The eminent scholar, educator and advocate for continuous improvement W. Edwards Deming once said, “Every system is perfectly designed to achieve the results it gets.”
The U.S. spends more on healthcare than any other country. Yet among wealthy nations, we have the lowest life expectancy. Maybe no healthcare system could have been prepared for a pandemic, but we were not nearly as prepared as places like South Korea and Taiwan, which spend far less. As COVID-19 metastasized, America’s healthcare system, designed to deliver episodic, acute care but not health care, was nearly crippled. The negative effects, on the professionals and the bottom line, could last for years.
Our healthcare system gives little thought or resources to improving population health by preventing and managing disease. We spend our treasure on health services, not on social services, which is upside down and backward. Maybe it takes a pandemic to get people to realize, holy mackerel! Population health! I guess that’s kind of important.
It’s too late to do more than scramble and do the best we can with what we’ve got, but education is about the future. What can we do in our healthcare curricula today to make sure we don’t find ourselves in this predicament tomorrow?
Healthcare reform is about adopting the tenets of population health, which align perfectly with the Quadruple Aim: enhancing patient experience, improving the health of communities, reducing costs, and reducing caregiver burnout. Clinicians of the future won’t be ready to lead this kind of system redesign unless they have the tools to do it.
I’d like to share some key components of a curriculum designed to do just that:
Public health. The U.S. was unprepared for COVID-19, despite the fact that national leaders had been briefed about the likelihood of a pandemic. The basic tenets of public health are in our graduate-school curricula right now: monitor and diagnose community health, mobilize partnerships, develop policies and plans, evaluate effectiveness, and research innovative solutions. We need to double down here.
Leadership education. More than ever, we need physicians who can envision and adapt to change, and lead organizational responses. MBA programs excel at teaching the skills and strategies that effective leaders need. Medical and nursing schools can learn from these leadership programs, the sooner the better, and incorporate leadership training, the earlier the better.
Population health intelligence. Artificial intelligence, big data and predictive analytics are indispensable tools that assess information in a way no single clinician could. If we mine and analyze large data sets, we can distill information for making better-informed decisions about patient care. These tools also help us identify fraud, waste and abuse. Let’s insist that clinicians can create, interpret and extrapolate from patient registries and that they are grounded in probability theory too.
Performance improvement. The tools have been around for 30 years: performance and quality improvement, waste or error reduction, and reallocation of wasted resources. Based on the evidence, one-quarter to one-third of healthcare spending, roughly $1 trillion, is of no value. Imagine if we had been able to reallocate those resources for masks, gowns and ventilators. The statistical process control tools of quality improvement, including run charts, and the like, must be taught starting on day one.
Social determinants of health. Good health and ill health are more than biomedical conditions: they’re the outcomes of social inequality. Research shows that the principal predictors of health are poverty, housing and access to good food. To improve health, we have to improve social services. Let’s insist that all trainees have community-based service experience, to understand how we can work together to reduce disparities.
These are not electives or nice curricular add-ons. Like anatomy and taking a personal history, they encompass the core knowledge and essential skills future healers must have to become leaders who can see beyond the status quo. Neglecting them in a curriculum meant to train future caregivers is like marching into a pandemic with too few ventilators and not enough personal protective equipment. Let’s rethink and reform the curricula for all healthcare professionals today so we don’t get the same results tomorrow.
