department of Performance Management, Jinan Central Hospital Affiliated with Shandong University, Jinan 250013, China

Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Jun Yao. Chinese Research Hospital Association, Beijing 100039, China. Email: m18611717182@163.com.

Abstract: Discipline is the basic unit of the hospital. Discipline construction includes many aspects, such as talents, medical treatment, teaching, scientific research, and culture etc., which are the core contents of the hospital construction. The comprehensive construction level of the discipline of the hospital decides the quality and brand of the hospital. Therefore, the research hospital must pay attention to the discipline construction and enhance the core competitiveness of the hospital.

Keywords: Discipline construction; research hospitals; hospital


Received: 04 August 2016; Accepted: 06 September 2016; Published: 25 October 2016.

doi: 10.21037/jrh.2016.10.03


Connotation of research discipline

Basic definition

The research discipline is the foundation of the research hospital, which can be defined as follows.

The discipline that it is clinical based with the mission of generating and disseminating new medical knowledge and medical technology. It adheres to the method of clinical work, teaching and research developing simultaneously, to solve the clinically difficult and complicated diseases. During the process of independent innovation, it continues cultivating high-level talents and the birth of high level outcomes, leading technology innovation and development, forming technical guidelines, occupying the commanding heights of academia, while paying attention to and promoting the continuous improvement of the level of clinical diagnosis and treatment.

Main features

The research discipline generally has the following seven features: (I) it has the ability to diagnose and treat difficult and complicated diseases; (II) it has the ability to lead the development of the industry’s technology innovation; (III) it has the ability to train compound talents with high quality; (IV) it has the ability to produce high level scientific research results; (V) it has the research direction with international competitiveness; (VI) it has a well-known domestic academic leaders; and (VII) it has a highly efficient translational medicine model. The difference between research discipline and general discipline is shown in Table 1.

Table 1
Table 1 The difference between research discipline and general discipline
Full table

The idea of construction of research discipline

Deeply understand the connotation, and have a clear discipline target.

The construction of research disciplines should adhere to providing services for the community to obtain benefits, to aim at the international first-class level to seek innovation, to cultivate talents to meet the needs of the future, and to promote the sound and fast development of discipline.

Grasp the characteristics and rules and have a clear discipline orientation.

The hospital should have a clear discipline orientation in combination with the actual situation of the hospital and the gap analysis of the discipline development between the domestic and foreign.

Clarify the development of ideas and refine the characteristics and advantages.

The development thought of the research discipline can be summarized as follows: to improve the quality of the discipline and to innovate the discipline management.

Deeply analyze elements and enhance the comprehensive strength.

Research discipline construction is a systematic project. It is necessary to analyze the key elements of the discipline for building a good research discipline. The key elements of discipline construction are the following six aspects.

In the direction of academic development of the discipline, we should aim at the disease with high morbidity and great harm in this field to do research in a persistent way.

In terms of discipline personnel, the research hospital must adhere to be people-oriented, and make efforts to create a tolerance of the humanities environment, liberal academic environment and a comfortable living environment. Also pay attention to the formation of a reasonably structured talent team.

In the construction of a discipline platform, in accordance with the principle of “unified construction, managed by specific personnel, shared use”, the research hospital should adhere to a high starting point, high standard and high level, to ensure the provision of effective support to engage in the frontier, fundamental and highly applied research.

The tasks of the research discipline should not be limited to the completion of the hospital’s medical, scientific research, teaching goals, it should also have a breakthrough.

In the discipline management, the academic leaders must adhere to learning advanced management theories, actively explore new methods, strengthen the system construction, and gradually form the characteristics of its discipline management.

In the academic atmosphere, the research hospital should create a good teaching atmosphere, medical atmosphere, academic atmosphere and research atmosphere and mobilize and stimulate the enthusiasm of the members of the discipline.

Assessment system

Research discipline is a new type of discipline construction mode, which pays more attention to the combination of clinical practice and medical research. Discipline assessment is a powerful means and an effective method to promote the discipline construction.

Through the evaluation of discipline development and the literature research and analysis of building research hospitals, according to the relevant documents and evaluation standards, and with reference to the experience of the research hospital construction and experts’ opinions, we draw up the discipline assessment index system of the research hospital, which is composed of 5 first level indicators, 15 second level indicators and 43 third-level indicators (Table 2).

Table 2
Table 2 The discipline assessment index system of research hospitals
Full table

Scientific overall planning for research discipline construction

The main characteristics and trends of the construction of the hospital discipline

As a system engineering, the discipline construction of the hospital has very obvious characteristics, and it is mainly summarized as follows.

Integration and systematization

Hospital discipline construction is a comprehensive project. It involves the work of each link in the hospital. At the same time, the discipline construction of the hospital is limited by the factors from inside and outside the hospital, such as the hospital’s goal orientation, development plan and so on.

