hpm252 daily class reading assignments · hpm252 daily class reading assignments . class #1 . march...
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HPM252 DAILY CLASS READING ASSIGNMENTS Class #1 March 22 Thinking Strategically, Preparing to Negotiate
Class #2 March 24 Distributive Bargaining: Claiming Value
Read for Class:
Galinsky, A. “Should You Make the First Offer?” Negotiation, Vol. 7 No.7 pp.3-5. July, 2004.
https://cb.hbsp.harvard.edu/cbmp/pl/48617073/48617087/7dc78c92966cdd44de99be5cb23e747d
Schweitzer, M. “Aim High, Improve Negotiations Results.” Negotiation, Vol. 9 No.8 pp. 4-27 August, 2006. “The Crucial First Five Minutes.” Negotiation, Vol. 10, No. 10, October2007.
Class #3 March 29 Trust, Competition and Cooperation Read for class:
Robinson, R. “Errors in Judgment Implications for Negotiation and Conflict Resolution Part 1, Biased Assimilation of Information.” HBS Case #9-897-103
https://cb.hbsp.harvard.edu/cbmp/pl/48617073/48617075/808531cbbe57b8ab1320c772f75e0b86
Class #4 March 31 Integrative Bargaining: Creating Value -- Framing, Tobacco Settlement
Read for Class
C Galinsky, A.; Liljenquist, K. “Putting on the Pressure: How to Make Threats in Negotiations.” Negotiation Vol. 7 No. 12, Dec. 2004. Pp. 3-5.
https://cb.hbsp.harvard.edu/cbmp/pl/48617073/48617089/a1ba00721f4aa7cfb170859fb9a679ea
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Allred, K. and Mandell, B. “Positive Illusions that Backfire: The Implications of Seeing Yourself as More Cooperative than Your Counterpart Views You,” Paper presented at the Annual Meeting of the International Association of Conflict Management, June 2000, St. Louis, MO.
Allred, K. “Distinguishing Best and Strategic Practices: Framework for Managing the Dilemma between Claiming and Creating Value,” Negotiation Journal, Oct 2000, pp. 387-397. http://onlinelibrary.wiley.com.ezp-prod1.hul.harvard.edu/doi/10.1111/j.1571-
9979.2000.tb00766.x/pdf
Bordone, R. Divide the Pie -- “Without Antagonizing the Other Side.” Negotiation, Vol. 9 No. 11, Nov. 2006 Hammond, J.; Keeney, R; and Raiffa, H. “Even Swaps, A Rational Method for Making Trade-offs.” Harvard Business Review. March-April, 1998. pp.137-149. https://cb.hbsp.harvard.edu/cbmp/pl/48617073/48617081/534b4a651c4dcd4418eb878cb90fc173 Tierney, J. “The Advantages of Closing a Few Doors.” New York Times February 26, 2008. http://www.nytimes.com/2008/02/26/science/26tier.html
Class #5 April 5 Tactics for Integrative Bargaining: Framing, Persuasion
Read for class:
Conger, J. “The Necessary Art of Persuasion.” Harvard Business Review. May-June, 1998.
https://cb.hbsp.harvard.edu/cbmp/pl/48617073/48617079/fc15cb66fe634e8205beba2bae6f3fd1
Carey, B. “This is Your Life (and How You Tell It).” New York Times, May, 22, 2007.
http://www.nytimes.com/2007/05/22/health/psychology/22narr.html
Hinchman, L. and Hinchman, S. (eds.) “Memory, Identity, Community: The Idea of Narrative in Human Sciences.” Pp. 176-180. Bruner, J. “What is a Narrative Fact?” Annals of the American Academy of Political and Social Science.Vol. 560. November, 1998. pp. 17-27. http://ann.sagepub.com.ezp-prod1.hul.harvard.edu/content/560/1/17.full.pdf+html Bronner, E. “The Bullets in My In-Box.” New York Times. January 26, 2009.
http://www.nytimes.com/2009/01/25/weekinreview/25bronner.html
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Class #6 April 7 Multi-Party Negotiations and Coalitions Read for class:
Watkins, M. and Rosegrant, S. “Sources of Power in Coalition Building,” Negotiation Journal, Jan, 1996, pp. 47-68. http://onlinelibrary.wiley.com.ezp-prod1.hul.harvard.edu/doi/10.1111/j.1571-9979.1996.tb00078.x/pdf
Sebenius, J. “Sequencing to Build Coalitions: With Whom Should Talk First?” Chapter 18, Raiffa, et al. Wise Choices, Decisions, Games and Negotiations, HBS Press, 1996, pp. 324-348.
Susskind, L. “ Winning and Blocking Coalitions: Bring Both to Crowded Table,” Negotiation, No. N0401B, Jan 2004. https://cb.hbsp.harvard.edu/cbmp/pl/48617073/48617091/a8f645d99c4257fed40ceae8f98625f7
Bordone, R. “Dealing with a Spoiler? Negotiating Around the Problem,”
Negotiation, Vol. 10, No. 1, January 2007.
Class #7 April 12 Coalitions II, Personal Bargaining Styles Fill out TKI inventory Read for Class:
Shell, R.G. “Bargaining Styles and Negotiation: The Thomas-Kilmann Conflict Mode Instrument in Negotiation Training.” Negotiation Journal, April 2001, Read pages 166-171 http://onlinelibrary.wiley.com.ezp-prod1.hul.harvard.edu/doi/10.1111/j.1571-
9979.2001.tb00233.x/pdf
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Class # 8 April 14 Power and Fairness
Read for Class:
Anderson, C. and Berdahl, J. "The Experience of Power: Examining the Effects of Power on Approach and Inhibitions Tendencies." Journal of Personality and Social Psychology. 2002, Vol 83, No. 6, 1362-1377. http://ezp-prod1.hul.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=pdh&AN=2002-08203-011&site=ehost-live&scope=site
Class #9 Emotion, Escalation, and the Cost of Conflict April 19 Read for class:
Bazerman, M. H. and Neale, M. A. “The Irrational Escalation of Commitment.” Negotiating Rationally chapter 2, , The Free Press, 1993.
Rubin, J. et al. “The Persistence of Escalation,” chapter 7, Social Conflict: Escalation, Stalemate and Settlement, Rubin et al. (Eds.), McGraw-Hill, 1994, pp. 98-116. Charts on pages 83, 86. Fisher, R. and Shapiro D. “Address the Concern, Not the Emotion.” Beyond Reason: Using Emotions as You Negotiate, Viking, 2005. Chapter 2, pp.15-21. Robinson, R. “Errors in Judgment Implications for Negotiation and Conflict Resolution Part 2, Partisan Perceptions.” HBS Case #9-897-103
https://cb.hbsp.harvard.edu/cbmp/pl/48617073/48617083/ba463f7c1389009208a6840f891043d5
Class #10 April 21 Multi-Party Negotiations: Power Dynamics and Managing Internal Stakeholders Read for Class: Putnam, R. “Diplomacy and Domestic Politics: The Logic of Two-Level Games,”
International Organization, MIT Press, Summer 1988, excerpt: pp. 427-441. http://www.jstor.org.ezp-prod1.hul.harvard.edu/stable/2706785 Class #11 April 26
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Multi-Party Negotiations: Managing Contentious Internal and External Relations - Class #12 April 28 Are there Do Gender and Cultural Differences in Negotiations? Read for class:
Macduff, I. “Your Pace or Mine? Culture, Time, and Negotiation.” Negotiation
Journal, Jan 2006, pp. 31-45. http://onlinelibrary.wiley.com.ezp-prod1.hul.harvard.edu/doi/10.1111/j.1571-
9979.2006.00084.x/full
LeBaron, Michelle, “Culture Based Negotiation Styles”. July, 2003. Beyond Intractability website, available only on-line: http://www.beyondintractability.org/essay/culture_negotiation/ Pradel, Dina; Bowles, Hannah Riley and McGinn, Kathleen L. ”When Gender Changes the Negotiation.” Working Knowledge, Harvard Business School. February, 2006. http://hbswk.hbs.edu/item/5207.html Kolb, D. and Williams, J. “Introduction,” Chapter 1, The Shadow Negotiation: How Women Can Master The Hidden Agendas That Determine Bargaining Success, Kolb, D. and Williams, J. (Eds.), Simon & Schuster, 2000, pp. 15-38.
Babcock, L. and Laschever, S. “Nice Girls Don’t Ask,”, pp. 62-84 Women Don’t Ask. Negotiation and the Gender Divide. Princeton University Press 2003, Vedantam, Shankar. “Salary, Gender and the Social Cost of Haggling.” Washington Post, July 30, 2007 www.washingtonpost.com/wp-dyn/content/article/2007/07/29/AR2007072900827.html
Class #13 May 3 Universal, Situational and Personal Ethics
Fill out ethics survey Read for class:
Schweitzer, M. “Negotiators Lie.” Negotiation. December, 2005. pp3-5. https://cb.hbsp.harvard.edu/cbmp/pl/48617073/48617093/06c629f5390553a669c4
b1774df3c77f
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Cohen, J. “The Ethics of Respect in Negotiation,” Negotiation Journal, April 2002, pp.115-120. http://onlinelibrary.wiley.com.ezp-prod1.hul.harvard.edu/doi/10.1111/j.1571-9979.2002.tb00254.x/pdf
Class #14 May 5 Complex Negotiations Read for class:
Lax, D. and Sebenius, J. “3-D Negotiations.” Harvard Business Review. Nov. 2003, pp. 65-74. https://cb.hbsp.harvard.edu/cbmp/pl/48617073/48617077/69a34d18c60d12e68033006c3c8c442a
Class #15 May 10 Read for class:
Cutcher-Gershenfeld, J. and Watkins, M. “Toward a Theory of Representation in Negotiation,” Negotiating on Behalf of Others Mnookin, R. H. and Susskind, L. E. (Eds.),1999, pp. 23-51.
Class #16 May 12 Dealing with Hard Tactics and Course Review
Harvard School of Public Health
HPM 255
PAYMENT SYSTEMS IN HEALTHCARE
Spring 2: March 23-May 13, 2015 Tuesday and Thursday 8:30 to 10:20 a.m.
Location: FXB G13 Instructor: Liz Seeley Email: [email protected] TAs: Megan McMenamin and Melanie Sottile Email: [email protected] Office Hours: by appointment I. Course Description and Objectives The admonition "Follow the money" is good advice to anyone seeking a deeper understanding of any health care system. Money is a major tool for shaping the delivery of health care, for both good and ill. And, in the US, the flow of money is often the mechanism by which health care policy is implemented. This course will follow the money as it flows through provider payment systems, and examine the effects of these flows on those who give, receive and pay for health care. It will also examine the broader health policy environment and review current and emerging issues and trends which will affect the flow of money in the future. Topics will include policy and payment strategies for hospital care, physician services, prescription drugs and long term care. Guest speakers will provide a first-hand perspective on selected topics. Materials will include cases about a range of health care organizations and payers (hospitals, health plans, physician groups), supplemented by background readings. II. Learning Objectives The major objectives of the course are to provide students with:
1. Information about the different methods used to pay different types of providers; 2. An understanding of the impact of payment methods on the behavior of providers,
payers, purchasers and patients; 3. An understanding of how to assess and assign risk and accountability in payment
arrangements between health insurers and provider organizations; 4. An introduction to some of the major issues at the intersection of health policy and
provider payment; 5. Emerging innovations in payment and direction of payment reform; 6. The opportunity to develop skills in policy analysis and critical thinking.
III. Methods of Evaluation
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Grades will be based on the following four elements:
1. Risky Business Presentation/Memo 25% Due Tuesday, April 5, 2016 2. Germany drug case 25% Due: Thursday, April 21, 2016 3. Projects 40% Due: Tuesday, May 10, 2016 4. Class Participation 10%
IV. Assignments Descriptions of the assignments can be found at end of the syllabus. V. Readings Most course readings are available on the web and the syllabus contains links to them. The syllabus and other readings and cases are posted on the course iSite. In addition to the required readings, some supplementary resources have been identified for those who want to go into a topic in more detail.
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VI. Class Sessions
Class Day Date Title 2015 Assignment 2015 Instructor 2015
1. Tues March 22 Basics of Payment: Hospitals Seeley
2. Thurs March 24 Basics of Payment: Physicians and Post-Acu Care Providers
Seeley
3. Tues March 29 Prices, Rates and Market Dynamics Seeley 4. Thurs March 31 HMO of Millbrook and Introduction
Guest: Nancy Turnbull Turnbull and Seeley
5. Tues April 5 Issues in Global Payment Guest: Karen Quigley
Risky Business case due
Karen Quigley
6. Thurs April 7 Innovations in Payment Systems in the US Guest: Belen Fraile
Fraile and Seeley
7. Tues April 12 Paying for Drugs: United States
8. Thurs April 14 Paying for Drugs: Other countries
Seeley
9. Tues April 19 Paying for Performance Guest: Norbert Goldfield
Norbert and Seeley
10. Thurs April 21 Paying for Drugs: Germany as a case study
Germany drug assignment due
Seeley
11. Tues April 26 The Ecosystem of Long Term Care Guest: Marva Serotkin, President and CEO of The Boston Home
Serotkin and Seeley
12. Thurs April 28 Risk Adjustment in Provider Payment Guests: Juliana Hart and Dr. Jamie Colbert, Verisk Health
Hart and Colbert and Seeley
13. Tues May 3 An In-depth look at ACOs and Provider risk bearing arrangements Guest: Dervilla McCann
McCann and Seeley
14. Thurs May 5 Dual Eligibles: Payment Innovations for Patients with Medicare and Medicaid Guest: Stephanie Giannetto, Commonwealth Care Alliance
Giannetto and Seeley
15. Tues May 10 Applying Behavioral Economics to Provide Payment Guest: Jeff Levin-Scherz, MD
Projects Due
Levin-Scherz and Seeley
16. Thurs May 12 Dental Case and Wrap Up Seeley
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Session 1: Tuesday, March 22 Introduction and Basics of Payments:
Hospitals Goal for the session: To provide an overview of the course and to get a sense of the background, interests and goals of students. To give an overview of Medicare’s major methods of payments for inpatient and outpatient hospital care. To illustrate the perverse incentives in the current payment system with regard to quality and efficiency of care delivery. Please also come to class prepared to discuss the following questions:
1. What should be the goals of a well-designed provider payment system? 2. Based on your personal and professional experiences, how well are current provider
payment methods in health care serving the needs of: - consumers and patients - purchasers (e.g., employers, governments) - providers - payers (e.g., health plans)?
3. In what specific ways have you seen provider payment affect the cost and quality of medical care (in both good and bad ways)?
Readings for sessions 1-2:
1. Barnes, Julie. "Moving Away From Fee-for-Service." The Atlantic. N.p., 7 May 2012. Web. 22 Mar. 2013. http://www.theatlantic.com/health/archive/2012/05/moving-away-from-fee-for-service/256755
2. Brill, Steven. "Bitter Pill: Why Medical Bills Are Killing Us." Time. Time, 4 Mar. 2013. Web. 22 Mar. 2013. http://ezp-prod1.hul.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=85760535&site=ehost-live&scope=site
Hospital Payment Readings
1. Medicare Payment Basics: Hospital Acute Inpatient Services Payment System. MedPAC, October 2015. http://medpac.gov/documents/payment-basics/hospital-acute-inpatient-services-payment-system-15.pdf?sfvrsn=0
2. Medicare Payment Basics: Outpatient Hospital Services Payment System. MedPAC, October 2015. http://medpac.gov/documents/payment-basics/outpatient-hospital-services-payment-system-15.pdf?sfvrsn=0
3. Medicare Payment Basics: Critical Access Hospitals Payment System. MedPAC, October 2015. http://medpac.gov/documents/payment-basics/critical-access-hospitals-payment-system-15.pdf?sfvrsn=0
4. Medicare Payment Advisory Commission. Report to Congress: Medicare Payment Policy. March 2016. Chapter 3, “Hospital Inpatient and Outpatient Services.” pp. 55-
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83. http://www.medpac.gov/documents/reports/march-2016-report-to-the-congress-medicare-payment-policy.pdf?sfvrsn=2
Session 2: Thursday, March 24 Basics of Payment: Physicians and Post-
Acute Care Providers Goal for the session: To give an overview of Medicare’s method of payment to physicians. We will use the Geographic Practice Cost index (GPCI) and the Sustainable Growth Rate to illustrate the politics involved in payment systems. This session will also discuss Medicare spending on post-acute care providers, and the distorted incentives under the current system. Readings: Physician Payment Readings
1. Medicare Payment Basics: Physician Services Payment System. MedPAC, October 2015. http://medpac.gov/documents/payment-basics/physician-and-other-health-professional-payment-system-15.pdf?sfvrsn=0
2. Medicare Payment Advisory Commission. Report to Congress: Medicare Payment Policy. March 2016. Chapter 4, “Physician and Other Health Professional Services,” pp. 93-115. http://www.medpac.gov/documents/reports/march-2016-report-to-the-congress-medicare-payment-policy.pdf?sfvrsn=2
Post-Acute Care Payment Readings
1. Medicare Payment Advisory Commission. Report to Congress: Medicare Payment Policy. March 2015. Chapter 7, “Medicare’s post-acute care: Trends and ways to rationalize payments,” pp. 159-175. Find it at: http://www.medpac.gov/documents/reports/chapter-7-medicare's-post-acute-care-trends-and-ways-to-rationalize-payments-(march-2015-report).pdf?sfvrsn=0
2. Medicare Payment Advisory Commission, Testimony before the Subcommittee on Health Committee on Ways and Means. (Washington: MedPAC, June 14, 2013). “Medicare post-acute care reforms.” pp. 1-16. Find it at: http://www.medpac.gov/documents/congressional-testimony/20130614_wandm_testimony_pac.pdf?sfvrsn=0
3. Mechanic, R. (February 2014). “Post-Acute Care — The Next Frontier for Controlling Medicare Spending.” The New England Journal of Medicine. 370;8 pp1-3. Find it at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1315607
Session 3: Tuesday, March 29 Price, Rate and Market Dynamics
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Goal for the session: To compare hospital and physician payment rates across payers and to explore the market dynamics that drive negotiations. We will also explore the implications of these payment rates on access to care for payers’ respective beneficiaries.
Assignment: Please come to class prepared to discuss the following questions
1. What are examples of market oriented strategies that could reduce hospital and physician prices?
2. What are examples of regulatory strategies that could reduce hospital and physician prices?
3. Given the current political and economic climate, which strategies (market oriented or regulatory) do you think would be the most effective?
Readings:
1. Neprash, H. and Chernew M. (December 2015). “Association of Financial Integration Between Physicians and Hospitals With Commercial Health Care Prices” JAMA Vol.175(12), pp.1932-9. http://archinte.jamanetwork.com.ezp-prod1.hul.harvard.edu/article.aspx?articleid=2463591
2. Burns, J “What Can Be Done to Counteract the Growing Power of Providers?” Managed Care Magazine, July, 2011. http://www.managedcaremag.com/archives/1107/1107.marketpower.html
3. Ginsburg, PB “Wide Variation in Hospital and Physician Payment Rates Evidence of
Provider Market Power.” Center for Study of Health System Change 2010. http://www.hschange.com/CONTENT/1162
4. Health Care Provider Price Variation in the Massachusetts Commercial Market: Results from 2011. Center for Health Information and Analysis. February 2013 http://chiamass.gov/assets/docs/r/pubs/13/relative-price-variation-report-2013-02-28.pdf
Assignment: Please read “The HMO of Millbrook” case and come to class prepared to discuss. Session 4: Thursday, March 31 Guest speaker: Nancy Turnbull
HMO of Millbrook
Goal for the session: We will explore issues around fee for service and capitation by analyzing and discussing the HMO of Millbrook case. Case: Read “The Case of the Risky Business” (see assignments at end of this syllabus) and come to class with any questions on this assignment, which is due on April 5.
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Session 5: Tuesday, April 5 Issues in Global Payment Guest Speaker: Karen Quigley, Aurora Consulting Group Assignment Due: Risky Business Case Goal for the session: Please come to class prepared to discuss your written assignment. Session 6: Thursday, April 7 Guest speaker: Belen Fraile
Innovations in Payment Systems in the US
Goal for the session: To provide an overview of the various payment reforms in the US that strive to improve the value of health care. This session will cover bundled payment, global payment, patient centered medical homes, Medicare’s Value-based Purchasing Program and CMS’ Readmissions Reduction Program.
Assignment: Please come to class prepared to discuss the following questions
1. What are the pros and cons of bundled payments versus global capitation?
2. Under what conditions do you feel a hospital would rather choose to participate in a bundled payment arrangement over global capitation? In global capitation over a bundled payment arrangement?
3. Do you feel hospital readmissions are an appropriate measure for CMS to target in
order to reduce costs and improve quality? 4. Do you feel reimbursement should be based on patient satisfaction surveys?
Readings:
1. Landon, B. Keeping Score under a Global Payment System New England Journal of Medicine 2012; 366:393-395 http://www.nejm.org/doi/full/10.1056/NEJMp1112637
2. CMS Bundled Payments for Care Improvement (BPCI) Initiative. http://innovation.cms.gov/initiatives/bundled-payments/
3. Painter, M. “Bundled Payment Across the U.S. Today: Status of Implementations and
Operational Findings.” Health Care Incentives Improvement Institute. http://www.healthreformgps.org/wp-content/uploads/HCI-IssueBrief-4-2012.pdf
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4. Cassidy A. “Health Policy Brief: Bundled Payments for Care Improvement Initiative,” Health Affairs, November 23, 2015. http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_148.pdf
5. Medicare Payment Basics: Accountable Care Organization: Payment Systems. MedPAC, October 2015. http://medpac.gov/documents/payment-basics/accountable-care-organization-payment-systems-15.pdf?sfvrsn=0
6. Forster, A. (August 2012) “Accountable Care Strategies: Lessons from the Premier Health Care Alliance’s Accountable Care Collaborative.” The Commonwealth Fund. Pp1-32. http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2012/Aug/1618_Forster_accountable_care_strategies_premier.pdf
7. January 2012. “Next Steps for ACOs. Will this new approach to health care delivery live
up to the dual promises of reducing costs and improving quality of care?” Health Affairs. Health Policy Brief. Pp 1-6. http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_61.pdf
8. Friedberg, M. et al. (February 2014). “Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care.” Journal of the American Medical Association. 311(8):815-25. http://jama.jamanetwork.com.ezp-prod1.hul.harvard.edu/article.aspx?articleid=1832540
Session 7: Tuesday, April 12 Paying for Drugs: The United States
Goal for the session: To provide an overview of the different pharmaceutical coverage and reimbursement policies for Medicare, Medicaid and private health plans in the US and to analyze the effects these policies have on spending, utilization and access.
Assignment: Please come to class prepared to discuss the following questions
1. What should be the goals of Medicare, Medicaid and private payers in constructing pharmaceutical payment policies?
2. What pharmaceutical cost containment policies have you seen your health insurer—whether private or public-- use and in what ways, if any, have they changed your purchasing behavior?
Readings:
1. Bruen B. and Young K. Kaiser Family Foundation Issue Brief. “What Drives Spending and Utilization on Medicaid Drug Benefits in States?” December 2014. http://files.kff.org/attachment/brief-what-drives-spending-and-utilization-on-medicaid-drug-benefits
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2. Duffant B and Garb A. 2014 Overview of the Specialty Drug Trend: Succeeding in the
Rapidly Changing US Market. IMS Health. Article available on course website.
3. Frederic R. Curtiss et al. What Is the Price Benchmark to Replace Average Wholesale Price (AWP)? Journal of Managed Care Pharmacy, September 2010 Vol. 16, No. 7, p. 492. http://www.amcp.org/data/jmcp/492-501.pdf
4. Rentmeester, CA. Rebates and Spreads: Pharmacy Benefit Management Practices and Corporate Citizenship. Journal of Health Politics, Policy & Law; Oct2008, Vol. 33 Issue 5, p943-963 http://ezp-prod1.hul.harvard.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=34467400&site=ehost-live&scope=site
5. National Association of State Medicaid Directors. Letter to Congress. October 28, 2014. http://medicaiddirectors.org/wp-content/uploads/2015/08/namd_sovaldi_letter_to_congress_10-28-14.pdf
Session 8: Thursday, April 14 Paying for Drugs: Approaches in Other Countries
Goal for the session: To understand the US’ successes and failures in pharmaceutical coverage and reimbursement policies compared to other developed countries according to the following parameters: utilization, access, equity, price, and industry friendliness.
Assignment: Please come to class prepared to participate in the following group discussion:
Your group has been invited to a meeting with U.S. Senator Sheldon Whitehouse, the senior senator from Rhode Island, and a member of the Senate Committee on Health, Education, Labor and Pensions. Senator Whitehouse wants to introduce legislation that improves pharmaceutical payment policy in the US. Drawing from your knowledge of the pros and cons of pharmaceutical payment across payers in the US, and the experience of other countries, what recommendations would you make to Senator Whitehouse?
