Linking up with the community: a fertile strategy for a university hospital?

To systematically identify, describe and characterise the collaborative initiatives, which have been established between the Academic Medical Centre/University of Amsterdam and local health care providers in the adjacent community.

The viability of university hospitals is jeopardised. Their narrowed orientation on delivering the most advanced services to the sickest patients challenges their missions in patient care, science and education. By linking up with local health care providers, university hospitals create synergistic relationships that should secure these three academic missions for the future.

We conducted a multiple case study in two stages. Initially, division leaders and the director of integrated care were consulted to identify all existing collaborative initiatives of the Academic Medical Centre. Successively, face-to-face interviews were held with the leaders of these initiatives. During these interviews data were primarily collected through a questionnaire. Notes of the interviewer, and documents (if available) were also collected. The analysis focused on systematically describing and characterising the initiatives using the concept of 'community-based integrated care'.

Twenty-seven heterogeneous initiatives were identified. Half of these initiatives are targeted to the adjacent community of the Academic Medical Centre, but only four of them are initiated on the basis of community information and involve the community and/or patients. Furthermore, the extent of integration differed per dimension. Functional integration within the initiatives has been relatively low, clinical integration mixed, and professional integration quite advanced.

The results indicate that a considerable number of collaborative initiatives have emerged. Still, these initiatives are loosely 'community-based' and hardly focus on the full integration of care services. This suggests that the community linkages of the Academic Medical Centre in Amsterdam could be further developed by gaining the full support of all clinical departments for the strategic approach and by adapting an overall hospital perspective to monitor the progress towards community-based integrated care.