The science of health care delivery. What is it?

A presentation I heard this week about reducing maternal and child mortality, two of the UN's Millennium Development Goals, coalesced with something that Josh Ruxin said at the recent Unite for Site Global Health & Innovation conference. Ruxin directs the Millennium Village Project in Rwanda, and during his presentation he stressed the importance of good management in improving health and health care. What Rwanda needed most, he asserted, was not more doctors, but more Quickbooks, better accounting skills, better systems management.

The presentation on maternal and child health was by Dr. Deborah Maine of Boston University. After delineating the leading causes of maternal death as being hemorrhage, infection, hypertensive disease, obstructed labor, and induced abortion, she pointed out that these were all conditions that required medical intervention to treat. Despite global health efforts to increase their numbers, skilled birth attendants or midwives alone won't suffice. Even a skilled obstetrician would need lighting, sterile equipment, and antibiotics to treat them. And with the exception of induced abortion, there is no known prevention. This is one of those cases where we really do need a health system and clinical intervention to improve health. Reducing maternal mortality, Dr. Maine asserts, comes down to only three issues: Coverage of medical services, quality of care, and utilization of those services. Coverage, quality and utilization.

So what did those two presentations have in common? They both highlight the need for efficient, skilled health care delivery. Quality improvement in developed health care systems similarly emphasizes redesign of process to improve outcomes. Not necessarily changing clinical know-how, but how to efficiently and consistently deliver high quality care in a timely manner to those who need it. Or, as folks around my office say, getting the right care to the right patient at the right time.

Were Ruxin and Maine in fact calling out for health care delivery science? That's the hitherto non-existent field being created by Dartmouth President Dr. Jim Kim. In the coming months Dartmouth will be launching a masters degree in healthcare delivery science that combines the management expertise of Tuck business school and quality improvement and measurement expertise of The Dartmouth Institute for Health Policy and Clinical Practice (who is my employer, as well as my alma mater). Dr. Kim envisions an Institute for the Science of Healthcare Delivery, and the extension of delivery science into the undergrad curriculum so that good management and measurement practice becomes part of the DNA of future health care and public health professionals.

Great ideas perhaps. Possibly answering a great need. But the term may take some time to catch on, and have meaning to us. What comes to your mind when you hear "healthcare delivery science"?

Photo credit: The author