Harvard University's decision to axe its international consultancy arm has created a flurry of uncertainty among its clients - which include Dubai Healthcare City.
MT investigates whether DHCC has been caught in the middle of a messy divorce, or if the project has finally found itself the ideal Partners.
In one sense, there are few processes as superficial as a re-branding. But Harvard Medical International's (HMI) reincarnation as Partners Harvard Medical International (PHMI) has bypassed the paintwork and gone right to the core of Dubai Healthcare City's newly-laid foundations.
The separation between university and corporate entities...is a very controversial topic right now in the United States.
As announced earlier this year, HMI will now cease to be owned or operated by Harvard and will belong entirely to US-based Partners HealthCare System. By the end of 2012, it is expected to have dropped Harvard from its name entirely.
From a practical point of view, the shift could result in very little disruption for DHCC and its inhabitants. All current HMI obligations are set to be honoured by PHMI and over 60 staff-members are expected to join the migration.
In fact, with its greater experience in managing clinical facilities, Partners' involvement should lead to some positive improvements on the ground.
But what is more interesting for Dubai's flagship healthcare facility is how Harvard University arrived at this decision and the deeper implications this has for DHCC and its standing in a global market.
It is one thing for a fledgling facility to bear the Harvard stamp of approval; it is another thing altogether to get halfway through construction and have to order a change of stationery.
Getting the right balance
The decision to spin off HMI centres on a perceived deviation from the organisation's initial purpose, according to Dr Andrew Jeon, now PHMI's acting president and CEO.
"As we evolved here at HMI, more and more of our work and its interpretation by the University's leadership was less aligned to their core issues of education and research," he says. "They felt that we were doing more and more strategic consulting - things that belonged in a private sector initiative."
Yet the accusation seems slightly disingenuous, given that HMI was founded in 1994 as a means of raising funds for the main medical school. By capitalising on Harvard's international prowess in healthcare, the reasoning went, a global organisation could repatriate funds to Harvard.
Dr Daniel C. Tosteson, who was dean of the medical school when HMI was created, is quoted in The Harvard Crimson, Harvard University's daily student newspaper, as saying that HMI was designed with a mandate "to find pockets around the world...[that had the] capacity to pay" for advice in medical education.
The key tension for HMI, it seems, has been between the desire to raise funds and the struggle to keep its focus on education, rather than the delivery of healthcare systems.
Harvard University is America's first and oldest educational institution, but it is also America's first and oldest corporation. Whether or not it is for profit, it still needs to balance its books - and if any institution wants to grow it needs excess funds to invest.
In this case, it appears that HMI may have become a victim of its own success.
Now a profitable US$21-million-a-year organisation, HMI is active in approximately 30 countries. Its primary role may have shifted towards consultancy, but that hasn't happened overnight - in fact it has been the significant driver in HMI's growth for a number of years.
Harvard University might be justified in seeing a drift from HMI's original remit - but why now? And why was it allowed to happen in the first place?
Changing of the guard
The contradictory nature of HMI's development appears to echo an internal divide at Harvard over the organisation.
In a recent two-part series, The Harvard Crimson documented how an internal power struggle took place following the departure of controversial University president Lawrence H. Sumners in February 2006.
Sumners had granted the organisation implicit support throughout his tenure, but when he was ushered out of office following controversial remarks regarding women in science, HMI was suddenly vulnerable.
"After Dr Larry Sumners resigned the presidency of Harvard University a former president took over as interim, a gentleman by the name of Derek Bok," states Jeon.
"He was a rather strong advocate of the separation between university and corporate entities - which is a very controversial topic right now in the United States."
By the time Sumner's successor had been appointed, claims Jeon, the decision to spin off HMI was presented as a fait accompli. It is no surprise that a university such as Harvard retains the right to shifts in strategy - but nevertheless the decision came as a shock to HMI associates around the world.
"There is no question that our partners were concerned," admits Jeon. "Some had name associations and had made huge investments because of their belief in the long term commitment of HMI and its staff. Sovereign health funds
For private companies, investing in DHCC (and Dubai's relatively untested healthcare market) was always going to be a risk. What HMI's presence offered investors was security - if Harvard was willing to set up there, then why wouldn't they be?