Readings:
1. Puig-Junoy, J Impact of European pharmaceutical price regulation on generic price competition: a review. Pharmacoeconomics. 2010;28(8):649-63. http://link.springer.com.ezp-prod1.hul.harvard.edu/article/10.2165%2F11535360-000000000-00000
2. Davidoff, F. The Heartbreak of Drug Pricing, Annals of Internal Medicine. 5 June 2001;
134(11):1068-1071. http://annals.org.ezp-prod1.hul.harvard.edu/article.aspx?articleid=714551
3. Morgan, S. and Kennedy, J. “Prescription Drug Accessibility and Affordability in the United States and Abroad.” The Commonwealth Fund. June
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2010. http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2010/Jun/1408_Morgan_Prescription_drug_accessibility_US_intl_ib.pdf
4. Kalipso Chalkidou, Comparative Effectiveness Review Within the U.K.’s National
Institute for Health and Clinical Excellence. Commonwealth Fund Report Issue Brief, July 2009. http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2009/Jul/Chalkidou/1296_Chalkidou_UK_CER_issue_brief_717.pdf
5. Garber A. and McClellan M. 2007. “Satisfaction Guaranteed — “Payment by Results” for Biologic Agents” New England Journal of Medicine. 357; 16. Pg 1575-1577. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/pdf/10.1056/NEJMp078204
Session 9: Tuesday, April 19 Paying for Performance Guest Speaker: Dr. Norbert Goldfield, 3M Clinical and Economic Research Goals for the Session: To understand pay for performance reimbursement methods by analyzing recent proposed legislation. Readings: TBD Session 10: Thursday, April 21 Paying for Drugs: Germany as a Case Study Assignment Due: Drug Case
Goal for the session: To study the case of pharmaceutical reimbursement policy in Germany over the past decade and to understand the political, economic and other factors that influenced these recent changes in Germany.
Assignment: The case on pharmaceutical cost containment in Germany shows that over the past decade, Germany transitioned from one of the most supportive countries for pharmaceutical innovation to one of the most stringent purchasers of new drugs.
Please read the “Pharmaceutical Cost Containment in Germany” case come to class prepared to discuss the following questions,
1. How did these changes over the past decade come about? 2. What are the implications for pharmaceutical companies? 3. Can you envision any ways in which the pharmaceutical industry might have prevented
these policy changes? 4. How relevant are these recent changes in Germany to other countries?
Readings:
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1. Elizabeth Seeley and Marc Roberts. “Pharmaceutical Cost Containment in Germany: 2002-2012.” Harvard School of Public Health. Executive and Continuing Professional Education. (Posted on course iSite)
2. Henschke, C. et al. Structural changes in the German pharmaceutical market: Price setting mechanisms based on the early benefit evaluation. Health Policy. 2013 Mar;109(3):263-9. http://www.sciencedirect.com.ezp-prod1.hul.harvard.edu/science/article/pii/S0168851012003326
3. Gandjour, A. Reference Pricing and Price Negotiations for Innovative New Drugs:
Viable Policies in the Long Term? PharmacoEconomics (2013) 31:11–14 http://link.springer.com.ezp-prod1.hul.harvard.edu/article/10.1007%2Fs40273-012-0002-9/fulltext.html
4. Stock, S. et al. The Influence Of The Labor Market On German HealthCare Reforms.
Health Affairs 25, no. 4 (2006): 1143–1152. http://content.healthaffairs.org/content/25/4/1143.full
Session 11: Tuesday, April 26 The Ecosystem of Long Term Care Guest Speaker: Marva Serotkin, President and CEO of The Boston Home Goal for the session: To explore patient center medical homes and other innovative programs in the post-acute care setting, using the Boston Home as an example. Readings: In addition to the reading below, please also refer to the post-acute care readings from session 3. As we will learn in class, the Boston Home is not a traditional nursing home. However, for anyone who would like to read about payment systems issues affecting nursing homes in the US, additional resources have been posted on the course iSite.
1. The Kaiser Commission on Medicaid and the Uninsured. (September 2013). “Five Key
Facts about the Delivery and Financing of Long-Term Services and Supports.” Find it at: http://kaiserfamilyfoundation.files.wordpress.com/2013/09/8474-02-five-key-facts-about-the-delivery-and-financing.pdf
2. Mechanic, R. (February 2014). “Post-Acute Care — The Next Frontier for Controlling Medicare Spending.” The New England Journal of Medicine. 370;8 pp1-3. Find it at: http://www.nejm.org/doi/pdf/10.1056/NEJMp1315607
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Session 12: Thursday, April 28 Risk Adjustment in Provider Payment Arrangements Guest Speakers: Juliana Hart and Dr. Jamie Colbert, Verisk Health Goal for the session: To understand the critical importance of risk adjustment in certain provider payment methods and some of the major risk adjustment methods, and their strengths and weaknesses. Required Readings:
1. Ash, A. and Ellis, R. Risk-adjusted Payment and Performance Assessment for Primary Care. Medical Care. 50;8 pp 643-653. August 2012. http://www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu/pmc/articles/PMC3394905/
2. Milliman, Inc. Risk Adjustment and Its Application in Global Payment to Providers. Prepared for the Massachusetts Medical Society. July 18, 2011. Available at: https://www.massmed.org/Advocacy/Key-Issues/Payment-Reform/Risk-Adjustment-and-its-Applications-in-Global-Payments-to-Providers-%28pdf%29/
3. Siegel, M. Moving from Volume to Value with Risk-Adjusted Base Payment Models. Verisk Health White Paper. 2014. (Posted on course isite)
Supplemental Readings:
4. Milliman, Inc. Risk adjustment: Important considerations for global payments to providers, July 2011. http://www.massmed.org/Advocacy/Key-Issues/Payment-Reform/Risk-Adjustment--Important-Considerations-for-Global-Payments-(pdf)/
5. Verisk Health, Inc. Medicare Risk Adjustment Models: DxCG Risk Solutions vs. CMS-
HCC, 2012. (Posted on course isite)
6. Healthcare Transformation Task Force. July 2015. Proactively Identifying the High Risk Population. White Paper. Available on the course canvas site.
7. Haas L. and Takahashi P. (September 2013). “Risk-Stratification Methods for Identifying
8. Patients for Care Coordination” The American Journal of Managed Care. Volume 19: 9. Pg 725-735.
Session 13: Tuesday, May 3 An In-depth Look at ACOs and Provider Risk Bearing Arrangements Guest Speaker: Dervilla McCann Goal for the session: To understand and analyze the transformation process a provider must undergo in becoming a successful ACO. Using an ACO in Maine as an example, this session will focus on the importance of information systems, relationships with physicians, care management programs and community engagement.
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Assignment: Please read through the materials on the ACO in Maine and come to class prepared to discuss. Readings: TBD
Session #14: Thursday, May 5 Dual Eligibles: Payment Innovations for Patients with Medicare and Medicaid Guest Speaker: Stephanie Giannetto, Commonwealth Care Alliance
Goal for the session: To gain an understanding of cutting-edge health reform initiatives aimed at controlling costs and improving care for one of America’s most complex and expensive populations: Dual Eligibles. “Dual-eligibles” are a growing group of patients that qualify for both Medicaid and Medicare due to disability, low income, and/or advanced age. Due to gaps in care and coordination between the U.S. government’s two largest payers, duals are at-risk for high cost and low value medical care. During today’s lecture, you will learn what States are doing to develop innovative, integrated care programs for dual eligibles, and how payment reform played a critical role in the process. Assignment: Please come to class prepared to discuss the following.
1. Who are “dual eligibles” and why is care so expensive? 2. What are the opportunities for cost-savings and care improvement? 3. Explain how recent payment policy reform(s) changed the game in favor of integrated
care for dual eligibles. 4. Investigate State-level approaches for financing the care of dual eligibles. 5. Explore the resulting care delivery innovations. 6. What are the benefits and challenges of leveraging the private insurance market to unify
two major government payers? Readings:
1. Medicare Payment Advisory Commission, A Data Book: Health care spending and the Medicare program. Chapter 4; “Dual Eligibles.” June 2015. http://www.medpac.gov/documents/data-book/june-2015-databook-health-care-spending-and-the-medicare-program.pdf?sfvrsn=0
2. Meyer, H. “The Coming Experiments in Integrating and Coordinating Care for Dual
Eligibles.” Health Affairs. 31;6 pp.1151-1155. June 2012. http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/content/31/6/1151.full.pdf+html
3. Musumeci, M.B. “Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS.” The Kaiser Commission on Medicaid and the Uninsured. July
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2014. https://kaiserfamilyfoundation.files.wordpress.com/2014/07/8426-06-financial-alignment-demonstrations-for-dual-eligible-beneficiaries-compared.pdf
4. Crowe, J. “How Competitive Private Plans Can Improve Care for Dual-Eligible
Beneficiaries of Medicare and Medicaid.” The Heritage Foundation Backgrounder. No. 2925. July 10, 2014. http://thf_media.s3.amazonaws.com/2014/pdf/BG2925.pdf
Recommended:
1. Reaves, E. et al. “Faces of Dually Eligible Beneficiaries: Profiles of People with Medicare and Medicaid Coverage.” The Henry J. Kaiser Family Foundation. July 2013. https://kaiserfamilyfoundation.files.wordpress.com/2013/07/8446-faces-of-dually-eligible-beneficiaries1.pdf
Session 15: Tuesday, May 10 Applying Behavioral Economics to Provider Payment Guest Speaker: Jeff Levin-Scherz, HSPH Department of Health Policy & Management Assignment Due: Final Papers Goals for the session:
1. Explain the precepts of behavioral economics, using examples from inside and outside health care
2. Assess how these precepts help explain provider response to proposed and actual payment shifts
3. Illustrate how health care planners can use behavioral economics concepts to design more effective payment and incentive systems
Assignment: Please come to class prepared to discuss the following questions
1. Do penalties or rewards motivate people more? 2. What type of reward will be most likely to motivate a patient or a physician? 3. Is “choice” always good? (When is choice bad?) 4. What is libertarian paternalism? 5. What is choice architecture?
Required Readings:
1. Ezekiel A, Ubel P, Kessler J et al 2016. “Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.” Ann Intern Med. 164(2):114-119. http://annals.org.ezp-prod1.hul.harvard.edu/article.aspx?articleid=2471601
2. Lowenstein, G, Asch, DA, Volpp KG “Behavioral economics holds potential to deliver better results for patients, insurers, and employers.” Health Aff (Millwood)2013, 32: 1244-50 http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/cgi/pmidlookup?view=long&pmid=23836740
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3. Glasziou PP, Buchanan, H, Del Mar, C, Doust J et al “When financial incentives do more good than harm: a Checklist” BMJ 2012;345:e5047 http://www.bmj.com.ezp-prod1.hul.harvard.edu/content/345/bmj.e5047.pdf%2Bhtml
Optional resources: For anyone who wants to do more reading on behavioral economics, we have posted a list of additional recommendations from Jeff on the course site under the Supplementary Reading tab.
Session 16: Thursday, May 12 Dental Case Wrap Up & The Future
Goal of this session: To apply the various payment methodologies the course has covered to a case on reimbursement for dental care. There will also be an opportunity to discuss unanswered questions and issues, and assess likely future trends in provider payment.
1. Snyder A. and Kanchinadam K. March 24, 2015. “A Check-Up On Dental Coverage and The ACA” Health Affairs blog. http://healthaffairs.org/blog/2015/03/24/a-check-up-on-dental-coverage-and-the-aca/.
Assignment #1 The Case of Risky Business Description The goal of this assignment is to evaluate the issues that arise in contracting in a global capitation environment and understand goals and strategies from three perspectives:
• the health plan (potential agreement with two different physician organizations) • a physician group that would provide significant benefit to the plan by participating • a physician group that is currently participating and has some concern if it does not
continue to participate
To evaluate the potential contractual agreements:
1. Read the case and analyze the issues from the point of view of the plan and each of the two physician groups. The issues include: • Potential volume growth (members for the plan/patients for the physicians) • Ability to retain current volume (members for the plan/patients for the physicians) • Competitive issues • Clinical challenges and the ability to manage care • Contract: financial issues (i.e. will the potential contractual agreement likely improve,
be a neutral, or be negative for the financial performance of each organization?)
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2. Write a 3-page paper describing your analysis of the issues from each of the perspectives outlined above (health plan and the two physician groups); the pros and cons of the proposal presented by the plan to each group; what changes might be negotiated; and your assessment of what the optimal terms would be to create a positive outcome for the plan and for each of the physician groups. The positive outcome could be either moving forward with a contract or not moving forward with a contract.
3. The paper is due on April 5th and needs to be submitted at the beginning of the class session on that day. We will discuss the case in class. Please be prepared to outline the issues each organization faces, their options, and the potential for different outcomes in negotiations.
Assignment #2 Drug Policy in Germany
The case, “Pharmaceutical Cost Containment in Germany” shows that over the past decade, Germany transitioned from one of the most supportive countries for pharmaceutical innovation to one of the most stringent purchasers of new drugs.
Please read the case and prepare, and bring to class, a written paper no longer than 4 double-spaced pages that answers the following questions,
1. How did these changes over the past decade come about? 2. What are the implications for pharmaceutical companies? 3. Can you envision any ways in which the pharmaceutical industry might have prevented
these policy changes? 4. Pick a country with which you are most familiar and discuss how relevant these recent
changes in Germany are to that country.
The paper is due on April 21nd and needs to be submitted at the beginning of the class session on that day. We will discuss the case in class. Assignment #3 Final Papers Final papers are due on Tuesday, May 10th. This project will give you an opportunity to research a provider payment issue that is of interest to you.
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• Pair up with another student in the class. (If you would like to do an individual project or work in a group larger than 2 students, you must get Liz’s approval. No groups larger than 3 will be approved.)
• Pick a provider payment method or issue of interest to you. This could include:
--An innovative method of payment --Developing a method of payment for a new service or technology --Exploring the current payment methods and issues for a type of care that has not been covered in class (e.g., mental health care, nursing home care, home health care, hospice) Your topic should be narrow and specific enough that you can explore it in some detail. As part of preparing the paper, we strongly encourage you to talk to someone who is involved in the issue (e.g., a provider group, a health plan, a drug or device manufacturer, a government official). Your topic and approach must be approved by Liz no later than April 19.
• The final product will be a paper of no more than 12 double-spaced pages (excluding
footnotes and any appendices). • The form of the paper will vary depending on your topic. However, in general, your paper
should cover the following topics:
• A brief overview of the provider payment issue, and why it is important • Discuss the evidence that exists for the effect that this method of payment has on
promoting efficiency and quality or, if the method is not in use yet and no evidence exists, what are the goals of this payment method.
• Summarize the pros and cons of the method in terms of promoting efficiency and quality. • Discuss how the delivery system is structured to manage this form of payment now, and
if not structured for successful management, what would it take to move the system? • What issues have arisen around the payment method within the provider community? • Any suggestions you have to adjust the payment method, with supportive arguments. • Should this payment method be used in the future?
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HPM 260 Health Economics with Applications to Global Health Policy
Summer 2016, Online
Purpose of this Course Economic thinking plays an important role in health policy at all levels. Patients, clinicians, and firms involved in the health sector make decisions and act in part based on economic incentives, which are often manipulated to achieve policy goals. There is an underlying logic and a language to economics that is critical to understand in order to make sense of and influence policy. Knowledge of economic concepts can also help a wide variety of stakeholders and participants in the health care sector dissect, debunk and advocate for and against specific proposals. In effect, this course is intended to be “conversational” economics for health policy stakeholders.
Course Description Students will learn how to analyze current health policy issues through the application of basic economic principles. No previous economics training is required. The course will begin with an introduction to health economics. The concepts we will be learning are widely generalizable to both industrialized and developing country contexts and students are encouraged to learn from and teach each other about the different health systems of which participants have experience. Among the topics we will discuss are health insurance coverage, physician payment incentives, consumer decision making, and competition.
Diversity and inclusiveness are fundamental to public health education and practice. It is a requirement that you have an open mind and respect differences of all kinds. I share responsibility with you for creating a learning climate that is hospitable to all perspectives and cultures; please contact me if you have any concerns or suggestions.
Course Objectives Upon successful completion of this course, you should be able to:
Recognize economic issues as they arise in health care practice and health policy around the world
Critique and form economic arguments for and against particular health policies Describe key economic concepts including efficiency, asymmetric information, agency,
moral hazard, and adverse election Compare the appropriateness and economic impact of health care financing and
payment policies used in different settings around the world
Pre-Requisites None
Credits 2.5 credits
Instructor Information General questions can be posted to the discussion board or sent by email to the teaching staff. Responses can be expected within 48 hours of posting.
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Faculty Meredith Rosenthal, Ph.D. Professor of Health Economics and Policy, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health Email: [email protected] Teaching Assistants Simiao Chen Doctoral Candidate in Department of Global Health and Population, Harvard T.H. Chan School of Public Health Email: [email protected] Noah Haber: Doctoral Candidate in Department of Global Health and Population, Harvard T.H. Chan School of Public Health Email: [email protected] Curriculum Fellow Jennifer Stuart Doctoral Candidate in Epidemiology, Harvard T.H. Chan School of Public Health Email: [email protected]
Optional Seminars Teaching assistants will hold synchronous seminars every Thursday and Sunday. The timing will vary each week to accommodate differing student schedules. In these interactive sessions the teaching assistants will review the week’s material, expand on a few points, and answer any other questions you may have. Although these seminars are optional, it is strongly recommended that you join one or watch a recording later. The Blue Jeans links for the seminars will be posted on the Overview page for each week.
Course Structure and Assessment of Learning This is an online course that includes synchronous and asynchronous components. It will be composed of weekly video lectures, weekly homework quizzes, various participation components (synchronous and asynchronous), an essay, and a final project. Course materials include:
Selected readings (see the course schedule at the end of this document for more detail)
Selected videos (see the course schedule at the end of this document for more detail)
In general, the weeks for the course will run from Wednesday through Tuesday. At the beginning of the course, the materials for the first three weeks will be posted; and then one additional week of material will be posted each week after that. This will allow you to work ahead of time if you know that you will be travelling or have other conflicts. The final grade for this course will be based on:
Weekly homework quizzes (20%)
Participation (30%)
Essay (20%)
Final project (30%) Weekly Videos (Ungraded)
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Each week, you will view a sequence of recorded lecture videos on a specific topic. The weekly topics are embedded into six modules, which are described in the course schedule at the end of this document. The total length of the videos for each week is between one and two hours. Weekly Homework Quizzes (20%) There will be a total of 5 graded weekly homework quizzes. These multiple-choice quizzes are designed to help you apply the concepts covered in the lecture videos and the required readings. Quizzes will be due on Tuesdays at 11:59 pm EDT. Participation (30%) Participation will be broken into three components, worth 10% each: discussion, Oregon case study, and price transparency exercise. Discussion Prior to the first week of class, you will be assigned to a discussion group with 4-5 of your peers. Your group will have its own Canvas discussion board where you will discuss a prompt related to the subsequent week’s topic. This prompt is meant to gauge your initial thoughts and background knowledge. You will be assigned one week to serve as your group’s discussion moderator and report out to the class discussion board. Moderators must post to the class discussion board by Tuesdays at 11:59 pm EDT. Oregon case study After reading the Harvard Kennedy School’s case on the Oregon health insurance experiment, you will be required to attend one of two synchronous sessions led by the teaching staff. In these sessions we will explore the discussion questions that accompany the case study. Discussion will be focused on big picture issues such as what the findings from the Oregon health insurance experiment suggest about the arguments in favor and in opposition to universal health coverage. The synchronous session will occur on Thursday, July 14, 2016 and Sunday, July 17, 2016. If you are unable to attend either synchronous session, you must answer a set of discussion questions related to the case and submit them by Tuesday, July 19, 2016 at 11:59 pm EDT. Price transparency exercise For this exercise, you will need to find the amount you would have to pay out of pocket to get an echocardiogram at the hospital or physician office you regularly visit for primary care – or a nearby one if you don’t have one. In a few sentences (no more than a paragraph) describe what you did and what you learned. This exercise will be due on Tuesday, July 26, 2016 by 11:59 pm EDT. Essay (20%) Students will be presented with a policy scenario and asked to identify and describe the economic issues inherent in the scenario and make recommendations based on economic intuition. Essays are limited to 3 pages double-spaced, one-inch margins and at least 11-point font. The essay will be due on Tuesday, August 2, 2016 by 11:59 pm EDT. Final Project (30%)
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You will be required to submit a final project, worth 20%, and a critique of a peer’s final project, worth 10%. The purpose of the final project is to allow you to frame a specific problem in health policy in economic terms, use data to describe the problem, and identify potential solutions that leverage what you have learned about demand and supply in the health care context. The final project, in the form of a 3-minute video, will be due on Tuesday, August 16, 2016 by 11:59 pm EDT. The peer critique will be entered into a structured critique form on Canvas and will be due on Friday, August 19, 2016 by 11:59 pm EDT. The final project must be completed by you individually, and may not be discussed with any other students, including those in your discussion group. Learning Objectives Evaluation Survey (Ungraded) At the end of each week, you will be asked to complete a brief learning objectives evaluation survey. These surveys will help us evaluate whether the learning objectives are met and identify topics that may need additional clarification.
Technical Information Assistance Canvas If the issue is Canvas-related (e.g., you can’t figure out how to use something or a feature seems broken), first try the documentation located under the Help menu in the upper right-hand corner of Canvas. If the issue is not covered there, contact Instructure directly, also via the Help menu. You can e-mail, text, or speak live with them at any time day or night. If you cannot access Canvas to view the Help menu, you can reach Instructure by phone at +1 (844) 326-4466. Blue Jeans For help with Blue Jeans for video conferencing, first check the tutorials and online help at http://bluejeans.com/support. The Chan School has a priority service support plan in place with Blue Jeans. To access priority support, call the company at 408-698-8198 (worldwide access), or 866-613-4030 (Canada and 48 continental US states). Harvard-Specific Issues If the issue seems Harvard-specific (e.g., HUID or myHarvardChan/Novell username authentication, email not working, etc.), contact the Helpdesk at mailto:[email protected] or +1 (617) 432-4357. Other If you are unsure where to turn but think the issue is related to technology or the course lecture videos, contact the Helpdesk as noted above. Technical Requirements
• Current Mac or PC (less than 3 years old; Mac Mavericks OS 10.9 or Windows 7 operating system)
• High-speed internet connection (e.g., cable, DSL, corporate LAN)
• Modern and updated web browser (e.g., recent versions of Firefox, Chrome, or Internet Explorer)
• Web camera and microphone (integrated into computer or USB peripheral)
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Please note that while it is possible to access most of the course materials via mobile and wireless devices, video conferencing and other bandwidth-intensive sessions will have the greatest reliability on a wired high-speed connection.
Course Evaluation Completion of the evaluation is a requirement for each course. Your grade will not be available until you submit the evaluation. In addition, registration for future terms will be blocked until you have completed evaluations for courses in prior terms.
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Course Schedule Topics Objectives Readings/Videos Assignments/Activities
Module 1: Introduction to economics and health economics (Meredith Rosenthal)
Week 1: July 6 – July 12
Applying economics to health policy
Practicing the theory of demand for health care
Practicing the theory of supply for health care
Market function and market failure
Upon successful completion of this week, you should be able to:
1. Explain the basic idea of the theory of demand
2. Explain the basic idea of the theory of supply
3. Describe the underlying theory of behavior from which demand and supply is derived
4. Discuss the precise economic concept of market failure and why it matters to health policy
5. Identify the key departures from standard economics that health and health care require
Refresher
Khan Academy: Introduction to Economics video
Khan Academy: The Demand Curve video
Khan Academy: The Supply Curve video
The Economics of Demand handout [available on Canvas page]
The Economics of Supply handout [available on Canvas page]
Required
Savedoff, William D. "Kenneth Arrow and the Birth of Health Economics." Bulletin of the World Health Organization 82.2 (2004): 139-140.
Recommended
Haas-Wilson, Deborah. "Arrow and the information market failure in health care: the changing content and sources of health care information." Journal of Health Politics, Policy and Law 26.5 (2001): 1031-1044.
Arrow, Kenneth J. "Uncertainty and the welfare economics of medical care." The American economic review 53.5 (1963): 941-973.
Homework quiz 1
Due by 07/12 at 11:59 pm EDT
Participation: health insurance discussion
Due by 07/12 at 11:59 pm EDT
Learning Objectives Evaluation Survey
Due by 07/12 at 11:59 pm EDT
Optional seminars
07/07 at 6:00 pm EDT
07/10 at 10:00 am EDT
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Module 2: Health insurance (Meredith Rosenthal and Gunther Fink) Week 2: July 13 – July 19
Health insurance
o Risk aversion and insurance
o Adverse selection
o Moral hazard
o Key concepts review
Community-based health insurance
o Review of key health insurance concepts
o Introduction to community-based health insurance
o Burkina CBHI program: background and settings
o Burking CBHI program: impact
o Summary
Upon successful completion of this week, you should be able to:
1. Describe the basic concept of risk aversion
2. Describe the goal of insurance from an economic perspective
3. Identify the market failures – adverse selection and moral hazard – inherent in voluntary insurance schemes
Required
A Note on Risk Aversion [available on Canvas page]
A Note on Adverse Selection [available on Canvas page]
A Note on Moral Hazard [available on Canvas page]
“Expanding Health Insurance to Millions: Learning from the Oregon Health Insurance Experiment.” Harvard Kennedy School Case #799.
Robyn, Paul J., et al. "Health Insurance and Health-Seeking Behavior: Evidence from a Randomized Community-Based Insurance Rollout in Rural Burkina Faso." Social Science & Medicine 75.4 (2012): 595-603.
Recommended
Fink, Günther, et al. "Does Health Insurance Improve Health?: Evidence from a Randomized Community-Based Insurance Rollout in Rural Burkina Faso." Journal of Health Economics 32.6 (2013): 1043-1056.
