Table of Contents
Cover image
Title page
Copyright
Contributors
Foreword
Preface
1 What is health systems science? Building an integrated vision
I.Theneedforcurriculainhealthsystemsscience
II.Therapidlychanginghealthcareenvironment
III Clinicianreadinesstopracticeintheevolvinghealthcaresystem
IV.Thethirdmedicalscience:Healthsystemsscience
V.Healthsystemssciencecurriculardomains
VI Casestudies:Renaldiseaseandtreatment wherebasic,clinical,andhealth systemssciencemerge
VII.Professionalidentityformation
VIII Challengesforlearnerstoengagehealthsystemsscience
IX Chaptersummary
X.Overviewofbookchapters
XI.Chaptertemplate
Questionsforfurtherthought
References
Annotatedbibliography
References
2. Systems thinking in health care: Addressing the complex dynamics of patients and health systems
I Burningplatformforchangeinhealthcaredeliveryandtheneedforsystems thinking
II.Systemsthinkinginhealthcare
III.Healthcaredeliveryascomplexadaptivechallenges
IV Thehabitsofasystemsthinker
V.Applicationofsystemsthinkingtohealthcare
VI.Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
3. The health care delivery system
I.Desiredoutcomesofhealthcaredelivery
II CatalystsforchangeinUShealthcaredelivery
III Newmodelsofhealthcaredelivery
IV.Congruenceofcurrentdeliverysystemswithaccountablecareandpopulation health
V Closinggapsinthehealthcaredeliverysystem
VI.Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
4. Health care structures and processes
I Introductiontothedonabedianmodel
II.Structuresacrossthecontinuumofcare
III.Processeswithinthehealthcaresystem
IV Clinicalmicrosystems
V.Futuredirections
VI.Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
5. Value in health care
I.Introductiontovalueinhealthcare
II Knowledgeandeducationgapsinhigh-valuecare
III Definingvalue
IV.Valuefromstakeholders’perspectives
V AssessingthecurrentvalueofUShealthcare
VI Keyattributesofahigh-valuehealthcaresystem
VII.Barrierstohigh-valuecare
VIII Whatcanhealthcareprofessionalsdotopromotehigh-valuecare?
IX Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
6. Patient safety
I.Introduction
II Basicprinciplesofpatientsafety
III.Specifictypesofmedicalerrors
IV.Factorscontributingtoerror
V Communicatingwithpatientsafteradverseeventsduetomedicalerrors
VI.Secondvictims
VII.Reportingsystems—mandatoryversusvoluntary
VIII Assessmentofriskandmitigationofmedicalerrors
IX.Evaluationofnearmissesanderrors
X.Patientsafetyimprovementstrategies
XI Changingthefutureofpatientsafety
XII.Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
7. Quality improvement
I Qualityimprovementinhealthcare
II.Qualitymeasurement
III Qualityreporting
IV Qualityimprovementmethods
V.Commonqualityissuesandsuccessfulinterventions
VI.Qualityimprovementscholarship
VII Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
8. Principles of teamwork and team science
I.Introduction—teamsasacriticalaspectofhealthsystemsscience
II Thepromiseofinterprofessionalpractice
III.Teamsandcollaboration
IV.Evaluatingteamsandteamwork
V Understandinghealthsystems,systemsthinking,andteams
VI.Teamtraining
VII.Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
9. Leadership in health care
I.Introduction
II Thehealthcareleadershipimperative
III Whoarehealthcareleaders?
IV.Theimportanceofclinicianleadership
V Influentialleadershiptheories
VI Guidingprinciplesofhealthcareleadership
VII.Healthcareleadershipcompetencies
VIII.Specificattributesforhealthcareleadersindifferentsettings
IX Pathwaystoleadership
X Newleadershiproles
XI.Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
10 Clinical informatics
I.Rationaleandterminologyofclinicalinformatics
II.Useofclinicalinformaticsinhealthcaredelivery
III Secondaryuseofclinicaldata
IV.Outcomesandimplicationsofclinicalinformatics
V.Competenciesofclinicalinformatics
VI Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
11. Population health
I Introduction
II Whatispopulationhealth?
III.Whyafocusonpopulationhealth?
