Appendix of the 5th academic senate session minutes 21. 5. 2003
Long-term reasons for restructuring have their origin in:
- the gradual changes in character and representation of individual illnesses in childhood over recent years
- the changes in methods of treatment (transfer of maximum care to ambulant sphere)
- the decrease in fertility and the child population in recent years
- the comparison with hierarchy of paediatrics branches abroad (haematology and oncology)
- the need to create competitive work places in paediatrics
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the necessity to strenghten the paediatric and developmental orientation of the Faculty and the education of doctors for practical paediatrics
An immediate reason for submitting a proposal is the forthcoming end of the functional term of heads at the 1st and 2nd Paediatrics Clinics (November 2003) and head of the Clinic Paediatrics Oncology (June 2003).
CURRENT SITUATION, SUGGESTED CHANGES AND CONTRIBUTION OF ORGANIZATIONAL CHANGES TO TREATMENT-PREVENTIVE, EDUCATIONAL AND RESEARCH ACTIVITIES
1. TREATMENT-PREVENTIVE ACTIVITY
1.1. Current situation
Care of the paediatric patient suffering from tumor illnesses (solid tumors or lymphomas) is ensured at the Paediatrics Oncology Clinic except for leukaemia, which is treated at the department of Haematology of 2nd Paediatrics Clinic. Other branches are ensured by 1st Paediatrics Clinic (nephrology, endocrinology, gastro-enterology, nursery care), 2nd Paediatrics Clinic (pneumology, haematology, endocrinology, nursery care) and Paediatrcs Cardiocentre (part of cardiology). After abolishing expectation ward care of common paediatrics patients is hindered and patients are treated either at 1st or 2nd Paediatrics Clinics which take turns. While some of the sub-branches of Paediatrics are excellent not only in national but also on the international standard, others are of average quality or even below average. The Faculty does not have enough quality staff to have 2 Paediatrics Clinics which in their domain will be the leading work places in this country or (abroad). Teaching should be coordinated and orientated to prepare the students for the practice of paediatrcians. Possibilities to grow are very limited at these places. Currently there is nobody who would be ready to defend his second doctorate or professorship. Clinical research of high quality is under way only in several branches.
The current Paediatrics Oncology Clinic stands a chance, with its background and public support, to become a centre of European class. The problem is the staff and scientific work.
1.2. Suggested changes
The suggestion is to establish a Paediatrics Clinic Haematology and Oncology and fuse 1st and 2nd Paediatrics Clinics into one Paediatrics Clinic, where the sub-branches will be organized in divisions with more autonomy. After competition for head of Paediatrics Clinic Haematology and Oncology a competition for heads of individual divisions would be announced. It would ensure the highest possible quality of leadership of the sub-branches. It will be necessary to build-up some sub-branches (paediatrics cardiology – current cardiocentre in Motol does not cover all cardiology, paediatrics metabolism unit etc.).
1.3. Contribution of organizational changes
After a fusion of Haematolgy Clinic with Oncology Clinic, the care of patients with tumor illnesses would be concentrated into one unit. Division of haematological malign tumors for lymphomas and leukaemia tumors would be dropped. Material capacities and intellectual authorities would be concentrated in the therapeutic area because treatment procedures are similar in tumor illnesses (savings in watering down the cytostatics, using of transplantation unit). A bigger pool of the middle-medical staff and other experts (psychologists) trained to treat patients with tumor illnesses (contribute in ensuring the service and care of the mental health of patients) would be concentrated in one place. All in all this organizational change should cut costs.
Patients suffering from leukaemia are perceived by the public as patients with tumor illnesses so this fusion is logical even from this point of view (concentration of grant financial means). Paediatrics Haematology and Oncology, have thanks to a common climate, have extremely good conditions. Therefore there is a belief that with new leadership and orientation to scientific activity there is a ground for the rise of an extremely successful clinical work place which would represent an unusual but well-orientated and positive work place at the Faculty. A fusion of the current Paediatrics Clinics would be a reason for getting rid of the duplicity of some branches (endocrinology, nursery care, cystic fibrosis) and ensure the better care of patients whose character of illness is systematic and is not limited to one organ (systematic autonomous illnesses, impairments of endocrine and metabolic system, etc.). It would be easier, thanks to a bigger number of physicians, to make a list of on-duty physicians and so be in line with the work code. Saved bed-capacities would be used for the wards of acute ambulance reception offices of patients with common illnesses or for patients awaiting diagnosis, which will enable to send them to a specialized ward. In addition the system of joint paediatrics Clinics should take over the role of the lead ing centre in the area of preventive paediatrics. Altogether this restructuring in paediatrics clinics should mean savings in treatment-preventive activity.
