Recently, PUMCH consecutively held 11 evaluation meetings centering around high-quality development of disciplines, in which a hundred domestic medical experts were invited to evaluate 54 clinical, medical technological, and platform departments. Such a high-level “consultation” is like a “physical examination” that reveals challenges to overcome and sets the tone for future high-quality development.
Prioritize Quality over Scale
For PUMCH, its positioning as the healthcare pacesetter in China has become increasingly clear over the past century since its founding. Having turned out a number of medical giants such as Zhang Xiaoqian, Lin Qiaozhi, Zeng Xianjiu, Wu Jieping, and Zhu Futang, PUMCH has established a system to train modern medical talents for China.
However, there are animated discussions within the hospital about the future development of disciplines, which, in general hospitals, are generally characterized by small scale, insufficient beds and personnel, and limited resources. That begs the question, how to make a big difference with a small size and how to leverage disciplines to promote hospital-wide development?
During the assessment meetings, Xiang Yang, Director of the Gynecological Oncology Center, bluntly said that currently Europe and the United States still lead the development of gynecological oncology disciplines and spearhead the R&D of most new drugs and therapies. “Owing to our relatively few clinical studies, we are not well-positioned to produce breakthrough findings. That is our weakness.”
PUMCH already made a series of significant strides in the diagnosis and treatment of gestational trophoblastic tumors and malignant germ cell tumors. “In terms of leading national and even global clinical multicenter research and in conducting innovative translational medicine researches, the hospital is still not well-positioned. We need to catch up,” said Xiang Yang. According to him, there remains much to be done in the research of the overall diagnosis and treatment strategy of endometrial cancer, the standardized diagnosis and treatment of germ cell tumors, and the establishment and optimization of an integrated diagnosis and treatment system for gynecological tumors based on pathological, molecular and immunological characteristics for Chinese women, etc. “We must relentlessly improve ourselves to be able to treat diseases that others can’t and be the pathfinder for the clinical diagnosis and treatment of intractable gynecological tumors”.
“We hope to propose one to two new HIV antiretroviral treatment protocols in the next 3 to 5 years, revising and updating domestic HIV treatment guidelines, and establishing a national collaborative network for standardized HIV treatment.” At the assessment meeting, Li Taisheng, mentioned that the Department of Infectious Diseases, which he heads, is a relatively small department at PUMCH, with only 40 staff members and 38 beds, and 50,000 outpatient visits a year.
Such a “small” department, though, confronts many medical challenges. At the beginning of the 21st century, Li Taisheng led his team to carry out a project on “antiretroviral therapy for AIDS patients in China”, which not only proved that the efficacy of domestic generic drugs was comparable to that of foreign original drugs, but also proposed a “Chinese protocol” for treatment. “In the future, we will continue to advance multi-center cohort studies for the breakthrough of achieving the functional cure of AIDS,” Li Taisheng said.
The experts who attended the assessment meeting asked Li Taisheng a thornier question. “In COVID-19 studies, China needs to have a stronger say internationally. We very much hope that PUMCH can make headway in this regard. In the face of the outbreak of a more serious infectious disease, say next year or the year after that, can China respond to it more efficiently?” asked Dr. Li Xiaoying, the eighth chairman of the Chinese Society of Geriatrics of the Chinese Medical Association and chief physician of the Cardiovascular Department of the Chinese PLA General Hospital.
A Critical Message from Heavyweight Experts
The Department of Endocrinology has always been an advantageous department at PUMCH. It receives mostly patients with intractable diseases from all over China and its grand round records are highly sought-after among peers and viewed as the “golden standard” for clinical diagnosis. In recent years, the annual outpatient visits of the Department of Endocrinology have been rising, and its research efforts involve various aspects related to endocrine metabolic diseases including epidemiology, clinical treatment and basic research. With such a glorified past that inspires so many patients to place high expectations of being cured and recovering health on it, the Department of Endocrinology can be aptly described as “carrying a mountain of stress”.
Before standing on the podium, Xia Weibo, Director of the Department of Endocrinology, marked out the key points on his script: with socio-economic development, endocrine metabolic diseases have become a serious threat to people’s health, and the prevention and control of endocrine metabolic diseases is an important task for a healthy China. “Previously, we have formed national collaborative networks and corresponding study cohorts for diabetes, obesity and osteoporosis, etc. In the future, we will work towards a diagnosis, treatment and research model in which communities, hospitals and the collaborative networks work together. We seek to ultimately reduce the long-term disease burden of patients with metabolic diseases through a combination of community screening, risk stratification, targeted treatment and long-term follow-up interventions,” Xia Weibo said.
Xia Weibo expected applauses at what he said, instead he was met with a critical response from the heavyweight experts. Chen Xiangmei, Director of the National Chronic Kidney Disease Clinical Research Center at the Chinese PLA General Hospital, gave an example: domestic doctors generally still use the clinical staging criteria of type 1 diabetes to determine the progression of type 2 diabetic nephropathy, which is unscientific. “We need to overcome the diabetic research barriers so that scientific research no longer lags behind clinical application. I hope that experts across the country can work together to come up with the clinical staging criteria for type 2 diabetic nephropathy to guide clinical practices as soon as possible.”