Homework quiz 2
Due by 07/19 at 11:59 pm EDT
Participation: Oregon case study live session
07/14 at 7:00 pm EDT
07/17 at 9:00 am EDT
Participation: consumer decision making discussion
Due by 07/19 at 11:59 pm EDT
Learning Objectives Evaluation Survey
Due by 07/19 at 11:59 pm EDT
Optional seminars
07/14 at 8:00 pm EDT
07/17 at 10:00 am EDT
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Module 3: Consumer decision making (Jessica Cohen and Anna Sinaiko)
Week 3: July 20 – July 26
Free distribution or cost-sharing? Evidence from a randomized malarial prevention experiment
o Pricing for public health products
o Arguments for and against cost-sharing
o Randomized malaria prevention experiment: background
o Randomized malaria prevention experiment: results
o Conclusions
Price transparency: a strategy to improve value in health care?
o The case for health care price transparency
o Price transparency challenges
o Early evidence
o Reference-based pricing benefit design
o Summary and future directions
Upon successful completion of this week, you should be able to:
1. Identify inconsistencies between the assumptions required for consumer choice to be efficient and the realities of health care
2. Examine the role of consumer prices — including subsidies and cost sharing — in achieving specific policy goals
3. Summarize the theoretical arguments for and practical challenges to achieving meaningful price transparency in the health care sector
Required
Cohen, Jessica, and Pascaline Dupas. “Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment.” Quarterly Journal of Economics 125.1 (2010): 1-45.
Sinaiko, Anna D., and Meredith B. Rosenthal. “Increased Price Transparency in Health Care – Challenges and Potential Effects.” New England Journal of Medicine 364 (2011): 891-894.
Robinson, James C., and Timothy T. Brown. "Increases in Consumer Cost Sharing Redirect Patient Volumes and Reduce Hospital Prices for Orthopedic Surgery." Health Affairs 32.8 (2013): 1392-1397.
Homework quiz 3
Due by 07/26 at 11:59 pm EDT
Participation: price transparency
Due by 07/26 at 11:59 pm EDT
Participation: provider payment discussion
Due by 07/26 at 11:59 pm EDT
Learning Objectives Evaluation Survey
Due by 07/26 at 11:59 pm EDT
Optional seminars
07/21 at 6:00 pm EDT
07/24 at 11:00 am EDT
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Module 4: Provider payment (Jasmin Kantarevic and Martin Roland)
Week 4: July 27 – August 2
Physician payment reform: theory and evidence from Ontario
o Overview
o Institution background
o Conceptual framework
o Empirical framework
o Selected evidence
What is the place of pay for performance in health care: the UK's experience of the Quality and Outcomes Framework (QOF)
o Variation in the quality of care
o Payment systems and the delivery of health care
o UK experience of P4P in primary care
o Introducing P4P
o Interview
Upon successful completion of this week, you should be able to:
1. Describe the major types of provider payment methods including “value-based” approaches
2. Explain the principles of incentive design
3. Analyze the likely effects and potential adverse consequences of alternative payment approaches
Required
Hutchison, Brian, and Richard Glazier. "Ontario’s Primary Care Reforms have Transformed the Local Care Landscape, but a Plan is Needed for Ongoing Improvement." Health Affairs 32.4 (2013): 695-703.
Roland, Martin, and R. Adams Dudley. "How Financial and Reputational Incentives Can Be Used to Improve Medical Care." Health Services Research 50.S2 (2015): 2090-2115.
Roland, Martin, and Stephen Campbell. "Successes and Failures of Pay for Performance in the United Kingdom." New England Journal of Medicine 370.20 (2014): 1944-1949.
Recommended
Kralj, Borsin, and Jasmin Kantarevic. “Quality and Quantity in Primary Care Mixed-Payment Models: Evidence from Family Health Organizations in Ontario.” Canadian Journal of Economics 46.1 (2013): 208-238.
Robinson, James C. “Theory and Practice in the Design of Physician Payment Incentives.” Milbank Quarterly 79.2 (2001): 149-177.
Gosden, Toby, et al. "Capitation, Salary, Fee-for-Service and Mixed Systems of Payment: Effects on the Behaviour of Primary Care Physicians." Cochrane Database of Systematic Reviews 3.3 (2000).
Homework quiz 4
Due by 08/02 at 11:59 pm EDT
Essay
Due by 08/22 at 11:59 pm EDT
Participation: Competition discussion
Due by 08/02 at 11:59 pm EDT
Learning Objectives Evaluation Survey
Due by 08/02 at 11:59 pm EDT
Optional seminars
07/28 at 8:00 pm EDT
07/31 at 10:00 am EDT
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Module 5: Competition (Leemore Dafny and Kurt Brekke)
Week 5: August 3 – August 9
Hospital competition
Reference pricing: the Norwegian case
o Financing of prescription drugs in Norway
o Norwegian RP scheme
o Lessons from Norwegian RP scheme
Upon successful completion of this week, you should be able to:
1. Identify the assumptions that are required for competition to occur
2. Describe the ways in which competition in health care is imperfect
3. Identify policy tactics for increasing competition in health care
Refresher
Khan Academy: Perfect Competition video
Khan Academy: Monopoly video
Khan Academy: Between Perfect Competition and Monopoly video
Required
Dafny, Leemore. "Hospital Industry Consolidation—Still More to Come?" New England Journal of Medicine 370.3 (2014): 198-199.
Dafny, Leemore S., and Thomas H. Lee. "The Good Merger." New England Journal of Medicine 372.22 (2015): 2077-2079.
Brekke, Kurt R., Tor Helge Holmas, and Odd Rune Straume. "Reference Pricing, Competition, and Pharmaceutical Expenditures: Theory and Evidence from a Natural Experiment." Journal of Public Economics 95.7 (2011): 624-638.
Homework quiz 5
Due by 08/09 at 11:59 pm EDT
Participation: Overuse of low-value care discussion
Due by 08/09 at 11:59 pm EDT
Learning Objectives Evaluation Survey
Due by 08/09 at 11:59 pm EDT
Optional seminars
08/04 at 6:00 pm EDT
08/07 at 11:00 am EDT
Module 6: Final project on overuse of low-value care (Meredith Rosenthal)
Week 6: August 10 – August 19
Defining and measuring overuse
Choosing Wisely
Assignment
Upon successful completion of this week, you should be able to:
1. Apply the economics of supply and demand to an important health policy problem
2. Use economics to frame a solution to a specific health policy concern
3. Identify the limits of economic incentives as policy instruments
Morden, Nancy E., et al. “Choosing Wisely—The Politics and Economics of Labeling Low-Value Services.” New England Journal of Medicine 370.7 (2014): 589-592.
Final project
Due by 08/16 t 11:59 pm EDT
Final project critique
Due by 08/19 at 11:59 pm EDT
Learning Objectives Evaluation Survey
Due by 08/19 at 11:59 pm EDT
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HPM 276s: Introduction to Methods and Applications in Health Services Research HSPH Building 4: François Xavier Bagnoud, Classroom G-12
July 2 – July 24, 2015, 3:30 – 5:15 p.m.
Contents Instructor .................................................................................................................................................. 2 Teaching assistant ..................................................................................................................................... 2 Office Hours ............................................................................................................................................. 2 Course Description ................................................................................................................................... 2 Learning Objectives ................................................................................................................................. 2 Text and Reading Materials ..................................................................................................................... 3 Evaluation/Grading .................................................................................................................................. 3 Class Schedule .......................................................................................................................................... 4 Session 1 (Thursday, July 2; 3:30-5:15pm) .............................................................................................. 4 Session 2 (Monday, July 6; 3:30-5:15pm) ............................................................................................... 4 Session 3 (Tuesday, July 7; 3:30-5:15pm) ............................................................................................... 5 Session 4 (Wednesday, July 8; 3:30-5:15pm) .......................................................................................... 6 Session 5 (Thursday, July 9; 3:30-5:15pm) .............................................................................................. 6 Session 6 (Friday, July 10; 3:30-5:15pm) ................................................................................................ 7 Session 7 (Monday, July 13; 3:30-5:15pm) ............................................................................................. 8 Session 8 (Tuesday, July 14; 3:30-5:15pm) ............................................................................................. 9 Session 9 (Wednesday, July 15; 3:30-5:15pm) ........................................................................................ 9 Session 10 (Thursday, July 16; 3:30-5:15) ............................................................................................... 9 Session 11 (Friday, July 17; 3:30-5:15pm) .............................................................................................. 9 Session 12 (Monday, July 20; 3:30-5:15pm) ......................................................................................... 10 Session 13 (Tuesday, July 21; 3:30-5:15pm) ......................................................................................... 11 Session 14 (Wednesday, July 22; 3:30-5:15pm) .................................................................................... 12 Session 15 (Thursday, July 23; 3:30-5:15pm)........................................................................................ 13 Session 16 (Friday, July 24; 3:30-5:15pm) ............................................................................................ 13 Instructions for the Midterm Exam ........................................................................................................ 13 Instructions and Guide for the Final Exam ............................................................................................ 14
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Instructor Joel S. Weissman, PhD Associate Professor (Health Policy) Harvard Medical School Deputy Director/Chief Scientific Officer Center for Surgery and Public Health Brigham and Women's Hospital/Harvard Medical School One Brigham Circle, 1620 Tremont Street, 4-020 Boston, MA 02120 Email: [email protected] Tel: 617-525-7727; Cell: 339-221 1263; efax: 831-301-7390 Asst: Lavere Foster, 617-525-7300, [email protected] http://www.brighamandwomens.org/csph
Teaching assistant Portia Cornell, MSPH Candidate, PhD Program in Health Policy Email: [email protected]
Office Hours Dr. Weissman will hold office hours on Mondays and Wednesdays from 5:30 – 6:30 pm in his office at the Center for Surgery and Public Health, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont Street, 4-020 (This is a 4-5 minute walk from HSPH). Additional time for consultation may be scheduled as needed.
Course Description This course will provide an introductory survey of methods commonly used in carrying out health services research. Individual sessions will focus on study design, analysis of large databases, assessment of quality of care, risk adjustment, cost effectiveness, assessment of appropriateness, use of focus groups and surveys, assessment of health-related quality of life, and practical issues in health services research. Course requirements include oral and written critiques of journal articles and grant applications, to be provided by the instructors. The course is designed to cover a broad range of topics at an introductory level.
Learning Objectives The main objective is to familiarize students with a repertoire of methods that are often encountered in the conduct of health services research or in the academic literature. The topics we will touch upon include: the basics of study design; assessment of quality of care; conduct of focus groups and survey research; measurement of race, ethnicity and socioeconomic status; assessment of health status; and risk adjustment. The course will not provide an actual research experience. Students can use the lessons and material gleaned from this course as a springboard to explore these and other methods in depth for their own efforts in applied research.
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Text and Reading Materials Students will be expected to read the assigned material in advance of each lecture and be prepared to discuss it. Only the articles marked with an asterisk * are required and will all be available either online or posted on the course Isite page. Please note: The additional readings are provided as useful reference for the interested reader to seek out and read on their own.
Evaluation/Grading In view of the goals of this course, grading will be based on a two written assignments: 1) A Critical Review of one of two manuscripts for the mid-term exam (20%); and, 2) A written critique of a grant proposal, due on the last day of class (80%). The first assignment will be described in class. Instructions and expectations for the both assignments are in the last section of the syllabus. Grades also may be influenced by class participation.
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Class Schedule
Session 1 (Thursday, July 2; 3:30-5:15pm) Introduction to Health Services Research Lecturer: J. Weissman Topic: In the initial session, we will review course objectives, the format for future sessions,
and examination procedures. Dr. Weissman will give an overview of health services research and quasi-experimental design.
* Required Reading: * The Sage Encyclopedia of Social Science Research Methods. “Quasi-
Experiment.”Sage Publications. Thousand Oaks CA. 2004, pp. 898-902.
* Eisenberg, JM. 1998. "Health services research in a market-oriented health care system." Health Affairs (Project Hope) 17 (1): 98-108. http://content.healthaffairs.org.ezp-prod1.hul.harvard.edu/cgi/reprint/17/1/98
Additional Suggested Reading Kahn CR. Sounding board: Picking a research problem - The critical decision. N Eng J Med. 1994; 330(20): 1530-33. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/pdf/10.1056/NEJM199405263302113 This article suggests criteria for what constitutes a “good” and an “outstanding” research topic.
Session 2 (Monday, July 6; 3:30-5:15pm) Quality Measurement I Lecturers: J. Weissman; B. Landon, discussant Topic: This session will review ways in which quality can be assessed (structure, process,
outcome), the uses of implicit and explicit criteria, the advantages and disadvantages of these methods and the relationships among them. Additional attention will be devoted to current efforts to measure quality in the hospital or health plan setting.
* Required Reading:
* NQF: ABCs of Measurement - National Quality Forum http://www.qualityforum.org/Measuring_Performance/ABCs_of_Measurement.aspx
* Brook RH, McGlynn EA, Cleary PD. Quality of Health Care. Part 2: Measuring Quality of Care. N Engl J Med. 1996; 335: 966-70. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJM199609263351311
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Additional Suggested Reading: NQF: Measure Evaluation Criteria - National Quality Forum http://www.qualityforum.org/Measuring_Performance/Submitting_Standards/Measure_Evaluation_Criteria.aspx
Donabedian, A. 2005. "Evaluating the quality of medical care.” The Milbank quarterly 83 (4): 691-729.
http://www.jstor.org.ezp-prod1.hul.harvard.edu/stable/3348969?seq=1#page_scan_tab_contents
Blumenthal D. Part 1: Quality of Care – What is it? N Engl J Med. 1996; 335: 891-4. http://content.nejm.org.ezp-prod1.hul.harvard.edu/cgi/content/full/335/12/891
Allison, J.J., T.C. Wall, C.M. Spettell, J. Calhoun, C.A. Fargason Jr, R.W. Kobylinski, R. Farmer, and C. Kiefe. 2000. "The art and science of chart review." The Joint Commission journal on quality improvement. 26 (3): 115-36. http://bit.ly/1FSDGtG Mant J. Process versus outcome indicators in the assessment of quality of health care. Int J Qual Health Care. 2001; 13(6): 475-480. http://bit.ly/1JKOijV
Session 3 (Tuesday, July 7; 3:30-5:15pm) Survey Methods I Lecturers: J. Weissman; C. Desroches, discussant Topic: In this session, which is the first of two sessions on survey methods, we will describe
the concept of total survey design, introduce concepts of sampling and sample size, discuss how to use focus groups to develop questionnaire content, and begin to discuss how to write survey questions that are easily and consistently understood by respondents.
*Required Reading: * Aday, Lu Ann. Chapter 6. Deciding who will be in the sample. Chapter 7. Deciding how
many will be in the sample. In Designing and Conducting Health Surveys. 3rd edition. San Francisco, CA: Jossey-Bass, 2006; Chapter 6 pp. 124-141; Chapter 7 Skim only FYI: pp. 154-193.
Additional Suggested Reading Krueger RA, Casey MA. Chapter 2, “Planning the Focus Group Study,” Focus Groups: A Practical Guide for Applied Research. 3rd ed. Thousand Oaks, CA: Sage Publications; 2000; 21–37.
Krueger RA, Casey MA. Chapter 11, “Answering Questions About the Quality of Focus Group Research,” Focus Groups: A Practical Guide for Applied Research. 3rd ed. Thousand Oaks, CA: Sage Publications; 2000; 195–207.
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Session 4 (Wednesday, July 8; 3:30-5:15pm) Survey Methods II Lecturers: C. Desroches; J. Weissman Topic: In this second session on survey methods, we will continue the review of how to
compose good survey questions, the principles to keep in mind when developing response scales, and considerations related to survey administration.
* Required Reading:
* Groves RM, Fowler FJ, Couper MP, Lepkowski JM, Singer E, Tourangeau R. Chapter 7. Questions and Answers in Surveys. Survey Methodology. New Jersey: John Wiley and Sons, 2004; p. 201-213.
Additional Suggested Reading:
Fowler, Floyd J., Jr. Survey Research Methods Chapter 6. Designing questions to be good measures. Chapter 7. Evaluating survey questions and instruments. Chapter 8. Survey Interviewing. Applied Social Research Methods Series. Volume 38. Thousand Oaks: Sage Publications, 4th edition, 2008; pp. 87-113; 115-126; 127-144.
Streiner DL & Norman GR. Health Measurement Scales. A Practical Guide to their Development and Use. 2nd edition. New York: Oxford Press, 1995, pp. 28-84.
Session 5 (Thursday, July 9; 3:30-5:15pm) Large Scale Administrative Database Methods Lecturers: D. Schrag; J. Weissman, discussant Topic: This session will consider use of large databases for evaluation of differences in
utilization, cost, quality and outcomes.
*Required Reading:
Please read the first two (Zhu et al. And Birkmeyer et al.) for class discussion. Please jsut skim the second two (Lentine et al. And Shahinian et al.).
*Zhu, J., D.B. Sharma, S.W. Gray, A.B. Chen, J.C. Weeks, and D. Schrag. 2012. "Carboplatin and paclitaxel with vs without bevacizumab in older patients with advanced non-small cell lung cancer." JAMA : the journal of the American Medical Association 307 (15): 1593-601. http://jama.jamanetwork.com/article.aspx?articleid=1148151
*Birkmeyer, J.D., A.E. Siewers, E.V. Finlayson, T.A. Stukel, F.L. Lucas, I. Batista,
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H.G. Welch, and D.E. Wennberg. 2002. "Hospital volume and surgical mortality in the United States." The New England journal of medicine 346 (15): 1128-37. http://www.nejm.org/doi/full/10.1056/NEJMsa012337
Lentine, K.L., M.A. Schnitzler, H. Xiao, G. Saab, P.R. Salvalaggio, D. Axelrod, C.L. Davis, K.C. Abbott, and D.C. Brennan. 2010. "Racial variation in medical outcomes among living kidney donors." The New England journal of medicine 363 (8): 724-32. http://www.nejm.org/doi/full/10.1056/NEJMoa1000950
Shahinian, V.B., Y. Kuo, and S.M. Gilbert. 2010. "Reimbursement Policy and Androgen-Deprivation Therapy for Prostate Cancer." N Engl J Med 363 (19): 1822-32. http://www.nejm.org/doi/full/10.1056/NEJMsa0910784
Additional Suggested Reading
Connell FA, Diehr P, Hart LG. The use of large databases in health care studies. Ann Rev Public Health 1987; 8: 51-74. [We recommend pages 51-65]. http://www.annualreviews.org.ezp-prod1.hul.harvard.edu/doi/abs/10.1146/annurev.pu.08.050187.000411 Ioannidis JP. Are mortality differences detected by administrative data reliable and actionable? JAMA. 2013 Apr 3;309(13):1410-1. http://jama.jamanetwork.com.ezp-prod1.hul.harvard.edu/article.aspx?articleid=1674216
Session 6 (Friday, July 10; 3:30-5:15pm) Quality Measurement II Lecturers: E. Schneider; J. Weissman, discussant Topic: This session will extend and reinforce the material presented in session 2. In addition
the session will review the foundations of assessing clinical appropriateness and applications to measuring underuse and overuse of medical services.
*Required Reading:
* Epstein AM, Weissman JS, Schneider EC, Gatsonis C, Leape LL, Piana RN. Race and Gender Disparities in Rates of Cardiac Revascularization: Do They Reflect Appropriate Use of Procedures or Problems in Quality of Care? Med Care. 2003; 41(11): 1240-1255. [We suggest that you read the introduction and methods section and skim the rest of the paper. Your goal should be to understand use of the methods]. http://bit.ly/1dxdsWT * Roth CP, Lim Y-W, Pevnick JM, Asch SM, and McGlynn EA. The Challenge of Measuring Quality of Care from the Electronic Health Record. Am J Med Qual 2009. Epub ahead of print. [Please skim to obtain general impression of the challenges]. http://ajm.sagepub.com.ezp-prod1.hul.harvard.edu/cgi/rapidpdf/1062860609336627v1
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* McGlynn EA. Choosing and evaluating clinical performance measures. Jt Comm J Qual Improv. 1998; 24(9):470-9.
Additional Suggested Reading:
Hemingway H, Crook, AM, Feder G, Bannerjee S, et al. Underuse of Coronary Revascularization Procedures in Patients Considered Appropriate Candidates for Revascularization. N Engl J Med 2001; 344: 645-654. http://bit.ly/1IGqpvg Schneider EC, Leape LL, Weissman JS, Piana RN, Gatsonis C, Epstein AM. Racial differences in cardiac revascularization rates: does ‘overuse’ explain higher rates among whites? Ann Intern Med, 2001; 135: 328-337. http://annals.org.ezp-prod1.hul.harvard.edu/article.aspx?articleid=714723 Park RE, Fink A, Brook RH, Chassin MR, et al. Physician ratings of appropriate indications for six medical and surgical procedures. Am J Pub Health 1986; 76(7): 766-772. http://bit.ly/1GzfBPd Shekelle PG, Kahan JP, Bernstein SJ, Leape LL, Kamberg CJ, Park RE: The reproducibility of a method to identify the overuse and underuse of medical procedures. N Engl J Med 1998; 338(26): 1888-1895. http://bit.ly/1KWHWwE Phelps CE. The methodologic foundations of studies of the appropriateness of medical care. N Engl J Med 1993; 329: 1241-1245. http://bit.ly/1e3CYUJ
Session 7 (Monday, July 13; 3:30-5:15pm) Cost-effectiveness Lecturers: J. Kim; J. Weissman , discussant Topic: This session will review cost-effectiveness and cost benefit analyses. The goal of this
session is to introduce the key methodological components such as calculation of costs, sensitivity analyses and discounting. At the end of the session, students should be able to develop basic cost-effectiveness analyses and critically review existing literature.
Required Reading:
* Weinstein MC, Stason WB. Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med 1977; 296(13): 716-721. http://bit.ly/1KWIC52
Additional Suggested Reading: Meltzer MI. Introduction to Health Economics for Physicians: Health Economics Quintet. The Lancet. 2001; 358: 993-998. http://bit.ly/1KtHsQo
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Session 8 (Tuesday, July 14; 3:30-5:15pm) Statistical Issues in Health Services Research Lecturers: F. Cook; J. Weissman, discussant Topic: This session will review the basic analytic techniques to control for biases and
confounding due to selection in health services research projects. Expanding on the commonly used techniques of stratification and modeling, methods based on propensity scores will be discussed.
*Required Reading:
* Lecture notes: Cook F. Statistical Issues in Health Services Research. Will be posted on course website.
Session 9 (Wednesday, July 15; 3:30-5:15pm) In Class Review Lecturers: J. Weissman, L. Nguyen, discussant
Session 10 (Thursday, July 16; 3:30-5:15) Midterm due Journal club on surveys and health status measurement Lecturer: J. Weissman, Discussant: P. Cornell (TA) Topic: The critical review of studies in health services research can be a useful tool for
developing your own research ideas and methods. For this session, you will be asked to read each of the two articles below and provide a critical review. Class discussion will cover these issues and focus on both articles. Please refer to the section below entitled, “Instructions for the Midterm Exam.”
Assigned Papers: “Delays Seeking Care: Predictors and Outcomes”
“Quality of Care in Teaching Hospitals.” WILL BE POSTED ON COURSE WEBSITE.
Session 11 (Friday, July 17; 3:30-5:15pm) Race, Ethnicity, and Socioeconomic Factors Lecturer: J. Weissman Topic: This session will explore the concepts of race, ethnicity, and socioeconomic factors in
health services research. Methods for measuring and analyzing these concepts will be discussed, along with their strengths and limitations.
* Required Reading: * Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, Posner S.
Socioeconomic Status in Health Research: One Size Does Not Fit All. JAMA 2005;
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294(22): 2879-2888. http://jama.ama-assn.org.ezp-prod1.hul.harvard.edu/cgi/content/full/294/22/2879 Additional Suggested Reading:
Adler, Nancy E., and William W. Stead. "Patients in context—EHR capture of social and behavioral determinants of health." New England Journal of Medicine 372.8 (2015): 698-701. http://bit.ly/1BZp9eS Arispe, I.E., J.S. Holmes, and E. Moy. 2005. "Measurement challenges in developing the national healthcare quality report and the national healthcare disparities report." Medical care. 43 (3 Suppl): I17-23. http://bit.ly/1JG07tk Krieger N, Williams D, Moss N. Measuring social class in US public health research. Annu Rev Public Health. 1997; 18:341-78. http://bit.ly/1JMI5WH Kaplan JB, Bennett T. Use of Race and Ethnicity in Biomedical Publication. JAMA. 2003; 289(20): 2709-2716. http://jama.jamanetwork.com.ezp-prod1.hul.harvard.edu/article.aspx?articleid=196632 National Quality Forum. Review of Draft National Quality Forum (NQF) Report: Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors http://www.qualityforum.org/risk_adjustment_ses.aspx Smedley, Stith, and Nelson, Eds. “Data Collection and Monitoring” Chap 7 in: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Institute of Medicine. National Academy Press, 2002. http://iom.nationalacademies.org/Reports/2002/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care.aspx Weissman JS, Betancourt JR, Carrillo JE, Green AR, Meyer GS, Tan-McGrory A, Nudel JD, Zeidman JA. Commissioned Paper: Healthcare Disparities Measurement. National Quality Forum (NQF), Washington DC. October 4, 2011, http://bit.ly/1FJtrJ9
Session 12 (Monday, July 20; 3:30-5:15pm) Using health status and outcomes in health services research Lecturers: J. Katz; J. Weissman, discussant Topic: This session will address health status and outcomes as assessed by the individual, and
examine why it has become so important in assessing population health status, monitoring health outcomes in clinical research and practice, as well as in risk management (e.g., the prediction of health care costs, work productivity and mortality). By the end of the session, students should be able to distinguish health status from patient satisfaction with care, identify important health outcomes, distinguish between generic and disease-specific measures, and state their strengths and weaknesses, know how each can be measured in terms of functioning and well-being, appreciate the importance of interpretation guidelines and other advantages of standardizing health
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status measures across applications and be familiar with the implications of recent advances in measurement models and computerized adaptive testing approaches to health assessment.
