By Chris Moriates, MD
I have a made-up administrative title. I know this because, in 2016, we made it up. When you make up a title, you get to be the first “assistant dean for healthcare value”… but I do not want to be the only one. So, what does an “assistant dean for healthcare value” do?
In this month’s Academic Medicine, Dr. Pam Johnson and colleagues from Johns Hopkins describe <LINK> the critical role academic institutions must play in advancing high-value care. They “charge academic institutions to go beyond dissemination of best practice guidelines and demonstrate accountability for high value quality improvement implementation.” At Dell Medical School at The University of Texas in Austin, my position represents some of that accountability. It demonstrates the commitment of the institution to elevate the work of high-value care education and implementation to the dean’s office. In my assistant dean role, I strive to be a “bridging leader” to “merge the health system and education silos,” as described by Drs. Reshma Gupta and Vinny Arora in a 2015 JAMA article.
At Dell Med, I am far from alone in this role. I work with and learn from international leaders in value-based health care, such as Kevin Bozic and Elizabeth Teisberg. However, in other training programs across the US, lack of local faculty trained to teach value-based health care is a major barrier to integrating value into curricula. Thus, through a generous grant from the Episcopal Health Foundation, we developed free, interactive, online learning modules that teach the foundations of value-based health care and can be used by students, residents and clinicians anywhere in the US. The first three modules, bundled as “Introduction to Value-Based Health Care,” had more than 1,500 users and 11,000 pageviews in the first three months of release.
To move even further “upstream,” we are launching Choosing Wisely STARS to empower first-year medical students to lead. Mirroring the successful STARS program started in 2015 by Choosing Wisely Canada, we invited two students from each of 25 medical schools to participate in a summit, where they will learn about fundamentals of Choosing Wisely, health care value, leadership, and advocacy. Following the summit, these students will work with local faculty to lead campaigns and initiatives. They will be part of a national learning network to share successes and barriers. Students and schools who are not part of this first year’s program can still join our learning network to share tools and resources.
Yet, all the teaching in the world can be undone within a few hours of a student hanging out on the wards with a senior resident who does not embrace the same principles. In their article, Dr. Johnson and colleagues provide an “implementation blueprint,” <LINK> with a number of pragmatic steps and examples of how academic medical centers can advance high-value practice. They have organized an impressive group of more than 80 academic medical institutions across the US and Canada, forming the High Value Practice Academic Alliance (HVPAA). At a recent HVPAA summit, there were more than 100 abstracts, largely authored by trainees, illustrating widespread efforts to integrate the concepts of value into health care delivery. In my role, I support our trainees and faculty to pursue these types of value improvement projects. In addition, a number of academic medical centers have created larger programs to provide centralized support to assist with implementation. I directed one such crowdsourcing program at UCSF, and we are planning to implement a similar model here at Dell Med, called “Bridges to Better Care.” These programs amplify trainee’s voices by giving them a forum that is hardwired to medical center leadership.
Developing a leadership role for creating programs that integrate value education and implementation is an emerging imperative for academic institutions. It doesn’t matter what you call it – feel free to make up your own title.
Christopher Moriates MD is Assistant Dean for Healthcare Value, and Associate Professor of Internal Medicine at Dell Medical School at The University of Texas, Austin. He is also Director of Implementation at Costs Of Care.