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Leading Transformation In Health Care Delivery

WELCOME TO MHCDS The Master of Health Care Delivery Science (MHCDS) program at Dartmouth College was launched in 2011 as a collaboration between the College’s Tuck School of Business, and Geisel School of Medicine. The program’s mission is to equip leaders and emerging leaders with the skills they need to transform the delivery of health care. The Dartmouth College experience has long been characterized by excellent teaching, rigorous course materials, and strong social bonds. MHCDS is the first Dartmouth degree program to deliver online curriculum specifically tailored to a student population of adult working professionals. The program’s success relies upon its ongoing ability to meet the College’s standards of scholarship, teaching and social engagement in this new learning environment. This work is licensed under the Creative Commons Attribution 4.0 International License 1

VISIONARY LEADERSHIP Shared Leadership Dartmouth College has long differentiated itself within the Ivy League with a focus on excellent undergraduate teaching in an intimate residential setting. The MHCDS program delivers Dartmouth’s trademark teaching excellence using an online curriculum delivery completely new to the college. As the world’s first graduate degree program in Health Care Delivery Science, there were no existing models or standards for curriculum content. The program and college leadership all the way up to the president’s office recognized the need for a new model to overcome these challenges (see graphic “A Purpose-Built Program, Purposefully Built” on the following page). In the spirit of shared leadership, MHCDS engages a very active curriculum committee comprised of faculty from across the campus, librarians, and curricular and technology support staff. Regular meetings explore opportunities for improvement and innovation with curriculum and teaching methods. From the outset, the program was built for innovation—starting with a motivated team, a clear mandate and a culture that supports and fosters risk-taking with transformative approaches to both learning and working.

Individual Leadership Katy Milligan, MHCDS Program Director, expects constant innovation and experimentation in educational delivery. Katy’s expertise is frequently sought when new educational delivery methods are being considered across the campus. Click on the image to hear Katy describe MHCDS’s technology innovation imperative.

Recognizing a need to provide a stable, mobile, common platform to guarantee student access to course material and to fuel innovations in education delivery, in 2012 MHCDS adopted a 1:1 iPad program. 2

A Purpose-Built Program, Purposefully Built ...Consists of a series of surveys, course evaluations, and interviews evaluates program effectiveness. As a professional program, feedback from employers and alumni features prominently. At its core, program evaluation assesses the extent to which faculty are satisfied that students are acquiring the appropriate level of understanding and skills, and students are satisfied that they are acquiring the right knowledge. (See the section on Evidence of Success, on page 13, for more details on the program assessment cycle.)

...An 18-month hybrid/low residency program structured for adult working professionals. Three 6-month online terms are interspersed with four residential periods. Online courses are 2 to 6 weeks in duration, and all students work through the same courses together. Coursework in leadership, strategy, and negotiation, and an action learning project run the length of the program. In addition to a rigorous academic experience, residential sessions allow for the social bonding necessary for effective teamwork during the online terms. The online terms allow students to return to their places of work while taking classes. Each week of every course has the same structure, creating a predictable routine to fit into busy schedules. Busy working professionals also expect a high level of service, which MHCDS delivers with a dedicated team focused on creating the best possible learning environment for both students and faculty (see page 21 “Creating a Culture of Innovation�).


Recognizing that the US health care system is in crisis, the MHCDS program equips leaders and emerging leaders to bring transformative change to the delivery of health care. Upon graduation students take with them the skills, frameworks, and relationships necessary to: •Envision the future of health care •Lead change in their organizations, states, and the nation •Develop professionally ...Are leaders and emerging leaders from all sectors of the health care industry, roughly balanced between clinicians and administrators. Characteristics of a recent MHCDS cohort:

...Are multidisciplinary, a collaboration between The Dartmouth Institute for Health Policy and Clinical Practice (TDI)— part of Dartmouth’s Geisel school of Medicine-- and Dartmouth’s Tuck School of Business. Competencies contributed by each partner include: TDI: Variation Analytics and Outcomes Shared Decision-Making Accountable Care Organizations Population health/Measurement Tuck: Leadership Development Strategy and Economics Health Care Finance Teamwork Practicum Management Science and Operations

