Health systems science

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.{{Cite journal |last1=Gonzalo |first1=Jed D. |last2=Dekhtyar |first2=Michael |last3=Starr |first3=Stephanie R. |last4=Borkan |first4=Jeffrey |last5=Brunett |first5=Patrick |last6=Fancher |first6=Tonya |last7=Green |first7=Jennifer |last8=Grethlein |first8=Sara Jo |last9=Lai |first9=Cindy |last10=Lawson |first10=Luan |last11=Monrad |first11=Seetha |last12=O'Sullivan |first12=Patricia |last13=Schwartz |first13=Mark D. |last14=Skochelak |first14=Susan |date=January 2017 |title=Health Systems Science Curricula in Undergraduate Medical Education: Identifying and Defining a Potential Curricular Framework |url=https://journals.lww.com/academicmedicine/fulltext/2017/01000/health_systems_science_curricula_in_undergraduate.34.aspx |journal=Academic Medicine |language=en-US |volume=92 |issue=1 |pages=123–131 |doi=10.1097/ACM.0000000000001177 |pmid=27049541 |issn=1040-2446}}

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.{{Cite web |last=McGagghie |first=William |date=1978 |title=Competency-based Curriculum Development in Medical Education |url=https://apps.who.int/iris/bitstream/handle/10665/39703/WHO_PHP_68.pdf |access-date=6 May 2024 |website=World Health Organization}} The quality and patient safety movement of the 1980s and 1990s further reinforced the need for physicians to understand systems thinking.{{Cite web |last=Godfrey |first=Blanton |date=6 May 2024 |title=Quality Digest |url=https://www.qualitydigest.com/static/magazine/sep96/health.html |access-date=2024-05-06 |website=www.qualitydigest.com}}{{Cite web |title=About NCQA |url=https://www.ncqa.org/about-ncqa/ |access-date=2024-05-06 |website=NCQA |language=en-US}}{{Cite web |title=History {{!}} Institute for Healthcare Improvement |url=https://www.ihi.org/about/history |access-date=2024-05-06 |website=www.ihi.org |language=en}}{{Cite book |last=Institute of Medicine (US) Committee on Quality of Health Care in America |url=http://www.ncbi.nlm.nih.gov/books/NBK222274/ |title=Crossing the Quality Chasm: A New Health System for the 21st Century |date=2001 |publisher=National Academies Press (US) |isbn=978-0-309-07280-9 |location=Washington (DC) |pmid=25057539}} 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.{{Cite web |last=Association of American Medical Colleges |date=2014 |title=Core Entrustable Professional Activities for Entering Residency |url=https://store.aamc.org/downloadable/download/sample/sample_id/63/ |access-date=6 May 2024 |website=Association of American Medical Colleges}} That year, the Accreditation Council for Graduate Medical Education also included systems-based practice as one of its six core competency domains.{{Cite web |last=Eno |first=Celeste |date=2020 |title=Milestones Guidebook for Residents and Fellows |url=https://www.acgme.org/globalassets/pdfs/milestones/milestonesguidebookforresidentsfellows.pdf |access-date=6 May 2024 |website=Accreditation Council for Graduate Medical Education}} In 2001, the Health Resources and Services Administration funded an 18-medical-school consortium to launch several pilots related to systems-based education.{{Cite journal |last1=Wood |first1=Douglas L. |last2=Babbott |first2=David |last3=Pascoe |first3=John M. |last4=Pye |first4=Karen L. |last5=Rabinowitz |first5=Howard K. |last6=Veit |first6=Kenneth J. |date=January 2004 |title=Lessons learned-UME-21 project |url=https://pubmed.ncbi.nlm.nih.gov/14961419/ |journal=Family Medicine |volume=36 Suppl |pages=S146–150 |issn=0742-3225 |pmid=14961419}} In 2005, the book, Professionalism in Tomorrow's Healthcare System, outlined several aspects of the systems-based practice competency.{{Cite book |last=Mills |first=Ann E. |url=https://books.google.com/books?id=K6MTAQAAMAAJ |title=Professionalism in Tomorrow's Healthcare System: Towards Fulfilling the ACGME Requirements for System-based Practice and Professionalism |date=2005 |publisher=University Publishing Group |isbn=978-1-55572-037-7 |language=en}}

