Core Courses

The Science of Health Care Delivery brings together the ideas, methods and tools from multiple disciplines with the goal of improving people’s welfare through better health.

At Dartmouth, when we discuss Health Care Delivery Science, we emphasize science, in that we use theory and evidence to understand and to improve health care delivery.  Throughout this course we will challenge you to examine and explore the rigor of evidence you see and hear. We emphasize integration across disciplines because improving health care delivery and health must involve principles from management as much as it involves medicine and clinical practice per se. We emphasize value as a means of encompassing outcomes along multiple dimensions, as well as cost. We also include an emphasis on population health, which means that our focus is on health and welfare, not just health care. And, most important, we believe that health care delivery must be based on the strongest possible ethical foundation.

In this introductory course, we begin the journey of applying health care delivery science to our mission of enabling leaders to bring transformative change to health care. Transformative change will not come from one-off applications of even the best improvements in health care delivery – it will require large scale and lasting change of the organizations within a health care system. The overall learning objectives of the MHCDS program are focused on change at the organization and system level as well as the professional development required for individuals engaged in such change. 

The health care sector generates an enormous amount of data at an ever-increasing pace. The ability to wisely use the associated analytic by-products is a rare and differentiating skill among health care leaders.
The Leveraging Data course will promote this skill through the introduction of quantitative reasoning toolkits reinforced with on-the-ground case studies. We will discuss the relative merits and limitations of common types of data sources in health care – such as electronic health records, claims databases, and surveys – and will introduce a framework through which managers can detect and diagnose data quality concerns. We will also explore descriptive, predictive, and evaluative methods, demonstrating how each of these informs the return-on-investment (ROI) calculations that typically underlie high-level strategic decisions. By the end of this course, students should be able to generate and critique quantitative estimates of the primary value drivers in ROI models supporting critical health care management decisions.

Reforming health care systems to deliver greater value will require a substantive understanding of the fundamental economic forces driving system-wide incentives and competition. This is as true of reform at both the public policy level and at the level of organizational policy and strategy.
While the economics of the health care industry appear different from other industries, the behaviors and outcomes are often the result of no more than the incentives faced by individuals and organizations, in combination with some form of competition. This course will equip participants with knowledge of health economics that enables them to understand the current state of affairs and to incorporate sound economic analysis in their role as managers. Topics to be covered include: economics of risk pooling and insurance markets, especially adverse selection and moral hazard; cost analysis; incentive effects of different payor and financing systems; supply of medical and physician services; supplier induced demand; and the economics of nonprofit organizations.

Faced with pressures on both the revenue and cost side, leaders in health care delivery are now required to do more with less. Managing the balance between clinical outcomes and financial soundness has become more demanding.
The goal of this foundational course is to develop a framework with tools and models to enable participants to make value-enhancing financial decisions in health care delivery. The course will develop the relevant ideas in three stages. The first stage (financial accounting) will build participants' skills in interpreting, analyzing, and forecasting financial statements (the income statement, the balance sheet, and the statement of cash flows). The second stage (managerial accounting) will develop your skills in the use of financial information to measure, evaluate, and control management decisions. Key topics include cost accounting, cost allocation, standard costs and variances, financial planning, and activity-based costing systems.
The third stage (corporate finance) will advance and synthesize the ideas from the first two, build your skills to make investment and financing decisions, and develop your abilities in business valuation. Topics include free cash flow and capital budgeting, different types of financing to fund investments, cost of capital, and finally, tools to value businesses using cases/examples of acquisitions in the health care delivery sector.

Healthcare services make important contributions to the delivery of healthcare. Yet, too often the role and contribution of those who are ill, or who care for such people is overlooked.
The term ‘coproducing health Care’ is used to cover how individuals and communities are an essential part of a care delivery system. How do decisions get made? Are the values and preferences of individuals respected in a shared decision-making process? Are individuals supported to self-manage long term illness? Do health systems engage users in designing their workflows and systems? In other words, is healthcare designed around the needs and preferences of patients? Or is the term ‘patient centered’ an empty marketing message? This module will explore policy developments, research, and implementation efforts to bring the concept of co-producing healthcare to day-to-day operations.

Health care services are characterized by enormous variability and multiple objectives. Given these challenges, this course aims to provide you with the language, concepts, insights, and tools to evaluate, design, and operate health care processes in order to increase value for patients and reduce costs.
Two themes will run throughout the course: 1) aligning the design and management of processes with the goals of the health care system and 2) managing variability. In health care, the first theme is crucial but complex, for the system's goals may be multidimensional. The second theme is also particularly challenging, for health care systems are faced with variability generated by fluctuations in customer demands, treatment times, patient expectations and preferences, and patient willingness or ability to participate in treatment. Specific concepts and tools in the course include process flow analysis, the theory of constraints, queueing/congestion analysis, quality improvement, and capacity management.

Organizational outcomes depend on the alignment of people and teams, working together toward common goals.
In this course, we examine alignment through the lens of applied psychology, particularly theories of motivation. We explore how motivation theory and research inform important tools of alignment: Compensation, job design, and decision-making. We discuss positive changes health care leaders can make to increase alignment and thereby increase the chances that health care delivery teams and organizations will have successful outcomes.