Individual wards and Paediatrics Clinic Haematology and Oncology should co-operate closely with corresponding adult wards concerning the care of the chronically ill, whose life expectancy is high (diabetes, CF, chronical bowel and kidney inflamations, tumor illnesses, heart deficiencies). In a lot of branches this co-operation already works in others it is necessary to establish it or intensify.
The Faculty would strengthen its position in paediatrics by the suggestion of these changes because it is a crucial part of it. If the Faculty is only mediocre in paediatrics then the reason for its existence in competition with other medical faculties may seem to be a big problem.
2. TEACHING
2.1. Current situation
The teaching of paediatrics is co-ordinated by the head of the paediatrics branch and is ensured both by 1st and 2nd Paediatrics Clinics and other wards according to the character of specialization (Paediatrics cardiocentre – cardiology, Department of Immunology – clinical immunology, Department of Biology – clinical genetics, general practitioners in terrain, Paediatrcs Clinic Pod Petřínem etc.)
2.2. Suggested changes
Suggested changes should be reflected in teaching. A bigger stress should be put on teaching of practical paediatrics. Paediatrics Clinics should educate well orientated paediatricians with a good knowledge of preventive paediatrics. The first criterion is the frequency of occurrence of illnesses and the correct algorythm when making a decision in peripheral practice. Academic interest in an illness becomes a secondary criterion. Suggested enlargement of paediatrics wards with acute general paediatrics and closer co-operation with the wards of clinics would from this point of view be crucial for teaching.
On the contrary, for postgraduate teaching, a concentration of specialized wards would contribute to professional and scientific education. Orientation on postgraduate studies is a sign of quality and it will enable it to survive in competition. There are even historical premises to implement the postgraduate studies internationally toward developing countries nad eastwatrds.
2.3. Contribution of organizational changes
Coordination of teaching would go on both within the framework of Paediatrics Clinics and other branches. All paediatricians should be involved in teaching no matter what organization units they belong to. It would be a contribution for undergraduate teaching to create the ward of acute ambulance office. A complex of concentrated paediatrics branches should be more contributive (possibility of circulation before postgraduate diploma).
3. SCIENTIFIC-RESEARCH ACTIVITY
3.1. Current situation
Scientific-research activity is uneven at the Clinics. While 2nd Paediatrics Clinic is the best concerning publishing and grants at the 2nd Medical Faculty, 1st Paediatrics Clinic is below average and Paediatric Oncology Clinic is average. The biggest contribution for publishing and research activity of 2nd Paediatrics Clinic is a haemato-oncology group, but recently the area of research of paediatrics diabetology and revmatology has developed. It is the result of co-operation by physicians of the Clinic with other work places (e.g. The Department of Biology and Medical Genetics etc.) policlinic etc. within the frame of paediatrics orientated research aim.
3.2. Suggested changes
Changes in research should concern only the sub-branches of paediatrics where publishing and research activity is currently insufficient. Continuity of quality projets under way will not be endangered.
3.3. Contribution of organizational changes
Future development of research work will still go beyond the boarders of individual wards, clinics, departments, even faculties (see new research goals of the Ministery of Education and Science and projects of the Department of Health and Social Security of the Czech Republic. Organizational changes should not influence current research of a high quality in any way. Organizational changes in leading of sub-branches of paediatrics should lead to strenghtening of publishing and scientific work in branches, which currently lag behind.
Working out of the detailed structure of Paediatrics Clinic 2nd Medical Faculty, Charles University will be a task and condition for a competition for the head of the clinic.