Medical schools and residency and fellowship programs, however, struggled to teach these competencies.{{Cite journal |last1=Borkan |first1=Jeffrey M. |last2=Hammoud |first2=Maya M. |last3=Nelson |first3=Elizabeth |last4=Oyler |first4=Julie |last5=Lawson |first5=Luan |last6=Starr |first6=Stephanie R. |last7=Gonzalo |first7=Jed D. |date=2021-04-08 |title=Health systems science education: The new post-Flexner professionalism for the 21st century |url=https://www.tandfonline.com/doi/full/10.1080/0142159X.2021.1924366 |journal=Medical Teacher |language=en |volume=43 |issue=sup2 |pages=S25–S31 |doi=10.1080/0142159X.2021.1924366 |pmid=34291713 |issn=0142-159X|hdl=10342/11559 |hdl-access=free }} 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. It aims to educate physicians to become systems citizens.{{Cite journal |last=Gonzalo |first=Jed |date=2019-02-01 |title=Building Systems Citizenship in Health Professions Education: The Continued Call for Health Systems Science Curricula |url=https://psnet.ahrq.gov/perspective/building-systems-citizenship-health-professions-education-continued-call-health-systems |journal=PSNet |language=en}}

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.{{Cite journal |last1=Gonzalo |first1=Jed D. |last2=Baxley |first2=Elizabeth |last3=Borkan |first3=Jeffrey |last4=Dekhtyar |first4=Michael |last5=Hawkins |first5=Richard |last6=Lawson |first6=Luan |last7=Starr |first7=Stephanie R. |last8=Skochelak |first8=Susan |date=January 2017 |title=Priority Areas and Potential Solutions for Successful Integration and Sustainment of Health Systems Science in Undergraduate Medical Education |url=https://journals.lww.com/academicmedicine/fulltext/2017/01000/priority_areas_and_potential_solutions_for.23.aspx |journal=Academic Medicine |language=en-US |volume=92 |issue=1 |pages=63–69 |doi=10.1097/ACM.0000000000001249 |pmid=27254015 |issn=1040-2446}} 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.

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{{Cite journal |last1=Gonzalo |first1=Jed D. |last2=Haidet |first2=Paul |last3=Blatt |first3=Barbara |last4=Wolpaw |first4=Daniel R. |date=May 2016 |title=Exploring challenges in implementing a health systems science curriculum: a qualitative analysis of student perceptions |url=https://pubmed.ncbi.nlm.nih.gov/27072441/ |journal=Medical Education |volume=50 |issue=5 |pages=523–531 |doi=10.1111/medu.12957 |issn=1365-2923 |pmid=27072441}} and limitations in the number of medical school faculty with expertise to teach HSS domains.{{Cite journal |last1=Gonzalo |first1=Jed D. |last2=Caverzagie |first2=Kelly J. |last3=Hawkins |first3=Richard E. |last4=Lawson |first4=Luan |last5=Wolpaw |first5=Daniel R. |last6=Chang |first6=Anna |date=June 2018 |title=Concerns and Responses for Integrating Health Systems Science Into Medical Education |url=https://pubmed.ncbi.nlm.nih.gov/29068816/ |journal=Academic Medicine: Journal of the Association of American Medical Colleges |volume=93 |issue=6 |pages=843–849 |doi=10.1097/ACM.0000000000001960 |issn=1938-808X |pmid=29068816}}

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,{{Cite web |title=Department of Health Systems Science {{!}} Kaiser Permanente Bernard J. Tyson School of Medicine |url=https://medschool.kp.org/about/offices-and-departments/department-of-health-systems-science |access-date=2024-05-06 |website=medschool.kp.org |language=en}} 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.{{Cite web |last=Medicine |first=Alice L. Walton School of |title=News {{!}} Alice L. Walton School of Medicine |url=https://alwmedschool.org/news/alice-l-walton-school-of-medicine-announces-leadership-hires.html |access-date=2024-05-06 |website=alwmedschool.org |language=en}}