HMI's original mandate was to "build the infrastructure for education, research and quality management" at DHCC. The accusation implicit in the decision to spin off HMI, therefore, is that in DHCC and its other projects, HMI was failing on education and research.
Harvard University is America’s first and oldest educational institution, but it is also America’s first and oldest corporation.
But the anomaly for HMI is that its name has barely been seen in DHCC for the past three years.
"The HMI brand was not really being used in Dubai," says Dr Robert Thurer, chief academic officer at Harvard Medical School Dubai Center (HMSDC).
"The Harvard brands are the HMSDC, the Dubai Harvard Foundation for Medical Research and the Al Maktoum Harvard Medical library."
None of these titles are currently under threat, says Thurer, as they are each felt to remain in line with the University's vision of education and research. "For all practical purposes this is a tempest in a teapot," he argues.
"Nothing in a practical way has changed at all - this is to do with internal governance at Harvard and really has nothing to do with the projects."
Despite Thurer's comments, DHCC is referred to by The Harvard Crimson as the "embodiment of HMI's mission gone awry", which suggests that even with the presence of HMSDC, a perception exists that Harvard is under-delivering on research in Dubai.
"We don't have any research buildings yet just like we don't have a hospital yet, those are in the planning stages," confirms Thurer.
In terms of clinical research...there are some very small projects that are in the pipeline now by the existing physicians at DHCC, but the main research will happen when the University Hospital opens and we have our clinical faculty.
Just who that clinical faculty will comprise of, however, seems to be shrouded in confusion. With PHMI currently denying it will be running or staffing DHCC's University Hospital, it remains unclear exactly who will be supplying the clinical staff to conduct the research HMSDC intends to facilitate.
For an American University, especially a prestigious one, setting up shop in the Middle East is not without its perils. The reality is that prejudices exist against such projects.
Despite a general trend towards internationalisation, American educational institutions are all striving to maintain a squeaky clean reputation back home and being seen to auction off your name to a project tends to generate bad press.
The recent fallout between Abu Dhabi and Yale University over a proposed arts institute is a case in point.
Following an enthusiastic courtship, Abu Dhabi was left at the altar by Yale over one irreconcilable difference: unlike its Ivy League rival, Cornell University in Qatar, Yale was not prepared to offer fully-fledged Yale degrees through a satellite campus.
The comments of Elizabeth Ellis, principal of the New York-based AEA Consulting, revealed the attitudes surrounding these international activities. "What's in it for Yale? Abu Dhabi needs Yale, but it is not clear to me that Yale needs Abu Dhabi," she told American press.
"It seems to me such deals make most sense for institutions looking to raise cash and their international profile. Last time I checked, Yale needed neither."
Now that Harvard has taken its name, and some might say its prestige, out of the operational side of DHCC, the onus will be on its remaining research facilities to bloom. After all, in the clinical community it can be very straightforward to assess the contributions of an academic centre.
Yet perhaps the market is being a little impatient with HMSDC. Dr Andrew Jeon believes that people underestimate how sizable a task DHCC is facing.
What Dubai wants to build is an institution committed to research - I don't care how many billions of dollars you have to spend you cannot build such an institution overnight, in five years, or in 10 years," he warns. "It has taken us 150 years to do what we do here in Boston."
How the demise of HMI will impact on the success or failure of DHCC as a whole could be crucial, or it could be negligible. But for Harvard to emerge with credit it must start producing quantifiable research sooner rather than later, otherwise its legacy will be of a partnership gone sour.
THE FACTS: Partners in time
While Harvard might be a globally-recognised name, there will be few in the Middle East who have encountered the Massachusetts-based Partners HealthCare System.
Founded in 1994, the same year as Harvard Medical International, the organisation grew out of two Harvard-affiliated facilities; Brigham and Women's Hospital and Massachusetts General Hospital.
Partners is a non-profit organisation and is expected to focus more on developing DHCC's administrative and clinical framework - theoretically allowing HMSDC to concentrate on developing DHCC as a research centre.