By now you must be all too familiar with the challenges facing our health system. And by now you’ve probably also heard that innovation and quality improvement is the way forward for health system transformation. The question is, how do we approach this in practice? Where do we start? For me the answer is simple: people. For innovation to be adopted within health systems on the scale that is needed, it will take a “leadership army” of individuals with an unique combination of skills, and education with a broad range of perspectives, who work collaboratively within inter-professional teams to lead innovation. There is growing evidence to support the value of this team-based approach, which begs the question, why aren’t we training and educating future leaders within team environments so that when they enter the workforce, collaborating in cross-disciplinary teams is not a new concept?
Currently, university programs rely heavily on insular models of learning whereby each discipline is housed separately, taught in classrooms autonomously and with little or no interaction with other disciplines. Students graduating from these programs are then expected to work productively in health care teams without any previous opportunity to learn from the ideas and models each professional perspective has to offer. Education of this sort is not only outdated, it perpetuates non-collaborative practices for which patients ultimately pay the price, as evidenced by Canada’s low rankings on health quality when compared to other OECD countries. University programs must prepare future health system leaders early, commencing in first year, so that students are socialized towards inter-professional models of practice, which are likely to be effective in leading innovation and change.
Students need education programs that reach beyond the traditional practice competencies of health disciplines, including those which are foundational to innovation. Strategy, entrepreneurship, finance, organizational behavior, health economics, and consumer marketing are all skills that are taught in core courses in business schools; however, they are not routinely offered to students in health disciplines. Despite health systems being the largest “business” in Canada, business schools are generally not active in health sector innovation.
This disconnect extends beyond health disciplines. Engineering and computer science are the bedrock of innovative technologies for health systems. However, students in these streams create technologies of the future with no formal education opportunities to learn with the very students in health disciplines who will be integrating process redesign and technologies into their practices. How can we expect our engineers and computer scientists to create systems that meet clinical needs if they never have the chance to learn about those needs?
Post-secondary institutions must respond by developing strategies for inter-professional education. At our Centre, we have addressed this need by creating “health innovation projects”, whereby students work in cross-disciplinary teams in collaboration with the public health sector and industry partners to develop solutions to real-world health system problems. Project teams include students from IT, engineering, faculties of medicine and business, working together on health system challenges, such as the introduction of personal health records in primary care settings.
Now is the time for post-secondary institutions to take action in order to ensure future health system leaders graduate with the skills they need to transform our health system into one that can better serve Canadians, today and tomorrow.
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I like where you’re going with this, Dr. Snowdon, but I have to question: Why must one be something of a generalist in order to be an effective team-member? Perhaps I’ve misread you. Supposing I haven’t, I suspect that what is most desirable in a team is a wealth of opinions, frameworks, and perspectives – knowledge transfer – and the open-mindedness and willingness to learn on the part of each individual member. Effective communication skills could go a long way in facilitating this. As you point out, the life of an academic is largely insular and typically departments are anything other than porous. Not surprisingly, book smarts don’t always translate effectively into constructive and engaging dialogue cross-discipline. That said, being a sociable person, in my experience as a graduate student, isn’t a skill that best lends itself to advancement in the field, because the push is to publish… and then publish some more, and this takes time, discipline, and often solitariness. I do take your point for those academics who have clear direction at the start of their university career and so can be “groomed” to be interdisciplinary team players, if you will. But I suspect these are the exceptional cases, such that universities would do well to keep their current model in place, and encourage interdisciplinarity through audited and elected courses until the graduate level when interests are firmly in place.
I think this is an amazing discussion. Both Postings are accurate. I agree with both points of view. So what to do? The view from an ability to understand the detail yet be able to also zoom out and understand both the people in the mix (stakeholder perspectives) and the underlying technical needs from the specialty perspective and speak to them both. Then synthesize a final state of the art and growth to legacy capability is a rare talent that takes TEAM with a broad set of expertise. This does not come with the new graduate students who are pushed to focus on publishing for marketable product alone. It comes from the dynamic developed by experience within the the arenas of work and the years of interaction with a variety of projects and stakeholders to not only have that theoretic knowledge but to develop that strategic and critical thought :: synthetic thought process base that allows for creative problem solving amongst the TEAM and stakeholders.
