The Science of Health Care Delivery brings together the ideas, methods and tools from multiple disciplines with the goal of improving people’s welfare through better health.
At Dartmouth, when we discuss Health Care Delivery Science, we emphasize science, in that we use theory and evidence to understand and to improve health care delivery. Throughout this course we will challenge you to examine and explore the rigor of evidence you see and hear. We emphasize integration across disciplines because improving health care delivery and health must involve principles from management as much as it involves medicine and clinical practice per se. We emphasize value as a means of encompassing outcomes along multiple dimensions, as well as cost. We also include an emphasis on population health, which means that our focus is on health and welfare, not just health care. And, most important, we believe that health care delivery must be based on the strongest possible ethical foundation.
The MHCDS program consists of 12 core courses plus the continuing Personal Leadership Plan and Action Learning Project courses. Students take one course at a time, working with their assigned study group to complete assignments and share perspectives. Each course begins during one of three residential periods on the Dartmouth College campus, and each has a significant distance-learning component designed to require an average of 15 hours of student work per week.
Explore the Core Curriculum
This course, taught primarily during the on-campus sessions at Dartmouth, builds the basic toolkit necessary for leadership in health care delivery, including ethics, teamwork, communications, negotiations, and a practical introduction to policymaking.
The goal of this course is to help people become more critical consumers of information; learn how to see through exaggerated, incomplete and misleading messages; and make better choices. Topics include: research basics, study design, risk communication, statistical uncertainty, special issues about observational studies and randomized trials, screening, and overdiagnosis.
Reforming health care systems to deliver greater value will require a substantive understanding of the fundamental economic forces driving system-wide incentives and competition. This is as true of reform at both the public policy level and at the level of organizational policy and strategy.
While the economics of the health care industry appear different from other industries, the behaviors and outcomes are to a great extent the result of incentives faced by individuals and organizations, in combination with some form of competition and, of course, a large degree of regulation. This course will equip participants with a knowledge of health economics that enables them to understand the current state of affairs; to foresee likely effects of policy changes; and to incorporate sound economic analysis in their role as managers. Likely topics to be covered include: costs and pricing; industry consolidation both vertical and horizontal; economics of risk pooling and insurance markets, especially adverse selection and moral hazard; and incentive effects of different payor and financing systems.
The health care sector generates an enormous amount of data at an ever-increasing pace. The ability to wisely use the associated analytic by-products is a rare and differentiating skill among health care leaders.
This course introduces quantitative reasoning toolkits reinforced with on-the-ground case studies. We will discuss the relative merits and limitations of common types of data sources in health care – such as electronic health records, claims databases, and surveys – and will introduce a framework through which managers can detect and diagnose data quality concerns. We will also explore descriptive, predictive, and evaluative statistical methods, demonstrating how each of these informs high-level strategic decisions. By the end of this course, students should be able to critique quantitative estimates supporting critical health care management decisions.
Faced with pressures on both the revenue and cost side, leaders in health care delivery are now required to do more with less. Managing the balance between clinical outcomes and financial soundness has become more demanding.
This course develops frameworks, tools, and models to enable participants to make value-enhancing financial decisions in the delivery of health care by developing the relevant ideas in two stages. The first stage (financial accounting) will build participants' skills in interpreting, analyzing, and forecasting financial statements (the income statement, the balance sheet, and the statement of cash flows). The second stage (corporate finance) will advance and synthesize the ideas from the first by building skills to make investment and financing decisions, as well as to value businesses.
Health care services are characterized by enormous variability and multiple objectives. Given these challenges, this course aims to provide you with the language, concepts, insights, and tools to evaluate, design, and operate health care processes in order to increase value for patients and reduce costs.
Two themes will run throughout this course: 1) aligning the design and management of processes with the goals of the health care system and 2) managing variability. In health care, the first theme is crucial but complex, for the system's goals may be multidimensional. The second theme is also particularly challenging, for health care systems are faced with variability generated by fluctuations in customer demands, treatment times, patient expectations and preferences, and patient willingness or ability to participate in treatment. Specific concepts and tools in the course include process flow analysis, the theory of constraints, queueing/congestion analysis, quality improvement, and capacity management.
Organizational outcomes depend on the alignment of people and teams, working together toward common goals.
In this course, we examine alignment through the lens of applied psychology, particularly theories of motivation. We explore how motivation theory and research inform important tools of alignment: compensation, job design, and decision-making. We discuss positive changes health care leaders can make to increase alignment and thereby increase the chances that health care delivery teams and organizations will have successful outcomes.
