Health Systems Science

Book Title: Health Systems Science

Book Authors: Susan E. Skochelak and Richard E. Hawkins, eds

Publication Information: Philadelphia, Elsevier, 2017, 228 pp., $59.99, softcover

Since Abraham Flexner published his report on the state of American and Canadian medical education in 1910,1 the pillars of medical education have been the basic and clinical sciences. Although in the past century both pillars have experienced dramatic changes, this educational structure has remained the same. Increasingly, however, medical educators have recognized that mastery of the basic and clinical sciences alone is insufficient preparation for clinical practice. In the early 20th century, there were no health maintenance organizations, continuous quality improvement processes, clinical informatics, or population health management—all concepts that are essential for today’s physicians to know.

In 2013, the American Medical Association formed the Accelerating Change in Medical Education Consortium, a group of 11 medical schools tasked with developing innovative curricula to encompass the additional knowledge, attitudes, and skills necessary to prepare students and residents for 21st-century practice. Although my home institution was not part of the consortium, as director of a required first-year course in health disparities and health policy, and as advisor for our population health scholarly track, I have followed its work with great interest. In a series of papers in Academic Medicine, consortium leaders proposed adding a third pillar of medical education called “health systems science.”2-4 Health Systems Science, an introductory textbook edited by Drs Susan Skochelak and Richard Hawkins and authored by 36 consortium participants (mostly medical doctors), describes the content and framework of this new field. Helpful features in each chapter include well-developed learning objectives, visually compelling graphics, illustrative case studies, questions for further thought, and an annotated bibliography.

The book’s first two chapters introduce health systems science and explain why it should be taught alongside the basic and clinical sciences. Defined as “the principles, methods, and practice of improving quality, outcomes, and costs of health care delivery for patients and populations within systems of medical care” (p. 11), its core curricular domains include health care structures and processes; health care policy, economics, and management; clinical informatics; population health; value-based care; and health system improvement. According to the authors, health systems science requires that a new generation of physicians “view themselves as part of an interprofessional care team, rather than as an independent autonomous provider,” and move away from the physician-centric role identity of the past toward a patient-centered, systems role identity (p. 6).

The remaining 13 chapters review each of the core curricular domains and their interactions with related topics such as leadership, teamwork, evidence-based practice, professionalism, scholarship, and systems thinking. Several topics (the health care delivery system, policy and economics, socioecologic determinants of health, and population health) receive relatively superficial coverage, while others (value, patient safety, and quality improvement) are discussed in greater depth. The chapters on team science and leadership in health care are well-focused, but the Application of Foundational Skills chapter is a grab bag of topics that didn’t fit into other chapters: clinical practice guidelines, formularies, patient portals, and organizational culture. The Assessment chapter provides helpful tips for medical educators on measuring the health systems science performance of learners at different levels. Finally, a concluding chapter suggests structural reforms to make it easier to integrate this content into medical education, such as preferentially admitting students with well-developed teamwork skills, teaching with simulation and in community-based settings, and involving students in real-life practice improvement and health care delivery transformation.

Whether or not this collection of topics truly constitutes a new “science” rather than a blending of existing fields is debatable, but it is certain that in the future, more physicians will be caring for populations within health systems rather than individual patients one at a time. I decided not to adopt Health Systems Science as a required text for my first-year students due to its too-broad scope and somewhat uneven quality. Those shortcomings aside, this book can still serve as an excellent starting point for medical school or residency educators who are planning courses or electives that overlap with one or more of the content domains.