A growing share of medical schools are embracing the inclusion of health systems science (HSS) in their curricula because of its ability to catalyze medical education to assimilate upstream topics and better address root causes of health inequities.
But implementing a new curriculum can be fraught with pitfalls. It requires change management and a concerted effort at integrating organizational assets with stakeholder engagement. In other words, successful implementation relies tremendously on adequate pre-implementation.
A first-of-its-kind, instructor-focused field book, Health Systems Science Implementation: Development and Implementation, equips educators not just to teach HSS but also to know how to integrate and implement it comprehensively and effectively across the curriculum.
Chapter 1, “Getting Started: General Considerations for Health Systems Science Implementation,” looks at where to begin in implementing an HSS curriculum, including how to analyze stakeholder readiness and deploy an effective team.
“Pre-implementation is a vital stage that antecedes the implementation process to promote successful outcomes,” wrote the chapter’s authors, noting that pre-implementation planning greatly increases the odds of success. “In organizations where process and information flows have been critically observed, nearly 70% of projects fail during implementation when a rigorous pre-implementation stage is bypassed.”
The chapter’s authors are:
- Nana E. Coleman, MD, system senior vice president for academic and faculty affairs at CommonSpirit Health and associate professor of pediatrics at Baylor College of Medicine.
- Mitchell J. Gitkind, MD, professor of medicine at University of Massachusetts Chan Medical School.
- Jung G. Kim, PhD, MPH, director of research and scholarship, New York University Grossman School of Medicine.
- Paul F. Weber, MD, RPh, associate dean of continuing medical education at Rutgers University Robert Wood Johnson Medical School.
Drawing on the Kotter change-management process and the Kern curriculum-development model, the authors outlined the three steps of the pre-implementation phase.
“Illuminating and incorporating specific drivers and values to align curriculum with the health care delivery system is key” to catalyzing the curriculum change process, the authors wrote.
To name just a couple of examples, the U.S. has the highest infant mortality and obesity rates among high-income countries and about 28 million Americans are uninsured.
“These systems-related drivers inform national health reform efforts that demand a physician workforce that can demonstrate the necessary readiness and resiliently respond to these complex challenges accordingly,” they wrote.
Stakeholders in a curriculum transformation may include people from across the medical education continuum, ranging from internal and external leadership to front-line workers. The chapter includes templates for identifying, analyzing and engaging stakeholders, not all of whom may be obvious.
“Unveiling stakeholders who may be ‘hidden’ or distal to everyday curriculum operations will provide a clearer understanding of the impact of curricular transformation and maintain the inertia of change management,” the authors wrote.
In addition, stakeholders who challenge the implementation process can help provide a balanced perspective on the present viability of a curriculum transformation.
“Proceeding without recognizing their institution’s key stakeholders and incorporating these stakeholders’ respective readiness for change opens the door for implementation challenges, obstacles and failure,” they wrote.
One way to do this is through co-production, which can promote alignment of outcomes and dismantle silos. One example could be pairing an HSS curriculum centered on patient safety with an existing quality improvement project.
“Additionally, it incorporates the systemness, aligning the health care delivery systems with health professionals training to foster the vision of a ‘learning health system’ across competing goals within academic health centers,” the authors wrote.
The textbook is the fourth volume in an AMA series providing practical guidance for local implementation of the education innovations tested and refined by the AMA ChangedMedEd Initiative.