This is what change looks like!
Our founding class of online Master of Public Health students just arrived in Hanover for the first of six week-long residential periods required in the two-year-long program. This group of accomplished working professionals has come here from almost every region in the country because they want to be part of The Dartmouth Institute’s tight-knit community of health care ‘rebels.’
They understand that right now health care isn’t working for far too many of us, and that we could do much better — for ourselves and our loved ones, for our communities, and for our population as a whole. We’re excited to welcome this group of highly intelligent, driven and impassioned individuals to The Dartmouth Institute. This is what health care change looks like!
Janelle Robinson (Philadelphia, PA) is a research associate at the American College of Radiology where she manages Head and Neck Cancer radiology clinical trials. She wants to effect change in health policy working in the government sector.
On Day 1 Janelle heard from Dartmouth Institute Director Elliott Fisher on why health care needs a revolution. Setting the stage for the week's discussions and the students' online MPH journey to learn how to come up with better solutions, Elliott led a group session on discussing the symptoms of a dysfunctional health care system.
"The biggest takeaway today was for all of us to 'rethink' health and health care, and to take a step back and see where we, in our professional roles, can make changes," Janelle said afterward. "Through a lot of group work we started talking through what that means, and acknowledging that there isn't 'just one right answer.'"
As a health care leader, Elliott is also a health care ‘rebel’ who has dedicated his career to developing innovative new models of healthcare delivery and payment that improve quality while cutting costs! Learn more: https://www.youtube.com/watch?v=PizGtylrGkQ
Students built foundational knowledge of population health and public health. Dartmouth Institute faculty Paul Gardent and Carolyn Murray talked about:
- Defining the population – who are you talking about?
- Determining where focus needs to be placed.
- Thinking about which metrics need to be used to determine whether we are improving population health.
For Jonathan Smith, a quality improvement advisor at Kansas Healthcare Collaborative,the topic hit close home: “Growing up in the metro Detroit area where there’s a liquor store or smoke shop on every corner, there’s a great need to improve population health. Today, I really enjoyed being in a room with like-minded people in wanting to do something about that. It’s almost like Dartmouth is equipping us as soldiers to all go out and combat inequalities and health care disparities throughout the entire world.”
Day 3 started off with Drs. Lisa Schwartz and Steven Woloshin talking about the misconceptions surrounding prescription drugs and the FDA approval process:
- According to a national survey of U.S. adults, many (~ 40%) mistakenly believe FDA only approves—and only permits advertising of—extremely effective drugs or drugs without serious side effects.
- In a national survey of U.S. physicians, many (73%) mistakenly believe that approval means that the new drug is as effective as other drugs for that condition.
Inspired by a box of Cocoa Krispies (literally), Schwartz and Woloshin created the DrugFactsBox™ in order to more accurately convey information about the potential benefits and harms of prescription drugs. They also described how their efforts to get the FDA to adopt drug facts boxes eventually led them to form their own company called Informulary, with the Consumer Reports as their first client.
As a senior project and regional operations manager at the Institute for Healthcare improvement (IHI), Lauren Magoun helps to keep the organization’s many healthcare improvement projects on time and on budget.
“Here, at The Dartmouth Institute, there is a determination to continue challenging assumptions, one that I’ve never before seen among such a large group of people. Listening to Lisa Schwartz and Steve Woloshin describe their work in health care communication and in creating Informulary and the DrugFactsBox™ reinforces my passion for pushing for health care improvement from a variety of angles.”
In a session on Leading Change from the Front Line, Chris Trimble encouraged students to think about implementing innovation in health care delivery with the aim of reaching better outcomes and lower costs, what he terms “double wins.” However, innovation is a two-part challenge between generating ideas and executing on them. “The big idea is only the beginning; then the journey begins from breakthrough idea to breakthrough impact,” he said. When describing the “physics of innovation,” he talked about ways to mobilize, motivate and organize small teams to implement innovation projects.
Chris' approach resonated with Chelsea Strandberg, who manages business development at the Public Health Institute in Oakland, CA. “I think too often we get hung up on looking for the bright shiny new innovative idea, but what it takes to actually implement it is often very complicated. I really liked today’s discussion about how to drive innovation forward.”
Today Glyn Elwyn, Dartmouth Institute professor and leading expert on shared decision making, talked to students about what it means to help people make health care decisions that align with their needs, values and priorities, in, effect, to develop an informed preference. And, he did it while referencing René Descartes, Martin Luther, Jimmy Carter and Seinfeld!
"Patients hate to feel abandoned when making tough decisions," he said. The last thing they want to hear is ‘here are your choices, now go make decision.’ They want to feel supported and part of a team that includes their physician/s, family members, nurses and others."
As an emergency medicine physician in southwest Texas, Matthew Harrison says he has been practicing shared decision making for the past several years, and while it may take a little extra time, he says it can also help a patient to avoid an unnecessary CT scan or an additional charge on their bill.
"It was very helpful to hear Dr. Elwyn put into context what I’ve been trying to do in my own practice," Matthew said. "It’s not always easy to implement but fully listening to what the patient has to say, establishing a dialogue, and making sure they completely understand the options makes what is usually a very traumatic experience be as positive as it can be."
If you want to learn more about shared decision making, look for the third edition of “Shared Decision Making in Health Care” edited by Glyn Elwyn, Adrian Edwards and Rachel Thompson to be published by Oxford University Press this fall.
To end the week, students were asked to take a personal stand and share why and how they want to make a difference in health care. Director of Education Tim Lahey said their vision would continue to evolve during the program as they learn more about what it takes to lead and effect change.
For Sarah Kinsler, her vision is that we, as a society, “provide a ‘social safety net’ and deliver key health services to everyone, regardless of income, age, race or educational background.” A senior health policy analyst at the Department of Vermont Health Access whose background is in working on Medicaid payment and delivery system reforms, Sarah is passionate about Medicaid’s mission.
“In the work I do, I want to help create a new system to better serve some of our most vulnerable,” she says. “That includes thinking about how we can better support patients getting the right care at the right time and in the right setting, in a way that is equitable, high quality, and reflects patient choice.”