*Required Reading: * Ware JE, Jr. Conceptualization and measurement in health-related quality of life:
Comments on an evolving field. Archives of Physical Medicine and Rehabilitation.2003; 84: S43-S51.
http://www.archives-pmr.org/article/S0003-9993(03)00195-3/abstract
* Ware JE, Jr., Bayliss MS, Rogers WH, Kosinski M, Tarlov AR. Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. Results from the Medical Outcomes Study. JAMA. 1996; 276: 1039-47. [This article is an application and can be skimmed] http://jama.jamanetwork.com.ezp-prod1.hul.harvard.edu/article.aspx?articleid=408692
Additional Suggested Reading:
Robert L. Kane and David M. Radosevich. Conducting Health Outcomes Research. Jones and Bartlett Learning, LLC: Sudbury, MA 2010 Ware JE, Kosinski M, Bjorner JB, et al. Applications of computerized adaptive testing (CAT) to the assessment of headache impact. Quality of Life Research. 2003; 12(8): 935-52. http://link.springer.com.ezp-prod1.hul.harvard.edu/article/10.1023/A:1026115230284 Wilson IB, Cleary PD. Linking Clinical Variables with Health-Related Quality of Life: A Conceptual Model of Patient Outcomes. JAMA. 1995; 273(1): 59-65. http://jama.jamanetwork.com.ezp-prod1.hul.harvard.edu/article.aspx?articleid=385444
Session 13 (Tuesday, July 21; 3:30-5:15pm) Risk Adjustment and Severity of Illness Lecturers: L. Iezzoni; J. Weissman, discussant Topic: This session will present a conceptual framework for assessing severity of illness. It
will review the concept of risk adjustment, how one measures risk, and the implications of the methods for interpreting the results. The potential utility of severity measurement in quality assessment and reimbursement will be considered.
* Required Readings: * Iezzoni LI. Reasons for Risk Adjustment. (2013). In Risk Adjustment for Measuring
Health Care Outcomes. Iezzoni L (ed.), Chicago, Illinois: Health Administration Press. Fourth Edition. (p.1-14).
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* Iezzoni LI. Getting Started and Defining Terms. (2013). In Risk Adjustment for Measuring Health Care Outcomes. Iezzoni L (ed.), Chicago, Illinois: Health Administration Press. Fourth Edition. (p.15-28).
Session 14 (Wednesday, July 22; 3:30-5:15pm) Application of Health Services Research Methods in an Academic Teaching Center Lecturers: E. Mort; J. Weissman, discussant Topic: The goal of this session is to provide an overview of how a working knowledge of
health services research methods, and quality measurement in particular, is critical in the role of a physician manager/leader in an academic medical center. In this session, students will be asked to assume the role of a Chief Quality Officer in an academic medical center. You will be tasked with managing the hospital’s quality measurement and improvement “system”. The system must not only be responsive to the growing number of regulatory and contractual demands but must also drive improvement within the institution. In this case, comprehensive includes all six domains of quality described in the IOM’s scheme. Examples from a Boston teaching hospital and Partners Health Care network will be used in the discussion. Please read the review article by Fung and colleagues on the importance of public reporting on quality improvement. Keep in mind that the literature on the impact of public reporting and quality improvement is evolving.
* Required Readings:
* Fung CH, Lim Y-W, Mattke S, Damberg C, Shekelle PG. Systematic Review: The Evidence that Publishing Patient Care Performance Data Improves Quality of Care. Ann Intern Med 2008; 148:160-161. http://bit.ly/1B72pia
Additional Suggested Reading:
Lindenauer PK, Remus D, Roman S, Rothberg MB, Benjamin EM, Ma A, Bratzler DW. Public Reporting and Pay for Performance in Hospital Quality Improvement. N Engl J Med 2007; 356:486-96. http://content.nejm.org.ezp-prod1.hul.harvard.edu/cgi/content/full/356/5/486 Jha AK, Li Z, Orav J, Epstein AM. Care in US Hospitals – The Hospital Quality Alliance Program. N Engl J Med. 2005; 353: 265-74. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMsa051249#t=article Epstein AM. Performance Reports on Quality - prototypes, problems, and prospects. N Eng J Med. 1995, 333: pp 57-61. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJM199507063330114
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Session 15 (Thursday, July 23; 3:30-5:15pm) Practical Matters in HSR: Authorship, QI vs Research, Writing Grants Lecturers: J. Weissman, S. Weingart Topic: This session will address two practical matters in health services research: 1). Deciding
on authorship, especially when data are gathered from multiple sites. 2) Writing grants.
The first topic will be covered via use of the case study method. The second topic will be a guided discussion.
Required Readings:
To be distributed in class.
Additional Suggested Readings: Fan, Eddy, et al. "How to use an article about quality improvement." JAMA 304.20 (2010): 2279-2287. http://bit.ly/1JFWFim
Session 16 (Friday, July 24; 3:30-5:15pm) Review of Final Exam – Grant Critique Lecturer: J. Weissman, Discussant: P. Cornell (TA) Topic: The final exam will be reviewed in class.
Instructions for the Midterm Exam As noted above, you will be asked to read each of the two articles (which we will distribute in class) and choose one on which to write a critical review. For your review, please provide a brief summary of the article (maybe 5 sentences), then in bullet points, list its strengths and weaknesses. Focus in particular on issues of validity, the process of data collection and resources required, the generalizability of the findings, and the clinical and policy significance of the study.
Format Please limit yourself to 2 pages.
On the first page, include the title of the paper, the course title, your name(s), and the date. Papers should be limited to a maximum of two (2) pages single-spaced.
It is strongly suggested that you used “bullets” to make your points. Prose is not necessary. The purpose is mostly to determine if you recognize the strengths and weaknesses of the papers.
Papers should be typed; 12 point font is preferred.
Hard copy pages should be numbered, and stapled or clipped together.
Submission instructions Both a hard copy (paper) and an electronic copy should be submitted. The hard copy must be handed in at the beginning of class on the due date. In addition, One electronic copy per group should be
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uploaded to the course dropbox. Please name your file with the last names of each person in your team. For example, “Weissman-Obama-Einstein midterm 2015 HPM276.doc”
Forming Teams We expect the students to form groups of 2 or possibly 3 and to submit a joint review. We have found that students working in groups enhance the educational value of the exercise by allowing you to share ideas and develop others. If you have any trouble joining a group, please let one of us know and we will assist you.
Instructions and Guide for the Final Exam The final exam for the course will be based on a written review of a mock grant application. Review and discussion of this exercise will also comprise the last session.
The ability to write a comprehensive, focused grant review is particularly important. It requires that the reviewer understand the key components of a grant and in turn, wearing a different hat, what reviewers likely are going to look for when they review one’s own grant. The following is meant to be a guide to the components one might include in a formal grant review. Generally, try to avoid merely raising broad questions about the study or making overly general statements without explaining what you mean and, where possible, offering suggestions for improvement.
When reading the proposal, identify major strengths and weaknesses, and prepare to assign scores to each of the 5 “core” criteria (Significance; Investigator(s); Innovation; Approach; and, Environment) and Overall Impact. The NIH grant application scoring system uses a 9-point scale. A score of 1 indicates an exceptionally strong application with essentially no weaknesses. A score of 9 indicates an application with serious and substantive weaknesses with very few strengths; 5 is considered an average score.
For more information on the NIH review process see: http://cms.csr.nih.gov/PeerReviewMeetings/ReviewerGuidelines/
For Definitions of Criteria see: http://grants.nih.gov/grants/peer/critiques/rpg.htm#rpg_overall
*** Links to the NIH review materials are provided for your information. However, keep in mind that, because the intent here is to teach contextual and conceptual skills, the requirements for this class will not track exactly the NIH procedures.
Format Papers generally run 8-12 pages double-spaced.
Papers should be typed; 12-point font is preferred.
All pages should be numbered.
Submission instructions The file should be uploaded to the course dropbox. There is no need to submit a hard copy, though it is recommended that you bring your paper to refer to for class discussion. Please name your file with the last names of each person in your team. For example, “Weissman-Obama-Einstein final exam HPM276.doc”
Forming Teams We expect the students to form groups of 2 or possibly 3 and to submit a joint review. We have found that students working in groups enhance the educational value of the exercise by allowing you to share ideas and develop others. If you have any trouble joining a group, please let one of us know and we will assist you.
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The written exam should have the following sections and format:
I. Description The reviewer should provide a concise description of the project including specific aims, hypotheses, and descriptive information presented in the application. The description may be adapted from the investigator’s abstract or executive summary.
II. Overall impact Score: (1=exceptional, 9=poor) Definition of Overall Impact according to the NIH: Reviewers will provide an overall impact score to reflect their assessment of the likelihood for the project to exert a sustained, powerful influence on the research field(s) involved, in consideration of the following five core review criteria, and additional review criteria (as applicable for the project proposed).
II.a. Significance Score: (1=exceptional, 9=poor) Definition of Significance according to the NIH: Does the project address an important problem or critical barrier to progress in the field? If the aims of the project are achieved, how will scientific knowledge, technical capability, and/or clinical practice be improved? How will successful completion of the aims change the concepts, methods, technologies, treatments, services, or preventative interventions that drive this field?
The scientific contribution of the project is assessed in two key dimensions:
1) The review should comment on the significance of the question or issue proposed to be studied. Is it a priority area for the agency or foundation?; and
2) The review should indicate the significance of the applicant’s particular project.
In the critique you should note both the strengths and weaknesses. In addition to these two points above, a thorough review should comment on the adequacy of the literature reviewed. Is it relevant to the research problem and does it accurately review the scientific base on which the research rests? For purposes of this exercise, assume that all references are accurate and real.
II.b. Investigators Score: (1=exceptional, 9=poor) Comment here on the experience of the investigators and their qualifications to perform the requisite work.
II.c. Innovation Score: (1=exceptional, 9=poor) This section should again indicate strengths and weaknesses. Is the area new or understudied? Are there new data sets, novel data linkages, innovative approaches to survey or statistical analyses? Will the work produce actionable findings?
Definition of Innovation according to the NIH: Does the application challenge and seek to shift current research or clinical practice paradigms by utilizing novel theoretical concepts, approaches or methodologies, instrumentation, or interventions? Are the concepts, approaches or methodologies, instrumentation, or interventions novel to one field of research or novel in a broad sense? Is a refinement, improvement, or new application of theoretical concepts, approaches or methodologies,
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instrumentation, or interventions proposed?
II.d. Approach Score: (1=exceptional, 9=poor) This section may include a variety of different components depending on the specific proposal. Reviews should specifically highlight both strengths and weaknesses. Although some issues are generic (e.g. were hypotheses provided) some are specific to study design (e.g. primary data collection vs. secondary data analyses). Some of the key aspects of methodology often worthy of comment are listed and described below. We expect that this section will be the most detailed in your exam and in an actual grant review:
1) Objectives. Were the study objectives clearly defined?
2) Hypotheses. Were hypotheses identified explicitly?
3) Overall Study Design. Was the basic study design clearly described? Were descriptive text, diagrams, or flow charts adequate, or was more detail necessary?
4) Study Population. How was the study population identified? Is the population appropriately representative to answer the research question? Were the sampling and recruitment procedures well described? Were they likely to be effective? Is non-response likely to be a problem in terms of bias or sample size?
5) Data collection. Describing plans for collecting information is critical. What data will be collected, from whom, how often, and by what techniques? Are there alternative data collection methods or sources of information that should have been considered? Will the data allow the researchers to address the key concepts? Are the variables clear; is there a good description of the match between what is to be investigated and the particular data to be collected? Is it clear what variables are dependent and what variables are independent, and what other factors need to be measured or accounted for because they may otherwise confound the analyses?
If relevant, discuss the project’s cross-sectional aspects and longitudinal aspects over time. Are any of the data collected unnecessary?
If the study involves primary data collection are the data collection instruments valid and reliable? If the instruments are new, are the proposed instrumentation or procedures for developing and testing instruments adequate? Are data collection procedures sound and has adequate time been allocated for data collection? What procedures would be used to assure quality? How will abstractors or surveyors be selected, trained and reviewed?
Are secondary data used? Are the data sources appropriate, available, and complete? Are there any idiosyncrasies or limitations to the data?
If special data collection problems are foreseen, the application should indicate what they are and what efforts will be made to overcome them
6) Data management. This is an important issue. The application should address how the data will be held, managed, and processed. For example, who will have the main responsibility for organizing, storing, and archiving completed questionnaires? Who will maintain computer data tapes and make files available to those who analyze the data? How will the privacy of information be guaranteed?
7) Evaluation and analysis plans. There should be a general outline that explains how the collected data will be used and analyzed. This section should be convincing that the proposed methods are consistent with the hypotheses and issues to be studied.
Analytic methods should be identified. In this section the proposal should specifically discuss what
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analytic methods will be used to address which questions. It is often helpful to give examples of analyses or show what tables of results might look like. Analytic pitfalls should be identified.
8) Organization of the project and Qualification of key staff. The review should comment briefly on the adequacies of roles and task assignments of key staff as well as the overall project in terms of key events and products. To the extent possible, the persons the applicant believes are crucial to the successful project should be named in the section. This, or a parallel section, should be used to describe any experience the applicant’s organization has had in conducting similar projects, especially insofar as that experience will be available as backup and support for the key staff.
9) Work plan. The review should comment on the adequacy of two key components:
A. Description of tasks. The proposed work should be sufficiently well planned so that the applicant can specify a set of tasks that will cover all the activity needed to complete the project. The aim is to identify all the tasks to be accomplished regarding study design, analysis and report.
B. Time schedule. The application should provide a Gantt chart or some other diagram to illustrate when the tasks outlined will be completed.
10) Generalizability. Here the review should focus on potential for implementation, generalizability, and dissemination.
II.e. Environment Score: (1=exceptional, 9=poor) Comment on the adequacy of facilities and resources at the applicant’s institution and other study sites as well as the documentation of agreements among the participants. Is support and commitment from key organizations and consultants included?
III. Human subjects <Exclude for this exam> Assess the adequacy of proposed procedures for protecting human subjects against potential risks. Identify and explain any reservations and indicate whether reservations are a comment or a concern.
IV. Women and minority subjects <Exclude for this exam>Address the adequacy of including women and minorities in the study population. If women and minorities are not included, clear and compelling reasons should be provided.
SKILLS AND METHODS OF
HEALTH CARE NEGOTIATION AND CONFLICT RESOLUTION
HPM 278
Kresge G2, Thursdays 8:30-10:20
Department of Health Policy and Management
Program for Health Care Negotiation and Conflict Resolution
Instructors:
Leonard J. Marcus, Ph.D., Barry C. Dorn, M.D., M.H.C.M., Eric J. McNulty, MA
[email protected] , [email protected], [email protected]
Office: 8 Story St., Suite 310, P.O. Box 381488 Cambridge, MA 02238-1488
Staff Assistant: Andrew Schwartz Telephone: (617) 496-0867
Teaching Assistant:
Idalid Franco
626-423-2965
Spring 2016
1.25 credits
1. BACKGROUND AND DESCRIPTION
In the current climate of rapid health system change and public health innovation, one key “lesson learned” centers on the importance of collaboration among people and agencies responsible for the public’s health. Leaders must act quickly, decisively, and expect the unexpected. Often, circumstances require local, state, and federal agencies to coordinate their efforts in new and significant ways. Public health and health care organizations likewise must cooperate with other institutions often outside their scope of customary operation, such as the business sector, community organizations, professional societies, and government agencies. And within an organization, staff must find new ways to coordinate their resources and efforts in response to changing contingencies. “Unity of effort,” “Integration of services” and unobstructed coordination of among stakeholders have all assumed new importance.
New attention has been placed on reinforcing the public health infrastructure so that it can better respond both to periodic crises as well as to day-to-day public health contingencies. Creating that capacity is not only a matter of infusing new equipment and new monies into the system. It is also a matter of enhancing the problem solving capacity and skills of people who are responsible for public health intervention. Among those critical skills are conflict management and collaborative problem solving.
To be at the front lines of public health leadership or health service delivery today is to be in the midst of frequent conflicts and disputes. These conflicts include differences among: vocal constituents who have a stake in community health issues; clinicians about the appropriateness and quality of care; clinicians and managers over financial and administrative matters; providers and patients over medical procedures and service access; and on the policy level, between funders, providers and recipients over the access to and quality of care. Many of these conflicts are an outgrowth of larger changes occurring in the health system. In the United States, adoption of the “Affordable Care Act” led to the establishment of “Accountable Care Organizations” that are expected to balance a number of policy objectives, including: control health spending, enhance patient care, improve patient satisfaction, and advance population health. These developments have led to: ambivalence about the role of the public sector in directing health expenditures and organization; tensions between prevention and treatment priorities; concerns about policies that modify reimbursement for services; disputes regarding reorganization that realigns interactions among health professionals; pressures resulting from social trends that are changing relationships between consumers/patients and the health system. On top of all this, there remains the complexity of responding to potential and unknown bioterrorist threats.
These changes have created a range of systemic and personal/professional dilemmas. As health systems change and reshape their organizational base, they face arduous questions of community values, access and responsibility. As professionals confront their new roles of
allocating as well as providing care, they question their own motivation for entering the field and doubt the motivation of others. As communities assess the health status of their population, they wonder how best to reduce the risks and stimulate activities that will improve the well being of their constituents. And, as consumers face perplexing insurance limitations and costly service options, they confront the dilemma of just what the health system can do for them. These developments are combining with rapid change, shifting reimbursement policies, and shortages/surpluses of personnel to strain the system and people associated with it, as evidenced by prevalent contentious, adversarial behavior and interaction.
These conflicts can be viewed as a problem: they can also be viewed as an opportunity. By addressing rather than ignoring disputes that arise, providers, managers, consumers and public health leaders can generate opportunities for communication, collaboration and creative resource expansion and allocation. While some conflict is unavoidable, many disputes are amenable to prevention, management and resolution. And these disputes, when constructively and intentionally resolved, can lead to system learning and change that reduces the likelihood of recurrence.
The course will direct our attention to framing conflict in order to achieve more inclusive and satisfactory outcomes: from the interpersonal to the organizational and policy levels.
How can this be achieved?
As a first step, the nature and substance of the conflicts must be recognized and understood. In particular, it will be useful to learn how structural and financing arrangements affect relationships among those in the system: in what ways, for example, do prospective payment, peer review and limited service accessibility increase contentious interaction? How have changing opinions about public health issues – violence, smoking, poverty and even terrorism – changed relationships among those addressing these problems? How has service delivery been affected by malpractice actions, the closing of hospitals and services, and more competitive marketing tactics? In what ways has the health care system re-aligned incentives to place people on a path toward conflict?
Next, new models for building negotiation among health providers, consumers and communities must be developed and disseminated. These models are based on the values of access to the negotiation process, collaborative problem solving, and pursuit of common interests for mutual gain. One aspect of that process is reframing and reconceptualizing interests and
relationships, thereby reaffirming the original motives for working and engaging in the health system. Another aspect is the development of models of conflict resolution, such as mediation venues, for the purpose of addressing and resolving issues so that “lessons learned” through dispute resolution can be translated into system change and improvement.
The complexity and multiplicity of interests and conflicts in the health system make it uniquely amenable to such perspectives and mediation mechanisms, since the focus of conflict resolution and negotiation is on prevention, resolution, and change. Evidence from the use of conflict resolution techniques in other arenas demonstrates effectiveness with situations comparable to those found in public health.
This course will offer students the skills and knowledge of negotiation and multi-dimensional problem solving as well as conflict analysis, management, intervention and resolution. Through our readings, in-class simulation exercises and lecture discussion, we will examine the field and explore its application to complex, multi-professional public health and health care settings and issues. The course is offered with the hope that its content and lessons will become a valuable building block in the professional repertoire of participating students, whether it is for crisis management or for better accomplishing the everyday objectives that attracted us to the important work of public health and health care.
1. COURSE OBJECTIVES
Knowledge: By the end of the course, you will have knowledge of:
1. The overt and covert causes of conflict. 2. Frameworks for analyzing conflict. 3. A variety of methods useful in preventing, resolving, managing and when necessary,
creating conflict.
Skills: By the end of the course, you will be able to:
1. Identify the parties, interests, issues and positions relevant to a conflict. 2. Frame a conflict in a manner that creates opportunities for creative and collaborative
negotiation among the parties. 3. Mediate, at a beginning level, a conflict between multiple parties.
Values: The course is based on the following values and assumptions:
1. Conflict is neither "good" nor "bad." Rather, it is a natural phenomenon in a pluralistic society, and it oftentimes accompanies change. The negative elements of conflict are found in its by-products, such as reduced effectiveness and efficiency. Its positive effects are in promoting change and providing a check and balance, especially important in complex decision-making.
2. Improved negotiation and communication can offer constructive opportunities for enhancing the collaboration necessary for public health intervention and health service delivery, and for reducing the negative by-products of conflict. Adversarial relations can erode the climate for quality planning and work.
3. Inclusive negotiation can provide opportunities to “give voice” to those parties whose needs and interests are often not represented at the decision-making table. The buy-in and outcome of the negotiation is improved if these parties are included in the process.
Measurable Outcomes: Your grade will be based on the ability to demonstrate the following:
1. Understanding of the conceptual framework and practice skills of negotiation and conflict resolution and the ability to apply that framework to the analysis of and intervention in health care problems.
2. Rudimentary skills of conflict resolution. 3. A familiarity with the field of negotiation and conflict resolution, and its application to
health care organization and policy change.
III. COURSE ASSIGNMENT/BASIS FOR GRADING
The required reading for the course is the text: Leonard J. Marcus, Barry C. Dorn, and Eric McNulty. 2011. Renegotiating Health Care: Resolving Conflict to Build Collaboration, Second Edition. San Francisco: Jossey-Bass Publishers.
Our class sessions will include lecture and discussion as well as simulations and exercises that require the active participation of each student. The final examination will be completed in class during the final session. The exam is comprised of a series of questions each requiring a one sentence answer, and covering course readings, lectures, discussions, and exercises. The result of the final comprises the bulk of the course grade, though it can be adjusted by the quality of in-class contributions and participation. Students are expected to be in class on time: failure to do so will negatively affect one’s course grade. Computers are not to be used during class time (except with permission of the instructors).
1. COURSE OUTLINE
Session 1: Interest-based negotiation in contrast with positional problem solving
March 24, 2016: Lenny and Barry
• Positional bargaining versus interest-based negotiation. • Integrative problem solving and complexity: its importance for public health negotiation
and conflict resolution. • The workings of the brain, the emotions of conflict and conflict resolution, and pathways
to help you rise above expected obstacles to reach effective problem solving.
Exercise: The Arm Wrestling Exercise
Required readings: Renegotiating Health Care, Second Edition:
Chapter One: Why Conflict
Chapter Two: Moving Beyond Conflict
Chapter Three: Setting the Stage for Negotiation
Session 2: Multi-Dimensional Problem Solving and Public Health
March 31, 2016: Eric and Lenny
• Is conflict good or bad? What are the implications for understanding and managing conflict?
• Multi-dimensional problem solving: different perspectives and implications for individual and organizational learning and conflict resolution.
• Organizational learning: how to translate disputes into system correction and improvement.
Exercises: Multi-Dimensional Problem Solving, Thomas-Kilmann Conflict Mode Index and Health Promotion in Oppidania
Required readings: Renegotiating Health Care, Second Edition:
Chapter Four: Interest-Based Negotiation
Chapter Five: Framing to Generate Options
Chapter Six: Reframing to Spur Momentum
Session 3: The Walk in the Woods
April 7, 2016: Barry, Eric and Lenny
• The Walk in the Woods: Four steps of the process • Framing and reframing what the parties hope to gain through the negotiation process. • Getting the right people to the table and involving them in effective problem solving
Required readings: Renegotiating Health Care, Second Edition:
Chapter Seven: The Walk in the Woods
Chapter Eight: Positional Bargaining
Chapter Nine: Mediation, Arbitration, and Dispute Resolution
Session 4: Conflict Resolution: Mediation to Reframe the Dispute
April 14, 2016: Barry and Lenny
• Risk and Reward: differences in perceptions and implications for considering and exercising negotiation options.
• Conflict escalators and conflict de-escalators: understanding, building and working with the options.
• Options for problem solving, from negotiation to mediation, arbitration, litigation, and outright “war”.
Exercise: Observed mediation exercise – “R.E.S.C.U.”
Required readings: Renegotiating Health Care, Second Edition:
Chapter Ten: Meta-Leadership
Chapter Eleven: Designing a More Cohesive, Better-Linked Health System
Chapter Twelve: Evolving with Technology
Session 5: Conflict Analysis
April 21, 2016: Barry
• Simple, Representational, and Symbolic Negotiation: Charting your negotiation map. • Building consensus in a complex, multi-party, public dispute. • Positional bargaining: how to win when that is the only or the best option.