As health care continues to evolve, the importance of HSS is expected to grow.{{Cite web |title=Harvard Macy Institute - Blog - Health Systems Science: The future of medical education and the solution to improving health care |url=https://harvardmacy.org/blog/health-systems-science |access-date=2024-05-06 |website=harvardmacy.org |language=en}} 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.{{Cite web |last=Elsevier |date=2023-08-03 |title=Does everyone in health care need training in health systems science? — The answer: A resounding "Yes" |url=https://bookmark.elsevierhealth.com/does-everyone-in-health-care-need-training-in-health-systems-science-the-answer-a-resounding-yes/ |access-date=2024-05-06 |website=The Bookmark |language=en-US}}

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.{{Cite web |last=National Academies |date=6 May 2024 |title=National Academies |url=https://www.nationalacademies.org/our-work/health-systems-science-education-a-workshop |access-date=2024-05-06 |website=www.nationalacademies.org}} HSS has been expanding to physician assistants,{{Cite journal |last1=Will |first1=Kristen K. |last2=Mutyala |first2=Jiya |last3=Essary |first3=Alison C. |date=2023-06-01 |title=Health systems science: A call to action |url=https://pubmed.ncbi.nlm.nih.gov/37229585/ |journal=JAAPA|volume=36 |issue=6 |pages=45–46 |doi=10.1097/01.JAA.0000931464.13332.f1 |issn=1547-1896 |pmid=37229585}} nurses, and other health care professionals.{{Cite web |title=Health Systems Sciences Interprofessional Scholars Program |url=https://nursing.jhu.edu/faculty-research/research/areas-of-expertise/interprofessional/initiative/ |access-date=2024-05-06 |website=Johns Hopkins School of Nursing |language=en-US}}

The Korean Association of Medical Colleges has proposed replacing medical humanities with health systems science in that country's medical education system, although critics say that it needs adaptation to the Korean health system.{{Cite journal |last=Kim |first=Taekjoong |date=2022-12-31 |title=Introduction of America's Health Systems Science Education and Its Criticism |journal=Korean Journal of Medical History |language=en |volume=31 |issue=3 |pages=519–546 |doi=10.13081/kjmh.2022.31.519 |issn=1225-505X |pmc=10556357 |pmid=36746403}}

The American Medical Association collaborated with the University of Witwatersrand to customize health systems science for the South African health system.{{Cite web |date=2018-07-10 |title=South Africa program takes health systems science international |url=https://www.ama-assn.org/education/accelerating-change-medical-education/south-africa-program-takes-health-systems-science |access-date=2024-05-23 |website=American Medical Association |language=en}}

Health systems science is also referred to as clinical governance in the United Kingdom, although this does not include all the domains included in the American HSS framework.{{Cite web |date=2018-05-22 |title=Health System Sciences {{!}} ProfMoosa |url=https://profmoosa.com/health-system-sciences/ |access-date=2024-05-23 |website=profmoosa.com |language=en-US}}

Susan Skochelak, MD, MPH, creator of the Accelerating Change in Medical Education initiative{{Cite web |last=walworth |date=2021-12-16 |title=Former DFMCH Faculty Elected to the National Academy of Medicine - UW Family Medicine |url=https://www.fammed.wisc.edu/former-dfmch-faculty-elected-to-the-national-academy-of-medicine/ |access-date=2024-05-06 |website=UW Family Medicine & Community Health |language=en-US}} 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 that helped create the HSS framework:

• Warren Alpert Medical School of Brown University
• Brody School of Medicine at East Carolina University
• University of California, San Francisco, School of Medicine
• University of California, Davis, School of Medicine
• Indiana University School of Medicine
• Mayo Clinic Alix School of Medicine
• University of Michigan Medical School
• New York University Grossman School of Medicine
• Oregon Health & Science University School of Medicine
• Penn State University College of Medicine
• Vanderbilt University School of Medicine

• Health systems engineering
• Medical humanities

Category:Medical education