VISTA: The Future of Health Care Is In Hospital Delivery Sciences

Eleven years ago, I remember being a junior faculty member attending the first “Quality Fair” at the University of Chicago, and presenting my work among roughly 20 posters on how to measure quality for hospitalized older patients. While I am proud to say this poster actually won an award, I am also embarrassed to say that I did not improve anything. That is perhaps where the state of the science was; we were still talking about how to measure quality and where the safety problems were as opposed to the science of actually improving it.

Fast forward, this past week, I attended the 11th annual University of Chicago Medicine’s Quality and Safety Symposium. Over 120 posters were presented on a wide range of innovations, including how to improve patient transport times, predict the next heart attack in the community, as well as proactively screen patients before they develop hospital-acquired infections. This explosion of interest in quality and safety is at the nexus of both hospital operations and innovation, as well as traditional research. Recognizing this fusion, and under our leadership of our Chief Quality Officer Dr. Michael Howell, University of Chicago Medicine has recently launched the Center for Healthcare Delivery Sciences and Innovation. In other words, and borrowing from our website, “Healthcare delivery science integrates research-quality methods into what we actually do in the real world.

“While we are not the first institution to launch a center like this, it seems like “healthcare delivery science” as a distinct science has arrived. Just as the launch of the Journal of Hospital Medicine was a major milestone in highlighting the arrival of hospital medicine as a distinct specialty, a new journal has now specifically focused on innovations in healthcare delivery, focusing on payment, IT, quality improvement, and education. And of all the areas in healthcare delivery sciences, it is education and training that is actually most fertile for innovation.

As physicians, we spend a lot of time learning about about how to treat disease, but less time learning about the science of healthcare delivery. A Dhruv Khullar, an internal medicine resident who had the time to pen a wonderful op-ed piece in the New York Times last week wrote, “We diagnose disease with textbook knowledge and prescribe medications because those are the hammers we have.” He goes on to lament about how his traditional training lacks the hammers to address social determinants of health and function in a changing healthcare delivery system.

A group of medical schools are taking bold steps to tackle this. With funding from the AMA, a consortium of 31 schools has been funded to accelerate change in medical education to meet the nation’s healthcare delivery needs. At University of Chicago, where I work, we received funding to introduce healthcare delivery sciences in the form of value, improvement, safety, team training and advocacy or “VISTA” as we have affectionately bundled it. One of the key things we are hoping to change is the deficit model of medical education, where students say, “I’m just a medical student.” Not only does that signal hierarchical power dynamic that prevents speaking up and is implicated in never events like wrong site surgery, it is allowing a member of our healthcare teams to be undervalued and underutilized. Part of our program will focus on empowering students to ensure safe transitions through discharge, identify value opportunities using existing frameworks, use checklists to ensure quality processes are adhered to, and promote identification of hospital hazards through greater situational awareness.

Perhaps no place is this training more salient than for future hospitalists. I remember when hospitalists were new – others used to say internal medicine residency is great training for being a hospitalist. And true, internal medicine residency is largely inpatient based and that experience with sick patients is key. However, hospital medicine is also more than just caring for the patient, it’s caring for the healthcare system. The field of hospital medicine has recognized this from the outset, and incorporated knowledge of the healthcare system into its core competencies to define what hospitalists needed to know. So, for early career hospitalists looking to enter into academic career, there is no time like the present to position yourself as an expert in the healthcare delivery system to medical educators in your institution looking to incorporate healthcare delivery sciences into their curriculum.

Merriam Webster defines “vista” as a large number of things that may be possible in the future. By arming our future physicians, including the future of hospital medicine, with the tools to not only study, but also improve healthcare delivery, I certainly think many things are possible that will improve the care of our patients and health system.

Vineet Arora MD, MPP is Director of GME Clinical Learning Environment and Assistant Dean for Scholarship and Discovery at the University of Chicago Pritzker School of Medicine. Dr. Arora’s scholarly work has focused on resident duty hours, patient handoffs, sleep, and quality and safety of hospital care. She is the recipient of the SHM Excellence in Hospital Medicine Research Award in 2007. Her work has appeared in numerous journals, including JAMA and the Annals of Internal Medicine, and has received coverage from the New York Times, CNN, and US News & World Report. She was selected as ACP Hospitalist Magazine’s Top Hospitalist in 2009 and by HealthLeaders Magazine as one of 20 who make healthcare better in 2011. She has testified to the Institute of Medicine on resident duty hours and to Congress about increasing medical student debt and the primary care crisis. As an academic hospitalist, she supervises medical residents and students caring for hospitalized patients.

Dr. Arora is an avid social media user, and serves as Deputy Social Media Editor to the Jounral of Hospital Medicine, helping to maintain its Twitter feed and Facebook presence. She blogs about her experiences at and actively tweets at @futuredocs.