Health Care Delivery Science: Management is Key to Affordable Quality

One of the most exciting advancements in today's health industry is the growing field of health care delivery science. Granted, not everyone is aware of what this field is, and there's debate about whether it's a true science. But few doubt that it has great potential for improving the quality, value and potentially the financial solvency of American health care. A growing body of research support these hopes.

But first a disclaimer: This author is an instructional designer for the Master of Health Care Delivery Science Program at Dartmouth College (On twitter at @DartmouthMHCDS). This 18-month program represents several firsts, including: Dartmouth's first foray into online education (it's a hybrid program: Mixed online and residential), it's the first official "health care delivery science" program in the nation (and probably the world). It also represents a collaborative effort between two storied professional schools: The Tuck School of Business, and The Dartmouth Institute of Health Care Policy and Clinical Practice (formerly known as the Center for the Evaluative Clinical Sciences). The idea is to combine business strategy and leadership from a world-class MBA program, with the clinical and health policy know-how of a leading health care think tank to tool today's health care leaders with the skills to redesign care.

There are many reasons to suspect that better management is the prescription for improving health care, including a small but thought provoking new study in the Annals of Internal Medicine that sought to highlight the distinguishing characteristics of hospitals that were top performers in providing heart attack (AMI, or acute myocardial infarction) care. The researchers Interviewing 158 staff members at 11 hospitals whose risk-standardized mortality rates for AMI were either in the best 5% or the worst 5%.

Performance in six principle domains appeared to separate the industry leaders from laggards:

--"organizational values and goals

--senior management involvement

--broad staff presence and expertise in AMI care

--communication and coordination among groups, and

--problem solving and learning."

Management makes a difference.

Its interesting to note the dominating role that management, leadership and institutional culture plays in the list above, rather than technical ability. Creating a learning-organization, potentially utilizing health information technology to systematically improve communication and coordination, having buy-in from top management, and a sense of common goals, values and purpose. Those "basics" of leadership and management may well trump the adoption of the newest drugs and medical devices, at least when it comes to saving lives in heart attack patients.

Implementing such values naturally sounds good, but can be difficult: Cultures have inertia that can be hard to overcome. Clinicians and administrators are busy and may not have time to ponder redesign. Leadership may not be informed by data, because staff may not be inculcated with a culture that expects everyone to contribute to quality improvement, and to be dedicated to measurement. And is there really a business model to support the implementation of such feel-good principles? Turns out yes, but more on that in upcoming posts.

Photo credit: The author