In another assessment meeting, when learning about the low ratio of ICU beds to the total of hospital beds at PUMCH, Xi Xiuming, former President of Fuxing Hospital, Capital Medical University, pointed out sharply that the proportion of ICU beds to the total number of beds in large urban tertiary Grade A hospitals should reach 8% to 10%, whereas it already reached 20% in developed countries. He said: “The proportion of ICU beds to population should be 30/100,000, but it is only 3/100,000 in China. If large cities don’t have enough ICU beds, then they won’t be well-positioned to act swiftly and sufficiently in the face of major disasters. Considering that, we should definitely take stock of our ICU resources properly.”
Four Thought-provoking Questions Penetrating the Appearance of Success
Assessment meetings are not held for departments to show their achievements. The hospital invited strategic scientists and discipline leaders in the medical field to listen to presentations of each discipline one by one and offer their opinions, advice and guidance. A large number of academic leaders and senior experts, from the perspective of the overall planning of discipline development, “felt the pulse of various disciplines and offered their judgement” with domestic and international leading counterparts as the benchmark. Some of the judges sincerely said that PUMCH should not have shortcomings on the technology, capability, academic or talent front. Some experts bluntly pointed out that the development direction of some disciplines was not clear enough. Some scholars hit the nail on the head, exposing potential problems for top-ranked disciplines despite their appearance of success...
How to achieve high-quality development of disciplines with limited resources? Shen Yan, Academician of the Chinese Academy of Sciences, posed four thought-provoking questions: “What are the important diseases in the field? What are the long-standing strengths of your department? What are the strengths of other disciplines in the hospital that can be combined with yours to form new strengths for yourself? Which researches are promising to yield high-quality outcomes in the not so distant future?”
Academician Ba Denian of the Chinese Academy of Engineering attended four discipline assessment meetings and emphasized that “we should not care too much about who is ranked first and who second, what matters the most is to keep up the good work”. Academician Zhao Yupei, Honorary President of PUMCH, stated that “discipline development is mainly about inheriting good practices and innovating”. Academician Zhan Qimin of the Chinese Academy of Engineering is very familiar with PUMCH disciplines and commented that “disciplines should seek breakthroughs and then build up their strength on that”. Academician Wang Chen, President of the Chinese Academy of Medical Sciences (Peking Union Medical College), said that “each discipline should be grounded in PUMCH and at the same time conduct extensive intra-hospital, domestic and international cooperation.”
“The goal is not to publish papers, but to translate clinical needs into scientific questions to be resolved, so as to understand diseases and treat them.” Such remarks made by the experts at the meetings converged into a consensus: public hospitals represented by PUMCH should promote high-quality development, align themselves with the urgent needs of the country for self-sufficiency in advanced science and technologies and in promoting healthcare development, and make forward-looking moves in public health, preventive medicine, major disaster rescue, and mental psychology, etc., while factoring in changes in China’s disease spectrum and diseases with Chinese characteristics, playing an exemplary and leading role as a national pillar for healthcare.
“We appreciate and accept all experts’ advice”
“The four major pillars of high-quality development are: led by the Party, driven by disciplines, talents as the solid foundation, and improving management efficiency. The purpose of discipline assessment is to create new momentum for development, shift to a new way and model of development. Only when we see clearly where we came from do we know where we are going.” In the summary, Wu Peixin, Vice President of PUMCH, said that the assessment meetings were comprehensive, forward-looking, dynamic and pragmatic, through which the participating disciplines gained a clearer and soberer understanding of the situation and the way forward, and unleashed greater synergy. For internationally competitive disciplines, they should take it upon themselves to solve major scientific problems, compile international guidelines, lead international and domestic multi-center research, and spearhead medical development. For disciplines that are flourishing, they should further consolidate their advantages, train their own talents and bring in excellent talents, work with other advantageous disciplines, and engage in highly visible scientific research tasks.
With 54 specialties and more than 2,000 beds, PUMCH is roughly comparable in scale to first-class hospitals abroad, but only of moderate size in China. The nearly-40-hour brainstorming session brought clarity to the plan of “building PUMCH into a first-class hospital”.
“High-quality development must be grounded in the overall strength of the hospital, interdisciplinary interactions, integration and reconstruction of disciplinary clusters, and it must be supported by high-level platforms such as the National Medical Center, the State Key Laboratory of Complex, Severe and Rare Diseases, and the National Infrastructures for Translational Medicine. With the needs of clinical treatment in mind, we should start with clinical problems, actively carry out basic and clinical research, value the translation of research outcomes and their clinical applications, and strive for new breakthroughs in improving clinical outcomes,” said PUMCH President Zhang Shuyang, “For discipline planning to be actually implemented, we must clarify the projects to undertake, their topics, the platforms to build, the talents to deploy and the results to be achieved. To this end, we have proposed five goal-oriented lists in the planning: the list of platforms, of projects, of talents, of technologies, and of results.”
“We appreciate and accept all experts’ advice,” said President Zhang Shuyang; the task force is working intensely to sort out and summarize experts’ opinions and suggestions and give feedback to the departments involved, which will accordingly formulate and improve a high-quality development plan for their discipline. The hospital will also, according to assessment results, put in place favorable mechanisms, funding and platforms and other conditions to keep supporting discipline development.
Health News (Jian Kang Bao): Ye Longjie and Cui Fang
Reporter: Chen Mingyan and Chen Xiao
Correspondent: Xu Kun
Translator: Liu Haiyan
Editor: Wang Yao