How Leading Health Centers Can Serve Us Better

The U.S. health care system requires dramatic changes to better serve our population. This is a time for major stakeholders in the system to fundamentally re-evaluate their strategy to positively contribute to this change. Our academic institutions, and the health systems affiliated with them (collectively called Academic Health Centers or AHCs), with heavy federal subsidies, have traditionally been on the global vanguard, contributing to the invention of groundbreaking new medicines, procedures and medical devices. They have been less effective, however, at changing the health care system to achieve better health at a sustainable cost.

In a perspective piece recently published in Academic Medicine, my coauthors and I argue that our nation's leading AHCs, and the federal programs that support them, must make fundamental changes -- both in how they provide care and how they train the next generation of health care professionals -- to provide the kind of leadership our health care system needs now.

First, AHCs and federal programs need to create career development opportunities for talented faculty who want to fix our systems of care. For example, an innovator trying to train community health workers to help underserved patients engage in healthier behaviors and navigate our complex health care system -- an innovation that might dramatically improve care and reduce costs in unnecessary emergency room visits, hospitalizations and testing -- has little-to-no opportunity or incentive to do this type of work in today's AHCs. AHCs offer fellowships and funding to conduct lab experiments, but no equivalent opportunities exist for systems innovators.

Second, AHCs are responsible for developing our next generation of healthcare workers and leaders. Traditionally, medical schools and residency programs train future physicians in basic science and the skills required to diagnose and manage illness, but spend little time teaching how complex health systems work and how to improve those systems. If these programs fail to adapt their curricula and to expose trainees to high-functioning, innovative systems of care, we will never have a health workforce capable of getting our system back on track.

In my own clinic, which is part of one of Boston's largest AHCs, I have seen how changes in the function of a primary care team improves staff and patient satisfaction, and how systems changes can lead to considerable improvements in, for example, cancer screening. But I also know that we could do a better job of managing, say, hypertension if we implemented approaches that have been shown to be effective at less prestigious hospitals and practices -- if only there were more incentive and support for doing so.

The state of the U.S. health care system is an ongoing crisis, but times of crisis create opportunities. AHCs and federal policies that promote systems innovation will help lead our health care system into the 21st century. Failing to do so will compromise the competitive advantage of individual centers and the nation itself.