Published: 24/02/2005, Volume II5, No. 5944 Page 33 35

Harkness Fellowships offer professionals a chance to work with some of the US's leading health policy experts. And with fellows including Simon Stevens they are in good company. Andy Cowper reports

At a time of rising deficits, the usual pre-electoral squabbles about the health service and short, cold days followed by long, cold nights, many managers would be quite forgiven for thinking, 'there must be something more to life than this.

Couldn't I just go overseas, and come back in a year with some brilliant new insights from working with top people in, say, the US? And get paid for doing it? And get special bursaries to take my partner and family?' The answer to all of the above is, in fact, yes.

You could follow in the footsteps of luminaries as diverse as the late broadcaster Alistair Cooke and HSJ columnist and former Number 10 adviser Simon Stevens and apply for a Harkness Fellowship (see 'What the fellows say', page 33).

The Commonwealth Fund's Harkness Fellowships in healthcare policy were established in 1925. They offer mid-career health service researchers and practitioners from Australia, New Zealand and the UK a chance to spend up to 12 months in the US, conducting original research and working with leading US health policy experts.

The stated aim of the fellowships is for participants to 'gain an in-depth understanding of the US healthcare system and policy challenges; enhance their methodological skills; and develop valuable contacts and opportunities for ongoing cross-national exchange and collaboration'.

Anna Harkness founded the Commonwealth Fund in 1888 with the mandate to 'do something for the welfare of mankind' (see 'History of the fund', page 33). The fellowships are part of the fund's international programme in health policy and practice, which seeks to build 'a worldwide network of policy-oriented healthcare researchers and stimulate innovative thinking on health policy and practice in the US and other industrialised countries'.

The concerns of the programme look very much like a checklist of recent key areas in UK health policy:

access to affordable care;

quality of services;

responsiveness to patients;

innovative strategies for reducing barriers to care for at-risk populations;

long-term care;

allocation of resources.

In 2003, the fund joined with the UK's Health Foundation to launch two new Harkness/Health Foundation Fellowships, specifically targeted towards practitioners (as opposed to academics or researchers) from the UK to increase their chances of participating.

Health Foundation director Stephen Thornton says the think tank's new collaboration with the Commonwealth Fund, to support two additional fellowships from the UK each year, aims to encourage applications from clinicians and managers.

He explains applications are sought from 'policy-literate healthcare practitioners who ultimately see themselves moving into senior positions within academia, government, and healthcare'.

He adds: 'We will give them all possible assistance to ensure that the time investment they make is fruitful, both for them personally, and for the evolution of informed policy-making in the UK.' Successful applicants will get learning and networking opportunities, in partnership with the Nuffield Trust, 'both before they leave for the US and when they return'.

Each Harkness Fellowship provides up to $95,000 (about£50,000), to cover return airfares, living expenses and taxes. Importantly - and ironically, given the fund's declared interest in greater health equity - health insurance coverage while in the US is also included in the grant.

Options exist for fellows to arrange paid leave from their employers. More details of the financial arrangements and the programme for the next fellowship are provided on the fund's website.

Find out more

Commonwealth Fund Harkness Fellowship site www. cmwf. org/fellowships

Contact Robin Osborn, director of the international programme in health policy and practice, by e-mailing ro@cmwf. org


'The US is a hotbed of ideas' A recent Harkness fellow is Dr Claire Stebbing, specialist registrar in paediatric renal medicine at Guy's and St Thomas' Hospital trust. The 'prime objective' of her research is to make medicines safer for children - particularly by reducing mistakes.

She notes that although prescription errors have the potential to cause serious harm in paediatric patients, few studies have looked at this. 'The aims of my work are to assess, classify and determine the frequency and severity of prescription errors and to establish the role of error prevention strategies.' Dr Stebbing points out that 'the US is a hotbed of novel ideas and research, although not all of these can translate to the UK.' She says the fellowship 'has given me an amazing chance to broaden my outlook on healthcare. I also hope it will help me to find a way of combining my interest in patient safety with my clinical practice when I return to the UK.'