Managing modern health care organizations is a complex ordeal, more so in a time of health care reform. This course follows on the work done in previous courses and it anticipates what will come in the Management of Organization Change and the Strategy for Health Care Organizations courses.
Participants take the vantage point of a high-level manager in a health care system and understand how divisions, departments, and microsystems currently interact, and how they might. This course will explore all aspects of a health care organization that are necessary for success, from human resources to credentialing, from finance to supply management, and from union management to physician management in a voluntary staff model. In anticipation of health care reform, students will learn how team leadership, performance measurement, and incentive structures will have an impact on care delivery. The course draws heavily on the general management literature and uses cases to apply those ideas to health care organizations.
A unique contribution of this course is a discussion of public health systems and on social, behavioral, and environmental factors – factors outside of medical care – that influence health outcomes. Therefore, we will disproportionately focus on those two topics.
In this course, students will learn about the multiple determinants of health, how to measure health status, and how health disparities and socioeconomic status influence population health status. Students will come to understand the social mission of health care organizations and how they might work through social and behavioral determinants of health to improve overall health status, particularly as health care organizations adopt medical home models and begin to work with bundled and capitated payment systems.
This course will prepare the participant for the challenges in accomplishing significant change in health care organizations. Outside the world of health care, new patterns of competition, new technologies, and basic shifts in values have combined to require fundamental changes in the way that management is practiced.
Today, many organizations confront situations that require them to manage change on a continuous basis. This critical skill has become a core component of every manager's job and a substantial body of management knowledge has developed. In this course we will draw on the large body of relevant research and theory, and then complement and integrate this theory with experience from practice. We focus in particular on the process of change and on the sequencing of change activities. Recommended actions are matched with concrete, tested, and specific tools for their application. Proceeding from concepts to actions to tools provides a range and depth of practical understanding that is unusual in this important area of management activity. Our focus will be on the specifics of health care organizations, but much can be learned from studying other firms and industries that have seen substantial change.
This course will prepare participants to design and lead innovation initiatives in health care delivery.
There is no area in which innovation would positively impact society more than improvements in health care. However, the health sector is a complex, constrained, and difficult setting for new ideas and new practices. In this class we will examine the following themes:
1. What are the basic tenets of innovation, and how do they apply to the healthcare sector?
2. How can we use human centered design techniques to guide innovation?
3. What are ways to gather clear observational information on the needs of the customers, systems, and procedures.
4. Learn techniques to frame and reframe problems that lead to more successful innovations in the operational and clinical environments of healthcare.
Strategy for health care organizations is both a capstone course and one that is taught throughout the program in each of the residential periods as well as online. Participants will develop a framework for formulating and evaluating strategic decisions, tools for identifying opportunities and evaluating alternative paths, and methods for encouraging innovation.
This course focuses on the effective formulation of strategy for healthcare organizations. The course introduces key concepts and analytical methods for formulating strategies that add value for patients as well as for providers and other organizations that affect health care delivery. In addition to core concepts and methods, the course covers the strategic management of partnerships, innovation, strategy for organizations that offer services in multiple areas, health care systems, and strategic choice in uncertain situations. Through the application of course concepts to complex cases, the course develops skills in strategy formulation for senior leaders involved in health care delivery.
Transforming health care organizations presents special challenges and will require tremendous leadership by individuals within those organizations. This course provides participants with the knowledge to increase their personal leadership capability.
The focus of the course is concrete — building an understanding of one's strengths and opportunities for improvement as leaders, and using that knowledge to identify actions that advance leadership potential. The centerpiece of this course is a comprehensive, 360-degree assessment of each participant's leadership skills, based on confidential evaluations completed by bosses, co-workers, peers, and clients. During the course, participants will write their own Leadership Development Plan, a specific and measurable plan for strengthening their leadership skills.
As the culmination of their learning experience, students collaborate in teams on an Action-Learning Project. Applying classroom concepts to real organizational challenges provides an immediate return on the learning experience—and delivers a payoff to improve business and clinical performance for the client organization.
In this course, students work in teams to identify, define, plan and execute a strategic project that impact health and business outcomes. Projects have an external organizational client who provides motivation for the project and access to data and people in the client organization. Each team will work with a faculty advisor who approves the project and coaches the team on its planning and execution. Teams are also encouraged to consult with other Dartmouth faculty members in their respective areas of expertise. Teams formally present their findings and results to faculty, peers, and executives from sponsoring institutions.