“A challenging exercise,” is what Rianne Letschert, President of Maastricht University, calls the route they are currently taking. Towards a merger? She prefers the term ‘integration’. “Going deeper with each dig, you come across new questions.” But Letschert and her colleague Helen Mertens from MUMC+ are mainly very delighted, seeing “opportunities”, more “power”, and an attempt to enable the institutes to play “greater academic and social roles”. Letschert: “It is not the organisational interests that are leading; the university and the hospital are not here ‘for themselves, but for students, patients and other citizens.”
Helen Mertens and Rianne Letschert, photo: Appie Derks MUMC+
Initiative
Before Mertens and Letschert were in charge, there were also all kinds of integration attempts. Hospital with faculty, hospital with the entire university, but they failed. It was toilsome at the negotiation table, with the characters of the then chairs of the executive boards, their interests and prospects. Who took the initiative this time? Mertens? It is said that it is particularly in the Maastricht hospital’s interest, because a marriage with the university would make the institute more robust and with that become a more important player in the health care field. There is a fuss about the concentration of academic (very specialistic) care in the Netherlands. This can no longer be provided across the board in every UMC. The distribution is a very sensitive matter and logically every health care institute wants to maintain its ‘own territory’ (and preferably expand it).
But no, they said during the interview, this time there was nobody who took the lead. According to Letschert both came together at some stage and said to each other: ‘Shouldn’t we pick this up again?’ “We have a Joint Policy Body (GBO, or gemeenschappelijk beleidsorgaan, a regulation in the law regarding the coordination of mutual tasks of a university hospital and a university, ed.), which is just planned into your schedule and it is certainly not every week, and that is when you notice with some themes: ‘Gosh, we should have aligned this sooner’, or ‘That is a pity, why are we facing this now?’ If we had worked together in a more focused and intensive way, we would have shared those obstacles with each other sooner.”
The Maastricht Study
But do you have to merge to achieve good things together? Take The Maastricht Study, which focuses on the prevention, research and treatment of diabetes, in which the university and the hospital are involved and in which thousands of people from Limburg participate. This unique research has been running since 2010, it didn’t need a merger. Letschert: “No, but what you see, is that there are various parties involved, such as the hospital and the Faculty of Health, Medicine and Life sciences, which – when things get difficult, (the province’s subsidy period expired at the end of March, ed.) – each congregate in their own boardrooms and take decisions based on their own strategies and investment frameworks. These do not always run parallel and that can make such a project vulnerable.” Mertens also repeats the added value of “one boardroom. At the moment, each party makes a comparative assessment based on their own interests.”
As an example, she does not only mention The Maastricht Study, but also the four Brightlands campuses, the animal testing facilities (Biomedical Centre) and the Scannexus scanning facility. “One partner’s commitment is directly dependent on the commitment of the other.” In other words, if one does see the value of something and the other less so, then things could come to an end. Mertens: “As long as you have two different people with two different interests at the table, it is rather difficult to align matters properly.”
Social domain
Eyes have to be looking in the same direction. According to Mertens and Letschert that will certainly be the case on two themes: ‘healthy society’, including prevention, and ‘technological innovations’. The fact that a faculty such as Science and Engineering with computer and data science is joining in, seems like a logical step, just like the Faculty of Psychology and Neuroscience where human behaviour is looked at closely. But why would you want to involve legal specialists, economists, political scientists and historians, so the whole university? That is unique in the Netherlands.
As far as Mertens is concerned, this is not just about health care, but also about the family, the economy, all circumstances in the social domain. “That is exactly where we need the expertise from the city centre faculties.” She also refers to examples elsewhere in the country – such as Leiden and Rotterdam – where an integrated UMC (so a medical faculty and a hospital) “has veered off” and has come to be at too great a distance from the rest of the university. Both feel that this is undesirable.
Unwise
“Say, you only had the Faculty of Health, Medicine and Life sciences (FHML) merge with the hospital, because it was easier”, says Letschert, “then we would make our university vulnerable. A very large part of our health cluster, which we are very proud of and in which we have invested a great deal, we would be placing in the hands of another administrative body. And of course, we are more than FHML, we have become much bigger over the past ten years, but even still, in order to keep the university in balance, that would be an unwise choice.”