Physician Leaders 52% Health System Execs 20% National/State policy 13% Health Plans 9% Alternate Site Care 7% Average of 25 yrs of experience >90% have advanced degrees (MD, DO, MBA, JD, PhD) Job titles include: President, CEO, CMO, CQO, Chair, Chief, Director, General Counsel, Lieutenant Commander Students reside in 23 different states & two foreign countries Already highly trained and professionally accomplished, this student body requires a unique curriculum to meet the program objectives.

Enabling executive-level students to access this unique content required careful delivery design.


Community Engagement From its inception, MHCDS has endeavored to be closely linked with the rest of the College, even though its students and delivery methods are unique. The program depends on the College’s institutional support for faculty, as well as infrastructure such as classrooms and enterprise technologies. The college, meanwhile, benefits from MHCDS’s experience in delivering high-quality, high-touch hybrid education. Monthly campus-wide meetings allow the program to share experiences and best practices with instructional designers, educational technologists, and managers from around the College. MHCDS staff are frequently called upon to consult in areas relevant to distance delivery, such as best practices for designing and delivering synchronous online classes. In the larger healthcare community, expanding support for the MHCDS vision is evidenced by the number of healthcare systems who routinely sponsor not just individuals but teams of leadership staff to complete the program and fuel the pace of innovation within their organizations.

Josh Kim, one of the founders of the MHCDS program, now serves as Dartmouth’s Director of Digital Learning Initiatives—ensuring that MHCDS experience is widely shared on campus, and looked to as a model for innovative online programming



INNOVATION... Student Learning While MHCDS students share a common experience and curriculum, each student is able to personalize his or her experience (see Flexible Learning Environment on page 13 for more). In addition to allowing mobile access to core curriculum via private iTunesU courses, Apple’s iPad ecosystem allows each student to customize a core technology platform with the Apps of their choosing. Apps also allow for integration with the existing technologies of Dartmouth College, and those of each student. Using mobile Apps, students can remain engaged with weekly discussion-based assignments in the Canvas learning management system, collaborate with group projects using Google-Drive, and participate in weekly live web meetings using Adobe Connect.

How Our Students Use The iPad John Southall and Vinay Maheshwari, MHCDS ‘16s, talk about how they use the iPad to personalize their learning and integrate it with the rest of their lives. Click on the image to view the video.

As the program has matured, it has become evident that the students are bringing these classroom technologies into their workplace to enhance professional communication and collaboration. An example is the use of voice-over presentations recorded on iPads to share ideas with colleagues.

Instructional Practices MHCDS faculty are selected for their mastery of learning and teaching, usually within a traditional 6

The Mobile Learner Inger Buene, MHCDS ’15, explains how the iPad impacted her educational experience. Click on the image to view the video.

residential setting. To ensure optimization for both the MHCDS delivery method and the target student demographic, every MHCDS course is designed using a team approach. The course design team includes the faculty, an instructional designer, a media specialist, and a curriculum specialist (see the video “Curriculum Specialist: Part Coach, Part Teaching Partner” for a description of what a curriculum specialist does). The faculty bring their content knowledge and teaching experience, while curriculum specialists contribute deep knowledge of the students, best practices for educational delivery, and a global perspective of the program’s entire curriculum. An instructional designer and a media specialist round out the team, applying learning theory and technical innovation to content delivery. This resource-rich approach ensures that faculty feel supported, and that developing and delivering a course is a collaborative effort.

MHCDS students spend an average of 15 hours a week completing their online coursework.

“What Makes Teaching at MHCDS Different?”

Most importantly, this team approach frees faculty to engage more deeply with students on complex issues. Even faculty who were at first skeptical of online teaching now express the belief that technology enhances rather than inhibits engagement with students.

Rob Shumsky, MHCDS operations professor, describes the “Four Teams” that define his MHCDS teaching experience.

