Teaming up for better health

Rahel Kubik, member of the executive board of Kantonsspital Baden and head of th
Rahel Kubik, member of the executive board of Kantonsspital Baden and head of the Institute of Radiology, Monika Jänicke, CEO of the University Hospital Zurich and Christian Wolfrum, Vice President for Research at ETH Zurich. (f.l.t.r.) (Photograph: Kantonspital Baden, Universitätsspital Zurich, ETH Zurich / Montage ETH Zurich)
What’s the best way to translate research findings into clinical practice? A discussion with Monika Jänicke, CEO of the University Hospital Zurich, Rahel Kubik, head of radiology at Kantonsspital Baden, and Christian Wolfrum, VP for Research at ETH Zurich.

Research translation has been a hot topic in the headlines in recent years. What’s the best and fastest way to transfer the results of basic research into clinical practice?
Rahel Kubik:
It’s really important that any new method developed by researchers should address an existing challenge in clinical care. Costs in the healthcare sector are skyrocketing, so we need to ensure that research translation generates an actual benefit - and that means identifying genuine needs. But the success of a translation project also depends on the various professional groups involved: doctors, basic researchers and nursing staff all need to share a common language and have a bond of familiarity and trust. Research translation can be a long, hard road - so you need to make it a shared journey.
Monika Jänicke: You hit on two very important points there: trust and interprofessional teams. The ability of interdisciplinary teams to shorten the journey from basic research to clinical practice is something I find particularly fascinating.
Christian Wolfrum: As well as an interdisciplinary team, you also need people working at the interfaces. One way to make faster progress is by appointing people to dual roles. In terms of professorships, for example, that would mean someone holding two positions simultaneously, one at a hospital and one at ETH Zurich. You tend to get quicker results when you’re familiar with both worlds.
Jänicke: Exactly. If you have ties to multiple institutions, you feel a connection to them and understand what resources they have. Each individual institution has its own particular strengths, whether that’s Kantonsspital Baden, ETH Zurich or the University Hospital. By combining those strengths, you can get more done in less time.
Wolfrum: Get the structures right and you inevitably make translation faster. That only falters when you’re confronted with situations that require incredible amounts of energy to break new ground.

"The healthcare system isn’t designed to reward innovation. That’s definitely a problem."

Where does the most energy get wasted?
Most of the hurdles that hinder collaboration with basic research can be found on the hospital side. For example, we have much stricter privacy policies in the healthcare arena. Patient data is hugely sensitive and needs protection.
Wolfrum: We urgently need a solution that will enable a more progressive approach in this area. Obviously, I’m not talking about weakening data protection standards. But we do need to create clear guidelines and a uniform, standardised approach. Over-regulation can stifle innovation.
Jänicke: A good example of this is how each canton has its own data protection regulations, so the rules on what’s allowed differ from one canton to the next. It’s a tricky topic, because everyone is ultimately doing their best to handle patient data responsibly. But, above and beyond this, it really isn’t an efficient way to go about it.
Kubik: I’ve also noticed this uncertainty creeping into collaborative projects. We really need a framework agreement so that we don’t have to renegotiate the terms of cooperation for each and every project. It’s time to remove some of the administrative hurdles so that we can focus more of our attention on research and innovation. I would even go so far as to say that being in Switzerland puts us at a disadvantage here. My colleagues in the US and Asia can carry out huge research studies into artificial intelligence, databases and personalised medicine. Those kinds of data-rich studies are impossible here, unfortunately, yet they are exactly what we need to translate basic research into better patient care.
Wolfrum: That’s an important point. North America and Asia really are a long way ahead of Switzerland when it comes to large, data-intensive medical studies. There’s no doubt that the nationwide initiative Swiss Personalized Health Network has recently made enormous strides in strengthening data-based medical research and improving data sharing between universities and hospitals, but we still have a long way to go.
Jänicke: And it’s not just about removing obstacles. I think we also need to focus on incentivising innovation. So many of our colleagues working at the interface between lab and clinic are intrinsically motivated to come up with beneficial new developments for patients and for society. But we need to be ready to bear the costs of the innovations they produce. It can take years to negotiate a remuneration model for a new method! We should be taking a bolder approach.
Kubik: The healthcare system is not designed to reward innovation. That’s definitely a problem.

