The three-step workflow: a pragmatic approach to allocating academic hospitals' affiliations for bibliometric purposes.

This paper presents a method for classifying the varying degrees of interdependency between academic hospitals and universities in the context of the Leiden Ranking. A key question for ranking universities is whether or not to allocate the publication output of affiliated hospitals to universities. Hospital nomenclatures vary worldwide to denote some form of collaboration with a university: academic hospitals, teaching hospitals, university hospitals, and academic medical centres do not correspond to universally standard definitions. Thus, rather than seeking a normative definition of academic hospitals, we are proposing a workflow that aligns the university-hospital relationship with one of three general models: full integration of the hospital and the medical faculty into a single organization; health science centres in which hospitals and medical faculty remain separate entities albeit within the same governance structure; and structures in which universities and hospitals are separate entities which collaborate with one another. This classification system provides a standard by which we can allocate publications which note affiliations with academic hospitals. Our three-step workflow effectively translates the three above-mentioned models into two types of instrumental relationships for the assignation of publications: "associate" and "component". When a hospital and a medical faculty are fully integrated or when a hospital is part of a health science centre, the relationship is classified as component. When a hospital follows the model of collaboration and support, the relationship is classified as associate. The compilation of data following these standards allows for a more uniform comparison between worldwide educational and research systems.