Adaptability and innovation

Discipline construction of the hospital should meet the needs of science and technology development and the country, the society and the development of the hospital. It should actively aim at the frontiers of disciplinary development and the new trends of world medical science and technology development, and constantly open up new fields and new research directions.

Dynamics and expansibility

Hospital discipline construction is a dynamic process of constantly adjusting the discipline structure, improving the level of discipline and cultivating the discipline growth point on the basis of the historical accumulation of the hospital’s disciplinary structure. It should constantly enrich and develop the way and content of discipline construction according to the changes in the internal and external environment.

Long-term orientation and persistence

Hospital discipline construction is the strategic construction related to the long-term development of hospital, which has the characteristics of long term construction.

The development trend of hospital discipline construction has the following several aspects.

Transform from the traditional division of the discipline to specialization and integration

Currently, on the one hand, the hospital discipline will continue to develop forward professional refinement as more second and third level disciplines continue to emerge and specialties are split into a single disease or single technology. On the other hand, the disciplines tend to be integrated, forming a multidisciplinary superior group or center.

Transform from emphasizing professional and technical characteristics to optimizing functions

On the one hand, discipline should maintain the characteristic and the development superiority, continuously enrich the talent, the equipment and the technical strength. On the other hand, it should more encourage the cross and alliance between similar or related disciplines, to realize the purpose of improving and optimizing the specialty.

Transform from relying on academic leaders to paying equal attention to the discipline leaders and rational talent echelon

Too much relying on academic leaders, and the overall quality of the academic team while mismatching the discipline leader, will lead to the risk that the academic development of the discipline is stagnant or even shrinking.

Transform from focusing on the driving effect of key disciplines to emphasizing the dynamic management of the discipline level

Practice has proved that many national key disciplines not only lead to the development of hospital and related disciplines, but also cultivate a number of disciplines and technical backbones, and promote the competition among disciplines.

Transform from the information asymmetric communication to the international network automation development

The construction of a hospital information system plays a very important role in the discipline construction. The hospital information system based on the computer network has been developed as an important tool for focusing on analytical processing and assistance in decision making.

Transform from focusing on investment growth to pursuing sustainable development

With the increasingly fierce competition, the discipline construction should devote policy, manpower, material and financial resources to the key disciplines, so that the key disciplines can keep advanced, thereby promoting the development of the hospital.

Sub-discipline and comprehensive discipline

At present, the polarization trend from sub-discipline and comprehensive discipline of the hospital discipline development is obvious. On the one hand, with the breakthrough and application of new technology and key technology of medicine, the hospital discipline classification is to be more specialized and refined to improve the pertinence of medical technology and the efficiency of diagnosis and treatment. On the other hand, to adapt to the requirements of human death spectrum and disease spectrum change, with human major diseases and the body’s vital organs as a link, hospital discipline will integrate the disciplines related to prevention, diagnosis and treatment, etc. into joint multi-disciplinary comprehensive disciplines. Building integrated disciplines can integrate the relevant, advantageous resources to carry out cooperation to improve the efficiency of disease diagnosis and treatment. The setting of sub-discipline and comprehensive discipline is a kind of parallel, complementary relationship in hospital discipline construction.

Emerging disciplines and traditional disciplines

Emerging discipline is the frontier discipline emerging with the development of science and technology, which is the embodiment of innovation in scientific research. The traditional discipline refers to the discipline with higher academic maturity, rigorous logic, and long history of professional construction, and has continued to today.

The intersection of disciplines is often the new growth point and the frontier of science. Therefore, the development of emerging disciplines should attach importance to the integration of cross domains to keep on moving forward. At the same time, the hospital should pay more attention to the innovation of the management mechanisms of construction and development of traditional disciplines, through the promotion of traditional disciplines comprehensive levels, refinement of the traditional disciplines of professional characteristics and enhancement of the cross and integration of traditional disciplines, to construct the innovation competitiveness of traditional disciplines.

Key disciplines and general disciplines

The development of disciplines of the hospital is not balanced. It not only has the strong key disciplines, but also has the weak general disciplines. While strengthening the support for the construction of the key disciplines, the hospital should also pay attention to support the weak disciplines. The hospital should promote the development of general disciplines through the radiation of the key disciplines to promote the progress of key disciplines through the coordination and support of the general disciplines, so as to achieve a win-win situation.


The basic principles of the construction of the research discipline

Building a research hospital is fundamentally to go to all lengths to build research disciplines. Research discipline construction should focus on the following aspects.

The discipline construction should be towering and solid

The so-called “towering” means that the hospital should strengthen international exchanges, aim at the development frontier of the discipline at home and abroad, and at the highest point of the discipline field, strive to become the industry benchmark and leader.