Christian Wolfrum, why is collaboration with hospitals so important to ETH?
ETH has defined health and medicine as one of its strategic action areas. We can only pursue that through cooperation with clinics. Our insistence on linking basic research to its application is an integral part of what we stand for at ETH. We work with external partners in all areas of technology transfer. That includes industry, professional associations and, of course, hospitals.
Jänicke: And the same applies in reverse. You can only succeed by getting all the key players to work together.
Kubik: That applies to all the institutions along the entire healthcare chain, including the rehabilitation centres that offer follow-up care, for example.

"ETH has some 100 professorships conducting research into medical topics. This new platform transfers ETH expertise from the lab to the clinic."

What distinguishes a university hospital from a cantonal hospital when it comes to research?
Our strengths lie in different areas. If ETH was conducting a study into lung transplants, they would work with us, because we specialise in that field. But for more common diseases, a cantonal hospital would be the more suitable partner, because it does a better job of covering the full spectrum of diseases in the population.
Kubik: We’re pretty small compared to the University Hospital Zurich. That obliges us to take an interprofessional, interdisciplinary approach to our work, which I see as a positive. And because we do less research here, our patients are always eager to participate in studies.
Wolfrum: Of course, there are also many areas where there’s an overlap. Switzerland is a small country. So if we need high case numbers, we have to get all the hospitals involved, whether cantonal or university. That’s a great example of combining resources can achieve impressive results.

How important is physical proximity when it comes to collaboration?
Personal contact is important, because it gives basic researchers useful insight into our clinical work. At the same time, we learn more about the time and intellectual effort required to get a new method or an innovative device working.
Jänicke: It’s easier to share knowledge when people work in relatively close proximity and are in regular contact. But it’s also about the fun and energy of the whole process. When everyone is motivated to reach the same goal, you tend to get a better output and achieve more robust results.
Wolfrum: Successful research doesn’t just require specialist knowledge; it also relies on the soft skills of each individual partner.
Jänicke: I should add that being in close proximity doesn’t only mean working next door to each other. It’s also about being part of a network like Zurich-Baden or Zurich-Schlieren. And if we want to drive innovation, we should also be talking about new shared workplaces. For example, our campus at the University Hospital has so many listed buildings that we can’t build the kind of innovative lab facilities they can in Schlieren.

ETH Zurich recently created a digital platform for clinical research.
That’s right. We’ve launched our Clinical Trial Unit, which is primarily a virtual environment. But it also has a sizeable office in Baden as well as one in the new ETH GLC building right next to the University Hospital. This new platform forges links to hospitals, thereby enabling our researchers to team up with them on clinical research. ETH has some 100 professorships conducting research into medical topics, and this new platform is a great way to transfer ETH expertise from the lab to the clinic.
Kubik: ETH has significant expertise in many areas that are becoming increasingly important to the field of medicine, such as artificial intelligence, robotics, medical devices and wearable health technology. Ultimately, basic research should be about improving patient care. As a healthcare provider, we need to make sure that it gets translated into clinical practice.
Jänicke: It’s important to remember that we’re educating the medical professionals of the future - and that new technologies will form a key part of their day-to-day work.

Speaking of education: the first students to take the Bachelor’s degree in Human Medicine at ETH have now finished the next level of their studies, with the initial cohort completing their Master’s degree this year. What impact does education have on clinical practice?
Medicine is undergoing a profound transition, and I see plenty of disruption ahead. I have no idea if the job of radiologist will still exist in its present form 20 years from now, but I’m sure we’ll see new professions emerging. We need to lay the groundwork for a new generation of doctors. ETH graduates have a slightly different profile, which I think nicely complements traditional university degree programmes. But, even more importantly, they have the ETH network, which I think offers huge advantages when it comes to delivering translational research projects and technological innovations that will benefit patients.
Jänicke: A background in science is a great asset for everyone involved, and the technical and digital aspects will take on increasing importance as medicine continues to advance.

How might technological advances transform the practice of medicine?
The next generation of doctors will need different skills. The ability to evaluate and interpret technologies will grow in importance.
Jänicke: Despite the fact that healthcare is becoming more and more dominated by technology, we mustn’t forget the human dimension. We need that emotional component more than ever. The more technical medicine becomes, the more important it is to display emotional intelligence and empathy when dealing with patients.
Wolfrum: Medicine must continue to focus on the human factor.