IHP faculty lead discussions and showcase innovation in health systems sciences as invited scholars to global forum convened by the National Academies of Sciences, Engineering and Medicine in Washington, D.C.

Ask most people on the IHP campus what Health Systems Science is, and chances are good you’ll get a quizzical look or blank stare. The fact is, most aren’t familiar with the term, but, ironically, the IHP is already a leader in its application to health professions education.

Health systems, like Mass General Brigham, have an increasingly important role in driving innovation in healthcare delivery, research, education, and more. And to improve healthcare and deliver on what experts call the “quadruple aim” - enhancing the patient experience, reducing costs, improving health outcomes, and improving the work life of healthcare professionals - a platform and framework are needed for studying, understanding, and improving how healthcare is delivered.

“Health systems science, or the science of healthcare delivery, aims to understand how healthcare is delivered, how health professionals work together to provide that care, and how the health system can improve care and healthcare delivery,” said Reamer Bushardt, Provost & Vice President for Academic Affairs at the MGH Institute.

The Institute’s leadership in this emerging field was on full display earlier this month during a global forum at the National Academies of Sciences, Engineering, and Medicine in Washington, D.C. There, the IHP presented how it prepares students to apply systems thinking and a health systems science framework during their clinical training experiences, and the Tedy’s Team Center of Excellence in Stroke Recovery was highlighted as an example. Kimberly Erler, Associate Professor of Occupational Therapy, and director of the Tedy’s Team Center of Excellence in Stroke Recovery, presented with Rachel Pittmann, Assistant Dean for Interprofessional Practice, along with several other innovators from across the country. Bushardt moderated the panel discussion, which focused on designing, implementing, and evaluating health system science curricula.

The American Medical Association has done extensive work to advance this emerging field. Medical education has historically involved two pillars—basic and clinical sciences—and the AMA advocates that health systems science should be a third pillar.

“Thinking about health systems science as a new pillar for health professions education makes sense,” said Erler. “There's science happening in the lab that informs our understanding of the human body, injury, and disease. This work is enhanced by clinical science that involves individuals and how we evaluate, prevent, and manage illness. But how do students learn how to bring their knowledge, skills, and abilities together to generate the best outcomes within the spaces where healthcare is delivered? How do students learn to manage the complexity of these environments? The whole idea is that individual encounters between a clinician and the person they are caring for don’t happen in isolation. They occur within systems. And so, we need to better understand how the system impacts people, communities, and health outcomes.”

At the center of health systems science are the individuals, families, and communities being served. The health systems science pillar then offers a comprehensive framework of competencies related to value-based care, population health, interprofessional collaboration, health system improvement, and systems thinking. Leading healthcare educational institutions, like the MGH Institute, have found that strengthening core capabilities among its students, such as teamwork and leadership, help them excel in their clinical training and succeed in their careers. The AMA’s framework recognizes those two attributes and highlights other knowledge areas, such as ethics and legal issues, change agency and management, and advocacy. This graphic from the AMA conceptualizes how it works.

a circle with patient, family, and community written in the middle with systems thinking written around the edges

Core Functional, Foundational, and Linking Domains for a Health Systems Science Curriculum. The inner circle includes the core functional domains. The middle circle includes the foundational domains. Systems thinking is the domain that links all these concepts together. (Courtesy American Medical Association)

“The American Medical Association has invested heavily over the past decade to promote training in Health Systems Science (HSS) for medical students, residents and practicing physicians, as well as for our colleagues across health professions,” said Dr. Kim Lomis, Vice President, Medical Education Innovations for the American Medical Association. “We see HSS as the third pillar of medical education, alongside foundational biomedical/social sciences and clinical skills. Regardless of how knowledgeable or skilled an individual health professional may be, they will not attain optimal health outcomes for the patients and populations they serve without also knowing how to leverage and navigate the broader health system.”

“The intent is to have everyone in the healthcare system thinking from a systems perspective and being able to think about the interconnectedness of all of its parts,” said Pittmann.

The Tedy’s Team Center of Excellence puts that intent into practice every day. It was created from the observation that the U.S. healthcare system is failing many people in their post-acute rehabilitation, leaving entire populations who need additional services after their insurances ends to reclaim their lives and independence.

