In­te­grated ‘aca­demic health sys­tem’ of­fers new lessons for im­prov­ing care de­liv­ery

Modern Healthcare - - COMMENT - By Dr. Stephen R.T. Evans and Dr. Neil J. Weiss­man

Aca­demic medicine gen­er­ates the knowl­edge ev­ery physi­cian uses to­day when prac­tic­ing con­tem­po­rary, ev­i­dence-based medicine. To meet cur­rent chal­lenges in health­care, how­ever, aca­demic medicine must broaden its fo­cus to in­clude the science of how we im­prove the de­liv­ery of care.

To un­leash the full po­ten­tial of aca­demic medicine, on real-world op­er­a­tional prob­lems, we first need to re­lin­quish our con­ven­tional im­age of an aca­demic med­i­cal cen­ter.

Tra­di­tion­ally, aca­demic med­i­cal cen­ters have had three si­los: re­search, ed­u­ca­tion and clin­i­cal care. While this ap­proach has its virtues, in­clud­ing a great de­gree of in­de­pen­dence for in­ves­ti­ga­tors, it lacks align­ment be­tween health sys­tem lead­er­ship and re­searchers. As a re­sult, lead­er­ship may place a lower pri­or­ity on re­search and see re­search only as a cost, frus­trat­ing in­ves­ti­ga­tors who see their work as be­ing marginal­ized. No longer can the aca­demic en­tity stand apart from the health sys­tem enterprise.

The an­swer is an in­te­grated aca­demic health sys­tem where in­ves­ti­ga­tors work on real-world health­care sys­tem chal­lenges. In an aca­demic health sys­tem, re­search in­cludes creat­ing new knowl­edge that can be im­me­di­ately ap­plied to­ward im­prov­ing out­comes, safety, qual­ity, ac­ces­si­bil­ity and ef­fi­ciency. In­ves­ti­ga­tors see their work re­sult­ing in mean­ing­ful im­prove­ments for pa­tients, the com­mu­nity and their hos­pi­tal. Lead­ers see an im­me­di­ate re­turn on the work of en­gaged aca­demics. Most im­por­tantly, pa­tients see the ben­e­fits in their care.

How is this ac­com­plished? First, pa­tients must be at the cen­ter of all ac­tiv­i­ties, in­clud­ing aca­demics. This con­cept is the gen­e­sis of pa­tient-cen­tered out­comes re­search and is be­com­ing in­creas­ingly ac­cepted by clin­i­cal in­ves­ti­ga­tors.

Next, we must rec­og­nize the value of health ser­vices re­search, or re­search on the de­liv­ery of care. Med­i­cal re­searchers em­bed­ded in clin­i­cal de­part­ments of­ten de­vote their ef­forts to de­vel­op­ing new drugs or de­vices to im­prove our abil­ity to di­ag­nose or treat dis­ease. Health ser­vices re­search fo­cuses on how we ap­ply our care and im­prove its ef­fec­tive­ness. It stud­ies methods to make health­care safer, more af­ford­able, more ac­ces­si­ble and more ef­fi­cient.

One sec­tor of this re­search, im­ple­men­ta­tion science, fo­cuses on how change oc­curs and ap­plies a frame­work, us­ing sci­en­tific method­ol­ogy, to study and in­ter­vene. The premise is that dif­fer­ent care-de­liv­ery en­vi­ron­ments will have dif­fer­ent bar­ri­ers to change. There­fore, im­ple­men­ta­tion science must be ap­plied and tested in dif­fer­ent en­vi­ron­ments and not be con­strained to a sin­gle med­i­cal con­di­tion nor a sin­gle med­i­cal set­ting. This method can move us away from re­ac­tionary med­i­cal care to proac­tive health and well­ness care.

From an aca­demic point of view, a health sys­tem serv­ing a di­verse popu- la­tion in di­verse care en­vi­ron­ments be­comes an ideal lab­o­ra­tory to test dif­fer­ent methods and de­ter­mine how to over­come bar­ri­ers. For the health­care leader, this science prom­ises to solve press­ing im­ple­men­ta­tion chal­lenges. It is only in a sys­tem, and not a stand-alone cen­ter, that such work can be ac­com­plished.

At MedS­tar Health, we have set the foun­da­tion for an aca­demic health sys­tem. With more than 280 di­verse sites of care and aligned physi­cian gov­er­nance over 24 ser­vice lines, we can speed dis­cov­er­ies through the sys­tem and into the com­mu­nity. We have also max­i­mized our aca­demic and clin­i­cal part­ner­ship with Ge­orge­town Univer­sity with a uni­fied clin­i­cal trial man­age­ment sys­tem that will stan­dard­ize con­duct of clin­i­cal trial re­search.

MedS­tar has fully em­braced health ser­vices re­search and im­ple­men­ta­tion science. MedS­tar’s Na­tional Cen­ter for Hu­man Fac­tors in Health­care is a prime ex­am­ple. With 30 hu­man fac­tors en­gi­neers and other pro­fes­sion­als, this group is ac­tively ex­am­in­ing us­abil­ity of new equip­ment, the de­sign of elec­tronic health records, root causes of safety events, and the ef­fect of team in­ter­ac­tions and dis­trac­tions.

Med­i­cal in­ves­ti­ga­tors can align with health­care lead­er­ship by fo­cus­ing on re­search that can be im­me­di­ately ap­plied in a health sys­tem and can in­form pol­i­cy­mak­ers and aca­demic peers. Work­ing to­gether, sys­tem lead­ers and in­ves­ti­ga­tors can trans­form stand­alone, tra­di­tional aca­demic med­i­cal cen­ters into aca­demic health sys­tems to im­prove how we de­liver care to pa­tients to­day and to­mor­row.

Dr. Stephen R.T. Evans, left, is ex­ec­u­tive VP for med­i­cal af­fairs and chief med­i­cal of­fi­cer for not-for-profit MedS­tar Health; Dr. Neil J. Weiss­man is pres­i­dent of the MedS­tar Health Re­search In­sti­tute.

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