Team work is a key part of the MHCDS curriculum. Students complete weekly study team assignments, meeting in an Adobe Connect online meeting room assigned to each team. Platforms such as Google-Drive and Dropbox allow for groupediting of documents.

Click on the image to view the video.

Curriculum Design

MHCDS’s curriculum design rests These technologies serve as virtual learning labo- on a foundation of mutually ratories for collaboration and coordination across reinforced learning objectives time and distance. building from weekly assignments to overarching program goals. The learning is practical and active, designed to leverage students’ professional experience and knowledge - allowing them to immediately apply classroom concepts to further the transformation of the delivery of healthcare in their workplaces.


The technology used in the MHCDS program makes this applied approach to learning possible, allowing students to remain in their professional leadership positions while pursuing their studies. Recognizing the need for multidisciplinary approaches to solve healthcare’s most pressing problems, the MHCDS curriculum emphasizes leadership and teamwork. Practical experience in forming effective teams is gained as students rotate through a series of study groups responsible for weekly collaborative assignments. Typically geographically dispersed, these teams rely on collaborative technology to remain effective. In a program that emphasizes peer-learning, student-generated content is consistently integrated into the curriculum throughout the program. This takes many forms, including: •Case studies about the student’s workplace, written in conjunction with faculty •Video and written commentaries that fuel discussion •Team presentations that are analyzed during live, synchronous sessions.

Video Blogging Scott Wallace, MHCDS professor of health information technology strategy, utilizes the immersive nature of technology at MHCDS to enhance student learning. Click on the image to view the video.


MHCDS leverages the presence of iPads to create media-rich learning objects. Unlike traditional paper-based case studies, iBooks allows for rapid authoring of custom multimedia case studies. Using video, these multi-touch cases allow students to hear from protagonists in their own words, or to experience video “site visits� of communities being profiled. Pages from a sample case are shown here.



ONGOING PROFESSIONAL LEARNING... From its inception, MHCDS has worked to integrate the faculties of the medical and business schools. In addition to sharing individual research interests and establishing relationships, this integration is important for promoting a common understanding and language. Regular “faculty seminars” foster discussion of best practices and emerging issues related to the MHCDS curriculum. They also offer an opportunity to share student feedback. At the seminars, faculty also have an opportunity to hear from staff and experts in learning, technology, and health care-related subjects.

Curriculum Specialist: Part Coach, Part Teaching Partner. Adrienne (Addi) Faerber describes the unique role of the Curriculum Specialist. Most, like Addi, have doctorates in health care-related fields. Click on the image to view the video.

Course faculty report that teaching for MHCDS is unlike anything they have done before. Students are seasoned professionals in senior leadership positions, and often provide near instantaneous feedback to faculty about how well a classroom concept, construct or skill works by immediately applying it, then reporting back. MHCDS’s integrated approach to developing and teaching courses is viewed by faculty as an enriching experience that in turn informs the development of their non-MHCDS courses. Examples include using video lectures to “flip” their classes, experimenting with multimedia learning objects, and exploring greater integration and collaboration with other faculty.

Continuous improvement is part of the MHCDS ethos, and faculty fully expect to improve their courses each time they are offered. The team model for course development and delivery allows updates to reflect current events, changes in other related courses, as well as the strengthening of assignments or activities that have not performed as expected. Since many faculty only teach once a year online, they receive constant coaching from the learning team on best practices for creating 11

engaging online experiences, as well as on the unique characteristics of new cohorts.

A Collaborative Culture. Ellen Meara, MHCDS professor of health economics and policy, talks about the value of a collaborative approach to teaching.

Upon course completion, and after student course evaluations have been analyzed, the curriculum team meets to debrief with faculty about what went well, and what should be improved the following year.

Click on the image to view the video.

All faculty are enrolled in a faculty development course which provides learning tips, scenarios used by their peers, and analytic reports on student and course performance. Samples of these analytics appear later in this story.


