Health systems science

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Health systems science (HSS) is a foundational platform and 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.[1] It is one of the three pillars of medical education along with the basic and clinical sciences.[2] HSS includes the following core foundational domains: health care structure and process; health system improvement; value in health care; population, public, and social determinants of health; clinical informatics and health technology; and health care policy and economics.[1] It also includes four functional domains: ethics and legal; change agency, management, and advocacy; teaming; and leadership.[1] Systems thinking links all of these domains together.[1] Patient, family, and community are at the center of HSS.[3]

History and development[edit]

HSS, which was originally referred to as systems-based practice, emerged in response to the growing recognition that effective health care delivery requires more than just clinical expertise. It acknowledges that health care systems are complex, adaptive systems influenced by a multitude of factors, including social determinants of health, policy decisions, organizational structures, and patient preferences.[4]

The World Health Organization first recognized the need to educate physicians about the link between health and the systems in which people live, work, and play in 1978.[5] The quality and patient safety movement of the 1980s and 1990s further reinforced the need for physicians to understand systems thinking.[6][7][8][9] The Association of American Medical Colleges' Core Entrustable Professional Activities for Entering Residency (CEPAERs) started including identifying system failures and making contributions to a culture of safety and improvement in 1999.[10] That year, the Accreditation Council for Graduate Medical Education also included systems-based practice as one of its six core competency domains.[11] In 2001, the Health Resources and Services Administration funded an 18-medical-school consortium to launch several pilots related to systems-based education.[12] In 2005, the book, Professionalism in Tomorrow's Healthcare System, outlined several aspects of the systems-based practice competency.[13]

Medical schools and residency and fellowship programs, however, struggled to teach these competencies.[14] The framework for HSS was developed to address this struggle and is built on a foundation of systems thinking and the biopsychosocial model developed by George L. Engel.[4] It aims to educate physicians to become systems citizens.[15]

From 2013 to 2015 the American Medical Association's (AMA) Accelerating Change in Medical Education consortium of 11 U.S. medical schools worked to identify a comprehensive framework for HSS training.[16] In 2017, a review of 30 grant submissions to the AMA Accelerating Change in Medical Education initiative and an analysis of the HSS-related curricula at the 11 medical schools that were members of the Accelerating Change in Medical Education consortium formed the groundwork toward the development of a potential comprehensive HSS curricular framework with domains and subcategories.[4]

Barriers to incorporating HSS into medical education include student resistance because it is not always viewed as essential to passing physician licensing and credentialing exams[17] and limitations in the number of medical school faculty with expertise to teach HSS domains.[18]

An increasing number of new medical schools have created their initial curriculum with HSS fully integrated including Kaiser Permanente Bernard J. Tyson School of Medicine,[19] which matriculated its first class in July 2020, and the Alice L. Walton School of Medicine, which is expected to matriculate its first class in 2025.[20]

Future directions[edit]

As health care continues to evolve, the importance of HSS is expected to grow.[21] Efforts to integrate HSS into medical education and practice will be essential for preparing physicians to navigate the complexities of modern health care delivery, advocate for their patients, and contribute to improving the health of populations.[22]

HSS is also expanding to other health professions. In 2023, the National Academies of Sciences, Engineering, and Medicine hosted a series of workshops focused on integrating HSS across the learning curriculum.[23] HSS has been expanding to physician assistants,[24] nurses, and other health care professionals.[25]

Notable figures and organizations[edit]

Susan Skochelak, MD, MPH, creator of the Accelerating Change in Medical Education initiative[26] and lead editor of the first and second editions of the Health Systems Science textbook.

Schools involved in the AMA Accelerating Change in Medical Education initiative[16] that helped create the HSS framework:

See also[edit]

References[edit]