The so-called “solid” means that the hospital should lay a necessary and solid foundation for the construction of the research discipline, including the necessary workplace, high standard or advanced equipment and high-quality human resource allocation. At the same time, research disciplines should have a high level of clinical diagnosis and treatment ability and teaching strength, and have strong brand strength and adequate sources of patients in the local medical industry.

Discipline construction needs to be led by the master

The character and knowledge of academic leader (or department head) is very important and he (she) should be recognized as one of the scholars in the industry with a high level of medical technology and academic achievement.

Discipline construction should highlight the characteristics

Building a well-known discipline or leading discipline must identify the most conducive project for the discipline development based on their own actual situation, and ultimately form their own characteristics. On the other hand, the diagnosis and treatment of diseases is still one of the main tasks of research hospitals. The research discipline construction cannot leave the actual clinical work to study the scientific research project of “castles in the air” type.

Discipline construction should be clinical traction

“Clinical traction”, is to solve clinical problems, especially to solve the urgent key problems in the industry as the core, to determine the direction of research, choose the research topic, organize research teams, and finally form new ideas, new technologies, new methods and new standards (guidelines).

Discipline construction should be driven by innovation

The leader’s innovative thinking and the spirit of pursuing excellence in the construction of the research discipline is the most important thing. To adapt to the need for the construction of an innovative discipline, the research hospital must cultivate a scientific research team with innovative research ability.

Discipline construction should distinguish levels

There are a wide range of disciplines and specialties in large general hospitals in China. The hospital needs to understand the relationship between these disciplines and the influence of each other, and make the most effective resource allocation and policy support program.


Research discipline construction strategy

Strengthen and consolidate the dominant disciplines

Research oriented hospital discipline construction should strengthen and consolidate the dominant disciplines by optimizing the organizational structure, providing superior conditions, equipping with advanced hardware facilities, and strengthening supervision and inspection.

Comprehensively promoting the developing disciplines

The developing disciplines refer to the disciplines or departments that have the basic conditions of personnel, equipment, medical and scientific research room, which have a midstream status in the hospital. Because it is usually accounted for more than half of the total number of disciplines in the hospital, some of them may develop into the new dominant disciplines, hence, they should be highly concerned. The hospital decision-makers should identify the problem and the breakthrough of the discipline development and development of targeted development planning of each discipline, to solve the key problems encountered in its development.

Fully support the disadvantaged discipline

“Disadvantaged discipline” refers to the disciplines with a relatively weak position and strength in the discipline area. Due to the need of supporting the discipline group, the general hospital or a large hospital should not cancel a discipline because it is weak, but try to help it. The basic principle for providing help is “supplying the shortage”. If the discipline leader or director of the department is incompetent, the hospital should decisively replace him (her). In addition, the reasons for the weak disciplines are various. The hospital needs to find out the main reason, and gradually resolve it.

Strive to develop comprehensive disciplines

The “comprehensive discipline” mentioned here refers to the two kinds of specialized forms.

First is to point to the comprehensive department that can synthesize the complex diseases of acatalepsia in the field of traditional “big internal medicine” or “big surgery”, or the complex diseases that need to involve multiple disciplines in the clinical disposal process. Second refers to “the multidisciplinary team or medical center” with a clear diagnosis and treatment scope. Specialized construction should follow the principle of “walking on two legs”. On the one hand, the hospital should strive to develop the sub-discipline, on the other hand, the hospital should set up comprehensive disciplines and a large number of multi-disciplinary teams.


Constructing research discipline group

The importance of discipline group construction

The so-called “discipline group”, refers to the discipline group composed of a number of similar disciplines or interdisciplinary disciplines, which have specific objectives and tasks. The discipline group offsets the limitations of cognition of traditional disciplines to a large extent. The discipline group has a significant role for improving the level of science and technology, promoting formation of emerging disciplines, maximizing the utilization of resources, improving the technology innovation ability of the hospital, cultivating high-quality talents for research and enhancing the core competitiveness of the hospital.

Cross and integration of discipline group construction

Discipline group construction is not a formal cooperation of several related disciplines. Discipline group construction should be organically combined by the relevant disciplines complementing and supporting each other for the purpose of solving the interesting scientific problems and clinical problems to achieve common development. This cooperation with the support and guidance of the hospital, can make the discipline group in practice constantly learn from the experience and strengths of partners, constantly innovate, and cultivate a new generation of experts and scholars. This process is the process of realizing the cross and integration of the discipline, and it is also the highest level of the construction of the discipline group.

Integration and allocation of discipline group resources

The key point of successful implementation of the discipline group construction is to optimize the integration and allocation of discipline group resources, maximize the financial and material resources sharing of the existing partners of the discipline group, and achieve the cooperative benefit maximization with less input.