EVIDENCE OF SUCCESS The teaching model used by MHCDS was developed using current research and best practices around educating adult working professionals. Similarly, the curriculum content was selected based on market research and expert consultation into the current needs of a student population working in leadership roles within the rapidly changing field of health care (see video). Details of the program’s assessment cycle are shown on the following page. This cycle drives continuous improvement at all levels, from individual assignments, to courses, to the overall program.

Creating an Integrated, Student-Focused Curriculum. Alice Andrews, former Director of Curricular Affairs and current faculty member, discusses MHCDS curriculum design. Click on the image to view the video.

Course redesign is driven by both formal course evaluations and informal personal journals, where students reflect on the value of their learning and teamwork within each course. This data, as well as data collected during the delivery of the course by the faculty and curriculum team, is fed back to faculty and the teaching team during a debrief at the end of the course, and again during the course planning meeting at the start of each new year. The success of the program will ultimately be measured by the impact graduates have on redesigning the nation’s health care systems. While that data takes time to feed back, ongoing communication with employers (many of whom sponsor teams of students) and alumni speaks to the practical value of the skills and relationships developed during the program. Leveraging the familiarity with web conferencing gained over 18 months as students, alumni showcase to their peers, faculty and current students how they are applying the concepts and skills learned 13

during their time as MHCDS students. This takes place in the form of an online “grand rounds.”

The level of student-faculty contact enabled by a mobile digital curriculum allows for real time adjustment and improvement of curriculum.

Every graduating student takes part in a one-on-one exit interview about their experience, the curriculum, and the technology.

This includes rapidly authoring new lecture video to asynchronously clarify “muddy points” that emerge.

This information is formally analyzed and shared with the program curriculum committee and faculty directors.

Professional Testimonials: “The Science of Healthcare Delivery,” published in a newsletter for the American Academy of Orthopaedic Surgeons by MHCDS Alumni.


Program Assessment Cycle

Program Objectives (What will graduates learn/achieve?) •Envision and design efficient organizational responses to improve health care delivery, especially in the face of a changing environment •Lead the resulting organizational change •Achieve personal goals for professional development

Curriculum & Learning (Where/what will they learn?) Academic coursework •Learning goals mapped to program goals •Scan environment for new topics and ones to remove

Assessment (How will we know/ measure success?) Students •Anonymous course evaluations •Personal journals •Check-in phone calls •Exit interview phone calls

Team work & Leadership •Study group & ALP (action learning project) group

Alumni •Alumni survey (3 year) •Career trajectory •Presentations, papers, talks

Relationship & Community Building •Residentials •Annual symposia •Learning expeditions •Alumni communication •Collaboration tools

Faculty •Surveys •Evaluations •Interviews External •Employer survey •ALP evaluators •Environment scan (do we have the right topics?)


Analyze & Im- prove (What changes will result from assessment?) Iterative improvements during course •CS provides just-in-time feedback •Faculty make course corrections Course revisions across years •Pre-meetings with faculty •Post-course debriefs with MHCDS team & faculty Program level changes •New Faculty •Courses to add/remove •Admissions criteria and/or process change •Enhancing student experience Program oversight •Curriculum Committee •Executive Committee •Graduate Council

Leadership, teamwork, and execution are all hallmarks of business school education that infuse the MHCDS program. Leadership. Leadership figures prominently in students’ stated professional development goals. A leadership course spans the entire 18 month program, and includes a 360 assessment, mentoring, peer evaluation, theory, self-reflection, and case studies. Teams. Over the course of the program, students are members of at least two study groups and an Action Learning Project Team. Students receive teamwork training, meet weekly with their teams, and form incredibly strong professional and personal bonds. This experience provides hands-on training on how to form and maintain effective teams. Execution. In teams of 4-5, students formally apply coursework directly into a workplace setting in the form of a 12 month, teambased Action Learning Project (ALP).

Some 30% of students receive significant leadership promotions while enrolled or immediately following graduation.

