Center for Health Systems Innovation research may have profound impacts on health care systems

Monday, November 13, 2023

Media Contact: Jeff Hopper | Communications Coordinator | 405-744-1050 | jeff.hopper@okstate.edu

The Spears School of Business and the Oklahoma State University Center for Health Sciences are researching ways to impact health care education and your health care experience using groundbreaking curriculum shifts and experiential learning.

Researchers from CHSI, a collaboration between Spears Business and CHS, are using the methods and ideologies of lean health care and systems-based practices to equip medical students with the tools to observe, develop and implement impactful changes to the health care system.

“Lean health care and systems-based practices are not new concepts,” said Dr. Marjorie Erdmann, CHSI director. “However, in most cases those concepts are not introduced to students until their residency. We thought there might be a different way of introducing these subjects earlier in an already jam-packed curriculum.”

In 2019, a summer internship program was created to do exactly that. The first cohort of students were between their first and second years and spent a month learning and developing the concepts and tools of lean health care and systems-based practices. However, the students didn’t spend a month in a classroom, instead the OSU Medical Center opened its doors and challenged the students to solve a real-world problem that would allow them to sharpen their new skillset, while directly impacting health care system processes.

The students honed their observational, analytical and practical skills and then began researching, mapping and innovating a system process within the hospital to identify areas where the process could be reimagined or refined — in an effort to use hospital resources more efficiently and effectively.

“We found that the students left the month-long program with a much better understanding of how a hospital truly works,” said Ipe Paramel, project manager for CHSI and lean health care specialist. “Not only did they better grasp the processes that must occur for the health care system to run effectively, but they developed a better understanding of how they, as physicians, play an important role in those processes and how they can be better system citizens throughout their careers.”

The program stresses how interconnected hospital processes are and the importance of learning that a process may seem straightforward, however the actual implementation of a process can involve numerous other steps and subprocesses and have profound effects on the manner in which other system citizens perform their assigned tasks.

For example, past students of the internship program have worked to alleviate emergency department overcrowding, a crisis affecting hospitals across the nation. They targeted improving the flow of admitted patients to a standard room. Oftentimes, hospitals try to improve this on a department-by-department basis, however the students at CHS were challenged to look at the problem from a system-wide, multi-departmental perspective. Using lean tools, the students gained understanding of how changes in one department impacted other departments, thus allowing them to design solutions that increased efficiency and effectiveness across multiple departments. 

“The program not only provides students with the skills to identify root causes of problems and the associated safety and quality issues but to also design effective solutions,”[IP1]  Erdmann said. “As they develop solutions, we encourage them to investigate how those potential solutions could affect other citizens within the hospital system and to make sure the solution doesn’t just push a problem from one department to another, a situation that commonly occurs.

“Before the program, the students’ knee-jerk reaction to solve a problem is usually to do one of three things: hire more people, discipline the people you have or purchase more technology for people. However, by teaching them to observe and map processes and not people, they discover how things happen and realize that the possible solutions are, oftentimes, much simpler, cheaper and easier to implement. Almost always, it is a process problem, not a people problem.”

The program finished with its third cohort of students this past summer and has seen a marked increase in interest from students wanting to be involved.

“Students are eager to learn these skills because they have experienced health care inefficiencies themselves as many of us have,” Erdmann said. “They understand as physicians they will be expected to lead improvements to U.S. health care, which unfortunately right now frequently ranks last in outcomes and first in costs.”

Paramel said when students initially sign up for the internship, they don't understand what they are getting into.

“Now, the students have become ambassadors for the program and strongly encourage their peers to get involved. I have people contacting me before I have a chance to market upcoming opportunities,” Paramel said.

The success of the program has garnered attention from the administration at CHS, so much so that the CHSI staff has been invited to give an interactive lecture and lab during the upcoming spring semester to broaden early access to systems-based practice competencies. The students will engage in a total of four hours of instruction and lab training as a small introduction to the program being developed by CHSI.

The team also had a paper published in Academic Medicine, the Journal of the Association of American Medical Colleges covering their innovative, effective approach to teaching medical students systems thinking and solution design because The Accreditation Council for Graduate Medical Education recognizes the need for physicians to not only work effectively in health systems, but to also create and implement solutions.

“The U.S. health system has put a lot of emphasis on physicians innovating health care,” Erdmann said. “We need to create high quality, skilled innovators. We believe our system will help inform and develop those innovators, it’s at the heart of our mission. It’s rare for business schools to be teaching medical students. We are proud of Spears School of Business’ contribution to developing our future physicians.”