The fact that the university does not want to lose FHML, by the way, was never the reason to say ‘let’s then’ drag the whole UM along, she emphasises. “This really is about content, about the challenges we face, things like staff shortages, ageing society, disadvantages on the socioeconomic ladder, chronic health issues. To deal with these, we will have to innovate, we have no other choice but to involve other disciplines as well as the traditional health care.”
Autonomy
No matter how enthusiastically they present their story, about how good the merger will also be a solution for the everyday awkward issues such as two e-mail addresses and different access passes, there is also doubt, anxiety, even resistance among employees. Letschert already mentioned one: the fear that UM will become a health university. “There was a lot of discussion about that in the beginning, but it is not going to happen.” Europe and circularity (topics such as the reuse of raw materials and plastic recycling) are also important themes that Maastricht scientists can continue to concentrate on, she says. “A lot of our budgets go to the faculties; that won’t change. Besides, their scientific autonomy is legally anchored.” This is also guaranteed if we get a new administrative model and MUMC+ is another decision-maker, says Letschert.
Illustration: Simone Golob
A second point of concern: what about academic freedom? “Of course this will continue to be guaranteed; that goes without saying, doesn’t it? We would be the last board to come up with something that would undo that,” says Letschert. Still, this won’t put everybody’s mind at rest. A fictitious example: a group of researchers want to take a closer look at post-Covid care in Limburg hospitals. No matter how you look at it, the researchers will (in the case of a merger) be associated with azM. And hospitals in a region are also each other’s competitors. What does it say with regard to their independence or possible conflict of interest? “Scientists can position themselves independently in the future structure, also based on the code of scientific integrity which provides a very clear framework for this. The names ‘university’ and ‘university hospital’ will continue to exist, so you can still position yourself as an employee of the university,” says Letschert.
Amply proved
Researchers and physicians from Randwyck meeting with scientists from the city centre, and vice versa: interdisciplinarity is already welcomed. But it rarely occurs. Will a merger change this? If the initiative doesn’t come from the people themselves, it won’t happen, will it? Letschert: “Yes, but we can stimulate such co-operation, provide incentives. That is why a number of faculties are expanding rapidly on the Brightlands campuses. If we hadn’t invested in those campuses ten years ago, the university and the region wouldn’t have benefited so much. We have amply proven that impact.” To continue in terms of Letschert and Mertens, a single boardroom is more attractive for businesses and organisations. TNO (Netherlands Organisation for Applied Scientific Research), Philips, Medtronic, and RWTH Aachen, “have already contacted us. When there is a meeting, they always ask us how far we are,” says Mertens.
Culture
The question remains whether we are not just creating a large organisation where two very different cultures are coming together: the much more hierarchical hospital, managed as an enterprise and with a much less open culture, compared to the more easy-going model of the university, an open and informal atmosphere, with a journalistically independent university medium? Letschert: “We should not create the illusion that there is just one culture, one tradition at this university. The culture at the Faculty of Science and Engineering is not the same as, for example, the one at the Faculty of Arts and Social Sciences. There can even be diversity within a faculty. We cherish that diversity of cultures.”
Ping-pong
The ‘best’ management model will be presented to the community in June. The decision-making process will start after the summer: faculty boards, faculty councils, the University Council, the works council and other bodies in the hospital, all get to have a say. Letschert already said last September during an online Q&A, initiated by UM, that she wants to keep the “pressure” on. “Otherwise you can end up in a really long process.” She now also expresses her hope that they will “not be ping-ponging until 2030. Imagine that one faculty council decides: ‘We would like to have one change. Then it would once again have to go before all the other bodies. It should not take that long, people will lose the interest in putting their energy into the idea. At the same time, all stakeholders must be heard and be able to use their powers.” Finding a balance between the autonomy of faculties and hospital departments on the one hand and the “integral responsibility” of one co-ordinating board on the other hand, is another huge challenge, according to Mertens. And that is probably putting it mildly.
Lastly? What will change for the ‘ordinary’ person on the work floor? Will we notice anything about the merger? “Not everyone,” says Mertens. “And there is no need either,” Letschert adds. “Scientists or administrative and support staff who say: ‘I want to participate in this, because I see new opportunities,’ fine, you are very welcome, but again, there will be no forcing.”