Prior to forming their first team, nearly all students are apprehensive about working in teams. After working in their first team for six months, there is near universal enthusiasm for the teams, and strong bonds among members. Team conflicts are rare, and collaborations continue after graduation.

All ALPs have resulted in important learning, for example in the challenges of implementation, data gathering, forming and working with community coalitions. Several ALPs have resulted in lasting impacts, such as helping a major insurer reduce rates of elective C-section births that are both costly and harmful to the health of mothers and babies.


Analytics Inform Design Analytics from platforms such as Kaltura (for video streaming) and the Canvas learning management system provide quantitative data on student interaction with curriculum, and each other. For example, these graphs suggest course design elements that are working as planned, as well as some changes that may influence student behavior in desirable ways. Each of the analytics displayed was shared with faculty to inform course redesign.

Students may watch a larger percentage of a video in a single sitting if that video is shorter. This may result in less distraction, and better learning

Based on video viewing, the “Rhythm of the Week� is working: Most viewing occurs early in the week.


Assigning students to comment on specific peers produces more discussion over a longer period of time compared to the usual approach of requesting that students “comment on at least two other posts”. “Course A” began experimenting with this method of commenting in 2014. This graph shows the average number of discussion posts per week, compared to the usual approach, and to two other comparable courses- across three cohorts of students.

This graph compares the average number of posts per day, for a single cohort of students. It suggests that assigned commenting (course A) leads asynchronous discussions to be drawn out over a longer stretch of time. 18

FLEXIBLE LEARNING ENVIRONMENT... School Design and Facilities Colleges and universities spend lavishly to maintain their grounds, greens and buildings, and the spaces and places where students and faculty meet and mingle. As a primarily online program, MHCDS’s online portals and web conferencing spaces are where the students and faculty linger. The design and maintenance of this online campus is every bit as important as the physical campus. Intuitive design, and technology that is functional, reliable, and predictable are the hallmarks of MHCDS’s virtual spaces. As a relatively new degree program, MHCDS is also designed with the specific attributes of its student body in mind. The result is a program with sufficient flexibility and practicality to accommodate executivelevel students with exceedingly busy schedules. MHCDS students are adult working professionals, many are “c-suite” executives; all of them already work 60-80 hour weeks. For these students, consistency of program expectations and schedule predictability are essential. MHCDS records or live-streams all events, from weekly online meetings to residential class sessions. While video can never replace “being there,” students have grown accustomed to the video experience to the point where: • A student tuned into the residential classroom from his car while driving to a family funeral. • During the 2015 flu season, approximately one-third of the students used Adobe Connect to tune into the residential classroom from their sickbeds. One faculty member led a classroom discussion from home. • Alumni from around the world are able to continue their learning, with up to 90 alumni joining live online faculty seminars.

The hybrid, low-residency approach is essential to allow students to participate while maintaining their professional careers. It also allows them to immediately apply lessons from the virtual classroom, and report back on the experience. The emphasis on teamwork among geographically dispersed members, meanwhile, requires the foundation of intense social bonding provided by the residential experiences. MHCDS uses iBooks to create multimedia proceedings for the program’s annual Symposium on Health Care Delivery Science. Click here to access the proceedings. 19

Those bonds are maintained during weekly synchronous online meetings using Adobe Connect that provide live interaction with classmates and faculty. Student teams also have persistent access to their own online study group web conferencing rooms. Mobile tools such as the Adobe Connect iPad App allow students to continue to collaborate even while traveling.

“What Makes Teaching at MHCDS Different?” Anant Sundaram, MHCDS finance professor, talks about the “Three Ts” that differentiate the MHCDS teaching experience from a standard, residential classroom. Click on the image to view the video.

Faculty also see the benefit of flexibility, leading courses from literally every corner of the globe. MHCDS technology is able to provide a quality experience even in challenging technological circumstances, taking into account awareness of bandwidth constraints frequently faced by mobile students and faculty.

