We are excited you're here. You have decided that you are interested in a field that challenges the type of healthcare we deliver. That asks, “Why aren't things better?” That says, “Didn't we already learn the best practices in this field? Why aren't we using them?” We hope that you, the new healthcare delivery scientists, will find this book useful as you begin to fundamentally change the healthcare we provide to our patients.
Healthcare delivery science is a new entity to address an old problem— one that hasn't been solved with discipline that have come before. In health services research, the insights we glean are largely separated from healthcare operations. In healthcare operations, we largely learn from the business literature and, perhaps, the field of industrial design … but not from advances in the quantitative healthcare sciences. For quality improvement, we have made important strides in understanding the risks to our patients and developed methods to try to combat them, but sometimes our analyses should reflect the fact that systems of care are profoundly complex. We hope this book brings a new perspective.
A major theme of this book is that, to be healthcare delivery scientist, you need to be a generalist. The right way to answer a question and really strive to improve the care we deliver to patients may require a new statistical method, a new survey, a new technique. We need to build ourselves a toolbox of tools to deliver better, safer, higher-value care; we can't always look to apply our reliable, comfortable technique to whatever problem lies before us. We have sought out experts in several different fields to expose you to these ideas, and their authorship is noted by chapter; all other chapters were written by Dr. Howell or Dr. Stevens.
How should you read this book? Part I defines this new field of healthcare delivery science. Chapter 1 explains how we got here. Chapter 2 explains the concept of complexity. Together, we can see that some methods will work for complicated problems (e.g., a reliable system that is the sum of its parts) while others will work only for complex systems, like the complex physiology and pathophysiology of the healthcare system. Chapter 3 opens the door to the urgency of the unsafe and low-quality care in our current system, while Chapter 4 suggests where we need to be in the future.
Part II focuses on several new disciplines that are rarely taught in most healthcare professional schools, including human factors (Chapter 5), teams (Chapter 6), implementation science and healthcare leadership (Chapter 7), quality improvement methodology and Lean thinking (Chapters 8 and 9), and the intersection of our healthcare system with our community, state, and federal partners (Chapter 10). We're excited to have these disciplines all in one place.
Finally, Part III gets to the meat of many of these methods. Chapter 11 serves as a revealing opportunity to look “under the hood” of how data architecture is (and should) be designed for a health system. This chapter alone should fundamentally make you look at your dataset from your health institution with skepticism and concern, which will make you a much better scientist. Chapters 12, 13, and 14 should help you begin to poke at your data, consider how to present data, and understand why it matters, while Chapters 16 and 17 should lead you into new fields. Meanwhile, Chapter 15, on surveys, should give you a new, healthy respect for survey design; we hope that you will leave this text with a newfound respect for the sophistication of surveys and a view of the rocky shoals that call to those with poor survey designs. Finally, Chapters 19 and 20 should arm you with unexpected techniques from new fields to answer questions in healthcare that you didn't know you could ask.
We're thankful you're here. As the future of healthcare delivery science, the integration of many old and many new techniques, we know that you will ask the difficult, generalizable, and optimistic questions that fundamentally will challenge all of us to make healthcare better and safer for our patients. And you will be armed with the tools you'll need to do it.