Dartmouth wants to attract students who want to join us in trying to fix what is a pretty broken system right now. They can be in any stage of their careers. We have students who are coming out of college and wondering how they can get involved in making a difference in health care. We have students who are physicians, anesthesiologists, nurses who are in the middle of their careers coming back and saying, “I know all the ways that the system isn’t working. I need some tools to help figure out how to make it better.”
The multidisciplinary teaching and the diversity of the students create a learning environment that you don’t see in many other places. Much of our teaching takes place in intentionally small groups. In a group of four, you might have a physician, a nurse, a recently graduated college student, and an administrator all working together as a team. On these kinds of teams you really get the perspectives that you need to be able to see what is really going on — and to understand the complexity of the material that we are teaching.
Dartmouth has already changed the way people are thinking and has started to really change how health care is delivered. One area would be the practice of shared decision-making. This notion of informing patients about the meaningful choices that they face and helping them make a decision based on their preferences, not the physicians’ preferences, is a clear policy implication of a lot of the work that we have done here. A second area would be our understanding of what are the underlying causes of spending that we see across the country. We have a payment system that rewards doctors and hospitals for doing more stuff, regardless of whether it works or not, and where there are no performance measures that let us understand whether the stuff that health care providers are doing actually makes any difference in improving the health of the population they’re serving. Those insights led us to start to work developing this notion of the Accountable Care Organization. It’s a new payment model that we succeeded in getting into the Affordable Care Act. It’s being implemented around the country. And it’s making a difference.
We are not a lobbying organization, but we’ve spent a lot of time in Washington at the invitation of both Republicans and Democrats. My first visit to Washington was to the Bush Whitehouse. That administration showed lots of interest in translating our ideas into policies that could make a difference in the U.S. health care system.
Those of us in the health care system know we are going to have to change. Those who want to be prepared for those changes will benefit from the kind of education that we are offering here at Dartmouth. We want physicians who are saying, “I know fee-for-service medicine is a dead-end. It's not going to be here in ten years. I want to be at the forefront of learning how to make a difference, how to fix my practice.” We know nurses are as well positioned as anybody to help create badly needed changes in care transitions and care coordination. Or between hospitals and outpatient settings. You want to learn how to do that – come to Dartmouth. We want the people who are going to be leading the change in the U.S. health care system over the next ten years.
One of the most exciting things about Dartmouth is the recent decision by the college to commit to advancing the science of health care delivery across all of our campuses. To pull all of the schools together to say, “How can we, as an educational institution, lead in the change that we need to see in health care?” So we bring in Tuck, our business school, Thayer, our engineering school, and the college where we have a tremendous diversity of thoughtful social scientists, psychologists, economists, and sociologists. We bring in the medical school, where the interface between clinical practice and biological sciences and health system design and improving quality of care is critically important for the next generation of medical students. We are in a very exciting moment at Dartmouth right now. An historic moment.”