Rhythm of the Week. Every week of an MHCDS course has the same structure, allowing students to schedule their work and personal lives accordingly. DAY



Mon Tue

Weekly readings, video lectures Live Web Meeting

Prepare for & attend 1 hr. synchronous session

Wed Thr

Readings, videos Individual Assignment

Usually a short, discussion-based assignment applying the weekly concepts to personal work


Work with study team


Work with study team


Team Assignment

Main deliverable for the week, submit by midnight


Information Technology (IT) The IT infrastructure starts with a great team, and a culture where innovation and experimentation is encouraged, supported, and considered part of everyone’s job. All IT and learning design staff are provided with the entire suite of Apple products as well as Windows-based devices. This allows for constant experimentation, testing, and the delivery of IT support to students and faculty.

Using the iPad as a common platform eases access to materials that are often blocked by highly secured IT environments. Students have also used audio, video and photo capabilities of their iPads to enhance deliverables. Professional students live in a “mixed” IT world, a virtual potpourri of platforms and services, both personal and professional. iPad Apps allow relatively smooth integration into this heterogenous technology ecosystem.

Technology is the students’ lifeline to full engagement with the curricular and social experience at MHCDS. In addition to synchronous engagement using Adobe Connect, browser and iPad access allows constant engagement in the weekly discussion assignments while traveling, or during typically long days in professional and clinical health care settings. Perhaps most rewarding of all, students have taken the multimedia communication and collaboration approaches they learn at MHCDS back to their workplaces.

Creating a Culture of Innovation Leveraging technology to improve communication, collaboration, and information management—for students and staff—is one of the IT goals for MHCDS. The goal is not for the technology to be “invisible”, bur rather to be notable in how it contributes to an exceptional learning experience. The team culture promoting this is suported in many ways, including: • A dedication to the mission, and strong service ethic among all staff. • All staff are fully equipped with up-to-date equipment. • Flexible, results-based workplace encourages staff to work from distant locations, mirroring the student experience. • Streamlined procurement allows for rapid acquisition of lower budget technologies or services. • An “innovation rubric” guides efforts, and sets expectations and parameters. • The Learning and Technology team is fully cross trained, and members are given ownership of specific areas to “make their own.”



Special Thanks To:

Ano Lobb, Learning & Technology Manager, MHCDS. Twitter: @healthyrx

Students & alumni of the MHCDS program, who teach and inspire us. Faculty partners, whose curriculum & teaching prowess make MHCDS such an outstanding program.

Katy Milligan, Program Director, MHCDS. Twitter: @katymilligan90

Partners across Dartmouth College, including instructional designers, educational technologists, librarians, administrators, & those working in facilities.

George Newcomb, Director of Admissions, MHCDS. Twitter: @newcogl

Former MHCDS staff who helped to establish the program, including Josh Kim, Dave Baker, Thom Walsh, Andrew Grimson, Michael Rea, & Jeff Hawkins.

Josh Kim, Director of Digital Learning Initiatives, Dartmouth Center for the Advancement of Learning.

The entire MHCDS program team for being awesome coworkers.

Twitter: @joshmkim

Dave Numme, Oleg Timoshenko and Elli Goudzwaard of the MHCDS Learning & Tech team, who build amazing courses & provide an unrivaled level of support to our students & faculty.

Good Stories Told Simply. This project was produced using the same spirit of experimentation that infuses the MHCDS program. Video interviews were recorded on an iPad Air, and edited using iMovie. The process prioritized timely, efficient, rapid-authoring over high production values. Multimedia curriculum at MHCDS is produced following these same principles.

Paul D’Ascoli, Lars Ljungholm, & Ian Camera from Apple, the people behind a great technology partnership. Eric Wagstaff & the Dartmouth Computer Store, for creating a painless iPad procurement process. Thom Walsh for thoughtful feedback on this project. Jenny Hyslop for copy editing. 22

Welcome to mhcds  

Dartmouth College's first low-residency online degree program, and the World's first degree in Health Care Delivery Science.

Welcome to mhcds  

Dartmouth College's first low-residency online degree program, and the World's first degree in Health Care Delivery Science.