Exercise: ABOMR: Aridzone Board of Medical Registration
Required readings: Renegotiating Health Care, Second Edition:
Chapter Thirteen: The Negotiating Patient
Chapter Fourteen: Changing Work and a Changing Workforce
Session 6: Complex, Multiparty Negotiation
April 28, 2016: Lenny and Eric
• Time and timing as it affects negotiation and problem solving. • Developing and implementing plans of action: responding to contingencies. • Dynamics of the negotiation process: responding to opportunities.
Exercise: Multi-party negotiation exercise: “Dollars for Durbania”
Required readings: Renegotiating Health Care, Second Edition
Chapter Fifteen: Crafting the Essentials
Chapter Sixteen: Constructing a Resilient Balance
Session 7: Conclusion: Creating a Bridge Between Public Health and the Negotiation - Conflict Resolution Field
May 5, 2016: Barry and Lenny
• The importance of trust in the negotiation process and confidence building to get beyond the obstacles.
• Practical applications of mediation, negotiation and negotiation training to career development.
• The Shadow Effect: conflict embedded into organizational structure and strategies to foster collaboration.
Required reading:
Renegotiating Health Care, Second Edition: Review the book and prepare for the final
Session 8: Final Exam
May 12, 2016: Lenny and Eric
Recommended Readings:
Edward Dauer and Leonard Marcus. “Adapting Mediation to Link Resolution of Medical Malpractice Disputes with Health Care Quality Improvement” Law and Contemporary Problems, 60:185-218, Winter, 1997.
Daniel Goleman. 2004. “What Makes a Leader? Harvard Business Review. January 2004. pp. 1-11.
Roger Fisher and William Ury. 1981. Getting To Yes: Negotiating Agreement Without Giving In. New York: Penguin Books.
Leonard Marcus and Raja Kamal. “Stop the killing, start the talking.” Boston Globe, op-ed page, March 30, 2002.
William Ury. 1991. Getting Past No: Negotiating With Difficult People. New York: Bantam Books.
HPM 279: ENABLING CHANGE – YEAR 1
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HPM 279: Enabling Change – Year 1 (2.5 credits) Course Information Primary Instructor
Howard K. Koh, MD, MPH Harvey V. Fineberg Professor of the Practice of Public Health Leadership Harvard T.H. Chan School of Public Health | Harvard Kennedy School of Government
Co-Instructor
Shaloo Puri, MBBS, DTCD, MPH, MPA Deputy Director and Instructor, DrPH Program
Teaching Assistant
Madeline Morcelle, JD, [email protected] Class Time & Venue
Tuesdays, 1:30-3:20 PM (bi-weekly) Room: Varies by date – please check individual session details below
Office Hours With Dr. Koh by request via Ellen Smith, [email protected] With Dr. Puri by request, [email protected] With Madeline by request, [email protected] Canvas Course Site
https://canvas.harvard.edu/courses/7377 Course Description Why are some individuals successful in enabling positive change in public health? What applied skills do they have that allow them to create effective teams, organizations, and coalitions? How do they address the unique field of public health, with its diffuse power structures and multitude of stakeholders? The need for public health leadership is great, the challenges are many—how does one learn to lead? To be a successful applied public health practitioner individuals must go beyond traditional public health research skills and methodologies and learn how to
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enable positive change at four levels of application: within themselves, amongst their team, inside their organizations, and across systems. Students must also master practical competencies related to leadership, management, innovation, and communication. Students who address these competencies and apply them across each level of application will be the most ready to serve as public health leaders upon graduation. This course supplements other required courses in the DrPH Enabling Change curriculum. Each week students will be guided through exercises that will allow them to practice critical skills related to these competencies in a safe setting. Exercises and assignments will incorporate concepts covered in prior or concurrent coursework. This course will also prepare students for their field immersions by providing frameworks for team building, consulting skills, and principles of professionalism. This course will prepare students to enter the workforce with the skills needed to understand complex organizational dynamics and influence positive change in those organizations. Course Objectives At the end of this course, students will be able to:
• Establish an agenda for individual leadership goals.
• Persuade the public, professionals, policymakers, and other key constituents on public health issues utilizing scientific evidence, stakeholder input, public opinion data, and other key sources of information.
• Apply strategies to achieve consensus/resolution in multi-stakeholder settings.
• Apply marketing and management strategies to address public health and healthcare challenges.
• Build and sustain effective teams via team building strategies, individual development, and peer
coaching. Requirements & Grading This course meets 15 times over the Fall and Spring terms. See detailed session schedule for specific dates. Sessions will begin promptly at 1:30 PM and end at 3:20 PM. This course will be graded as pass-fail to allow students to deeply engage in their development without regard for grades. Students earn a ‘pass’ by meeting course expectations (below) and demonstrating development on the course objectives.
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Pass: Attendance at all sessions; completion of all required readings and pre-work; on-time submission of written assignments; active participation in class discussions; and providing candid and constructive feedback to peers.
Fail: Any unexcused absence; failure to complete required readings and pre-work; failure to submit
written assignments on time; failure to actively participate in class discussions; and failure to provide constructive feedback to peers.
This is a yearlong course worth a total of 2.5 credits (1.25 in the fall and 1.25 in the spring). Students must register for both fall and spring sections Expectations for Engagement As this is a course in practice and applied skills, it requires a commitment to trying new approaches and engaging fully in each exercise. Students should support one another during these exercises and embrace that everyone enters the DrPH program with the unique strengths or weaknesses. Specific expectations:
• Attend and participate in all classes. If you must miss a class due an emergency, please contact Dr. Puri as soon as possible.
• Complete all assigned readings. Links to most readings are provided below through the Harvard University Library. Readings without links below have been uploaded on the Canvas site at: https://canvas.harvard.edu/courses/7377
• Submit all assessment and written work on time. • Maintain an open disposition to understanding yourself in order to influence others. • Provide and receive candid and constructive feedback to and from one’s peers regarding
his/her effectiveness as a community member. Discussion Exercises (every session) Leadership Seat Exercise
At the start of each class session, one student will be called at random to lead a discussion of the readings for that day. Students should be prepared to lead a 5-minute discussion with their classmates. Being chosen to lead the discussion in a given week does not preclude being chosen subsequently.
Specifics to bear in mind:
• Students may not use notes or refer the readings in anyway during the exercise. • Students should prepare 2-3 questions to drive discussion that employ “critical thinking stems” as
discussed in King A. Designing the Instructional Process to Enhance Critical Thinking Across the Curriculum. Teaching of Psychology: Vol 22: No 1,Feb 1995.
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Front-Page News Exercise
In groups of 3-4, students will be assigned an article from a major domestic or international news publication on a recent issue relating to public health. Each student will be assigned a stakeholder identity and prepare one minute of oral arguments supporting that stakeholder’s position on the public health issue. Following the oral arguments, the students will serve on a brief panel and answer questions from the faculty and their classmates from the perspective of their particular stakeholder group. Each student will prepare four Front-Page News exercises over the course of the year.
Specifics to bear in mind:
• Students will be restricted to exactly one-minute for their initial remarks. • Students may not use notes during the opening remarks or panel.
Assignments Students should submit all assignments due electronically by 12 pm on the specified date or before in Word document format via the Canvas course site. Please include your name (and, if a team assignment, the names of team members), the course number (HPM279) and the name of the assignment (see below) at the top of the Word document. The written assignments are intended to be exercises in analytical thinking and effective communication. Consequently, the teaching team will assess the content, structure, organization, clarity, and persuasiveness of the written work. Fall Semester Assignments Mandatory Vaccination Statement (due 9/22/2105)
Students should prepare a 60 second-statement as the director of the California Department of Public Health for the State of California addressing the mandatory vaccination law for school age children.
eCigarettes Regulatory Statement (due 10/20/2015)
Students should prepare a 60 second-statement as the Commissioner of the U.S. Food & Drug Administration on how and why e-cigarettes should be regulated.
Fireside Reflection: Social Determinants & Disparities (Due electronically on 10/30/2015 by noon)
Write a reflection (no more than 500 words) that explores how disparities can be addressed (or not addressed) through the lens of Lederach’s “moral imagination” as discussed in HPM558 Leadership in Public Health: Personal Mastery.
Winter Field Experience Briefing Paper (due 12/1/2015)
In groups of 3-4, students will research their host organization for the Winter Field Experience. The paper should briefly review the organization, its history, and its mission. Students will also identify public health challenges of importance to the organization and discuss the most current literature on these topics. Briefings should include a discussion of how the current scientific literature could be
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relevant or applied to the host organization and its efforts. Students should also explore anticipated leadership challenges at the host organization.
The group will collectively write the briefing, which should be no more than 2000 words. Fireside Reflection: Disparities (Due electronically on 12/11/2015 by noon)
Write a reflection (no more than 500 words) discussing ways in which the challenges of addressing gender inequality and racial/ethnic disparities are similar and different. Draw on the readings and fireside discussions with David Satcher and Paula Johnson.
Spring Semester Assignments Winter Field Immersion Assignments
1. GHP 300-111: Individual reflection paper: will be reviewed by Jennifer (Due electronically by noon on 1/29/16)1 Reflective writing encourages students to make connections from theory to practice and learn from events, experiences, situations or new information, as it necessitates analytical and focused thinking. Most importantly, it is a valuable tool for helping one to formulate and clarify one’s thinking as it evolves. Rolfe et al (2001) proposes a framework for reflective practice that uses Borton’s (1970) developmental model. This model is based upon three simple questions: What? So what? Now what? (What) did you experience, (So what) did it mean to you, and (Now) what you are going to do with it? You do not need to discuss every experience or element of your field immersion. Pick a few experiences that you can explore within the context of your learning and end with a short summary on how you will apply to your future practice. Please connect the concepts you have learned in classes and workshops leading up to your winter experience to your personal and experiential reflection. All writing should have a clear focus and organized structure. Guidelines for Writing Quality Reflection Papers: • Use full sentences and complete paragraphs • Keep colloquial language to a minimum • Clarity and good observation in presentation of learning events and issues • Depth of self-assessment and detail of reflective accounts • Thoroughness of reflection and self-awareness • Representation of different cognitive skills (analysis, synthesis, evaluation, etc) Purpose of Reflective Writing:
1 Note that while this assignment should be submitted to the HPM 279 Canvas website under “Assignments,” it will be evaluated by Jennifer for GHP 300-111 (Winter Session Field Immersion Independent Study with Peter Berman).
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• To make connections • To examine your learning process • To clarify what you are learning • To reflect on mistakes and successes • To become an active and aware learner Deliverable Pick three of the questions below and submit a two-page reflection paper, 12-font, double spaced detailing your team-based field immersion experience and what you learned from it. Submit your paper through the Enabling Change Canvas Site by noon on Friday, January 29th. Your papers will be reviewed by and responded to by Jennifer Betancourt. Question Prompts: • Was there a leader on your team? Who was it and who decided who the leader would be? • Of the leadership practices you have learned so far, which did your leader(s) use? • Where did you identify personal/professional gaps in knowledge and skills related to team work
and leadership? • Discuss a mistake you made or failure you experienced and what you learned. • What was the most compelling lesson you learned about team dynamics through your field
immersion experience? • What surprised you the most about how you functioned, felt and reacted during your experience in
the state/country? • Which academic concepts become apparent during the experience? • Knowing what you know now, what would you have done differently? • Share a time when the winter team-based immersion challenged you personally and
professionally? Where and how?
2. GHP 300-111: Submit your Team Organizational Deliverable (due electronically by noon on 1/29/16)2 This is the deliverable your team submitted to your organization.
3. HPM 279: Enabling Change Session Field Immersion Team Dynamics Presentation (presented on 2/2/2016)3 Please note, this presentation is not about the deliverable you provided to your client or about the challenges your client faces – it should be focused on your team’s leadership development experience within the work.
2 Note that while this assignment should be submitted to the HPM 279 Canvas website under “Assignments,” it will be evaluated by Jennifer for GHP 300-111 (Winter Session Field Immersion Independent Study with Peter Berman). 3 This assignment is part of the HPM 279 curriculum.
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Each team needs a Spokesperson, Timekeeper, and Team Artifact
We ask you to address at least three of the following questions in your 8 minute presentation on your experience regarding organizing to learn v. organizing to execute. In addition, please identify and bring a team artifact that exemplifies your shared experience to present to the cohort as the closing of your presentation. Each presentation will be followed by 2 minutes of Q & A. Be succinct—presentations will be timed. No PowerPoint slides should be used.
Key Presentation Questions • What supported your team working together? What challenged your team’s ability to work
together? • Which teamwork competencies did you master and which competencies posed a challenge? • Give an example of a time when your team norms were challenged? • Share a moment when you self-corrected as a team. • What risks did your team take? Why? What risks did your team not take? Why? • What aspects of this team experience will you try to replicate in the future? • What aspects of this team experience will you try to avoid replicating in the future?
Spring Fireside Reflections: Students will prepare reflective papers in response to the fireside reflection prompts above. A strong reflection will analyze and apply the assignment prompt in the context of your own beliefs and experiences. Fireside Reflections should not exceed 500 words and should be submitted in Word document format via the Canvas course site by or before the date and time specified.
1. Fireside Reflection*: Leading in a Diverse World (Due electronically on 2/19/2016 by noon) Write a reflection (no more than 500 words) on how you leveraged (or failed to leverage) the diversity of your team during your Winter Session Field Immersion. What were the implications for your project?
2. Fireside Reflection: Reach & Scale in Public Health (Due electronically on 4/8/2016 by noon) Write a reflection (no more than 500 words) on how technology or media can be used to promote public health. Draw on the readings and discussions with Swati Piramal and Julie Rafferty (Using Social Media for Public Action).
Six Cities Scientific Defense (due electronically on 4/15/2015 by noon, presentations on 4/19/2015) In groups of 4-5, students will prepare 1) a 60-second statement in defense of the Six Cities Study and the National Ambient Air Quality Standards, and 2) a set of talking points (8-10 anticipated questions and appropriate responses). One team member will be chosen at random on 4/19/2015 to deliver your statement and respond to questions on the team’s behalf. Summer Field Immersion Assignments Due ~5/3/2016: Details TBD
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Session Details Fall Semester # Date Description 1 9/8/2015 Course Intro; Leadership, Relationships, & Emotional Intelligence
Special Guest: Fawn Phelps, Instructor and Director of Leadership Development Location: Kresge G2 Learning Objectives After this session, students will be able to:
• Recognize that personal relationships, self-awareness, and emotional intelligence are critical components of effective leadership.
• Engage effectively with their executive coaches. Session Agenda
• Welcome, Syllabus Review (30 mins) • Norms & Exec Coaching (20 mins) • Leadership, Relationships, & Emotional Intelligence (60 mins) • Field Immersion Info (5 mins) • Reflection (5 mins)
Readings
• Goleman D. What Makes a Leader. HBR’s 10 Must Reads On Leadership. HBR, 2011. Link
• Carter MZ, et al. Transformational leadership, relationship quality, and employee performance during continuous incremental organizational change. Journal of Organizational Behavior, J. Organiz. Behav. 34, 942–958 (2013) Link
• King A. Designing the Instructional Process to Enhance Critical Thinking Across the Curriculum. Teaching of Psychology: Vol 22: No 1,Feb 1995. Link
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Updated 3-31-2016
# Date Description 2 9/22/2015 Mock Press Conference (Group A)
Special Guests: • Timothy Johnson, ABC News Chief Medical Correspondent (ret.) • Julie Rafferty, Associate Dean for Communications • Vish Viswanath, Professor of Health Communications
Location: Kresge 10th Floor Leadership Studio Learning Objectives After this session, students will be able to:
• Communicate controversial public health information effectively. • Respond appropriately to press questions by apply active listening techniques. • Assess multiple stakeholder perspectives related to vaccination.
Session Agenda
I. Front Page News Exercise – 2 groups (25 mins) II. Mock Press Conference (85 mins)
Assignment Due – Mandatory Vaccination Statement
Readings These background readings may be supplemented with additional research
• National Vaccine Advisory Committee. Assessing the State of Vaccine Confidence in the United States: Recommendations from the National Vaccine Advisory Committee, Draft Report Version 2. U.S. Department of Health and Human Services, March 10, 2015. Link
• Hiltzik M. California moves to end personal belief exemptions for vaccination—At last. Los Angeles Times, February 4, 2015. Link
• Barbash F. California may opt out of its ‘personal belief’ vaccine opt-out. The Washington Post, February 5, 2015. Link
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# Date Description 3 10/6/2015 Your Personal Brand & Using Social Media for Public Action
Special Guest: Julie Rafferty, Associate Dean for Communications Location: Kresge G2 Learning Objectives After this session, students will be able to:
• Develop strategies for managing digital information to assure strong individual and organizational reputations.
• Apply effective social media and advocacy strategies for motivating public action.
Session Agenda
I. Leadership Seat Exercise (5 mins) II. Front Page News Exercise – 2 groups (25 mins)
III. Managing Your Personal Brand (40 mins) IV. Social Media for Public Action (40 mins)
Readings
• Mlotek H. What My Landlord Learned about Me from Twitter. New York Times, July 20, 2015. Link
• Fraser M, Dutta S. Barack Obama and the Facebook Election. U.S. News & World Report News. Nov. 19, 2008. Link
• Vargas JA. Obama Raised Half a Billion Online. Washington Post, Nov. 20, 2008. Link
• Bruns A, et al. The Arab Spring and Social Media Audiences: English and Arabic Twitter Users and their Networks. American Behavioral Scientist 57(7) 871–898. Link
• C. Here Comes Everybody. The Penguin Press, New York, 2008. (Recommended, not required)
• Aaker J, Smith A, and Adler C. The Dragonfly Effect: Quick, Effective, and Powerful Ways to Use Social Media to Drive Social Change. Jossey-Bass, A Wiley Imprint, San Francisco, CA, 2010. (Recommended, not required)
Delta Plus Meeting Space (after class) Kresge 439
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Updated 3-31-2016
# Date Description 4 10/20/2015 Mock Press Conference (Group B)
Special Guests: • Todd Datz • Julie Rafferty, Associate Dean for Communications • Vish Viswanath, Professor of Health Communication
Location: Kresge 10th Floor Leadership Studio Learning Objectives After this session, students will be able to:
• Communicate controversial public health information effectively. • Engage in active listening and respond appropriately to press questions. • Assess multiple stakeholder perspectives regarding FDA regulation of e-
cigarettes. Session Agenda
I. Front Page News Exercise – 2 groups (25 mins) II. Mock Press Conference (85 mins)
Assignment Due – eCigarettes Regulatory Statement
Readings These background readings may be supplemented with additional research
• Johnson SR. Sparking Controversy: Rise in e-cigarette use has public health experts questioning their safety, effectiveness as harm reduction. Modern Health Care, September 21, 2013. Link
• Hyde D. What are the risks of electronic cigarettes? – Interview with Vaughan Rees. KUOW.org, Oct 2, 2013. Link
• Blanding M, Drexler M. The E-Cig Quandary. Harvard Public Health Magazine. Link
• The Forum at Harvard T.H. Chan School of Public Health. Can eCigarette Regulation Protect the Public’s Health? Webcast from April 16, 2015. Link
Delta Plus Meeting Space (after class) Leadership Studio
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# Date Description 5 10/27/2015 Fireside Leadership Chat: Social Determinants & Disparities
Special Guest: David Satcher, Founder, Satcher Health Leadership Institute, Morehouse School of Medicine 10th Assistant Secretary for Health and the 16th Surgeon General of the United States Location: Kresge 10th Floor Leadership Studio Learning Objectives After this session, students will be able to:
• Incorporate lessons learned from a proven public health leader in their own leadership strategies.
• Identify the impacts of health disparities on individuals and public health systems.
• Assess the utility of various public health approaches to reducing health inequities.
Session Agenda
I. Leadership Seat Exercise (5 mins) II. Front Page News Exercise – 2 groups (25 mins)
III. Leadership Discussion (80 mins) Readings
• Speaker Bio • The Social Determinants of Global Mental Health (Authors: Dr. Michael T.
Compton & Dr. Ruth S. Shim); pp. 235-254: https://books.google.com/books?isbn=1585625175
• 21st Century Global Mental Health (author Dr. Eliot Sorel); pp. 71 – 92 (section 2, chapter 4); Jones & Bartlett Publishers, 2013; ISBN 1449627870, 9781449627874
• Rust, G. et al. Triangulating on success: innovation, public health, medical care and cause specific u.s. mortality rates over a half century (1950-2000). American Journal of Public Health (April 2010) Suppl 1:S95-104. Link
• Druss, B.G. Bridging mental health and public health. Prevention Chronic Diseases (Jan 2010) (1): A03. Link
• Wilensky, G. Don’t Forget About the Social Determinants. Health Affairs (March- April 2009) (2): 194-8. Link
Post-Session Assignment: Leadership Reflection due electronically on 10/30/2015 Delta Plus Meeting Space (after class) Leadership Studio
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Updated 3-31-2016
# Date Description 6 11/10/2015 Case Study – 23andMe: Genetic Testing for Consumers (A)
Special Guest: John Quelch, Professor in Health Policy and Management Charles Edward Wilson Professor of Business Administration, Harvard Business School Location: FXB G12 Learning Objectives After this session, students will be able to:
• Analyze the role of government agencies and new-product developers in shaping the future of health care.
Session Agenda I. Case Discussion (80 mins)
II. Front Page News Exercise – 2 groups (30 mins) Case Discussion Questions
• Is the sale of DNA tests to consumers in the public health interest? • Would you invest in 23andMe? Why or why not? • What should Wojcicki do in response to the FDA letter?
Readings **Please print the case study and bring it to class**
• 23andMe: Genetic Testing for Consumers (A) Link Delta Plus Meeting Space (after class) Kresge 439
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# Date Description 7 12/1/2015 Personal Mastery & Winter Field Immersion Teaming
Special Guests: • Fawn Phelps, Instructor and Director of Leadership Development • Jennifer Betancourt, Assistant Director for Field Practice
Location: FXB G12 Learning Objectives After this session, students will be able to:
• Identify key elements to promote successful team collaboration. • Determine processes to address conflicts. • Manage client organization expectations and time management needs by
applying basic consulting skills. Session Agenda
I. Leadership Seat Exercise (5 mins) II. Front Page News Exercise – 2 groups (25 mins)
III. Personal Mastery Check-in (30 mins) IV. Winter Field Immersion Teaming (50 mins)
Assignment Due – Winter Field Immersion Briefing Paper
Readings
• Kahn, W. A. (2009). The student's guide to successful project teams. New York: Routledge (Chapter 2, pp. 23-31)
• Marilyn, D., Parry, C., & Moore, J. (2005). Learning in the thick of it. Harvard Business Review, July-August, 83(7): 84-92 Link
• Edmondson, A., Bohmer, R., & Pisano, G. (2001). Speeding up team learning. Harvard Business Review, October, 79(9): 125–134 Link
• Driskell, JE; et al. What makes a good team player? Personality and team effectiveness. Group Dynamics: Theory, Research, and Practice. US, 10, 4, 249-271, Dec. 2006. ISSN: 1089-2699. Link
• HBS Press & Harvard Business School. Chapter: Becoming a Team Player: Your Most Important Assignment. Harvard Business Essentials: Creating Teams with Edge, 2004. Link
• Ancona D, Bresman H. Introduction: When Bad Things Happen to Good Teams. X-Teams: How to Build Teams that Lead, Innovate, and Succeed. Harvard Business Press, Boston, 2007. Link
Delta Plus Meeting Space (after class) Kresge 439
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Updated 3-31-2016
# Date Description 8 12/8/2015 Fireside Leadership Chat: Gender Disparities
Special Guest: Paula Johnson, Executive Director of the Mary Horrigan Connors Center for Women’s Health and Gender Biology; Associate Professor of Medicine, Harvard Medical School Location: FXB G12 Learning Objectives After this session, students will be able to:
• Incorporate lessons learned from a proven public health leader in their own leadership strategies.
• Discuss how gender and sex impact health and health outcomes. • Identify ways that gender disparities can be eliminated.
Session Agenda
I. Leadership Seat Exercise (5 mins) II. Front Page News Exercise – 2 groups (25 mins)
III. Leadership Discussion (80 mins) Readings
• Speaker Bio • Johnson PA. His and hers… healthcare. TEDWomen 2013, Dec 2013. Link • Johnson PA, Fitzgerald T. The Affordable Care Act and the Opportunity to
Improve Prevention in Women: How to Make the Most of the Law. Clinical Chemistry 60:1, 138-140, 2014. Link
• Johnson PA, Manson JE. How to Make Sure the Beat Goes On: Protecting a Woman’s Heart. Circulation. 2005;111:e28-e33. Link
Post-Session Assignment: Leadership Reflection due electronically on 12/11/2015 Delta Plus Meeting Space (after class) Kresge 439
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Spring Semester
# Date Description 9 2/2/2016 Winter Field Immersion: Teaming Debrief
Special Guests: • Fawn Phelps, Instructor and Director of Leadership Development • Jennifer Betancourt, Assistant Director for Field Practice
Location: Kresge 202A Learning Objectives After this session, students will be able to:
• Apply frameworks to assess their performance in resolving conflicts, as a team, and as individuals.