IV Solutionstoimprovepopulationhealth
V Futureofpopulationhealth
VI.Educationinitiativesinpopulationhealth
VII.Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
12
Structural and social determinants of health
I.Introduction
II.Casestudiesandexercise
III Howstructuralandsocialdeterminantsleadtoadversehealthoutcomes
IV.Structuraldeterminantsofhealthinequities
V.Socialdeterminantsofhealth
VI Interventionsfocusingonrootcauses
VII.Casestudyconclusions
VIII.Chaptersummary
Questionsforfurtherthought
Acknowledgments
Annotatedbibliography
References
13. Health law and ethics
I Introduction:Lawandethicsinhealthsystemschange
II Fiduciarydutyandconflictofinterest
III.Professionalself-regulationandmarketcompetition
IV Fraudandabuse
V Privacyandconfidentiality
VI.Healthinsurance
VII.Informedconsenttotreatment
VIII Medicalmalpracticeandredressingerror
IX Withholdingandwithdrawingcare
X.Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
14 Health care policy and economics
I.Introduction
II.Coreprinciplesofhealthpolicy
III Coreprinciplesofhealthcareeconomics
IV.Theoriesandhistoryofhealthcarereform
V.ThepathtotheAffordableCareAct
VI ThemajorcomponentsoftheACA
VII.TheeffectoftheACAonpatients,healthcareprofessionals,andinstitutions
VIII.Policycontroversiesandchallenges
IX Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
15. Application of health systems science competencies in patient care
I Introduction:Foundationalskillsforhealthcaredelivery
II Evidence-basedmedicine
III.Communicationskillsvianewtechnology
IV.Teamwork
V Professionalism
VI Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
16. The use of assessment to support students’ learning and improvement in health systems science
I Introduction
II.Currentattentiontohealthsystemsscienceinmajorassessmentframeworksin USmedicaleducation
III Assessmentofknowledge,skills,andpracticeperformanceinhealthsystems science
IV.Student-directedassessmentstrategiesfortheclinicalworkplace
V Assessmentofteamperformance
VI.Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
17. Looking ahead: The dynamic nature of health systems science, future trends, and the role of learners as change agents
I.Healthsystemsscience adynamic,rapidlydevelopingdomainandfieldof inquiry
II.Futuretrendsandtheirimplicationsforhealthsystemsscience
III Healthprofessionsstudentsandtraineesasmasteradaptivelearnersand changeagents
IV.Futuredirectionsforhealthsystemsscience
V Chaptersummary
Questionsforfurtherthought
Annotatedbibliography
References
Glossary
Index
Copyright
Elsevier
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HEALTH SYSTEMS SCIENCE, SECOND EDITION ISBN: 978-0-323-69462-9
Copyright © 2021 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www elsevier com/permissions
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).
Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Previous edition copyrighted 2017.
Library of Congress Control Number: 2020932480
Publisher: Elyse O’Grady
Content Development Specialist: Sara Watkins
Publishing Services Manager: Catherine Jackson
Senior Project Manager: Claire Kramer
Design Direction: Renee Duenow
Printed in Canada.
Contributors
Neera Agrwal, MD, PhD
Mayo Clinic Arizona
Chapter 5: Value in Health Care
Jose Azar, MD
Indiana University
Chapter 15: Application of Health Systems Science Competencies in Patient Care
Elizabeth Baxley, MD
American Board of Family Medicine
Chapter 12: Structural and Social Determinants of Health
Jeffrey M. Borkan, MD, PhD
Brown University
Chapter 1: What Is Health Systems Science? Building an Integrated Vision
Chapter 17: Looking Ahead: The Dynamic Nature of Health Systems Science, Future Trends, and the Role of Learners as Change Agents
Brian Clyne, MD, MHL
Brown University
Chapter 9: Leadership in Health Care
I. Glenn Cohen, JD
Harvard Law School
Chapter 13: Health Law and Ethics
Elliott J. Crigger, PhD
American Medical Association
Chapter 13/sidebar: The Code of Medical Ethics
Matthew Davis, MD, MAPP
Northwestern University Feinberg School of Medicine
Chapter 14: Health Care Policy and Economics
