Putting patient care in the context of a larger system is an increasingly critical part of running a more efficient and financially stable healthcare organization, providers and medical educators say.
Dozens of medical schools have been incorporating health systems science into their curricula for years, and the financial results are starting to show. Educators say the goal is to equip new doctors with the skills to implement health systems science practically in daily operations, and systems are reaping the benefits.
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The concepts are more important than ever in an increasingly consolidated healthcare industry dominated by the systems model. But the wide-ranging nature of health systems science can make the goals elusive and the result more difficult to track.
“When people hear [the] term, it feels very random and enigmatic and vague,” said Dr. Ami DeWaters, director of the Health Systems Science Office at Penn State College of Medicine. “I describe health systems science as being everything that affects patient care that isn’t actually writing a prescription or physically doing a procedure.”
Here's a look at why health systems science has gained traction and how it can contribute to a stronger bottom line.
What is health systems science?
Health systems science is the study of how care is delivered, how clinicians work together to provide care and how health systems can improve care delivery, according to the American Medical Association.
The curriculum encompasses a wide range of topics, including quality improvement, safety, technology, ethics and population health.
For example, leaders at Portland, Maine-based MaineHealth used health systems science to develop a team-based approach for better care coordination. At HonorHealth in Scottsdale, Arizona, clinicians implemented these concepts to cut down on wasteful use of resources.
How did it get started?
The AMA formally established health systems science as a pillar for medical education in 2013 and launched the Accelerating Change in Medical Education initiative. It also formed an Accelerating Change in Medical Education consortium starting with 11 medical schools, later adding 21 schools in 2016 and five in 2019.
“It has completely exploded in the last 10 years,” said Dr. Jesse Ehrenfeld, immediate past president at the AMA. “Practicing medicine today is so much more than my interaction with my patients as a physician. I’ve got to understand everything about the healthcare delivery system — the emergency department, primary care, different settings of care, community organizations, the patient’s family — all of those interactions that are part of patients’ journeys.”
The AMA has awarded millions of dollars in grants to medical schools and systems working to improve medical education, and the health systems science curriculum has been incorporated into schools across the country.
In 2019, MaineHealth received a $1.8 million grant as part of the AMA’s Reimagining Residency initiative that supported efforts to expand the system's Interprofessional Partnership to Advance Care and Education (iPACE) model to better coordinate care. The model brings together multiple care team members at a patient's bedside during rounds.
Are there financial benefits?
Medical educators and providers say teaching health systems science and implementing those concepts in day-to-day operations offers financial benefits, particularly from efficiency.
The iPACE model helped reduce the length of stay at Maine Medical Center Biddeford, which achieved an observed-to-expected ratio of 1.2 in fiscal 2024, down from 1.4 in fiscal 2022 and 1.3 in fiscal 2023.
The system estimated $3.5 million in annualized savings from length-of-stay reductions at Biddeford in fiscal 2023.
“We’re hopeful to keep growing the program and work on sustainability, and how do we transition from a very successful grant-funded pilot to standard operations here," said Dr. Sarah Hallen, assistant designated institutional official at Maine Medical Center.
HonorHealth conducted a quality-improvement study on preoperative tests, as part of the AMA’s 2022 Accelerating Change in Medical Education Health Systems Science Student, Resident and Fellow Impact Challenge.
HonorHealth focused on reducing wasteful or redundant tests before an operation. The system launched a SmartSet digital tool in its electronic health records to assess patients’ diagnoses and symptoms, and then list recommendations for appropriate tests. The study estimated cost savings of $51,350 to $126,400 for chest X-rays, specifically, due to avoiding unnecessary tests.
“In every single thing that we do, we’re trying to save money for the patient and save money for the healthcare system,” said Dr. Ben Gifford, internal medicine physician and member of the HonorHealth Clinical Innovation Department.
Are schools incorporating health systems science?
Dozens of medical schools are integrating health systems science into their curricula. Nearly half of conventional medical schools reported "meaningful integration," and 14% reported "deep integration," according to a recent AMA study that surveyed 140 medical schools.
Health systems science was a foundational part of the curriculum at the Kaiser Permanente Bernard J. Tyson School of Medicine, which opened in Pasadena, California, in 2020. The school has a department dedicated to health systems science.
“A bigger focus on health systems science in its different forms and different areas is becoming more and more integrated into schools," said Dr. John Dalrymple, dean and CEO of Kaiser's medical school. "The exciting part of the work I get to do is to think about better ways of teaching our students to be effective healthcare providers
Dalrymple said the curriculum is one factor that attracted him to Kaiser.
How are schools incorporating it?
Medical educators say taking these concepts to the clinical setting is critical.
“Health systems science is not separate from learning your other skills as a doctor,” Penn State’s DeWaters said. “You actually cannot be a good doctor if you’re not making value-based decisions.”
First-year students at Penn State’s medical school are placed in clinical settings with interdisciplinary teams to assess factors such as social determinants of health and how they should be addressed. This type of immersion teaches students about health system structure and processes, DeWaters said.
Mayo Clinic divides its health systems science curriculum into multiple blocks: leadership skills, team-based care, population-centered care, person-centered care, high-value care, health policy economics and technology, said Dr. Augustine Chavez, assistant dean for Diversity, Equity and Inclusion at the Mayo Clinic Alix School of Medicine.
The school then encourages students to practice the concepts they learn in the classroom during their clinical rotations, Chavez said.