“One of the reasons the IHP is ahead of the curve is that our faculty work hard to create authentic learning experiences for students that don’t shy away from the complexity and real-world challenges they’ll face in practice,” shared Bushardt. “It is partnerships like the one with Tedy’s Team, the Spaulding Rehabilitation Network, and the individuals and families who have been impacted by stroke who participate in our program that allow us to create authentic experiences for our students. Under the mentorship of faculty, students help deliver care, learn from those being served, and cultivate systems thinking. Students are strengthening their clinical skills but also gaining insights into healthcare delivery, barriers and challenges faced by families, strategies to improve health outcomes, and advocacy tactics to drive system-level change.”

Four people standing and smiling
Patricia A. Cuff, Forum & Study Director, Global Forum on Innovation in Health Professional Education; Kimberly Erler, director of the Tedy’s Team Center of Excellence in Stroke Recovery; Rachel Pittmann, Assistant Dean for Interprofessional Practice; and Reamer Bushardt, Provost & Vice President for Academic Affairs, at the global forum on Health Systems Science.

“Taking care of those individuals touches upon all the components of health system science,” added Pittmann, and “IHP students are learning all aspects of health systems science.”

“They’re delivering the clinical services but also debriefing and talking about the system factors and the issues that are related to the individuals and families they have just served. They are gaining confidence and proficiency in their physical therapy, occupational therapy, or speech-language pathology skills, for example, but they’re also unraveling how the systems are working or not working,” noted Pittmann. “Our students also gain firsthand insights into how healthcare systems can unfairly disadvantage specific groups or communities and explore steps they can take to improve health equity. They’re beginning to collaborate with the faculty and consider the different ways we could care for people after stroke that would give us better outcomes and not leave people behind, which is health systems science.”

Erler and Pittmann presented several examples during the global forum to describe how IHP students apply the health systems science framework in their studies:

  • Interprofessional teams: the Sanders IMPACT Practice Center and how students collaborate together, participate in care rounds, and how they consider social determinants of health on patient outcomes
  • Investing in leaders: students annually travel to Washington, DC for ‘Hill Day’ where they meet with Congressional staffers and advocate for legislation; this year they focused on telehealth and reimbursement models that are appropriate and adequate for patients.
  • Health equity: students learn how to evaluate  justice, equity, diversity, and inclusion (JEDI) principles in their practice, and take the Power, Privilege, and Positionality course to help change and impact the system
  • Harnessing the patient voice: everything students learn has individuals, families, and communities at the center of it; at the Tedy’s Team Center for Excellence, new opportunities are being created for stroke survivors to engage in the community.

“Using the Tedy’s Team Center as an anchor for our health system science education helps us prepare our students with the necessary abilities to become healthcare leaders and to influence change,” said Erler. “By having this center at the IHP, we are in a unique, advantageous place where our students can participate in these learning activities that their peers at other institutions aren't, so that when they enter practice as graduates, they are ready to both work within the system and also think about how they change the system for the better.”

A Future for Health Systems Science in the Classroom?

Health systems science isn’t new – it’s been around for a decade. What is new is increased recognition of its importance in health professions education and more examples about how to design, implement, and evaluate curricula that embrace this framework. This was clear at the recent global forum where healthcare organizations, professional associations, universities, government agencies, and patient advocacy groups came together at the National Academies. The group, which included representatives from more than 15 health professions, set out to accomplish two goals: discuss the relevance of health system science, and explore best practices for designing, implementing, and evaluating health system science education and training.

“The American Medical Association deserves credit for its leadership and pioneering efforts to advance this work, but health systems science is important to every health profession and anyone who receives healthcare in the U.S.,” said Bushardt. “The U.S. healthcare system is one of the most sophisticated systems in the world and we have tremendous talent delivering that care, but we need to do more to make high quality care more affordable and accessible, plus ensure our systems works for all Americans. It inspires me to see programs at the IHP like the Tedy’s Team Center, where individuals in need are receiving the care that will help them rebuild their lives after a stroke. Students are gaining hands-on clinical experience and systems thinking, and we are empowering the next generation of health professionals to drive positive change in how healthcare is delivered. We cannot afford not to make health system science a priority, and the IHP will continue to train students at the leading edge.”     

Whatever the healthcare professions and organizations that make up the Global Forum, like the American Medical Association, decide to do about this emerging field, the tenets of health systems science are here to stay at the IHP, which will continue to make its mark among the healthcare leaders of tomorrow – and today.

“We're positioned well to make change for the future,” said Pittmann. “We’re the only degree-granting entity of Mass General Brigham, the largest private employer in the Commonwealth. We're in a wonderful place to impart change and move the fractured, fragmented healthcare system to a better place in the future with this framework.”

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