You make an excellent point Dr. Snowdon. As someone active in the field of education and as a parent, I share your views.
No doubt, interdisciplinary projects are great, but we don’t reward interdisciplinary thinkers earlier in our university admissions process. There are two issues which discourage students from taking the interdisciplinary approach you suggest.
1. Our undergrad admissions process, including in health-related fields, is still largely marks-centered. I can say this with confidence after seeing my teens’ university application process, recently. We do not recruit undergrad to our top-rated health sciences or life sciences programs based on the breadth or depth of their varied interests and experience — we use very high marks in specific subjects, as cut offs. In some universities, 93% does not get you in the door of a health sciences program. They average out your top 6 relevant subject marks – usually, english, french, bio, math, chemistry or physics. Philosophy, history, accounting, economics etc may not make the cut because they are not “relevant” to health sciences entry. Other admissions forms show no interest in a student’s extra curriculars. This approach encourages high school students to think as narrowly as possible. The message is that interdisciplinary passions and explorations are extras, rather than integral to their education.
2. Our entrance to medical schools seem equally focused, and marks centered. I use the word “seem” deliberately; my knowledge is solely anecdotal. I know students who would love to take world history or psychology or human rights courses in their undergrad years but have not done so because those marks will not be rewarded in a competitive health sciences entrance process. While there is increasing talk about focusing on an applicants’ life experiences’ and “out of the box” perspectives, our application process sends a different message. Its intra-disciplinary.
Thank you for starting an important discussion on the role of education in a global, inter-linked, interdisciplinary world.
The engineering cross collaboration you speak of has already been evident in the construction of the field of clinical engineering in North America all the way back to when medical devices that required electrical safety management were first introduced into hospitals. Now the field has been delegated to supervise the management of technicians and technologists and ignore the growing fields producing more effective evidence based practice such as Health Technology Assessment (which hopes to provide economic and clinical benefit decisions through high quality evidence based analysis). The ignorance in training and focus on technology transfer for design purposes (which is alluded to in your article) produces researchers again with little to no practical knowledge in a field in which strives to improve the use of medical technology at point of care. It is no wonder that of the three programs in Canada, the University of Toronto’s program focused on research fails to compare when stacked up against ETS, USaks or even their american counterpart of UConn.
Your suggestion that interdisciplinary engineers in this environment seems laudable from an emotive reasoning standpoint but pales in the face of evidence, and the transition of a community from engineering practice to technologist practice, and the low quality of research that comes with it.
Furthermore, the veterans of industry can tell you that those engineers they require to build complex medical devices need the subspecialty training in order to “innovate” when building specific components. The translational skills of a clinical engineer are further wasted when specific knowledge of clinical practice is sought after by hiring an RN with IT “experience”, who has a shelf rather than a trunk of knowledge in the IT or electronics sector, but is familiar enough for hospital or research management’s job descriptions…
Engineers of all types undoubtedly play a vital role in health care. So do nurses, technicians, basic scientists, physicians, clerical staff, CEO, physiotherapists, nutritionists, social workers … as part of a very large network of teams. Each profession, role and in fact individual working or volunteering in some way contributes to the greater whole. Despite the reality that all health care requires a team effort to be effective we tend to emphasize the particular training, skills, rewards and incentives for individuals and profession groups … and assume it will work out.
It makes sense that engineers are part of a technology assessment process … but this is very different from engineers being solely responsible for technology assessment. This is a good example why greater emphasis on inter-professional training for all health care professionals (including engineers working in health care) is needed.
Oh, that makes one feel so much better that engineers are vital to the operation of healthcare… Why then are they tossed into the basement or ignored in favor of clinical decisions acting against the best practices for technology management and cost-effective care. What would inter-professional training mean, if not the supplantation of those engineering staff with an eye on the problem by nurses and others with “clinical value”. Unless you’re willing to train engineers or elevate them to the same level as clinicians in process improvement and cost-effectiveness evaluations (technology assessment), you’ll end up with a half-assed generalist worldivew, without the benefit of solutions that meet the needs of the industries that are brought in to “add value” to healthcare such as telecom or operations managmenet.
This would lay the necessary foundation for longer term sustainable improvements across health care.