How one professor uses historic milestones to help students understand the complex U.S. healthcare delivery system—and maybe drive future improvements.
Academic Director and Associate Professor in the Healthcare Leadership Program, University of Denver
PhD in Public Health with a focus on Healthcare Management, MS in Health Sciences (Emergency and Disaster Management), BA in History, minor in Government
“I went into healthcare because of what happened to me two decades ago,” says Bobbie Kite, PhD, academic director and associate professor of healthcare leadership at the University of Denver, Colorado, who was diagnosed with ulcerative colitis in 1991. “[For most of the next 15 years], I experienced—nonstop—all the horrible things that happen to a person who doesn’t have health insurance that covers preexisting conditions. Wanting to fix our broken system is what led me into this field.”
Today, with a doctorate in public health and experience in healthcare management, Kite is in a position to focus on finding real-world healthcare solutions. That is her number-one goal for herself, as well as for the students taking her course called Healthcare Data and Delivery by Perspective.
“I don’t focus on the wide range of problems within the healthcare delivery system, because that’s too much information too soon,” she says. “I meet the students wherever they are in their knowledge of the system. My goal is to give students the tools they need to investigate towards facts, which will place them in a better position to work on things. We have some of the best technology in the world for treating disease, but the problem is equitable access.”
It is her hope that, by helping students first understand the system and then learn how to be heard, this generation can move that dial.
Challenge: Having a limited perspective on a complex system
When studying the U.S. healthcare delivery system, Kite’s first objective is to help students wrap their minds around its complexity. She needs them to learn how to consider the system from many perspectives, not just their own. Key players, she explains, include patients, providers (such as medical professionals), payers (such as insurance companies), and the population (as a whole).
“At the start of the class, the biggest challenge is getting students to look at healthcare from all four perspectives,” says Kite. “They may only see healthcare from a patient perspective. But if you don’t understand how the healthcare delivery system makes money, then you can’t understand how to solve the problems. Specifically, if you don’t understand how fee-for-service works, it’s difficult to make a difference.”
Innovation: Teaching how to search for (and explain) relevant data
To help students begin to see all the perspectives in a complex system, Kite asks them to identify and chronicle milestones in healthcare history—moments when new ideas created positive change in the system. Then she has students submit their findings as what she calls the Interactive Timeline assignment, by plugging their research into a cutting-edge template (instead of giving a stagnant lecture or PowerPoint presentation).
This project requires in-depth, eye-opening research into the history of U.S. healthcare. Students explore not only concepts and philosophies but also relevant data and its practical application. There is no way a student can complete the assignment without learning the impact and context of actual events and numerous (usually conflicting) perspectives. The timeline lesson also shows students how they can use interesting presentation “tools” to state their case clearly and persuasively. This will help them and, she hopes, serve as drivers of further improvements to the healthcare delivery system.
Kite sees this lesson as a new application of tried-and-true teaching techniques. “Innovation isn’t creating something new,” she says. “It’s making something work that already exists. Nothing we do is new. It’s all small chunks of truth that we are considering and packaging in a new way.”
Course: HC 4600 Healthcare Data and Delivery by Perspective
Class size: 10–20
Course description: This course evaluates the environment of the U.S. healthcare delivery system and introduces the 4P (patient, provider, payer, population) perspective framework. This framework is generated from the natural flow of healthcare delivery, starting with the patient, moving to the provider, toward the payer, and evolving into population health. Students will learn about the associated data that is generated from the patient as a consumer, from the provider through clinical operations, from the payer perspective, and finally how all of these contribute toward population health data. This course will cover the basics of U.S. healthcare research and clinical intervention, and students will have the ability to model the conceptual as well as practical application of health informatics.
In her words: “This course is really for everyone from a patient to a provider to anyone who’s interested in understanding more about the U.S. health industry and the U.S. healthcare delivery system. It will take you from a limited experience within the delivery system to the bigger picture of learning from the health industry, which might be led by Apple and Nike and other companies you wouldn’t normally associate with healthcare delivery.”
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Lesson: An interactive timeline of healthcare history
Kite requires each student in her class to create a timeline highlighting key milestones in the history of the U.S. healthcare delivery system. Each timeline includes 15 milestones that occurred between the years 1900 and 2010. (She does not allow students to focus on the most recent 8 years because she wants them to research what they do not already know.)
