Wednesday, May 19, 2010

Let's RSVP with a "yes" to Doctor Kim

Dartmouth's President Jim Kim and his colleague James Weinstein make a sensible suggestion in an opinion article in the Washington Post, entitled, "Health Reform's Next Test."

We propose the rapid expansion of a new field to tackle the twin problems of how to provide high-quality health care while lowering costs: health-care delivery science.

...Experts in management, systems thinking and engineering, sociology, anthropology, environmental science, economics, medicine, health policy and other fields must join together to apply a laser focus to fixing the delivery system.

...We need a whole new cadre of people committed to applying their expertise to the challenge of health-care delivery.

We have begun building that cadre at Dartmouth with the establishment of a Center for Health Care Delivery Science. But it is our hope that many more institutions will work together to generate the needed evidence on health-care delivery solutions, to disseminate that knowledge and to train the current and future professionals who will put solutions into practice. We envision a network of centers across the country that will marry research and implementation from the start -- finding and testing delivery solutions with practitioners and patients on the front lines.

The four Massachusetts medical schools could be key partners in this effort, especially if they worked together to design coordinated curricula and research opportunities for faculty and students. I met with Jim Kim when he was at Harvard, before he knew he was going to be offered the Dartmouth job, and we talked excitedly about this possibility. That meeting is what prompted this blog post in July of 2008:

When will the thoughtful deans of our medical schools take on the concept of introducing the science of care delivery as a major focus of the curriculum, so that their faculty and new generations of doctors come to believe that field to be as interesting as the study of disease, diagnosis, and therapies? The opportunity exists for leadership opportunities for those universities that pave the way in this arena.

Lucien Leape has addressed this need in detail. Jim now generously offers the idea of a multi-institutional partnership. Is there a chance our folks will join in?


Anonymous said...

Paul, after three years of reading your blog and other public information, I regret to opine that the answer to your last question is a resounding "no." Of the 23 medical schools listed in the Leape report as those beginning to implement some of the recommended changes in education, Tufts is the only Massachusetts representative.
Boston has proven itself to be a thoroughly complacent and self-satisfied place when it comes to the introspection necessary to improve medical care delivery, present company excepted.

Health care delivery science will evolve outside of Boston's hallowed but calcified walls, and on the fringes of medicine itself. Engineers and other non-medical types (like water and sewer people?) understand these things better than those inside the field do, with a few exceptions.
Look to Dartmouth and the other 22 medical schools on the Leape reports list, as well as outside universities, for leadership here - not in your town.

nonlocal MD

Keith said...

Great idea! Takes the guys from PIH to realize what the real issues are. We clearly need an investment in this area to understand the best ways to deliver health care efficiently and effectively. Research and funding in this area can conceivably save us huge sums of money (the health care system, that is)

AMH in Ohio said...

Teaching practical things at colleges and universities? Doubtful. A degree in economics, yet we never once looked at the stock market in 4 years.

76 Degrees in San Diego said...

This is a great idea. Combining the academic and computational resources of a major university with an active multispecialty medical practice with robust primary care(an assumption)would seem to provide a great opportunity for both research and implementation of new ideas. Even better would be if the medical component had it's own managed care license to offer new health plans. Bravo!

Shereef Elnahal said...

There is little doubt that this is an excellent idea, and Dr. Kim is right to institutionalize it.

I am a student at HMS, and the first commenter may be unaware of the degree to which we emphasize health care policy in our curriculum. We have a dedicated health care policy course that is required of all students. We also have a student-faculty collaborative called ImproveHealthCare, for which I served as co-director one year ago. This is a national collaborative of medical schools that was started right here in Boston, whose mission is to insert the health care delivery sciences into medical curricula across the country. Feel free to explore what we do on our website:

Thank you.

Please visit my blog on the business of health care in America:

Kathy D said...

Dear Dr. Levy.
I could not agree more than the fact that this needs both a multidisciplinary approach combined with academic rigor to create change of the magnitude that we need. I had always assumed that government would step in to take and define that role, but you and Dr. Kim have nailed it. The place is as defined at Dartmouth. How exciting. Maybe we will begin to see the quality of study that these issues deserve. WIthout it, we can all just await the next round of bureaucratic regulatory rule making.

Anonymous said...


Thank you for submitting the link to your website. I find it interesting but perhaps a bit more superficial than envisioned by the Leape Institute. I would ask you to review the full Leape Institute report on medical education (pdf) and ask yourself if Harvard's curriculum satisfies all the recommendations in that report.

Also, I highly recommend the IHI Open School courses; I have taken all of them and they are an excellent, "nitty-gritty" introduction to the science of health care improvement and patient safety. Personally, I think they should be a required part of every medical school curriculum, as an introduction at least.

I also believe that most good insights into the science of health care delivery will come from outside of medicine, as I mentioned above. For instance, the National Academy of Engineers has done some work in this area.

nonlocal MD

Anonymous said...


My apologies for mispelling your name in my previous comment; I failed to proofread properly.

nonlocal MD

Unknown said...

I believe that David Nash, Dean at Jefferson's new graduate school of Population Health will be looking at ways to develop, implement and evaluate health policies and systems to CHANGE the way healthcare is delivered today. Someday someone will tackle the elephant in the room and challenge the archaic hospital structure and the outdated medical reimbursement system

Anonymous said...

I agree with the first comment. Healthcare in Massachusetts -- including medical education -- is presently part of the problem, not part of the solution. Best that the four Massachusetts institutions are not involved, as it would tug this important project towards "more of the same" rather than driving change.