Managing modern health care organizations is a complex ordeal, more so in a time of health care reform. This course follows on the work done in previous courses and it anticipates what will come in the Management of Organization Change and the Strategy for Health Care Organizations courses.
Participants take the vantage point of a high-level manager in a health care system and understand how divisions, departments, and microsystems currently interact, and how they might. This course will explore all aspects of a health care organization that are necessary for success, from human resources to credentialing, from finance to supply management, and from union management to physician management in a voluntary staff model. In anticipation of health care reform, students will learn how team leadership, performance measurement, and incentive structures will have an impact on care delivery. The course draws heavily on the general management literature and uses cases to apply those ideas to health care organizations.

Systematic health care problems undermine good-quality health care. Marketing plays an important and pervasive role in identifying problems and new opportunities to improve health care outcomes. This course will offer a philosophy and a set of tools.
Marketing philosophy is necessary to create, communicate, and deliver value to satisfy the needs of customers (patients, suppliers, and community) while meeting the goals of physicians, practitioners, and organizations. Marketing tools are needed to guide decisions on positioning (what do and don't we offer?), products and services (features, benefits, packaging, branding), price (list price, rebates, discounts), distribution (where and when it will be available), and communication (advertising, public relations, personal selling, social media, and direct marketing). Application of the marketing philosophy and tools will be based on in-depth knowledge of marketing research and health decision-making.

A unique contribution of this course is a discussion of public health systems and on social, behavioral, and environmental factors – factors outside of medical care – that influence health outcomes. Therefore, we will disproportionately focus on those two topics.
This course will take a broad perspective on population health; we do not privilege either of the prevailing conceptualizations of the discipline of population health – “population health management” or “total population health.” Instead, we seek to identify the points of leverage that people working in different sectors can use to address population health and to underscore the critical role of multi-sectoral partnerships in protecting and improving population health.

This course will prepare the participant for the challenges in accomplishing significant change in health care organizations. Outside the world of health care, new patterns of competition, new technologies, and basic shifts in values have combined to require fundamental changes in the way that management is practiced.
Today, many organizations confront situations that require them to manage change on a continuous basis. This critical skill has become a core component of every manager's job and a substantial body of management knowledge has developed. In this course we will draw on the large body of relevant research and theory, and then complement and integrate this theory with experience from practice. We focus in particular on the process of change and on the sequencing of change activities. Recommended actions are matched with concrete, tested, and specific tools for their application. Proceeding from concepts to actions to tools provides a range and depth of practical understanding that is unusual in this important area of management activity. Our focus will be on the specifics of health care organizations, but much can be learned from studying other firms and industries that have seen substantial change.

This course will prepare participants to design and lead innovation initiatives in health care delivery.
There is no area in which innovation would positively impact society more than improvements in health care.  However, the health sector is a complex, constrained, and difficult setting for new ideas and new practices.  In this class we will examine the following themes:
1. What are the basic tenents of innovation, and how do they apply to the healthcare sector?
2. How can we use human centered design techniques to guide innovation?
3. What are ways to gather clear observational information on the needs of the customers, systems, and procedures.
4. Learn techniques to frame and reframe problems that lead to more successful innovations in the operational and clinical environments of healthcare.

Strategy for health care organizations is both a capstone course and one that is taught throughout the program in each of the residential periods as well as online. Participants will develop a framework for formulating and evaluating strategic decisions, tools for identifying opportunities and evaluating alternative paths, and methods for encouraging innovation.
This course will focus on strategic innovation, strategy implementation, and combining strategic thinking with leadership skills to create successful change. All the previous course work will be brought to bear on strategic redesign of the health care delivery system. The course will re-examine best-in-class examples of system design to understand the strategic implications of systemic change. In addition, the course will use complex cases to examine the delivery system from the viewpoint of a CEO, a board member, or a senior public official, requiring learners to use all their skill sets to think through design options that create value and optimize measures including institutional accountability, patient outcomes, quality, cost, and employee satisfaction.

Transforming health care organizations presents special challenges and will require tremendous leadership by individuals within those organizations. This course provides participants with the knowledge to increase their personal leadership capability.
The focus of the course is concrete — building an understanding of one's strengths and opportunities for improvement as leaders, and using that knowledge to identify actions that advance leadership potential. The centerpiece of this course is a comprehensive, 360-degree assessment of each participant's leadership skills, based on confidential evaluations completed by bosses, co-workers, peers, and clients. During the course, participants will write their own Leadership Development Plan, a specific and measurable plan for strengthening their leadership skills.

As the culmination of their learning experience, students collaborate in teams on an Action-Learning Project. Applying classroom concepts to real organizational challenges provides an immediate return on the learning experience—and delivers a payoff to improve business and clinical performance for the client organization.
Action learning also unleashes a team's creative thinking and encourages the development of a common internal language around quality, strategy, efficiency, and leadership.
These hands-on projects provide participants with the opportunity to:
•    integrate their core academic knowledge and apply it to a real-world problem
•    gain practical experience in planning and executing a project
•    tailor the curriculum to their individual goals and those of their organizations
Participants work in teams to design and complete a project. Projects have an external client, often a sponsoring organization, who provides motivation for the project and access to data and people in the client organization. When feasible, the teams will include participants from the same organization, in order to translate their knowledge quickly into their workplace setting. The groundwork for a stronger, more team-focused organization is one of the most valuable program outcomes.
Each team also works with a faculty advisor who approves the project and coaches the team on its planning and execution. Learning to manage a project effectively is an additional major focus of this course. Participants will learn how to scope a project, develop a work plan, conduct primary and secondary research, implement the project, measure its results, and create and deliver an effective presentation.
During the final residential period, teams will present their findings to faculty, peers, and management from the sponsoring institutions.