First, though, Kite helps students begin to see the flaws that are inherent in America’s healthcare delivery system. “It’s essential that they have some sense of what’s not working, because that will motivate them to research and complete the timeline,” she says. “When their eyes are open, and they are questioning the status quo, that’s the perfect jumping-off point for the Interactive Timeline assignment.”
Here are her tips on replicating this lesson, including the activities she does to prep beforehand:
Artificial intelligence and collaborative informatics
Kite feels that “interactive” will have to take on a new meaning in the next 10 years. As the artificial intelligence field grows and replaces jobs, it will be important for students to be able to create something like this timeline—with other students working on it simultaneously.
She refers to this as “a collaborative informatics approach.” Google Docs is a current example: Several students might be working in a Google Doc at the same time, typing over or alongside each other. Version control maintains each comment or revision, so nothing is lost.
Whatever the advancements in technology, one thing will not change for Kite, and that is her pursuit of a better U.S. healthcare delivery system. She wants her students to be well prepared and ready to master whatever new technologies arise. With the best data and tools, and the presentation skills to deliver the information, she is confident that they will be heard.
Make it personal
“It’s a challenge to make students see how healthcare delivery impacts people,” says Kite. “So I share my personal experience. I was told I wouldn’t have a colon by the time I was 25, and I am 40 now. I bring them in through a narrative, and they say, ‘Oh, my gosh, I never thought of it from this angle.’” Sharing other people’s narratives (anonymously) can also be compelling.
Demonstrate the power of media
Kite knows that talking heads and a stale slideshow will not move the dial—they will just put your audience to sleep. To bring home the point, Kite shares multimedia, such as podcasts and TED Talks, to highlight what is effective in delivering a message. This helps students see why it is important to use an interactive and interesting approach for their timeline.
Offer a bite-sized exercise first
Before the larger assignment, Kite gauges students’ research and presentation skills with a bite-sized exercise. For example, she may ask students to quickly find 5 things that happened in technology in the last 50 years that impacted the U.S. healthcare delivery system. Other strategies are to assign an executive summary or a 1-minute video.
Clarify the criteria for a milestone
For the purpose of the timeline, a milestone is defined as a moment that changed things significantly and led to health data use and technological growth. One example she shares: Starting in the 1950s and ’60s, doctors were able to prescribe patients’ lab tests and review blood work. This often inspires students to ask, “Then why don’t doctors consistently send patients to the lab before seeing them?” When they ask questions like that, she knows the gears are turning.
Allow opportunities to revise and resubmit
Kite allows her students to make changes to their projects, even after they turn them in—provided that they have attempted to complete the assignment objectives during their first attempt but missed the mark in some way. Students who are struggling are provided additional coaching to help them rise to the occasion. (See “Complications and defense” below for more on this strategy.)
Complications and defense
Creating the grading rubric was the biggest challenge Kite faced with this assignment. “You have high hopes that students will be able to meet high-level criteria, but then students only give you the bare minimum,” she says. “So it’s about making the rubric robust but reasonable.”
Another challenge was that her faculty colleagues did not like her “revise and resubmit” policy. “I told them they didn’t need to do it for their students,” she says. “But do they want their students to really learn and be competent? There are very few jobs where someone gets fired for not getting a project right on the first try. I guarantee my students will learn more if I do this.”
Kite’s course evaluations from both the school and students are very positive. Most importantly, though, exploring milestones will provoke questions, which in turn leads students to wonder, “How can we improve this system?”
“Students want to share what they’ve learned,” says Kite. “They see what could have been and what is, and, just maybe, what could be. They see practical applications. They go from theoretical to practical reality very fast.”
These two excerpts from student emails have reaffirmed Kite’s enthusiasm for the timeline assignment:
“At first, learning the new tools—that is surveys, and new types of video presentations—seemed burdensome. Yet now I am happy to have them as new skill sets.”
“The course was very informative and presented a perspective of technology and database administration that I had not even thought of before! It seems the informatics program not only compliments [sic] the Database Administration degree, it is [an] area of healthcare that is advancing, however has not received the proper attention.”