  1. ^ a b c d "Health Systems Science - 9780323694629". US Elsevier Health. Retrieved 2024-05-06.
  2. ^ Rowe, Rebecca J.; Bahner, Ingrid; Belovich, Andrea N.; Bonaminio, Giulia; Brenneman, Anthony; Brooks, William S.; Chinn, Cassie; El-Sawi, Nehad; Haudek, Sandra B.; Haight, Michele; McAuley, Robert; Slivkoff, Mark D.; Vari, Richard C. (2021-02-01). "Evolution and Revolution in Medical Education: Health System Sciences (HSS)". Medical Science Educator. 31 (1): 291–296. doi:10.1007/s40670-020-01166-x. ISSN 2156-8650. PMC 7668405. PMID 33224556.
  3. ^ Bartoletta, Katherine M.; Starr, Stephanie R. (August 2021). "Health Systems Science". Advances in Pediatrics. 68: 1–19. doi:10.1016/j.yapd.2021.05.001. PMC 9188469. PMID 34243847.
  4. ^ a b c Gonzalo, Jed D.; Dekhtyar, Michael; Starr, Stephanie R.; Borkan, Jeffrey; Brunett, Patrick; Fancher, Tonya; Green, Jennifer; Grethlein, Sara Jo; Lai, Cindy; Lawson, Luan; Monrad, Seetha; O'Sullivan, Patricia; Schwartz, Mark D.; Skochelak, Susan (January 2017). "Health Systems Science Curricula in Undergraduate Medical Education: Identifying and Defining a Potential Curricular Framework". Academic Medicine. 92 (1): 123–131. doi:10.1097/ACM.0000000000001177. ISSN 1040-2446. PMID 27049541.
  5. ^ McGagghie, William (1978). "Competency-based Curriculum Development in Medical Education" (PDF). World Health Organization. Retrieved 6 May 2024.
  6. ^ Godfrey, Blanton (6 May 2024). "Quality Digest". www.qualitydigest.com. Retrieved 2024-05-06.
  7. ^ "About NCQA". NCQA. Retrieved 2024-05-06.
  8. ^ "History | Institute for Healthcare Improvement". www.ihi.org. Retrieved 2024-05-06.
  9. ^ Institute of Medicine (US) Committee on Quality of Health Care in America (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US). ISBN 978-0-309-07280-9. PMID 25057539.
  10. ^ Association of American Medical Colleges (2014). "Core Entrustable Professional Activities for Entering Residency". Association of American Medical Colleges. Retrieved 6 May 2024.
  11. ^ Eno, Celeste (2020). "Milestones Guidebook for Residents and Fellows" (PDF). Accreditation Council for Graduate Medical Education. Retrieved 6 May 2024.
  12. ^ Wood, Douglas L.; Babbott, David; Pascoe, John M.; Pye, Karen L.; Rabinowitz, Howard K.; Veit, Kenneth J. (January 2004). "Lessons learned-UME-21 project". Family Medicine. 36 Suppl: S146–150. ISSN 0742-3225. PMID 14961419.
  13. ^ Mills, Ann E. (2005). Professionalism in Tomorrow's Healthcare System: Towards Fulfilling the ACGME Requirements for System-based Practice and Professionalism. University Publishing Group. ISBN 978-1-55572-037-7.
  14. ^ Borkan, Jeffrey M.; Hammoud, Maya M.; Nelson, Elizabeth; Oyler, Julie; Lawson, Luan; Starr, Stephanie R.; Gonzalo, Jed D. (2021-04-08). "Health systems science education: The new post-Flexner professionalism for the 21st century". Medical Teacher. 43 (sup2): S25–S31. doi:10.1080/0142159X.2021.1924366. hdl:10342/11559. ISSN 0142-159X. PMID 34291713.
  15. ^ Gonzalo, Jed (2019-02-01). "Building Systems Citizenship in Health Professions Education: The Continued Call for Health Systems Science Curricula". PSNet.
  16. ^ a b Gonzalo, Jed D.; Baxley, Elizabeth; Borkan, Jeffrey; Dekhtyar, Michael; Hawkins, Richard; Lawson, Luan; Starr, Stephanie R.; Skochelak, Susan (January 2017). "Priority Areas and Potential Solutions for Successful Integration and Sustainment of Health Systems Science in Undergraduate Medical Education". Academic Medicine. 92 (1): 63. doi:10.1097/ACM.0000000000001249. ISSN 1040-2446. PMID 27254015.
  17. ^ Gonzalo, Jed D.; Haidet, Paul; Blatt, Barbara; Wolpaw, Daniel R. (May 2016). "Exploring challenges in implementing a health systems science curriculum: a qualitative analysis of student perceptions". Medical Education. 50 (5): 523–531. doi:10.1111/medu.12957. ISSN 1365-2923. PMID 27072441.
  18. ^ Gonzalo, Jed D.; Caverzagie, Kelly J.; Hawkins, Richard E.; Lawson, Luan; Wolpaw, Daniel R.; Chang, Anna (June 2018). "Concerns and Responses for Integrating Health Systems Science Into Medical Education". Academic Medicine: Journal of the Association of American Medical Colleges. 93 (6): 843–849. doi:10.1097/ACM.0000000000001960. ISSN 1938-808X. PMID 29068816.
  19. ^ "Department of Health Systems Science | Kaiser Permanente Bernard J. Tyson School of Medicine". medschool.kp.org. Retrieved 2024-05-06.
  20. ^ Medicine, Alice L. Walton School of. "News | Alice L. Walton School of Medicine". alwmedschool.org. Retrieved 2024-05-06.
  21. ^ "Harvard Macy Institute - Blog - Health Systems Science: The future of medical education and the solution to improving health care". harvardmacy.org. Retrieved 2024-05-06.
  22. ^ Elsevier (2023-08-03). "Does everyone in health care need training in health systems science? — The answer: A resounding "Yes"". The Bookmark. Retrieved 2024-05-06.
  23. ^ National Academies (6 May 2024). "National Academies". www.nationalacademies.org. Retrieved 2024-05-06.
  24. ^ Will, Kristen K.; Mutyala, Jiya; Essary, Alison C. (2023-06-01). "Health systems science: A call to action". JAAPA: Official Journal of the American Academy of Physician Assistants. 36 (6): 45–46. doi:10.1097/01.JAA.0000931464.13332.f1. ISSN 1547-1896. PMID 37229585.
  25. ^ "Health Systems Sciences Interprofessional Scholars Program". Johns Hopkins School of Nursing. Retrieved 2024-05-06.
  26. ^ walworth (2021-12-16). "Former DFMCH Faculty Elected to the National Academy of Medicine - UW Family Medicine". UW Family Medicine & Community Health. Retrieved 2024-05-06.
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