The people working on Tallinn's hospital network seem to have taken teacher Laur's advice to heart and have spent years trying to solve only half the problem, because they either cannot or, more likely, do not want to address the whole thing. By now, the city-owned West Tallinn Central Hospital and East Tallinn Central Hospital have been merged, along with the dental clinic and ambulance service, into a so-called "mega-hospital." Despite its ambitious name, however, it does not provide care for children and lacks a whole range of important services that are available only at the North Estonia Medical Center (PERH).

At one point, there was also a proposal to merge PERH and the Children's Hospital to create the country's largest state-owned hospital. The drawback of that plan, however, would have been the absence of maternity care and a women's clinic.

An even bigger problem is that Tallinn's hospitals are housed in outdated buildings and the city alone is not capable of constructing a new, modern hospital. And why should it have to? Regardless of ownership, Tallinn's hospitals provide medical care not only for the city but also for more than half of Estonia's population. Discussions are already underway on the European Union's next funding period, from which Estonia is expected to receive more than €6 billion. Why shouldn't that include funding for new hospital buildings in Tallinn?

Why not complete the entire task and merge all of Tallinn's hospitals into a single institution, regardless of their current owners? The result would be a true United Tallinn Hospital, jointly owned by the University of Tartu, the state and the City of Tallinn. A similar system has worked well in Tartu for several decades. Although, admittedly, the creation of the university hospital there was not exactly smooth sailing either.

One advantage of a unified hospital would be the ability to consolidate many support services, such as laboratories, radiology, pharmacy, food services, finance and human resources, IT systems and more. Larger units could invest in more advanced equipment while making operations more flexible and efficient. A unified hospital would also be better positioned to launch construction of a new hospital.

Given Tallinn's layout — whether one thinks of it as a butterfly or a bow tie — a unified hospital does not have to, and indeed should not, necessarily be located on a single campus. What matters is that departments that are closely connected or interdependent are located near one another. That principle should also guide the planning of a new hospital. For example, the maternity ward and the Children's Hospital should not be located in different parts of the city. A unified hospital would make it possible to standardize treatment methods, develop shared clinical guidelines, establish consistent approaches to patient care and organize joint training sessions and case discussions.

One concern raised about a unified hospital is reduced competition. In a country as small as Estonia, however, competition is limited in many specialties regardless. Moreover, healthcare professionals can always seek employment outside Tallinn. Private healthcare providers would also remain and their numbers are more likely to grow than decline.

Nor should unification mean merging the Children's Hospital and pediatric departments into adult departments, effectively eliminating the Children's Hospital altogether. For more than 100 years, it has been understood that children are not simply miniature adults; most aspects of their physiology differ significantly from those of adults. The methods used to treat adults therefore cannot automatically be applied to children.

Communication with children and their families is also an important part of a child's recovery and that requires pediatric nurses and physicians with specialized training. In addition, children are always more comfortable in a dedicated pediatric ward than among adult patients. For that reason, dismantling the well-established Children's Hospital — regardless of the justification — should not even be up for discussion. The Children's Hospital as a whole can, however, be part of a unified hospital system while making use of shared services. In major cities around the world, multidisciplinary hospitals are the rule rather than the exception.

Given Estonia's size, one medical school is sufficient. It has been part of the University of Tartu throughout its history and that should remain the case. Nearly 400 years of teaching experience are worth preserving. At the same time, medicine cannot be learned from books alone and with the growing number of medical students, the University of Tartu Hospital may no longer have enough patients to provide adequate clinical training. A united Tallinn Hospital could become an outstanding teaching base for the University of Tartu.

Physicians who also teach, regardless of which hospital they work in, should be employees of the University of Tartu and therefore meet all of the university's academic requirements. A united Tallinn Hospital could also serve as a base for clinical research. New and newly marketed medications may be highly innovative, but their true effectiveness and safety become apparent only after they are used more widely in everyday clinical practice.

In conclusion, let us stop experimenting with half-finished solutions. Instead, let us bring all interested parties to the table and develop a long-term plan for reorganizing Tallinn's hospital network that transcends party politics. The priorities should be the needs of patients, medical education and medical research — not political ambitions. A hundred years from now, no one will remember which political party the people behind the new hospital belonged to.

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