Health Systems Science, 2nd Edition

Addition to Health Systems Science Education: Development and Implementation

Written by Victoria Stagg Elliott, MA; Jeffrey Borkan, MD, Ph.D.; Maya Hammoud, MD, MBA

Health systems science (HSS), a foundational framework for the study and understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery^[i], is increasingly incorporated into the education and training of physicians,^[ii] but physicians don’t work alone. The full potential of the increased understanding of HSS by physicians—improved population health and a better patient experience along with other aspects of the Quintuple Aim— cannot happen without other healthcare professionals incorporating HSS into their education, training, and practice.

HSS emerged as a third science and pillar of medical education, to be integrated alongside basic and clinical sciences, about a decade ago with the formation of the American Medical Association (AMA) Accelerating Change in Medical Education Consortium^[iii] (since renamed ChangeMedEd). In 2013, the AMA awarded 11 medical schools $1 million in five-year grants to explore innovation in medical education^.[iv] The need for medical students to learn HSS emerged early in the consortium’s work, and faculty at member schools of the consortium developed an HSS framework. This is an amalgamation and integration of learning areas that were previously either ignored or scattered throughout the medical school curriculum such as leadership, health policy, informatics, and population health. Faculty of member schools of the consortium (which was expanded to 32 schools in 2015) then wrote the first edition of the Health Systems Science textbook. This was published by Elsevier in 2016.^[v] Elsevier published a second edition in 2020, and this book along with the Health Systems Science Review and the most recently published Health Systems Science Education: Development and Implementation have increased the incorporation of HSS into medical education. New medical schools are launching curricula that already include it.^[vi],[vii] Fortunately, the education of other healthcare professionals is increasing including health systems science as well.^[viii]

For example, the AMA’s Health Systems Science Scholars Program has long included many healthcare professionals in addition to physicians.^[ix] Medical schools often include non-physicians in HSS educational experiences.^{[x],[xi],[xii]} HSS is also increasingly included in the curricula for physician assistants, nurses,^[xiii], and other health care professionals.^[xiv]

Our hope is that medical schools and institutions that train other health professionals will implement HSS education in even greater numbers and to an even greater degree. Our latest textbook, Health Systems Science Education: Development and Implementation, explores exactly how to do that in the pre-clerkship curricula as well as in the clinical learning environment and in graduate medical education. A chapter is dedicated to interprofessional education and collaborative practice. Teaming is one of health systems science’s foundational domains, and interprofessional education is integral to strengthening physicians’ knowledge of the special skill sets of other health professionals and approaches in order to leverage the entire team’s capacity to advance optimal care.

Interprofessional care and collaboration are critical to good patient outcomes, and for HSS to achieve its full potential, all healthcare professionals need to be trained as systems citizens adept at incorporating HSS into everyday practice. This means that future physicians will sometimes train and work alongside other healthcare professionals while always understanding the importance of teaming and interprofessional practice. It will also mean that physician assistants, nurse practitioners, nurses, and other health care professionals will need their own training in HSS so that physicians and other health care professionals will work alongside each other even better than ever before. All can become system citizens who are effective stewards of the health care system.

^[i] Skochelak SE, Hammond MM, Lomis KD, et al., eds. Health Systems Science. 2nd ed. St. Louis: Elsevier; 2020.

^[ii] Gonzalo JD, Ogrinc G. Health systems science: the “broccoli” of undergraduate medical education. Acad Med. 2019;94(10): 1425-1432.

^[iii] Borkan JM, Hammoud MM, Nelson E, et al. Health systems science education: the new post-Flexner professionalism for the 21st century. Med Teach. 2021;43(suppl 2):S25-S31.

^[iv] Skochelak SE, Lomis KD, Andrews JS, Hammoud MM, Mejicano GC, Byerley J. Realizing the vision of the Lancet Commission on Education of Health Professionals for the 21st Century: Transforming medical education through the Accelerating Change in Medical Education Consortium. Med Teach. 2021; 43:sup2, S1-S6

^[v] American Medical Association. Just in time for the holidays: AMA’s health systems science textbook. Published December 15, 2016. https://www.ama-assn.org/press-center/press-releases/just-time-holidays-ama-s-health-systems-science-textbook. Accessed July 11, 2023.

^[vi] Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science. https://medschool.kp.org/about/offices-and-departments/department-of-health-systems-science. Accessed July 11, 2023.

^[vii] Alice L. Walton School of Medicine. Alice L. Walton School of Medicine Announces Leadership Hires. Published May 4, 2023. https://www.alwmedschool.org/news/alice-l-walton-school-of-medicine-announces-leadership-hires. Accessed July 11, 2023.

^[viii] Will KK, Mutyala J, Essary AC. Health systems science: A call to action. JAAPA. 36(6):p 45-46, June 2023.

^[ix] American Medical Association. Health Systems Science Scholars. Updated November 22, 2022. https://www.ama-assn.org/education/accelerating-change-medical-education/health-systems-science-scholars. Accessed July 11, 2023.

^[x] DeSimone AK, Siegel DT. Integrating Health Systems Science Education into Five Graduate Programs. Institute for Healthcare Improvement Open School, Emory University. https://www.ihi.org/education/IHIOpenSchool/resources/Documents/27ForumPosters/27Forum%20Ariadne%20DeSimone.pdf. Accessed July 11, 2023.

^[xi] Musick DW, Vari RC, Kraemer MS, Trinkle DB, Vari PM, Smith JC, Learman LA. Building Health Systems Science Education from the Core Domain of Interprofessional Education at Virginia Tech Carilion School of Medicine. Med Sci Educ. 2021 Feb; 31(1): 215–222.

^[xii] Gonzalo JD, Hamilton M, DeWaters AL, Munyon R, Miller E, Wolf H, Wolpaw DR, Thompson BM. Implementation and Evaluation of an Interprofessional Health Systems Science Professional Development Program. Acad Med. 2023 Jun 1;98(6):703-708.

^[xiii] Johns Hopkins School of Nursing. Health Systems Sciences Interprofessional Scholars Program. https://nursing.jhu.edu/excellence/interprofessional/initiative.html. Accessed July 11, 2023.

^[xiv]  Olson APJ, Danielson J, Stanley J, Graber ML. Improving Education – A Key to Better Diagnostic Outcomes. Rockville, MD: Agency for Healthcare Research and Quality; March 2022. AHRQ Publication No. 22-0026-1-EF. https://www.ahrq.gov/sites/default/files/publications2/files/dxsafety-issuebrief-education.pdf. Accessed July 11, 2023.