'It exceeded expectations' Professor Kieran Walshe combines his post as professor in public management and director of the centre for public policy and management at Manchester Business School with being an adviser to the National Audit Office and a member of the new Council for Healthcare Regulatory Excellence. His fellowship in 2000-01 focused on healthcare regulation.

He comments: 'I knew quite a bit about the Harkness fellowship before applying, having talked to other fellows - That is really important for would-be applicants.' Was the experience what he expected? 'It exceeded my expectations. It is a really wonderful opportunity to go and work and live in another country.

The Commonwealth Fund has unparalleled international networks, so you get to meet key policy people, academics and practitioners in North America.

They really are brilliant networks - It is access all areas!' And did it change his thinking?

'My experience of going to the US made me realise how European we really are. Because we speak the same language and share a lot of cultural references, in this country we tend to think we are like US, but our healthcare system is profoundly European.

'The US is very, very different: There is much less faith in shared community responsibility, and a quite foreign focus on the individual.

'We have far more in common with Canada: the visit there as part of the course was like going home.' While it was not his main motivation, Professor Walshe believes it has made practical differences to his career. 'When I came back, I soon moved from Birmingham University to a readership at Manchester, and things developed from there. The opportunities it gave me to work, write and think internationally were definitely influential. It is a life-changing experience - terribly Californian though that sounds!'

'An amazing programme' Simon Stevens is well known not only as an HSJ columnist, but as a former NHS manager who became the prime minister's adviser on health policy, and now heads US health management organisation UnitedHealth Group's expansion into Europe. He found out about the Harkness Fellowship through an advert, and had his placement in New York in 1994-95.

What effects did it have on his thinking? 'My work in New York focused on the interaction between public health and managed care. It made me think much more clearly about the role of incentives in stimulating change, and the pros - but mostly cons - of disconnecting the public health function from the healthcare delivery system.' Mr Stevens thinks learning about how other nations provide healthcare is 'crucial'. So what does the US have to teach the UK?

'Arguably the US health policy 'community' has been quicker off the mark tracking and analysing health inequalities in minority ethnic communities - partly because race and class are so entwined in US history.' What was his main lesson? 'That the patchwork of healthcare sub-systems makes the US an amazing laboratory, with a multitude of natural experiments.' And does he still use what he learnt there? 'Yes. The Harkness Fellowships are an amazing programme.'


Harkness Fellowships, their literature states, 'are designed for midcareer professionals who are committed to advancing health policy and practice in the Commonwealth Fund's principal areas of interest: improving health insurance coverage and access to care; and improving the quality of healthcare services'.

It is important to note that the f ellowships are not awarded to support study for academic degrees.

Successful applicants are generally in their mid 20s to early 40s.

The full criteria for potential applicants are available on the fund's website (see page 33).

The deadline for receipt of applications for the 2006-07 fellowship year is 1 September 2005.


Anna Harkness founded the Commonwealth Fund in 1888 with a gift of nearly $10m and the mandate to 'do something for the welfare of mankind'.

Until the 1940s the fund's work led to the development of the field of child guidance; contributed to the emergence of progressive public health departments around the US; and supported the construction of rural hospitals.

Following the Second World War it supported the development of new domestic medical schools aiming to address doctor shortages and the needs of communities lacking healthcare services.

Since 1995, the fund has concentrated on helping to address healthcare coverage and access issues, and on improving quality. It has also stimulated exchanges and collaborations among developed countries on health policy and practices.

Key points

The Harkness Fellowship in healthcare policy offers researchers and practitioners up to 12 months in the US to conduct original research.

Fellows include the late broadcaster Alistair Cooke and former Number 10 adviser Simon Stevens.

A substantial grant is provided to cover airfare, living expenses, taxes and health insurance.