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