Ami L. DeWaters, MD, MSc
Penn State College of Medicine
Chapter 4: Health Care Structures and Processes
Jesse M. Ehrenfeld, MD, MPH
Medical College of Wisconsin School of Medicine
Chapter 6: Patient Safety
Chapter 10: Clinical Informatics
Victoria Stagg Elliott, MA
American Medical Association
Chapter 17: Looking Ahead: The Dynamic Nature of Health Systems Science, Future Trends, and the Role of Learners as Change Agents
Tonya Fancher, MD, MPH
University of California, Davis, School of Medicine
Chapter 12: Structural and Social Determinants of Health
Martha E. (Meg) Gaines, JD, LLM
University of Wisconsin Law School
Chapter 1/sidebar: Patients: The Missing Critical Voice in Health Systems Science
Paul George, MD, MHPE
Brown University
Chapter 11: Population Health
Alicia Gonzalez-Flores, MD
University of California, Davis, School of Medicine
Chapter 12: Structural and Social Determinants of Health
Jed D. Gonzalo, MD, MSc
Penn State College of Medicine
Chapter 1: What Is Health Systems Science? Building an Integrated Vision
Chapter 2: Systems Thinking in Health Care: Addressing the Complex Dynamics of Patients and Health Systems
Sara Jo Grethlein, MD
Indiana University
Chapter 9: Leadership in Health Care
Chapter 15: Application of Health Systems Science Competencies in Patient Care
Maya M. Hammoud, MD, MBA
University of Michigan and the American Medical Association
Chapter 2: Systems Thinking in Health Care: Addressing the Complex Dynamics of Patients and Health Systems
Chapter 8: Principles of Teamwork and Team Science
Iman Hassan, MD
Albert Einstein College of Medicine
Chapter 17: Looking Ahead: The Dynamic Nature of Health Systems Science, Future Trends,
and the Role of Learners as Change Agents
Karen E. Hauer, MD, PhD
University of California, San Francisco, School of Medicine
Chapter 16: The Use of Assessment to Support Students’ Learning and Improvement in Health Systems Science
William R. Hersh, MD
Oregon Health & Science University
Chapter 10: Clinical Informatics
Jason Higginson, MD, MA
Brody School of Medicine at East Carolina University
Chapter 8: Principles of Teamwork and Team Science
Allison K. Hoffman, JD
University of Pennsylvania Law School
Chapter 13: Health Law and Ethics
Linda Hofler, PhD, RN, NEA-BC
Vidant Health
Chapter 8: Principles of Teamwork and Team Science
Jill Huber, MD
Mayo Clinic
Chapter 11: Population Health
Ian Kim, MD
University of California, Davis, School of Medicine
Chapter 12: Structural and Social Determinants of Health
Russell W.H. Kridel, MD
American Medical Association
Chapter 4/sidebar: Is Private (Solo or Group) Practice for You?
Natalie Landman, PhD
Arizona State University
Chapter 5: Value in Health Care
Luan E. Lawson, MD, MAEd
Brody School of Medicine at East Carolina University
Chapter 6: Patient Safety
Kimberly D. Lomis, MD
American Medical Association
Chapter 12: Structural and Social Determinants of Health
Chapter 16: The Use of Assessment to Support Students’ Learning and Improvement in Health Systems Science
Chapter 17: Looking Ahead: The Dynamic Nature of Health Systems Science, Future Trends, and the Role of Learners as Change Agents
Barbara McAneny, MD
American Medical Association
Chapter 4/sidebar: Ask an Expert About Private Practice
Erin McKean, MD, MBA
University of Michigan
Chapter 9: Leadership in Health Care
Ryan Munyon, MD
Penn State Hershey Medical Center
Chapter 4: Health Care Structures and Processes
Chemen Neal, MD
Indiana University
Chapter 15: Application of Health Systems Science Competencies in Patient Care
Robert E. Nesse, MD
Mayo Clinic
Chapter 3: The Health Care Delivery System
Timothy Reeder, MD, MPH
Brody School of Medicine at East Carolina University
Chapter 6: Patient Safety
William M. Sage, MD, JD
University of Texas at Austin
Chapter 13: Health Law and Ethics
Mark D. Schwartz, MD
New York University Langone Health
Chapter 14: Health Care Policy and Economics
Mamta K. Singh, MD, MS
Case Western Reserve University School of Medicine
Chapter 7: Quality Improvement
Susan E. Skochelak, MD, MPH
American Medical Association