Session Agenda
I. Leadership Seat Exercise (5 mins) II. Field Immersion Team Presentations, 10 min per group + 5 min discussion (90 mins)
III. Teaming Discussion (15 mins) Assignments Due – (1) Individual reflection paper: submit electronically by noon on 1/29/16 (2) Submission of Team Organizational Deliverable: submit electronically by noon on 1/29/16 (3) Prepare for the Enabling Change Session Field Immersion Team Dynamics Presentation: present in class on 2/2/2016 Readings
• Katzenbach JR & Smith DK. The Discipline of Teams. Harvard Business Review. Jul-Aug 2005. Link
• HBS Press and Harvard Business School Press. Chapter: Closedown Phase: Wrapping it Up. Harvard Business Essentials: Managing Project Large and Small. Harvard Business Press, Boston, 2004. Link Office Hours
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Updated 3-31-2016
# Date Description 10 2/16/2016 Leadership Fireside Chat: Leading in a Diverse World
Special Guest: Patti Bellinger, Executive Director and Adjunct Lecturer, Center for Public Leadership, Harvard Kennedy School Location: Kresge 202A Learning Objectives After this session, students will be able to:
• Explore the personal, interpersonal, organizational dimensions of being an effective leader capable of leveraging diversity at multiple levels.
• Define diversity in multiple contexts. • Discuss implicit bias and difference in their own lives and careers and how those biases
and experiences shape perceptions and interactions as leaders.
Session Agenda I. Leadership Seat Exercise (5 mins)
II. Front Page News Exercise – 1 group (25 mins) III. Leadership Discussion (80 mins)
Readings
• Patti Bellinger Bio circulated in announcement 2/12 • Jean Brett, Kristin Behfar, and Mary C. Kearn, “Managing Multicultural Teams,”
Harvard Business Review, 11/2006. Link • Mary Rowe: “Micro-Inequities and Micro-Affirmations,” 2008. Link • Berit Brogaard, “Micro-Inequities 40 Years Later,” about Mary Rowe’s work at MIT,
Psychology Today, 4/20/2013. Link • Sexism Persists, Even Among the Enlightened, Nicholas Kristof. Link added 2/12 • Kenji Yoshino and Christie Smith, "Uncovering Talent: A New Model for Inclusion",
Deloitte University, 12/2013 Link added 2/12 Post-Session Assignment: Leadership Reflection due electronically on 2/19/2016
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# Date Description 11 3/1/2016 Case Study - Vision 2020: Takeda Vaccine Business
Special Guest: John Quelch, Professor in Health Policy and Management Charles Edward Wilson Professor of Business Administration, Harvard Business School Location: Kresge 202A Learning Objectives After this session, students will be able to:
• Discuss globalization strategies for health care firms. • Explore the balance of accessibility and profitability in health care businesses.
Session Agenda
I. Leadership Seat Exercise (5 mins) II. Front Page News Exercise – 1 group (25 mins)
III. Case Discussion (80 mins) Case Discussion Questions
• What is the motivation for Vision 2020? • What are the differences between old Takeda and new Takeda? • Will Takeda achieve its goals in the vaccine business?
What role do/should pharmaceutical companies play in the public health arena?
Readings **Please print the case study and bring it to class** • Vision 2020: Takeda Vaccine Business Link updated 2/25
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Updated 3-31-2016
# Date Description 12 3/22/2016 Navigating the Adversarial Interview
Location: Kresge 202A Learning Objectives After this session, students will be able to:
• Critique the effectiveness of media interviews in conveying appropriate public health messages in an adversarial setting.
Session Agenda
I. Leadership Seat Exercise (5 mins) II. Front Page News Exercise – 1 group (25 mins)
III. Interview critique and discussion (40 mins) IV. Navigating the Adversarial Interview (40 mins)
Readings
• DeVelder CJ. Surviving the Adversarial Interview. Student Lawyer. 39.8 (Apr. 2011): p14. Link
• Gilman A. Preparing for a media interview. Journal of Communication in Health Care, Vol. 3 No. 2, pp. 152-158, Aug 2009. Link
• Walker KB. Confrontational Media Training for Administrators: Performance and Practice. Public Personnel Management Vol. 19 No. 4, Winter 1990. Link
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# Date Description 13 4/5/2016 Fireside Leadership Chat: Reach & Scale in Public Health
Special Guest: Dr. Swati Piramal, Vice Chairperson, Piramal Enterprises Limited Makeup Time: 8:30-10:00am Location: Kresge Room 200 Learning Objectives After this session, students will be able to:
• Incorporate lessons learned from a proven public health leader in their own leadership strategies.
• Describe the use of new technologies to deliver health services in India. Session Agenda
I. Leadership Seat Exercise (5 mins) II. Leadership Discussion (80 mins)
Readings
• Speaker Bio (messaged via Canvas) • John Macomber and Mona Sinha, “Sarvajal: Water for All,” HARVARD BUS. REV. (Sep. 3,
2013), https://services.hbsp.harvard.edu/services/proxy/content/47796145/47796171/5e134a102986491e09da39dbe0d54721.
• Rosabeth Moss Kanter and Matthew Bird, “Piramal e-Swasthya: Attempting Big Changes for Small Places - in India and Beyond,” HARVARD BUS. REV. (May 27, 2011), https://services.hbsp.harvard.edu/services/proxy/content/47796145/47796169/2b19b3612be5918eb131e8156aba7f6c.
Post-Session Assignment: Leadership Reflection due electronically on 4/8/2016
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Updated 3-31-2016
# Date Description 14 4/19/2016 Mock Adversarial Interviews
Special Guests: • Kevin Casey, Associate Vice President for Public Affairs and Communications, Harvard
University • Douglas Dockery, John L. Loeb and Frances Lehman Loeb Professor of Environmental
Epidemiology & Chair, Department of Environmental Health • Julie Rafferty, Associate Dean for Communications
Location: Leadership Studio updated 3/29 Learning Objectives After this session, students will be able to:
• Self-assess their interview skills. • Employ strategies to stay on message when confronted with an adversarial
interviewer. Session Agenda
I. Leadership Seat Exercise (5 mins) II. 6 Cities Statements and Q&A – 10 min per group (60 mins)
III. Reflections (20 mins) Assignment Due – Six Cities Scientific Defense Readings
• National Ambient Air Quality Standards: Particulate Matter (PM) Standards. United States Environmental Protection Agency. https://www3.epa.gov/ttn/naaqs/standards/pm/s_pm_index.html
• Dockery D, et al. An Association between Air Pollution and Mortality in Six U.S. Cities. N Engl J Med 1993; 329:1753-1759. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJM199312093292401 (requires Harvard login, also accessible on Countway Library website.
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# Date Description 15 5/3/2016 Summer Field Immersion Prep, Peer Coaching, & Professionalism
Special Guests: • Fawn Phelps, Instructor and Director of Leadership Development • Jennifer Betancourt, Assistant Director for Field Practice • Anne Litwin,
Location: Kresge 202A Learning Objectives After this session, students will be able to:
• Engage others in peer coaching conversations • Understand the applicability of peer coaching to their leadership development • Articulate leadership development goals for summer field practice • Articulate potential members of personal board of directors
Pre-Work (before class)
• Who’s at Your Table?—Print and bring to class. • Peer Coaching Pre-Work
Session Agenda
• Agenda and Overview: connect peer coaching to summer field immersion preparation • Introduction of Anne Litwin and peer coaching work • Clarifying what peer coaching is and its benefits for leaders • Introduction to GROW model • Peer coaching practice • Specific Instructions on use of peer coaching over the summer • Q&A about the logistics of peer coaching over the summer
Readings
• Andrew Thorn, Marilyn McLeod, Marshall Goldsmith “Peer Coaching Overview” (2007).http://www.marshallgoldsmithlibrary.com/docs/articles/Peer-Coaching-Overview.pdf (Links to an external site.).
• Jennifer Garvey Berger, “Growth Edge Coaching,” Chapter 4 and “Cultivating Wisdom,” Chapter 8 in Changing on the Job, (Stanford, California: Stanford Business Books, 2012.https://drive.google.com/file/d/0B7capbGAcwHvdnRUTGhqSnZCaHBXSGhVYlJiRUxBNGl0d1dJ/view (Links to an external site.)
• Gavett G. What does professionalism look like? Harvard Business Review. March 20, 2014.https://drive.google.com/file/d/0B7capbGAcwHvb2lELUpqUVdiREo0Skl6MjJNanV2cGZFelpZ/view (Links to an external site.).
• Personal Advisory Board reading (one page) http://www.bostonblackmba.org/about-us/blog/782-7-people-you-need-on-your-personal-advisory-board?utm_source=hootsuite (Links to an external site.) with worksheet (attached) Students should take a first pass at filling in their advisory board “table” before the May 3 session
• The Critical Few: Components of a Truly Effective Culture reading http://www.strategy-business.com/article/00237?gko=f5031 (Links to an external site.)
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HPM 281: ENABLING CHANGE – SPRING YEAR 2
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HPM 281: Enabling Change – Spring Year 2 (1.25 credits) Course Information Primary Instructor
Howard K. Koh, MD, MPH Harvey V. Fineberg Professor of the Practice of Public Health Leadership Harvard T.H. Chan School of Public Health | Harvard Kennedy School of Government
Co-Instructor
Shaloo Puri, MBBS, DTCD, MPH, MPA Instructor & Deputy Director of the DrPH Program
Teaching Assistant
Madeline Morcelle, JD, [email protected] Class Time & Venue
Tuesdays, 1:30-3:20 PM (bi-weekly, see specific dates) Location: varies by class, see specific dates.
Office Hours With Dr. Koh by request via Ellen Smith, [email protected] With Dr. Puri by request, [email protected] With Madeline by request, [email protected] Canvas Course Site https://canvas.harvard.edu/courses/11390 Course Description Why are some individuals successful in enabling positive change in public health? What applied skills do they have that allow them to create effective teams, organizations, and coalitions? How do they address the unique field of public health, with its diffuse power structures and multitude of stakeholders? The need for public health leadership is great, the challenges are many—how does one learn to lead? To be a successful applied public health practitioner individuals must go beyond traditional public health
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research skills and methodologies and learn how to enable positive change at four levels of application: within themselves, amongst their team, inside their organizations, and across systems. Students must also master practical competencies related to leadership, management, innovation, and communication. Students who address these competencies and apply them across each level of application will be the most ready to serve as public health leaders upon graduation. This course builds upon the Year 1 curriculum and supplements other required courses in the DrPH Enabling Change Curriculum. Each week, students will be guided through exercises that allow them to practice critical skills related to these competencies. Exercises and assignments will incorporate concepts covered in prior or concurrent coursework. This course will also prepare students for their field immersion and DELTA project experiences by providing frameworks for team building, consulting skills, and principles of professionalism. This course will prepare students to enter the workforce with the skills needed to understand complex organizational dynamics and influence positive change in those organizations. Course Objectives At the end of this course, students will be able to:
• Apply effective management, leadership, and communication strategies at the organizational- and system-levels.
• Employ effective team building and peer-coaching techniques to lead and empower others.
• Persuade the public, professionals, policymakers, and other key constituents on public health issues utilizing scientific evidence, stakeholder input, public opinion data, and other key sources of information.
• Analyze the causes of conflict in organizations and identify the appropriate use of power vs. influence
to reach a successful resolution.
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Requirements & Grading This course meets 8 times over the Spring term. See detailed session schedule for specific dates. Sessions will begin promptly at 1:30 PM and end at 3:20 PM. This course will be graded as pass-fail. Students earn a ‘pass’ by meeting course expectations (below) and demonstrating development on the course objectives.
Pass: Attendance at all sessions; completion of all required readings and pre-work; on-time submission of written assignments; active participation in class discussions; and providing constructive feedback to peers.
Fail: Any unexcused absence; failure to complete required readings and pre-work; failure to submit
written assignments on time; failure to actively participate in class discussions; and failure to provide constructive feedback to peers.
Expectations for Engagement As this is a course in practice and applied skills, it requires a commitment to trying new approaches and engaging fully in each exercise. Students should support one another during these exercises and understand that everyone enters the DrPH program with unique strengths or weaknesses. Specific expectations:
• Attend and participate in all classes. If you must miss a class due an emergency, please contact Dr. Puri as soon as possible.
• Complete all assigned readings. • Submit all assessment and written work on time. • Maintain an open disposition to understanding yourself in order to influence others. • Provide and receive candid and constructive feedback to and from one’s peers regarding
his/her effectiveness as a community member. Students will have an opportunity to establish consensus regarding additional shared expectations at the start of the semester.
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Discussion Exercises (every session) Leadership Seat Exercise
Starting with session #2, one student will be called at random to lead a discussion of the readings for that day. Students should come to class prepared to lead a 10-minute discussion with their classmates. Being chosen to lead the discussion in a given week does not preclude being chosen subsequently.
Specifics to bear in mind:
• Students may not use notes or refer to the readings in anyway during the exercise. • Students should prepare 2-3 questions to drive discussion that employ “critical thinking stems” as
discussed in King A. Designing the Instructional Process to Enhance Critical Thinking Across the Curriculum. Teaching of Psychology: Vol 22: No 1, Feb 1995. Link
Front-Page News Exercise
Students will be assigned articles from major domestic or international news publications on a recent issue relating to public health. In preparation for class, students should research various stakeholder positions on the public health issue and should prepare one-minute oral arguments supporting each stakeholder’s position on the public health issue before class.
In class, we will randomly select students to represent the stakeholder identities and, after two minutes to review their notes, deliver their statement for their assigned stakeholder. Following the oral arguments, the students will serve on a brief panel and answer questions from the faculty and their classmates from the perspective of their particular stakeholder group. This will be followed by feedback on communication and performance from the teaching team and fellow students.
Each student will prepare at least two Front-Page News exercises over the course of the semester. Specifics to bear in mind:
• Students must be prepared to represent any of the assigned stakeholder perspectives. • Students will be restricted to exactly one-minute for their initial remarks. • Students may not use notes during the opening remarks or panel.
Fireside Moderation
Students, in small groups, will host and moderate the Fireside Leadership Chats. Moderation responsibilities include:
Three-weeks prior
• Research the guest speaker’s work • Submit a preliminary list of topics and learning objectives for the speaker to Drs. Koh/Puri
Two-weeks prior
• Send a welcome email to the speaker that includes potential topics and learning objectives for his/her session
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In-session
• Welcome and introduce the speaker • Lead the first 10-15 minutes of discussion • Moderate the remaining discussion time • Thank the speaker for their insights and participation
Post-session
• Send a thank you email to the speaker
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Assignments (vary by session) Why Should Anyone be Led by You?
Part I. Written Reflection (Due electronically by noon on 1/22/2016, prior to first class) In order to lead, one must be able to engage followers effectively. How do you, or will you, inspire others to follow you? Write a reflection (no more than 2,500 words) responding to the question, ‘Why should anyone be led by you?’
In your response, draw on the framework provided in the reading by Goffee/Jones. Describe your successes or challenges in,
1) Exposing your vulnerability 2) Collecting and interpreting ‘soft’ data 3) Empathizing passionately, and realistically, with others 4) Capitalizing on your uniqueness
Your response should also include plans for how you plan to continue your leadership journey. Draw on the model provided by Bennis. How have you engaged in understanding the public health context as well as both ‘knowing yourself’ and ‘knowing the world’? What concrete steps will you take in the future to further your development? For additional structure, you may wish to draw upon the results of your Emerging Leaders Profile 360° Assessment last spring. In which competencies are you most confident? Which competencies remain challenging and how do you plan to address those challenges? Emerging Leaders Profile Competency Areas
• Learning and Agility • Communication Skills • Emotional Intelligence • Resilience/Flexibility • Self-Confidence • Creativity and Innovation • Moral Courage • Cultural Adaptability • Decisiveness • Personal Organization and Planning
Part II. Personal Presentation (Due on 1/26/2016, during first class)
Prepare a 5-minute oral summary of your reflection. In class, students will be randomly grouped to share their reflections in one-on-one pairs. Students should listen attentively to each other and be prepared to report back to the group on why anyone should be led by his or her partner.
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Readings • Goffee R, Jones G. Why Should Anyone be Led by You?: What it Takes to Be an Authentic Leader:
with a new preface by the authors. Harvard Business Review Press, 2015. • Bennis WG. On Becoming a Leader. Addison Wesley Publishing Company, Reading MA, 1989. • Results of your 360° Assessment from Spring 2015
Phantom Feedback
Public health leadership is performed on under intense scrutiny. Warren Bennis describes the discomfort of leading publically under this public gaze in his article, The Seven Ages of the Leader:
“You have to learn how to do the job in public, subjected to unsettling scrutiny of your every word and act, a situation that’s profoundly unnerving for all but that minority of people who truly crave the spotlight. Like it or not, as a new leader you are always onstage, and everything about you is fair game for comment, criticism, and interpretation (or misinterpretation). Your dress, your spouse, your table manners, your diction, your wit, your friends, your children, your children’s table manners—all will be inspected, dissected, and judged.”1
In order to explore this reality of our field in a safe setting, we will be asking you to engage in an exercise called Phantom Feedback. 1. In-class on 1/26/2016 you will select the name of a classmate at random
2. Email Madeline to let her know who you are observing
3. From 1/26-2/9/2016 observe that classmate whenever you see her/him, both in and out of classes
and be prepared to provide feedback on several dimensions: a. Technical abilities in classes b. Preparation for classes or projects c. Behaviors that makes the person seem approachable (or not)
Some things to look for: • How does s/he present and carry her/himself? • How does s/he interact with students, staff, faculty, friends, or strangers? • Is s/he prepared in class or on group projects? • Is s/he fun, charismatic, joyful? • Does s/he smile often? • Does s/he participate in discussions? • Does s/he listen to others? • What are her/his strengths and challenges? • What do you think others would most enjoy when interacting with this person (e.g., his/her
intelligence; his/her technical skills; his/her sense of humor; his/her company in general)?
1 Bennis WG. The seven ages of the leader. Harv Bus Rev. 2004 Jan;82(1):46-53, 112.
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4. In-class on 2/9/2016 we will discuss how to effectively provide feedback
5. Then you will privately and confidentially share your observations from the previous weeks with
the observed individual
Some considerations when preparing to give/receive feedback: • For the Giver:
• Before giving feedback, reflect on your intentions for this exercise--why have you chosen to share these particular observations?
• Describe specific, observable behaviors rather than making judgments • Be ready to answer clarifying questions
• For the Receiver: • Assume positive intent and suspend defensive responses • Ask clarifying questions about the feedback you receive
Fireside Reflections
You will prepare reflective papers in response to the topics below. A strong reflection will process, analyze and apply the call of the assignment in the context of your own beliefs and experiences. Fireside Reflections should not exceed 500 words and should be submitted in Word document format via the Canvas course site. You should include your name, the course number (HPM281) and the name of the assignment (see below) at the top of each Reflection.
Note: As Fireside Reflections are meant to be exercises in effective written communication we will also assess your written communication and persuasion skills.
Fireside Reflection 1: Changing Organizational Culture (Due electronically by noon on 2/26/2016)
Write a reflection (no more than 500 words) discussing the relative merits of power vs. influence in addressing the history of sexual assault and cultural norms at the Air Force Academy. Draw on the discussions and readings with Sara Singer and Dana Born.
Fireside Reflection 2: Developing a Diverse Workforce (Due electronically by noon on 4/1/2016)
Write a reflection (no more than 500 words) on a previous team experience. How did the diversity (or lack thereof) of the team affect the success of your work? Draw on the discussions and readings with Talia Fox.
Fireside Reflection 3: Leadership for Global Health (Due electronically by noon on 4/29/2016)
Write a reflection (no more than 500 words) on how systems theory can be used to address global health challenges. Draw on the discussions and readings with Peter Senge and John Monahan.
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Session Details Spring Semester # Date Description 1 1/26/2
016 Why Should Anyone Be Led by You? Special Guests:
• Fawn Phelps, Instructor and Director of Leadership Development Location: Kresge 502 Learning Objectives After this session, students will be able to:
• Self-assess their performance against their individual leadership goals. • Examine their peer coaching experiences.
Session Agenda
I. Expectations & Norms (30 mins) II. Why Should Anyone be Led by You? (70 mins)
a. Personal Presentations b. Group Reporting & Discussion
III. Intro to Phantom Feedback (10 mins) Assignment Due – Why Should Anyone be Led by You?
• Part I. Written Reflection due electronically by noon on 1/22/2016 • Part II. Personal Presentation due on 1/26/2016
Readings
• Goffee R, Jones G. Why Should Anyone be Led by You?: What it Takes to Be an Authentic Leader: with a new preface by the authors. Harvard Business Review Press, 2015.
• Bennis WG. On Becoming a Leader. Addison Wesley Publishing Company, Reading MA, 1989.
• Results of Spring 2015 360° Assessment from Spring 2015
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# Date Description 2 2/9/20
16 Fireside Leadership Chat: Changing Organizational Culture Special Guests:
• Dana Born, Lecturer in Public Policy, Harvard Kennedy School; Brigadier General (ret.), U.S. Air Force; and former Dean, U.S. Air Force Academy
• Michael McCormack, Director of Practice and Deputy Director of Public Health Leadership • Fawn Phelps, Instructor and Director of Leadership Development
Location: Kresge 502 Learning Objectives After this session, students will be able to:
• Incorporate lessons learned from a proven public health leader into their own leadership strategies.
• Enable cultural shifts in an organization. • Apply strategies to discuss sensitive issues effectively in professional settings.
Session Agenda
I. Leadership Seat Exercise (10 mins) II. Phantom Feedback (50 mins)
III. Leadership Discussion with Dana Borne (50 mins) Readings
• Weeks H. Taking the Stress out of Stressful Conversations. Harvard Business Review, July-August 2001. Link
• David S. Manage a Difficult Conversation with Emotional Intelligence. Harvard Business Review, June 19, 2014. Link
• Carmichael SG. Difficult Conversations: 9 Common Mistakes. Harvard Buisness Review, October 2010. Link
• Speaker Bio • Kotter JP. Leading Change: Why Transformation Efforts Fail. HBR 10 Must Reads on
Change Management. Harvard Business Review Press, Boston, 2011. Link updated 2/23 • Meyerson DE. Radical Change, the Quiet Way. HBR 10 Must Reads on Change
Management. Harvard Business Review Press, Boston, 2011. Link updated 2/23 • Schemo DJ. Rate of Rape at Academy is Put at 12% in Survey. New York Times, August 29,
2003. Link • Schemo JD. Air Force Ignored Academy Abuse. New York Times, September 23, 2003. Link • Shanker T. Commanders are Faulted on Assaults at Academy. New York Times, December
8, 2004. Link updated 2/2
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# Date Description 3 2/23/2
016 Power & Influence in the Organization Special Guest: Sara Singer, Associate Professor of Health Care Management and Policy Location: Kresge 502 Learning Objectives After this session, students will be able to:
• Distinguish complex dynamics of power and influence in organizations. • Apply when to use power vs. influence and strategies for their effective use.
Session Agenda I. Leadership Seat Exercise (10 mins)
II. Front Page News Exercise (20 mins) III. Case Discussion (80 mins)
Case Discussion Questions
• What does Conley's experience suggest regarding how power is built and maintained in academic medicine?
• Was Conley right to resign when she did? What other options did she have? • At the end of the case, after the latest senate meeting, Conley is having second thoughts
about her resignation. At this point, what would you advise her to do?
Readings • Fran Conley Case: Walking out on the Boys Link added 2/2 • McGinn KL, Lingo EL. 2001; revised 2007. “Power and influence: Achieving your objectives
in organizations.” Harvard Business School Note. HBR # 801425. Link updated 2/23 • Martorana PV, Galinsky AD, Rao H. 2005. “From System Justification to System
Condemnation: Antecedents of Attempts to Change Power Hierarchies.” Research on Managing Groups and Teams, 7, 283–313. Link added 2/2
• Pfeffer J. 1992. “Understanding Power in Organizations.” California Management Review, 34(2), 29–50. Link
• Slaughter AM. 2012. “Why women still can't have it all.” The Atlantic Link Post-Session Assignment: Fireside Reflection due electronically by noon on 2/26/2016
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# Date Description 4 3/8/20
16 Fireside Leadership Chat: Systems Thinking Special Guest: Peter Senge, Senior Lecturer, Leadership and Sustainability, MIT Sloan School of Management Location updated 2/23: Kresge Building 2, Room 102 (Genetics and Complex Diseases Conference Room) Learning Objectives After this session, students will be able to:
• Translate the abstract ideas of systems theory into tools for better understanding of economic and organizational change.
• Enhance employee productivity toward common goals. • Foster social and economic wellbeing through institutional changes.
Session Agenda
I. Leadership Seat Exercise (10 mins) II. Front Page News Exercise (20 mins)
III. Systems Thinking (80 mins)
Readings • Aronson D. Overview of Systems Thinking. Copyright 1996-8, Daniel Aronson. Link added
2/8 • Senge Peter M, Sterman John D. Systems thinking and organizational learning: Acting
locally and thinking globally in the organization of the future. System Dynamics, 1990:1007-1022. Link added 2/8
• Kim DH, Senge PM. Putting Systems Thinking into Practice. System Dynamics Review Vol. 10, nos 2-3 (Summer-Fall 1994):277-290. Link added 2/8
• Senge PM. Systems Citizenship: The Leadership Mandate for this Millennium. Leader to Leader, Summer 2006. Link
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# Date Description 5 3/29/2
016 Fireside Leadership Chat: Developing a Diverse Workforce Special Guest: Talia Fox, President & CEO, KUSI Training Location: Kresge 205 Learning Objectives After this session, students will be able to:
• Leverage the diversity of your workforce. • Use human resources management techniques to develop a diverse workforce • Draw on people of diverse backgrounds to create novel solutions to public health
problems. Session Agenda
I. Leadership Seat Exercise (10 mins) II. Front Page News Exercise (20 mins)
III. Developing a Diverse Workforce (80 mins) Readings
• Pope M. Embracing and harnessing diversity in the US workforce: what have we learned? International Journal for Educational and Vocational Guidance. March 2012, Volume 12, Issue 1, pp 17-30. Link
• Jordan J. Cohen, Barbara A. Gabriel and Charles Terrell. The Case For Diversity In The Health Care Workforce Health Affairs, 21, no.5 (2002):90-102. Link
Post-Session Assignment: Fireside Reflection due electronically by noon on 4/1/2016
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# Date Description 6 4/12/2
016 Navigating the Adversarial Interview Location: Kresge 10th Floor Leadership Studio Learning Objectives After this session, students will be able to:
• Critique the effectiveness of media interviews in conveying appropriate public health messages in an adversarial setting.