The main modes of discipline group construction

The discipline group of the hospital, namely, the cooperative model of multi-disciplinary team, can be divided into loose type, compact type and entity type.

Loose type mode

In the early stage of the construction of multi-disciplinary cooperative team, the cooperation model is mostly loose. Such a model does not require special personnel adjustments and administrative intervention, the cooperative parties have retained the right to operate independently, they only work together in the need for consultation and joint diagnosis and treatment of patients or conducting research. Its restrictions on the cooperative parties are few. It generally does not carry out or carries out very limited resources integration, and the effect of the discipline group is relatively poor. Loose mode is generally temporary.

Compact type mode

The compact type mode discipline group is generally based on the cooperative parties having long-term cooperation projects and the needs of cooperation. All parties have a stronger need and complementarity on the interests and discipline development, or they form a stable coalition because of the resource integration and appropriate administrative intervention carried out under the support and coordination of the hospital. Resource utilization and work efficiency of the compact model is higher, which is in accord with the interests of the cooperative parties, and the cooperation will be more durable.

Entity type

Entity type mode is the business unit or entity that is composed of several related disciplines or specialties according to the requirement of the administrative agencies such as government or hospital. It has officially budgeted posts, and is equipped with a business space and equipment. It also implements independent internal cost accounting. The entity type mode is the most stable one and has the highest resource utilization efficiency of these three models. In fact, this form is the prototype of the new disciplines. It represents the new direction of the development of clinical medicine.

These disciplines can be divided into the following three categories according to their cooperation ways.

Establish the discipline group according to the diagnosis and treatment chain of the disease

This is the most common one, namely to establish various diagnosis and treatment centers focusing on organs, systems, some kind of important disease or a common disease and frequently occurring disease that needs multidisciplinary cooperation in diagnosis and treatment. Such as: respiratory allergic disease diagnosis and treatment center, alimentary canal cancer diagnosis and treatment center, etc. These diagnosis and treatment centers break the boundaries of traditional disciplines, use all the advanced technology that can be used to select an optimal diagnostic path and treatment plan for the patient, therefore, it can achieve the best diagnosis and treatment effect on the basis of the existing technology.

Establish the discipline group in accordance with the similarity and complementarity of the discipline

For example, the medical imaging science discipline group is comprised of radiation medicine, ultrasound medicine and nuclear medicine.

Discipline group composed of disciplines with similar technological foundation

The most typical one is the organ transplant center. Its core technology is basically similar, such as tissue matching, organ removal and anastomosis, anti-rejection reaction, detection of drug toxicity, and so on.

The key link in the construction of the discipline group

The construction of discipline groups should pay attention to the following points.

Determine and select the type of discipline group

Before the establishment of the subject group, the hospital should determine which mode is the most appropriate based on the objectives and tasks of the construction of the discipline group, and the demands and characteristics of the cooperative parties. There is no obvious advantage and disadvantage of the three models mentioned above. The hospital can choose one depending on the needs.

Choose a suitable subject group leader

This is the key to the successful construction of the discipline group. Otherwise, even though the other conditions are good, it is also very difficult to succeed in the discipline group construction.

Introduce supporting policies adapting to the construction of discipline group

Discipline group construction requires the cooperation of multidisciplinary and multi departments in the hospital. In order to coordinate the relationship of the stakeholders, the hospital must design a set of policies to regulate the action of the various disciplines and functional departments.

Prepare a reasonable budget for the discipline group

The hospital should reasonably arrange the approval number of discipline construction for each year, according to its financial situation and the needs of discipline group development and the order of priority, to make the basic accurate budget.

Establish the performance evaluation and reward system of discipline group

Discipline group construction is a systematic project, and it can not be achieved overnight. In order to regulate the behavior of each discipline, the hospital should establish a set of effective performance evaluation and reward systems before or at the early stage of the construction of the discipline group.

Encourage discipline groups to carry out high level clinical research

The discipline group consisting of clinical specialties cannot be limited to solving the clinical diagnosis and treatment problems. It should pay attention to the collection of clinical data and specimens, sum up experience and lessons in a timely manner, and develop it into new theories, new technologies and new methods through scientific research.

Pay attention to the cultivation and use of young scholars

The academic leader of each discipline group should stand in the height of the development of the discipline group to see the problem, pay attention to find new talent, train new talent and use new talent.


Acknowledgements

The authors would like to thank Dr. Robert Peterson for proofreading the paper.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

doi: 10.21037/jrh.2016.10.03
Cite this article as: Yao J, Gao T. Introduction to the theory of research hospitals (series 6): discipline construction in research hospitals. J Res Hosp 2016;1:18.

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