Chapter 1: What Is Health Systems Science? Building an Integrated Vision
Stephanie R. Starr, MD
Mayo Clinic
Chapter 2: Systems Thinking in Health Care: Addressing the Complex Dynamics of Patients and Health Systems
Chapter 3: The Health Care Delivery System
Sara Teasdale, MD
University of California, Davis, School of Medicine
Chapter 12: Structural and Social Determinants of Health
Elizabeth Tobin-Tyler, JD, MA
Brown University
Chapter 14: Health Care Policy and Economics
Anne Tomolo, MD, MPH
Emory University
Chapter 7: Quality Improvement
Paul F. Weber, MD, RPh, MBA
Rutgers Robert Wood Johnson Medical School
Chapter 7: Quality Improvement
Natalia Wilson, MD, MPH
Arizona State University
Chapter 11: Population Health
Daniel R. Wolpaw, MD
Penn State College of Medicine
Chapter 1: What Is Health Systems Science? Building an Integrated Vision
Therese Wolpaw, MD, MHPE
Penn State College of Medicine
Chapter 17: Looking Ahead: The Dynamic Nature of Health Systems Science, Future Trends, and the Role of Learners as Change Agents
Steven Yuen, MD
Barrow Neurological Institute
Chapter 5: Value in Health Care
What is health systems science? Building an integrated vision
Jed D. Gonzalo, MD, MSc, Susan E. Skochelak, MD, MPH, Jeffrey M. Borkan, MD, PhD, Daniel R. Wolpaw, MD
CHAPTER OUTLINE
I.TheNeedforCurriculainHealthSystemsScience,2
II.TheRapidlyChangingHealthCareEnvironment,2
A.HealthCarePolicyInitiatives,3
B.PaymentReformandValue,3
C.HealthCareDeliverySystemInnovationandTransformation,3
D.TransformativeHealthInformationTechnology,Data,andInformatics,4
III.ClinicianReadinesstoPracticeintheEvolvingHealthCareSystem,5
IV.TheThirdMedicalScience:HealthSystemsScience,5
A.TheCurrentTwo-PillarModelofMedicalEducation,5
B.ConceptualizingHealthSystemsScience The“ThirdPillar”ofMedical Education,5
C.WhatIsHealthSystemsScience?,6
D.Engel’sBiopsychosocialModel,7
E.HowHealthSystemsScienceIsMoreThantheIndividualComponents, 7
F.HowHealthSystemsScienceIsConnectedtotheTripleandQuadruple Aims,8
V.HealthSystemsScienceCurricularDomains,8
A.CoreFunctionalDomains,8
1. Patient, Family, and Community, 8
2. Health Care Structure and Process, 8
3. Health Care Policy and Economics, 9
4. Clinical Informatics and Health Technology, 9
5. Population, Public, and Social Determinants of Health, 9
6. Value in Health Care, 10
7. Health System Improvement, 10
B.FoundationalDomains,10
1. Change Agency, Management, and Advocacy, 10
2. Ethics and Legal, 10
3. Leadership, 10
4. Teaming, 11
C.LinkingDomain:SystemsThinking,11
VI.CaseStudies:RenalDiseaseandTreatment WhereBasic,Clinical,and HealthSystemsScienceMerge,11
VII.ProfessionalIdentityFormation,12
A.Physician-CentricRoleIdentity,13
B.Patient-Centered,SystemsRoleIdentity,14
VIII.ChallengesforLearnerstoEngageHealthSystemsScience,15
A.AddresstheHiddenCurriculum,15
B.DemonstratethePotentialforAddingValuetothePractice,15
C.ImprovetheUndergraduate-to-GraduateMedicalEducationTransition, 16
IX.ChapterSummary,16
X.OverviewofBookChapters,17
XI.ChapterTemplate,17
In this chapter
For over 100 years, medical education has relied upon two pillars for training physicians ready to practice medicine: basic science and clinical science. Health systems science—the understanding of how care is delivered, how health care professionals work together to deliver that care, and how the health system can improve patient care and health care delivery has been part of the hidden curriculum or taught as part of elective courses. There have been many attempts to formalize the role of health systems science in medical school curriculum and make it the third pillar of physician education. Progress toward that goal is steadily advancing.
Health systems science is intimately intertwined with the two pillars of medical education but is also a subject in its own right requiring study by medical students. Additionally, physicians’ roles in the health care system are changing significantly, and physicians need to understand health systems science in order to fulfill their evolving roles. Health systems science competencies extend