Session Agenda
I. Interview critique and discussion (40 mins) II. Navigating the Adversarial Interview (40 mins)
Readings
• DeVelder CJ. Surviving the Adversarial Interview. Student Lawyer. 39.8 (Apr. 2011): p14. http://www.heinonline.org.ezp-prod1.hul.harvard.edu/HOL/Page?handle=hein.journals/studlyr39&id=416&collection=journals
• Gilman A. Preparing for a media interview. Journal of Communication in Health Care, Vol. 3 No. 2, pp. 152-158, Aug 2009. http://web.a.ebscohost.com.ezp-prod1.hul.harvard.edu/ehost/detail/detail?sid=8b7277c0-edd3-4f29-9bf4-3b2262767dc8%40sessionmgr4005&vid=0&hid=4109&bdata=JnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl&preview=false#db=heh&AN=53708224
• Walker KB. Confrontational Media Training for Administrators: Performance and Practice. Public Personnel Management Vol. 19 No. 4, Winter 1990. http://web.a.ebscohost.com.ezp-prod1.hul.harvard.edu/plink?key=10.4.20.29_8000_1542604155&db=bth&AN=9607031227&site=ehost-live&scope=site
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# Date Description 7 4/26/2
016 Fireside Chat: Leadership for Global Health Special Guests:
• John Monahan, Senior Advisor for Global Health to Georgetown University Location: Kresge 439 (updated 4/23) Learning Objectives After this session, students will be able to:
• Compare and contrast effective public health leadership in global and domestic contexts. • Plan for the unique challenges of public health leadership in international contexts.
Session Agenda
I. Leadership Seat Exercise (10 mins) II. Front Page News Exercise (20 mins)
III. Leadership for Global Health (70 mins) Readings
• Speaker Bio • Gostin A, et al. Law's power to safeguard global health: a Lancet–O'Neill Institute,
Georgetown University Commission on Global Health and the Law. The Lancet, Volume 385, Issue 9978, 25 April–1 May 2015, Pages 1603–1604. http://www.sciencedirect.com.ezp-prod1.hul.harvard.edu/science/article/pii/S0140673615607565
• Gostin L, Sridhar D. Global Health and the Law. N Engl J Med 370;18:1732-40, May 1, 2014. http://www.nejm.org.ezp-prod1.hul.harvard.edu/doi/full/10.1056/NEJMra1314094
• Downs J, et al. Increasing Women in Leadership in Global Health. Academic Medicine. 89(8):1103-1107, August 2014. http://www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu/pmc/articles/PMC4167801/
Post-Session Assignment: Fireside Reflection due electronically by noon on 4/29/2016
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# Date Description 8 5/10/2
016 Understanding Journeys and Endings Special Guests:
• Fawn Phelps, Instructor and Director of Leadership Development • Anne Litwin
Location: Kresge 205 Learning Objectives After this session, students will be able to:
• Assess their personal and professional evolution throughout the DrPH program. • Examine changing group dynamics around endings.
Session Agenda
• Mapping Your DrPH Journey (40 mins) • Understanding Endings (40 mins)
Readings
• Hanh TN; translated from Vietnamese by Annabel Laity. Chapter 8: The Raft is Not the Shore. In: Thundering Silence: Sutra on Knowing the Better Way to Catch a Snake. Parallax Press, Berkeley CA, 1983. https://drive.google.com/file/d/0B7capbGAcwHvS3JMc185cjRhdzBnYkNjNG9GUFk5RS1wWk1Z/view
• Van Steenberg LaFarge V. Chapter 8: Termination in Groups. In: Groups in Context: A New Perspective on Group Dynamics. Gillete J, McCollom M, eds. University Press of America Inc., Lanham, NY, 1995. https://drive.google.com/file/d/0B7capbGAcwHvUktVRTF6bVpQTEZZdjE0cGh0Z2JsTjZoSVBF/view
Department of Health Policy and Management
HPM 290: Applied Research and Practice (ARP) Academic Year 2015-2016 (Fall and Spring)
Course instructor: Class Sessions: Nancy Turnbull Tuesday 5:30-7:15 pm Office: Kresge 303 Kresge 200 [email protected] 617-432-4496 Office hours by appointment (please schedule with me via email) Course assistant: Nancy Perna Office: Kresge 112 [email protected] 1. Course Learning Objectives The Applied Research and Practice (ARP) is the practice and culminating experience for students in the two-year Master of Science degree program in the Department of Health Policy and Management. The objectives of the ARP are to help you:
• Integrate, synthesize and apply graduate-level skills and competencies you are gaining in your degree program to a real world problem or issue
• Explore a substantive public health or health care topic that is salient to a health care or public health organization and of interest to you
• Learn from professionals in the field • Enhance the skills you need to function in a professional public health setting,
particularly: o Goal setting o Producing professional quality work o Interpersonal relationships o Oral and written communication
• Build your confidence as a public health professional • Widen your professional network • Share your practicum experience and learn from the experience of others • Engage in professional self-assessment and critical reflection.
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2. Course Structure You must register for HPM 290 in both the Fall and Spring semesters (2.5 credits each semester, for a total of 5 credits). The course has two components: a. Project/Field Placement: You are required to work at least 140 hours on an approved project in a setting that is relevant to your track in HPM (i.e., health policy, health management or health research). This is the major component of the ARP; your work on your practice project, including a final evaluation from your preceptor, will account for 75% of your grade in the course. Please see pages 11-14 for more details. b. Classroom sessions: The class will meet most weeks during the fall semester, and several times in the spring semester. Please see pages 7-9 for a list of class sessions. The class sessions will focus on professional skills, including self-assessment (StrengthsFinder, MBTI and reflection memo), oral and written communication (presentations on your summer internship, reports on your project-in-progress, written project updates, and your final report and poster), and career skills (working in groups, meta-leadership, and alumni panels). Why self-assessment? Research on practice and field experiences has found that self-assessment and critical reflection are important strategies for enhancing learning in a practice setting. The purpose of these classroom sessions and assignments is to help you think about yourself, your career goals, and what you’re learning about yourself in a professional setting from your ARP. The sessions are intended to be a means to reflect on your professional values, goals, strengths and challenges, and think about the work that you find most joyful and rewarding. 3. Assignments There are 6 assignments for the course (most of which are very short):
• Summer internship paper: Due Tuesday, October 6, 2015 • Project Update #1: Due Tuesday, October 20, 2015 • Project Update #2: Due Tuesday, December 15, 2015 • Project Update #3: Due Tuesday, March 1, 2016 • A poster presentation: Tuesday, May 3 and May 10 • Final Project Report: Due Friday, May 6, 2016
See pages 5 and 6 for more details. Late policy: I expect your assignments to be submitted on time. Any assignment that is late (without prior approval by me) will not be accepted and you will receive a failing grade for it. I will grant extensions only under exceptional circumstances, out of fairness
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to other students. I also expect that you can read the syllabus and keep track of the deadlines for assignments without reminders from me. 4. Class Participation As indicated on pages 7-9, most class sessions are required but a few are optional. You are expected to attend every required session unless you have been excused by me in advance. While I hope that the optional sessions will be of value to everyone in the course, you may choose whether or not to attend them. No electronic devices in class, including laptops, cell phones, iPhones, iPads/tablets. There is no need for extensive note taking in the class, and people distracted by screens are less likely to engage with their classmates and with any guest speakers. The entire class will benefit from having an engaged environment in the classroom. (Please see http://www.nytimes.com/2013/05/05/opinion/sunday/a-focus-on-distraction.html?_r=0) or http://www.newyorker.com/tech/elements/the-case-for-banning-laptops-in-the-classroom or http://chronicle.com/blogs/linguafranca/2014/08/25/why-im-asking-you-not-to-use-laptops/?cid=at&utm_source=at&utm_medium=en if you want to understand the educational rationale for this policy. Please talk to me if you have a reason why you think I should make an exception to this policy for you.
5. Submission of grades Your grade in the course will be based on your performance during the entire year. As shown below, 75% of your grade is based on your project work (including an evaluation from your preceptor). Since the final project report and poster will be submitted in the spring, you will not receive a grade for the fall term until the spring term is completed. You will receive the same grade for all 5 credits of the course (i.e., the same grade for the fall and spring semester). Until your final grade is submitted in May, your transcript will show an “IP” for the fall section of HPM 290. However, you will receive feedback from me on other assignments as they are submitted (e.g., Updates), and, if I have any concerns about your performance along the way, I will let you know. If you have any questions about how you’re doing in the course, please talk to me directly. 6. Course Website This course will be using Canvas. Course documents, including the course syllabus, and ARP placement agreements, have been posted on the HPM 290 site. A drop box will be used to receive each assignment and these can be found on the course website. 7. Course Material You will be required to complete certain instruments in advance of the MBTI and StrengthsFinder sessions. You will receive an email from Anne Occhipinti in advance of
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these sessions telling you what to do. Please note that you will receive a charge of ~$80 on your term bill for the material used in this course (including the cost of printing the poster for the final poster session). 8. Practicum Project and Preceptor evaluation: You must complete the on-line Harvard Chan School Practicum Assessment form (which will be sent to you in the spring by the Office of Education) before you will receive a final grade for the course. 9. Course Evaluation: You will be also asked to complete the Harvard Chan School evaluation for the course at the end of the spring semester.
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Assignments and Grading % of Grade Due Date 1. Summer internship presentation and report Presentation: This should be 5 minutes long and designed to cover where you worked, what you did, and what you learned. You may use no more than two slides (and feel free to use none). Report: This report should be no more than 5 double-spaced pages, and cover the following: • Short background on the organization • A description of the work you did during the
internship. • Answers to the following questions:
o What were your personal goals for your summer internship? Did you achieve them or not? If not, why not?
o What skills and knowledge from Harvard Chan School did you apply during your summer internship?
o What new skills and knowledge did you develop?
o Pick one or two of your strengths from the StrengthsFinder session. How did you use this strength during the summer internship?
o Pick one of your MBTI preferences: how did this preference affect your work and interactions with your colleagues this summer?
o How did your summer internship affect the type of work you want to do and the type of organization/setting that you want to work in during your ARP? After you graduate from the School?
o Would you recommend the organization and supervisor to future students?
5% Presentations on: Tuesday, October 6, 2015 and Tuesday October 13, 2015 (Students will be assigned to one of the nights before the sessions.) Report due Tuesday, October 6, 2015
2. ARP Project Updates See page 15 for more detail about these updates.
10% Short written ARP updates are due on: Tuesday, October 20, 2015 Tuesday, December 15, 2015 Tuesday, March 1, 2016
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3. Final Project Report and Poster Final project report: No longer than 12 double-spaced pages, excluding abstract and appendices and personal reflections (See pages 16 and 17 for more detail.) Poster: More detail about the poster sessions and preparation of posters will be provided early in the spring semester.
65% Final Project Report: Due no later than Friday, May 6, 2016 Poster sessions: We will have two poster sessions. One will be on Tuesday, May 3 and the other on May 10.
4. Preceptor Evaluation The preceptor at your practice site will be asked to submit a formal written evaluation of your work near the end of the course.
10% The evaluation form will be sent directly to your preceptor.
5. Class Participation This includes attending all required class sessions and active and engaged participation.
10%
6. Harvard Chan School Practicum Assessment form You must complete the Harvard Chan School Practicum Assessment form (which will be sent to you in the spring by the Office of Education) before you will receive a final grade for the course.
Required to pass the course
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Fall Semester 2015 ARP SESSIONS AND ASSIGNMENTS
Date Topic Description September 8 Course overview
• Goals, requirements and assignments • Searching for a project • Small group brainstorming
September 15
Myers-Briggs Type Inventory (MBTI) This session will use the MBTI tool to help you better understand your personal communication style and improve your effectiveness with others, including your preceptor. If you have already done the MBTI and you know your type, you are not required to do the assessment again, although you still might want to do it.
Anne Occhipinti, Assistant Dean of Professional Education, will lead this session You will receive a link from Anne before the class to an assessment that you will need to complete; please follow her instructions.
September 22 ***No class session*** September 29
StrengthsFinder This session will use the StrengthsFinder assessment tool to help you identify areas where you have the greatest potential for building strength.
Anne Occhipinti will lead this session You will receive a link from Anne before the class to an assessment that you will need to complete; please follow her instructions.
October 6
Summer internship presentations **Summer Internship Paper is due** (post to drop box on Canvas)
You will be assigned to a presentation session on the first night of class
October 13 Summer internship presentations You will be assigned to a presentation session on the first night of class
October 20 ***No class session*** **Project Update #1 is due** (post to drop-box on Canvas)
October 27 Joint session with MPH/Health Management practicum students
Working in Teams: ***Please bring a laptop to this session
if you have one** In this interactive session, teams will be challenged to solve several different problems in a limited time frame. In addition to teamwork, this will provide an opportunity to see how differing leadership styles impact a team’s performance.
Instructors: Michael McCormack, Director of Practice and Deputy Director of Public Health Leadership, Office of Education Fawn Phelps, Director of Leadership Development, Office of Education
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Date Topic Description November 3 Joint session with MPH/management practicum students
Meta-Leadership: Part 1 Students at the Harvard T.H. Chan School of Public Health often aspire to leadership. How do all the courses in the curriculum – policy, biostatistics, epidemiology and others – prepare students to lead in the increasingly complex health systems in which they will work? The two Meta Leadership sessions (second class on 12/1) introduce students to two original models of leadership The first session is an integrative model of leadership that encompasses character, context and cohesion of effort in its theory and practices. Who are you as a person and why do you lead? How do you assess the situations through which you lead and develop strategies to link problems to solutions? And how do you forge connectivity and unity of effort among a wide set of critical stakeholders?
Instructors: Barry Dorn and Lenny Marcus, Lecturers on Public Health Practice, Department of Health Policy and Management
November 10 (attendance is optional)
Alumni Panel
See list of alumni on page 10
November 17 (attendance is optional)
Alumni Panel
See list of alumni on page 10
November 24 *No class session-Thanksgiving week* December 1 Joint session with students in the MPH/management practicum students
Meta Leadership: Part 2 The second Meta Leadership session is the “POP-DOC Loop” which defines a series of analytic and action steps designed to orient and order the work of numerous leaders who work together. The six steps of the Loop are: Perceive, Orient, Predict, Decide, Operationalize, and Communicate. For complex problem solving, when leaders together engage these activities, they are able to achieve order beyond control, an important quality for addressing highly complex and inter-dependent problems and solutions.
Instructors: Barry Dorn and Lenny Marcus
Wednesday, December 2 (attendance is optional) This session will be a joint session with the MPH/health policy students Classroom Location TBD
Working with the Press Communicating your work to key audiences is a core piece of impacting policy and a key leadership skill. This class will focus on strategies you need to think about when talking with the media.
Guest Lecturer: Colleen Chapman Colleen is a national health communications strategist who has worked on the most prominent health policy of the past decade. The session will include seasoned journalists who cover health and public policy.
December 8 (attendance is optional)
Alumni Panel Note: Students doing a team practicum project with a defined team that involves work during January term will be required to attend a Team Building session this night led by Michael McCormack and Fawn Phelps.
See list of alumni on page 10
December 15 **No class session: Fall2 finals**
**Project Update #2 due** (Post to drop-box on Canvas)
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Spring Semester 2016 ARP SESSIONS AND ASSIGNMENTS
Date Topic Description January 26 ***No class session*** February 2 Project update presentations Students will each present a 5-minute oral
update on his/her ARP project. You will be assigned one of the two nights for your presentation.
February 9 Project update presentations Students will each present a 5-minute oral update on his/her ARP project. You will be assigned one of the two nights for your presentation.
February 16-end of April Nancy will meet individually with each student about your projects and final reports
March 1
Check-in session
This is an informal opportunity to touch base with the class and get any help or advice about your project
**Project Update #3 is due ** (Post to drop-box on Canvas.)
March 29 Making Effective Posters This session will review the format for your poster and give some tips about designing it.
April 24 (revised date) Poster submission Your Poster is due to the drop-box on Canvas so it can be printed for the sessions the following week
May 3 and May 10
Poster Presentation Sessions Students will present their project posters to the class. You will be assigned one of the two nights for your presentation.
Friday, May 6 FINAL PROJECT REPORT DUE
Post your final report to the drop-box on Canvas.
Saturday, May 14 11 am
Graduation Brunch at Nancy’s House
Come and celebrate your graduation at 26 Francis Street, Brookline. More details closer to the date.
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Alumni Panels
November 10: Alumni who work in global health Jon Payne (2010): Senior Technical Adviser, mHealth Alliance, United Nations Foundation (previously worked for Partners in Health in Haiti and Mexico) Mitsuru Toda (2010): Japan International Cooperation Agency, working in Nairobi, Kenya [Mitsuru will join us via the web from Washington, DC] Joe Tayag (2010): Health Financing Specialist / Senior Analyst at Abt Associates in D. C. (worked previously at the International Labour Organization and the Asian Development Bank in Fiji and Tanzania) [Joe will join us via the web from Washington, D.C.] November 17: Alumni who work in provider organizations Kelly Dougherty (2007): Executive Director, The Cardiovascular Center, Tufts Medical Center
(previously worked at Chartis and Dana Farber Cancer Institute) Martyna Skowron (2012): Castlight Health (formerly worked at Chartis and Brigham and Women’s Hospital) Martyna will likely be joining us via the web from the west coast. Carrie Solomon (2014): Boston University Medical Center (she did administrative fellowship
at the hospital and has continued working there) December 8: Alumni who work in health policy Kris Bloch (2013): Product manager, Network Health (a Medicaid health plan) Jeff Davis (2010): Program Analyst, U.S. Dept of Health and Human Services (former Presidential Management Fellow) [Jeff will join us via the web from Washington, DC] Jessica Larochelle (2002): Blue Cross Blue Shield of Massachusetts Foundation (worked formerly as head of a consumer advocacy organization in western Pennsylvania and at Families USA)
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Your Practice Project
***I MUST APPROVE YOUR PRACTICE PROJECT BEFORE IT IS OFFICIAL***
You have flexibility to find an ARP project that meets your educational and career goals, as long as it meets the course criteria for an acceptable project and is approved by me in advance. I will try to be as helpful as I can in helping you find a project, by meeting with you individually, helping you network, and sharing information about potential projects. YOUR GOAL IS TO HAVE A PROJECT BY OCTOBER 30, 2015. Your Practicum Placement and Learning Agreement should be done by Friday, November 13th There are three general approaches to finding a project: #1: Do a practicum project with a Harvard Chan School ‘Practicum Partner’:
• Most are for small teams, though some are for individual work • These projects are listed in CareerConnect: https://hsph-harvard-
csm.symplicity.com/students/index.php • You must apply for these projects and be selected
#2: Do a practicum project that YOU identify and arrange independently:
• These can be done individually or in small teams, depending on the organization • For a listing of previous practicum sites see:
http://www.hsph.harvard.edu/public-health-practice-resources/student-information/prior-practice-sites/ #3: Do a practicum project that is part of a GHP WinterSession Field courses that has agreed to also participate in the practicum (GHP 297, Chile trip, and GHP 547, Material Health trip)
• You must apply for these trips and be selected. • You will be required to do a separate project in addition to participating on the
trip • For more information about these trips see the GHP Website:
http://www.hsph.harvard.edu/winter-session-ghp-field-trips The projects in CareerConnect have been pre-screened and meet the requirements for an acceptable ARP project. However, I still need to approve your project before it is officially approved for you.
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a. Criteria for an acceptable practicum project A practicum project must meet the criteria specified below:
• Requires you to work at least 140 hours on an approved project • Requires you to demonstrate and apply the graduate level skills and competencies
you are learning in HPM’s SM2 program • Addresses a problem that has significance to the sponsoring organization • Is of interest to you • Is relevant to public health (i.e., addresses a problem or issue you are likely to
encounter in public health practice) • Advances your skills and knowledge • Has a specific, well-defined project(s) as its primary focus (i.e., will allow you to
accomplish something specific over the course of the placement, write a final report on it, and prepare a poster)
• The project scope is manageable in terms of your time, skills and knowledge • You will be supervised by a preceptor who has the appropriate education and
training to oversee the project, agrees to the project plan in the ARP Placement Agreement, agrees to accept the responsibilities of a preceptor as outlined below, and is acceptable to the course instructor.
• Will enhance your career potential and professional development. Working with a faculty member on his/her research may or may not be an acceptable ARP project. Since the goal of the ARP is for you apply the skills and knowledge you are learning in your degree program in a “real-world” setting, working as a research assistant conducting literature reviews or doing data analysis for a professor is generally not an acceptable ARP project. However, if you are in the research track of the SM2 program, working on a research project can be an appropriate ARP project, provided it requires you to conduct some aspect of independent research and that I approve the project and your role in it. Occasionally faculty members are working on applied projects that would be appropriate ARPs, so if you have a question about a specific project, come and talk to me. Payment: Practicum projects can be paid or unpaid. The amount of any compensation is negotiated between you and the practice site. However, the possibility of payment will not be a consideration in deciding whether or not a project is acceptable for the course. Human Subjects: Please note that any practice project involving research on human subjects or analysis of identifiable data from human subjects may require pre-approval by the Harvard Chan School Office of Regulatory Affairs and Research Compliance (http://www.hsph.harvard.edu/regulatory-affairs-and-research-compliance/) . Please discuss this issue with me if your project involves human subjects. b. Responsibilities of the Preceptor
• Develop a realistic project proposal and work schedule with you • Orient you to the organization and project
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• Be available on a regular basis to meet with and supervise you and provide the guidance and support necessary for successful completion of the project and on-going feedback about your performance
• Provide resources needed to complete project (work space, computer on site, administrative support)
• Assist in your professional development (e.g., help you meet leaders of the organization, attend meetings during the practice placement, conduct informational interviews)
• Talk to the course instructor periodically to provide feedback on your performance
• Provide written feedback on your performance by completing a practicum evaluation form at the end of the practicum.
c. Process for approving practice projects A clear description of the ARP project’s scope, objectives and other key features enhances the probability of you having a positive and successful learning experience. Step1: Discuss your proposed project with me Step 2: Once your proposed project has been approved, a Practicum Placement and Learning Agreement must be developed by you and the preceptor, signed by both, and submitted to me for final approval and sign-off. The purpose of the Practicum an Learning Agreement is to make clear the work to be accomplished, its relationship to the goals of the practice site and the student’s learning objectives, clarify the student’s responsibilities in the project, and make sure that that the practice site has arranged for the student’s basic needs in the project to be met (i.e., supervision, clear responsibilities, orientation, a place to work, resources appropriate to the tasks assigned). A copy of the Agreement is included at the end of the syllabus and posted in the Project Forms folder on the course website. Please use the Practicum Placement and Learning Agreement dropbox on the course website to submit the agreement and email me to let me know you have submitted the form. d. Information for Potential Preceptors A copy of some background material on the ARP requirements that might be helpful to share with potential preceptors is included as Appendix 2 at the end of the syllabus and also posted in the Help Finding an ARP section of the course website.
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e. A Few Tips for a Successful ARP Start looking for a project early: In general, the sooner you find an ARP project, the better. Although the timing of finding and starting projects will vary from student to student, it is more likely that problems could arise if you delay looking for a project. The biggest risk is that you will procrastinate, and then find yourself working on a project that you might not enjoy as much as one you could have found with more effort and/or less time pressure. Focus on the project and the preceptor: In my experience, the three most important attributes of a good ARP are:
• a well-defined project that is important to the organization so it will get priority and attention
• a preceptor who cares that you have a good learning experience and will devote time and energy to making sure that you do
• a project focus that is interesting to you and will teach you something you want to learn.
Try to find a project that meets all three criteria. When ARPs don't go well, it's generally because the project never came together (i.e., it was not defined well upfront, the focus kept shifting and/or it gets put on a back burner because no one really cared enough about the project--it was nice to do if there was someone willing to do it but it gets no priority in the face of other more important issues; the preceptor doesn't spend the time and attention needed by the student). These problems are more likely to happen when the organization just comes up with some vague project because there is a student interested in working there but it's not an important project in terms of the priorities of the organization. Remember that you are only doing this project part-time: Watch out for any project that might not lend itself well to intermittent work because you won't be able to work on it or at the organization every day. If it's a project where lots is going to be happening on days you won't be there, it may be hard to keep up to speed and be an important on-going team member. More “self-contained” projects that lend themselves to part-time work usually work much better. But you also want to make sure that you won't just be working entirely independently, with so little contact with others that you feel isolated.
