The Dartmouth Center for Health Care Delivery Science

"Collins Airhihenbuwa, a researcher at the Penn State University, has written that “all knowledge is local,” which in my mind includes concepts of family, culture, community, things we don’t normally associate with knowledge. Perhaps pursuing research that identifies patients as knowledge experts rather than as a heart attack, colonoscopy, or prostate cancer patient will help inspire others to do the same.

Dartmouth has a history of leadership in the world of patient-centered care and shared decision making; we feel an obligation to revitalize innovative thinking, to bring forth new methods and ways of thinking that reflect this history. It’s a call to action." — Stuart Grande

"When I set out to understand the world of transfusion medicine in Northern Ireland, I learned that for an area of medicine that is commonly practiced, there was little solid evidence for the decision to transfuse. Of the 2500 records I reviewed, patient involvement in decision-making was virtually non-existent. Why was this not being measured routinely? Where was the accountability?

Ever since my PhD work, I have focused my research on understanding how patients can be more involved in their own care, with methods, measures, and interventions targeting the system level with the potential to impact the lives of the greatest number of patients. In 2012, I came across a research opportunity with a Professor Glyn Elwyn at Dartmouth College, who studied something known as ‘shared decision making.’ Two phone calls and a trip to the US later, I found myself on a bus travelling with Glyn to Boston discussing the challenge of measurement in SDM and the exciting opportunities to tackle this in the newly formed Dartmouth Center for Health Care Delivery Science. I have been hard at work ever since." — Paul Barr

"Some years ago, I was within earshot of a trusted colleague and friend bemoaning how poorly local health services were meeting the needs of the patients they were intended to serve. The simple, off-the-cuff remark was curious and provocative. Despite having worked in health promotion and being some way into a PhD in health psychology, I had never regarded hospitals and clinics as ‘services’ in the true sense of the word, and certainly had never considered patients as those to be served. This framing of patients contradicted my own experiences receiving health care. It was also at odds with the rhetoric to which I’d been exposed, which positioned patients as impediments to most good and useful things, including a healthy population.

The notion that health care could, and should, be organized around patients, although novel, immediately made more sense than any other model I had been taught, and prompted my interest in researching and promoting patient-centered care. My particular focus in shared decision-making developed naturally out of this, and I spent several years studying patient participation and shared decision-making in the maternity care system in Australia. Frustration with the relative infancy of the shared decision-making movement in Australia and the lack of a critical mass of researchers with whom to exchange ideas and problem-solve led me to relocate to the USA, to work with researchers focused on shared decision-making at The Dartmouth Center for Health Care Delivery Science." — Rachel Thompson

"I moved here more than a decade ago as a physical therapist to help start the Spine Center at Dartmouth-Hitchcock Medical Center. We designed the center for patient care and research. We used patient-reported data at the point of care to learn from and inform patients in real time. We also used aggregated data to monitor our work, to improve over time, and to share what we had learned by publishing our research.

I was lucky to be part of this start-up, and the experience inspired me to pursue a Master’s degree, then a PhD from The Dartmouth Institute for Health Policy and Clinical Practice (TDI). I'm now a post-doc with The Dartmouth Center for Health Care Delivery Science, where I research the implementation of innovations in health care delivery.

I'm motivated by a desire to do my fair share addressing the challenge of finding sustainable solutions for health care delivery. Two ideas about health care have driven me.

I consider health care a right. I also consider health care a common resource. When all individuals have access to a common resource, the resource tends to be used up completely, even to the detriment of society as a whole.

Imagine: Everyone has a right to a common resource that can bankrupt the society as a whole.... What does that mean from a policy perspective down to the level of a provider caring for a patient? This is a hard problem.

Working on hard problems motivates me." — Thom Walsh

"I’ve had the opportunity to see health care delivery from several perspectives in different contexts. As a physician practicing in Georgia (former Soviet Union) at the time of major transitions and as an MPH and PhD program graduate in the US, I have come to realize that effective and efficient health care delivery is both the result and the foundation of a well-functioning health system.

Establishing health care delivery as a field of science offers the potential to redesign health care in new and transformative ways. This has always been my interest, and I view my work at TDC as part of a bigger agenda of improving health care delivery. Rethinking clinical decision making in ways that promote patient involvement in the decision making process stands on ethically solid ground while at the same time offering potential for improved health outcomes. Is successful implementation a challenge? Certainly! There is a need to develop, test, and monitor interventions, and that is where I’d like to contribute through my work at TDC." - Maka Tsulukidze