What Is Health System Science?

00:01 Hello. Thank you for joining me today.

00:05 Today we will be introducing the concept of health system science and how it fits into medical education. We'll talk about the traditional two-pillar model of medical education and an emerging third pillar of health system science.

00:21 Traditionally, when we think about medicine, we think about the patient and the doctor sitting in a room together. And what is the care provided to an individual patient? What are the decisions being made in that room between the patient and the physician? What we recognize increasingly is that that model of just thinking about the patient and the doctor in a room together is not the whole picture, and that there is much more context to what is happening for the health of that patient.

00:52 And all of these things under the tip of this iceberg of the patient and the doctor are contributing to the health of the patient and the care that the doctor is able to provide.

01:04 And this is what health system science is.

01:07 It is thinking about the context.

01:09 The social determinants of health, the policies, the leadership decisions that have been made, the health systems, the population in play.

01:18 All of these things that contribute to what is happening in the room between the doctor and the patient, and the traditional model of medical education is evolving and it's changing. So they're they're traditionally been two pillars of medical education.

01:33 We think about basic sciences, the pathophysiology of disease, the organisms in play, the cellular biology of the person, and then the clinical science, how do we treat disease? What are the clinical manifestations of disease? What are the pharmacological options that we have? And the foundations of medical education were drawn from the Flexner Report to prepare students for practice over a century ago.

01:59 And these recommendations relied on a limited set of competencies and a relatively narrow view of the physician's role.

02:08 Now, medical education is evolving to meet the needs of the 21st century physician.

02:15 For the physician to be able to have an expanded view of their professional identity, one that situates the patient in the context of their community and the health system.

02:25 And that's where we see this third pillar emerge of health system science, which is everything else outside of the basic sciences and the clinical sciences that contribute to a patient's care.

02:38 What is health system science? Health system science is the study of how care is delivered, how healthcare professionals work together to deliver that care, and how the health system can improve patient care and health care delivery.

02:51 Our goals are to provide a view of the full complexity and the context of a patient's health, so that we can improve patient outcomes and increase satisfaction of medical professionals. Here's another way to think about health system science.

03:08 There are core functional and foundational domains of health system science, and at the center of this is the patient and their family and the community, as we might intuitively, um, think about when when we're looking at the patient and physician relationship.

03:27 And outside of that is all of these contributing contextual factors, the health care structures and process health systems improvement value in healthcare populations, public and social determinants of health, clinical informatics and health technology, and healthcare policy and economics.

03:45 We also have these linking ideas of leadership and teams, and ethics and change agency that will contribute to the health systems science model and overlying all of this is systems thinking.

04:01 How can we all be systems, citizens and thinkers in our society and contribute to the experience of our patients and their health? Let's talk about some examples of health systems science and the domains that are covered by this model.

04:19 When we think about population and public and social determinants of health, race as a social construct has emerged as a leading idea in medicine, reframing how we think about medicine and the inherent biases that have been built into our current models. We see this in the areas of chronic kidney disease and pulmonary function test assessments. When we recognize that these models have been differentially applied to patients solely on the basis of their race.

04:50 An example from clinical informatics and health technology is the inefficiencies and decreased satisfaction of both patients and providers due to electronic health records and the requirements that they've placed for documentation that really impact the physician patient relationship.

05:08 Another example from the social determinants of health domain is patients with congestive heart failure, for example, who might be advised to maintain a low sodium diet. But this patient lives in a food desert without easy access to low salt food.

05:22 We can see that that goes well beyond the physician and patient encounter in the clinic and is impacted by the larger community that the patient lives in.

05:33 In the domain of health policy and economics, the moral distress of physicians experiencing the increased corporatization of healthcare, who the payers are, and how money flows in healthcare is impacting the physician experience of healthcare.