There is no doubt that health care delivery is increasing in complexity. We are faced with new models of reimbursement based on changing federal regulations, the social determinants of health that often drive patient care and influence patient outcomes, and the infusion of artificial intelligence into all aspects of our care. The health care provider of today and in the future has to know about dimensions of health care that go beyond the basic science, physiological, and clinical care dimensions to the systems of care that affect patient care and outcomes. The ability to appreciate and understand the health system in which care is provided and its impact on patient outcomes is critical to becoming an effective health care provider.
Health system science is defined as the principles, methods, and practice of improving quality, outcome, and costs of health care delivery for patients and populations within systems of medical care (Skochelak et. al., 2017). When Berwick described the Triple Aim of Health Care in 2008, the three aspects of that model were enhancing the patient experience, improving population health, and reducing cost. Berwick and his successors recognized the critical impact the environment of care plays on the health outcomes of our patients. They recognized that an understanding of the physiology of the disease and the clinical manifestations were necessary elements of health care provider education, but they were not sufficient.
Health system science builds on the Triple Aim defined by Berwick. There are six core domains that make up the conceptual model of health system science: health care structures and processes; health care policy, economics and management; clinical informatics/health information technology; population health; and value-based care and health system improvement (Skochelak et. al., 2017). These are important content areas because without an understanding of these areas, providers will be handicapped in their ability to effectively help their patients and lead their organizations.
However, I think the more interesting dimensions of the health system science model are the cross-cutting domains that bring together or set apart the issues of individual patient care and the system in which the care is provided. The five areas identified as cross-cutting domains are: leadership and change agency; teamwork and interprofessional education; evidence-based medicine and practice; professionalism and ethics; and scholarship (Skochelak et. al., 2017).
As I reflected on the impact of these cross-cutting domains in our curricula at the IHP, I was encouraged by how much of our curricula is either guided by these domains or squarely represented in individual courses. You can find threads of each one of these domains in the IMPACT courses that students participate in over the course of their curriculum. The IHP is a model for how these cross-cutting domains are represented in a health professions curriculum. The result is that our graduates have a unique set of skills that will advance not only individual health care but the health care of the population.
Skochelak et. al., 2017, write that health care providers have to pay attention to the complex web of interdependencies, have an awareness of the whole and not just the parts, and be able to recognize multidirectional cause-effect relationships. She goes on to say that systems thinking allows a student to understand the influence of levels of health insurance coverage on the determinants of health within a community, and as a result, the ability for his or her patients to access health care and adhere to a care plan. I feel confident in saying that this description exemplifies an IHP graduate.
For more information about health system science, please see: Skochelak, S., Hawkins, R., Lawson, L., Starr, S., Borkan. J. & Gonzalo, J. (2017). Health System Science. American Medical Association/Elsevier.