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Project Update Assignments ARP projects are both exciting and sometimes challenging l experiences. The purpose of these updates is to help me keep tabs on how your work is going and provide any assistance you might need (e.g., advice, talking to your preceptor if that would be helpful, and working with you to identify other resources or supports that would enhance your project work). You can contact me whenever you like but I want to get formal updates from you in October, December and February. (Although I have asked for 3 updates, it is possible that some of you might finish your ARP projects before the third update is due in February. If this is the case, we can decide whether or not it makes sense to get a February update from you.) In March, I will have a meeting with each of you to review the status of your work more formally and talk about your final report and poster. Since you will each find and start working on your ARP projects at different times, the nature of the project updates will vary for each of you depending on where you are in your ARP journey. The types of issues I would like to hear about are: • How are you doing looking for an ARP? Do you need any help? • Once you have a project that is approved:
o What work have you accomplished? o Are you having any problems? Any great successes? o Is the project progressing as you expected? o Are you keeping to your timetable? o Are you encountering any big surprises? o How is your preceptor? Are you seeing him/her as much as you expected?
As much as you need? What are you learning from your preceptor? o How is your ARP experience helping you to clarify your professional goals? o What are you enjoying about your ARP? What are you not enjoying? o Are you getting the support you need to be successful with your project? o Is there anything that you need advice or help with from me?
Every ARP project has its unique joys and challenges along the way. While an important part of the learning from this course is to continue to hone your ability to identify problems and figure out how to deal with them, please do not ever hesitate to ask me for advice or help. There is nothing more frustrating for me than to hear too late about a problem that had a major effect on a student’s ARP experience and might have been addressed had it been brought to my attention earlier. I will be checking in with your preceptors occasionally during the course, and will share any feedback I get that is relevant to you or your project. My conversations with your preceptors will be most constructive if I get good and honest updates from you about how your project is going.
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Description of Final Presentation and Project Report 1. Poster Presentations: May 3 and 10, 2016 We will create a schedule for the poster sessions early in the spring, when everyone knows their class schedule for Spring 2. There will also be a session on March 29 about preparing effective posters. More details to come! 2. Final Project Report Final version of project report: Due no later than Friday, May 6, 2016 Your final project report should be no longer than 12 double-spaced pages in length, excluding the executive summary/abstract, personal reflections section and any appendices. It should be a professional, cogent and well-written report, in a style and format that would be produced by a consultant to the organization, or, in the case of research projects, in the form of a paper to be submitted for publication. The report should include the following sections:
a. Executive Summary/Abstract (200 words or less) For those of you completing a policy or management ARP, the abstract should be in the form of an Executive Summary. For those of you doing research projects, the abstract should take the form of one that would accompany a publishable paper. In either case, the summary/abstract should be a short statement of the project and summarize the results, conclusions, and recommendations. It should be concise, written in the past tense, and a stand-alone statement (i.e., the reader should be able to get a good sense of the project and its results without needing to read the report).
b. Project Report • Introduction (1-2 paragraphs) that gives an overview of the project, its purpose
and background, why it’s important, and your main conclusions or recommendations.
• Context: Summarizes the background and purpose of the project • For what organization was the project done? • What was the problem/issue that was being addressed by the project? • Why was the project of interest and importance to the organization? • Who were the key stakeholders/primary audience for the project? • What was your role in the project? What work did you do?
• Approach/Methods: What approach and methods were used in the project (e.g.,
data collection, analysis, interviews, lit reviews, modeling, focus groups, etc.)?
• Results: What were the findings/results of the project?
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• Conclusions and recommendations: What were the conclusions and recommendations of the project?
• Impact/Implications: How will the organization use the results of the project? Do the results of the project have wider implications for other organizations/managers/policymakers/researchers? What are they?
3. Personal reflections (2-3 pages) This is an opportunity for you to reflect on your ARP experience. You can reflect in any way that is useful to you. Some questions you might consider are:
• What did you learn from this project? • What might you do differently if you had the project to do over again? • Did you learn anything about yourself from your ARP that will be important as
you anticipate the next phase of your career? • Did your ARP change anything about how you think about your next steps or
your career as a whole? If so, in what ways? • What needs and opportunities for professional growth and development did your
ARP help you identify? How might you address these gaps?
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Appendix 1
Department of Health Policy and Management Two-Year Master of Science Applied Research and Practice (ARP) Course
Practicum Placement and Learning Agreement
Student’s Name: Name of Practice Site: Preceptor’s Name: Preceptor’s Title: Preceptor’s Phone Number: Preceptor’s e-mail: Preceptor’s mailing address: Please complete both sections of this form: I. Practicum Project Description Please answer the following questions on a separate attachment: 1. Practice Site: Short description of the practice site
2. Project Description: Several paragraphs on your project and what you will
accomplish
3. Public Health Connection: Describe how your project is relevant to public health
4. Student Learning Objectives: Outline the knowledge, skills and competencies you will develop
5. Deliverables: What is your final product or deliverable and when is it due
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2. Supervision and Mentoring of the Student How will the student be oriented to the organization and the project? What is the plan for regular meetings between the student and preceptor to review progress on the project and provide feedback on the student’s performance? What are the plans to expose the student to other key leaders within the organization? 3.Student work schedule Beginning date: End date: Number of hours per week: Days/hours per week on-site: Total number of hours that student expects to work on the project: 4. Resources What resources be provided or made available to the student to support his/her work on the project:
• Work space? • Access to equipment? • Administrative support? • Other?
5. Compensation (if any): Student’s signature: Date: Preceptor’s signature: Date: Course instructor’s signature: Date:
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Appendix 2
Department of Health Policy and Management Applied Research and Practice (ARP) Course
Background Information for Potential Preceptors
Instructor: Nancy Turnbull ([email protected] or 617-432-4496) The Applied Research and Practice (ARP) is the practice and culminating experience for students in the two-year professional master’s degree program in the Department of Health Policy and Management. The objectives of the ARP are to help students:
• Integrate, synthesize and apply graduate-level skills and competencies they are gaining in this degree program to a real world problem or issue
• Explore a substantive public health or health care topic that is salient to a health care or public health organization and of interest to the student
• Learn from professionals in the field • Enhance the skills they need to function in a professional public health setting,
particularly: o Goal setting o Producing professional quality work o Interpersonal relationships o Oral and written communication
• Build confidence as a public health professional • Widen their professional network • Share their practicum experience and learn from the experience of others • Engage in professional self-assessment and critical reflection.
a. Criteria for an acceptable practice placement A practice placement project must meet the criteria specified below:
• Requires the student to demonstrate and apply the graduate level skills and knowledge being acquired in the SM2 program
• Requires the student to work at least 140 hours on the project • Addresses a problem that has significance to the sponsoring organization • Is of interest to the student • Is relevant to public health (i.e., addresses a problem or issue likely to be
encountered in public health practice) • Advances the student’s skills and knowledge
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• Has a specific, well-defined project(s) as its primary focus (i.e., will allow the student to accomplish something specific over the course of the placement)
• Has a scope that is manageable in terms of the student’s time, skills and knowledge
• Will enhance the career potential and professional development of student. • Has a preceptor who:
o Has the appropriate education and training to oversee the project o Agrees to the project plan in the Project Placement Agreement o Accepts the responsibilities of a preceptor as outlined below o Is acceptable to the course instructor.
b. Student Hours and Project Timing Students are required to work at least 140 hours on their ARP project. The scheduling is flexible depending on the needs of the project and the student. Ideally, the work begins by October, although projects with later start dates are also possible. Students must complete the project no later than the end of April. c. Payment Practice placements can be paid or unpaid. The amount of any compensation is negotiated between the student and the practice site. d. Responsibilities of the Preceptor
• Develop a realistic project proposal and work schedule with the student • Orient the student to the organization and project • Be available on a regular basis to meet with and supervise the student and provide
the guidance and support necessary for successful completion of the project, as well as on-going feedback on the student’s performance
• Ensure the student has the resources needed to complete project (work space, computer, administrative support)
• Assist in the student’s professional development (e.g., help the student to meet leaders of the organization, arrange for him/her to attend meetings during the practice placement, conduct informational interviews)
• Talk to the course instructor periodically to provide feedback on the student’s performance
• Provide written feedback for the student and the school by completing a placement evaluation form at the end of the placement.
July 2, 2015
Syllabus for HPM 299: Research With Large Databases
Clinical Effectiveness Program Harvard School of Public Health
July 2-July 24, 2015 1:30-3:20 PM HSPH Room FXB-G13 Course Director: Ellen P. McCarthy, PhD, MPH Associate Professor of Medicine, HMS & BIDMC Assistant Dean for Development and Diversity, HMS e-mail: [email protected] Office hours: By appointment Visiting Professor: John Z. Ayanian, MD, MPP Alice Hamilton Professor of Medicine Director, Institute for Healthcare Policy and Innovation, University of Michigan Visiting Professor of Medicine and Health Care Policy, HMS & BWH e-mail: [email protected] Guest Lecturers: Alan Zaslavsky, PhD, Professor of Health Care Policy (Statistics), HMS Griffin Weber, MD, PhD, Assistant Professor of Medicine, HMS Christina Wee, MD, Associate Professor of Medicine, HMS & BIDMC Statistical Programming Teaching Assistant: Shimon Shaykevich (e-mail: [email protected]; phone: 617-732-7652) Office hours: By appointment Administrative Assistant for Dr. McCarthy: Jon Yee (email: [email protected]; phone 617-754-1448) Course Overview & Objectives This course addresses uses of existing large databases to study important questions related to clinical risk factors, treatment, outcomes and health policy. Strengths and limitations of large databases that are commonly used for research will be considered, and special attention will be devoted to large federal databases that are readily available to new investigators. Practical issues in obtaining, linking, and analyzing large databases will be emphasized throughout the course, and key statistical issues will be addressed, including survey sampling and risk-adjustment. Students will evaluate published studies based on large databases, complete programming exercises with statistical software, and prepare a proposal for analyzing a specific research question using a large database.
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Grading Grades will be based on students’ participation in class discussions (1/3) and written project proposals (2/3). Course projects that include appropriate preliminary analyses, when feasible, will receive extra consideration in the grading process. Students may opt for or pass/fail grading through the HSPH Registrar’s Office. Readings Readings for each class session are divided into Methods Readings and Web Resources. Readings marked with an asterisk (*) are required. Other readings are optional but strongly encouraged for additional background on the topics and databases to be discussed. Students who review optional readings and web resources before each class will understand the topics in greater depth and be able to participate more actively in class discussions. Database Studies will be discussed in a journal club format in class on Tuesday, July 21:
• What were the main study questions? • What features of the study database made it useful to address the study questions? • Was the study population representative and generalizable? • Were there any special features of the statistical analysis? • What were the main study findings? • What were the strengths and limitations of the database and analysis?
Computer Lab Sessions Didactic lab sessions will be held on July 8/10, 13 and 17 to present statistical programming concepts for large databases using SAS and SUDAAN software. Open lab sessions will be held in on July 14, 20 and 24 for students to receive guidance on performing data analysis for their course projects. Course Data Directory Datasets and documentation for class projects and computer lab sessions can be found in the HSPH computer labs on the directory “G:\Shared\HPM299”. Sample programs will be posted at “G:\Shared\HPM299\EXAMPLES”, accessible only within the HSPH computer labs. Course Website The syllabus, lecture slides, and handouts will be available on the course website. Course Evaluation Student feedback on the structure and content of the course is essential for enhancing the course. Feedback is welcomed and can be provided to Dr. McCarthy at [email protected] during the course. HSPH requires students to complete the anonymous on-line course evaluations at the end of the course in order to receive a course grade. Course Project Students will group in pairs to prepare a course project. This project is an integral part of the course. Students will draft a proposal to analyze a specific research question with a large database. Students are encouraged to conduct preliminary analyses of a large database, if feasible, as part of their course project. Most students will develop a project based on one of several databases posted on the class directory in the HSPH computer lab:
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• National Ambulatory Medical Care Survey (NAMCS) – see July 2 session • National Health Interview Survey (NHIS) – see July 6 session • National Health and Nutrition Examination Survey (NHANES) – see July 6 session • Nationwide Inpatient Sample (NIS) – see July 9 session • Kids’ Inpatient Database (KID) – see July 9 session • SEER cancer registry data – see July 15 session
Students also have the option of proposing a project with a database to which they currently have access or anticipate having access after the course. After selecting a research question and database to address it, each student group will specify a study cohort based on demographic and/or clinical criteria, select relevant variables from the database, and propose statistical analyses to address the study question. At minimum, the proposed analyses should include simple descriptive statistics for the study cohort, such as demographic and clinical characteristics, and the main endpoint of interest, such as the use of services, prevalence of risk factors, costs, or survival. Students interested in proposing more advanced multivariate analyses (e.g. logistic regression modeling of service use or survival models) are encouraged to do so. In the project report, students should address analytic issues covered in the course, including confounding variables, risk adjustment, clustering of data, and survey sampling weights. In prior years, many students have subsequently developed their projects as original research articles, as listed on the bibliography available on the course website. The product of the project will be a 5-page, double-spaced report:
• Introduction: ½-1 page for importance of topic & main study question or objective • Methods: 1- 1½ pages presenting data source, inclusion/exclusion criteria for study cohort,
description of key variables, and brief summary of analytic approach • Results (optional): 1 page presenting characteristics of study cohort and preliminary findings
related to the study question • Discussion: 1-1½ pages with strengths and limitations of data source and study design,
including generalizability, accuracy and completeness of variables, and potential biases; and implications for clinical practice, health policy, public health, or future research
• References: <10 citations related to the study question and database • Tables or figures (optional): up to 3 tables or figures showing characteristics of study cohort
and preliminary findings • Author contributions are required. Please provide information on the contributions of your
group to study design, analyses, drafting paper, critical revision of paper. By Wednesday, July 15, each group should send a 1-paragraph description of their proposed project, including the primary research question and database, to [email protected] . Email final reports to Dr. McCarthy ([email protected]) by July 24, 2015.
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Course Schedule Thursday, July 2:
Part 1 - Introduction to Research with Large Databases – Ellen McCarthy The 1st half of this session will provide an overview of the course, including the types of large databases that will be covered and the strengths and limitations of research with large databases. Computer labs and guidelines for class projects will also be discussed. Methods Reading: Smith AK, Ayanian JZ, Covinsky KE, Landon BE, McCarthy EP, Wee CC, Steinman MA. Conducting high-value secondary dataset analysis: an introductory guide and resources. J Gen Intern Med 2011; 26:920-929. Full article Web Resource: *Society of General Internal Medicine Research Dataset Compendium Part 2 - National Healthcare Provider Surveys The 2nd half of this session will focus on major national provider surveys including the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). These datasets are publicly available and can be downloaded directly from the internet. Web Resource: National Ambulatory Medical Care Survey (NAMCS) & National Hospital Ambulatory Medical Care Survey (NHAMCS): www.cdc.gov/nchs/ahcd.htm
Friday, July 3: No Class – Happy Fourth of July and Independence Day! Monday, July 6: National Population-Based Surveys – Ellen McCarthy This session will focus on large population-based health surveys funded by the U.S. federal government, including the National Health Interview Survey (NHIS), Behavioral Risk Factor Surveillance System (BRFSS), National Health and Nutrition Examination Survey (NHANES). For each of these surveys, a public-use dataset is readily available and can be downloaded directly from the Internet. The Medical Expenditure Panel Survey (MEPS), a hybrid database that is sampled from the NHIS cohort, will also be presented. Web Resources: National Health Interview Survey (NHIS): www.cdc.gov/nchs/nhis.htm National Survey of Children’s Health (NSCH): http://www.cdc.gov/nchs/slaits/nsch.htm Behavioral Risk Factor Surveillance System (BRFSS): www.cdc.gov/brfss Youth Risk Behavioral Surveillance System (YRBSS): www.cdc.gov/HealthyYouth/yrbs/
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National Health and Nutrition Examination Survey (NHANES): www.cdc.gov/nchs/nhanes.htm Medical Expenditure Panel Survey (MEPS): www.meps.ahrq.gov/ Methods Reading: Johnson PJ, Blewett LA, Davern M. Disparities in public use data availability for race, ethnic, and immigrant groups. National surveys for healthcare disparities research. Med Care 2010; 48:1122-7. Full article Tuesday, July 7: Statistical Issues in Design and Analysis of Surveys – Alan Zaslavsky This session will address important statistical concepts related to the design and analysis of large surveys, including sampling frames and weights, clustering, and missing data.
Methods Readings: The readings below are available on the course website under the tab labeled handouts for lectures. Zaslavsky AM. Notes on Research Design and Data Collection. Zaslavsky AM. Software for Analysis of Survey Data. Wednesday, July 8: Small Group Session (Seminar for Course Projects) or Computer Lab 1 For the classes on Wednesday, July 8 and Friday, July 10, we will divide the class into small groups. Groups will be assigned to either a small group session with Dr. Christina Wee (Wed) and Dr. John Ayanian (Friday) to discuss choosing database topic for the course project or a computer lab with Dr. McCarthy to review to review SAS data management skills and databases available in the computer lab for class projects. On Wednesday, Dr. Christina Wee will hold 2 small group sessions that will run from 1:30-2:20 and 2:30-2:20 in FXB-G13. Each group will consist of about 5 student groups to discuss their course project. On Wednesday, Dr. McCarthy will hold 2 lab sessions that will run from 1:30-2:20 and 2:30-3:20. Small group assignments and schedules will be distributed via email on Tuesday, July 7 and posted on the course website. Computer lab 1 – Ellen McCarthy
This session will present databases and documentation available for class projects. The session will also introduce data management skills such as merging and concatenating databases. The session will be particularly useful for students interested in using NHIS, NIS, KID, NAMCS/ NHAMCS, or NHANES. For students with limited SAS programming experience, this session will also introduce basic concepts, such as assigning data library names, reading in permanent data sets, creating and recoding variables, and running basic procedures in SAS.
Note: This session will meet in the computer lab (Kresge LL-6). No readings are assigned.
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Seminar - Choosing a database research topic – Christina Wee
This seminar provides an opportunity to discuss potential research topics and databases for the course project. By Wednesday, July 15, each group should submit a paragraph summary of a proposed project to Dr. McCarthy at [email protected] , including the primary research question and database.
Note: This session will meet in FXB-G13. No readings are assigned for this seminar. Thursday, July 9: State Health Care Data – John Ayanian This session will introduce large administrative databases that are typically used for billing or regulatory purposes. Basic elements of administrative databases, including diagnosis and procedure codes, will be reviewed. Administrative databases from the AHRQ Healthcare Cost & Utilization Project (HCUP) will be discussed, including the National Inpatient Sample (NIS), Kid’s Inpatient Database (KID), State Inpatient Databases (SID), State Ambulatory Surgery Services Databases (SASD), Nationwide Emergency Department Sample (NEDS), and State Emergency Department Databases (SEDD). This session will also introduce concepts related to risk adjustment in database studies using diagnosis and procedure codes. Methods Readings: * “Databases and Related Tools from the Healthcare Cost and Utilization Project (HCUP)”, June 2010, Agency for Healthcare Research and Quality (AHRQ). http://archive.ahrq.gov/research/findings/factsheets/tools/hcupdata/datahcup.pdf Mutter R, Stocks C. Using Healthcare Cost and Utilization Project (HCUP) data for emergency medicine research. Ann Emerg Med 2014;64:458-460. Virnig BA, McBean M. Administrative data for public health surveillance and planning. Annu Rev Public Health 2001; 22:213-30. Full article Best AE. Secondary databases and their use in outcomes research: a review of the Area Resource File and the Healthcare Cost and Utilization Project. J Med Systems 1999; 23:175-81. Full article Web Resources: Healthcare Cost & Utilization Project (HCUP): www.ahrq.gov/data/hcup HCUPnet is an on-line query system based on data from the Healthcare Cost and Utilization Project (HCUP). It provides access to health statistics and information on hospital inpatient and emergency department utilization: http://hcupnet.ahrq.gov/ Friday, July 10: Small Group Session (Seminar for Course Projects) or Computer Lab 1 On Friday, Dr. Ayanian will hold 3 small group sessions that will run from 12:30-1:20; 1:30-2:20 and 2:30-3:20 in FXB-G13 for students who attended the computer lab session on July 8. Each group will consist of about 5 student-groups to discuss their course project. On Friday, Dr. McCarthy will hold 2 lab sessions that will run from 1:30-2:20 and 2:30-3:20 in LL-6 for students who attended the small group session with Dr. Wee on July 8.
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Monday, July 13: Computer Lab 2 – Ellen McCarthy
For this session we will divide the class into 2 groups. These sessions will run from 1:30-2:20, and 2:30-3:20. This session will introduce arrays and do loops to identify diagnoses and procedures using ICD-9-CM codes, which are particularly useful for working with NIS, KID, NAMCS/NHAMCS, and Medicare or Medicaid databases. Note: These sessions will meet in computer lab room LL-6. No readings are assigned. For students planning on using NIS, KID or NAMCS/NHAMCS, this session will be most helpful if you have identified the ICD-9-CM diagnosis and procedure codes that you are interested and brought them to this lab session. Tuesday, July 14: Computer Lab 3 – Ellen McCarthy This session is an open computer lab intended to provide students with an opportunity to begin to analyze data for the course project with input from class instructors. The session will run from 1:30-3:20, and students may attend the lab for some or all of this session for programming help and guidance on analyzing data for their course projects. Note: This class will be held in the large computer lab room LL6. No readings are assigned. Wednesday, July 15: Clinical Registries & Condition-Specific Databases – Ellen McCarthy This session will present disease-specific databases that can be used for health services research, including state cancer registries; the NCI Survival, Epidemiology and End Results (SEER) Program; National Cancer Database (NCDB); National Surgical Quality Improvement Program (NSQIP); United States Renal Data System (USRDS), and large NIH-funded cohort studies. Methods Reading: Nattinger AB, McAuliffe TL, Schapira MM. Generalizability of the SEER registry population: factors relevant to epidemiologic and health care research. J Clin Epidemiol 1997; 50:939-45. Full article Warren JL, Klabunde CN, Schrag D, Bach PB, Riley GF. Overview of the SEER-Medicare data: content, research applications, and generalizability to the United States elderly population. Med Care 2002; 40(suppl):IV-3-IV-18. Full article Web Resources: Surveillance, Epidemiology and End Results Program (SEER): www.seer.cancer.gov SEER-Medicare data: healthservices.cancer.gov/seermedicare National Program of Cancer Registries (NPCR): www.cdc.gov/cancer/npcr National Surgical Quality Improvement Program: www.acsnsqip.org United States Renal Data System (USRDS): www.usrds.org/research.htm National Heart, Lung, and Blood Institute (NHLBI) databases: https://biolincc.nhlbi.nih.gov/studies
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Thursday, July 16: Medicare, Medicaid and VA Data – Ellen McCarthy The major types of Medicare data will be reviewed, including the Denominator File (enrollment and vital statistics), Part A (MEDPAR) hospital inpatient claims, Part B claims for physicians’ services and durable medical equipment, hospital outpatient claims, and Part D drug claims. Resources available to support analyses of Medicare data through the Research Data Analysis Center (RESDAC) will be presented. The Medicare Current Beneficiary Survey (MCBS), a federally funded hybrid database will be presented. Data resources for the Medicaid program and Veterans Administration will also be reviewed. Opportunities will be discussed for linking large databases with other relevant data sources, including Census data, county characteristics from the Area Resource File, physician characteristics, and hospital characteristics. Methods Readings: * “Medicare at a Glance”, August 2014, Kaiser Family Foundation. https://kaiserfamilyfoundation.files.wordpress.com/2014/09/1066-17-medicare-at-a-glance.pdf * Medicare Data File Descriptions, Research Data Assistance Center (ResDAC). http://www.resdac.org/cms-data/search?f[0]=im_field_program_type%3A1 * “Medicaid Moving Forward”, March 2015, Kaiser Family Foundation. http://kff.org/health-reform/issue-brief/medicaid-moving-forward/ Mitchell JB, Bubolz T, Paul JE, et al. Using Medicare claims for outcomes research. Med Care 1994; 32(suppl):JS38-JS51. Full Article Adler GS. A profile of the Medicare Current Beneficiary Survey. Health Care Financ Rev 1994; 15:153-63. Full article Cowper DC, Hynes DM, Kubal JD, Murphy PA. Using administrative databases for outcomes research: select examples from VA Health Services Research and Development. J Med Systems 1999; 23:249-259. Full article Krieger N. Overcoming the absence of socioeconomic data in medical records: validation and application of a Census-based methodology. Am J Public Health 1992; 92:703-710. Full article Baldwin LM, Adamache W, Klabunde CN, Kenward K, Dahlman C, Warren JL. Linking physician characteristics and Medicare claims data: issues in data availability, quality, and measurement. Med Care 2002; 40(suppl):IV-82-IV-95. Full article Schrag D, Bach PB, Dahlman C, Warren JL. Identifying and measuring hospital characteristics using the SEER-Medicare data and other claims-based sources. Med Care 2002; 40(suppl):IV-96-IV-103. Full article Web Resources: Medicare Research Data Assistance Center (RESDAC): www.resdac.umn.edu Center for Medicare and Medicaid Services (CMS): http://www.cms.hhs.gov/home/medicare.asp & http://www.medicaid.gov/ Medicare Current Beneficiary Survey (MCBS): http://www.cms.hhs.gov/MCBS
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Medicaid data: http://www.resdac.org/cms-data/search?f[0]=im_field_program_type%3A2 Veterans Administration (VA) data: http://www.virec.research.va.gov/ U.S. Census data: www.census.gov Area Health Resources File (AHRF) (formerly the Area Resources File): http://ahrf.hrsa.gov/ Friday, July 17: Computer Lab 4 – Ellen McCarthy & Shimon Shaykevich The first part of this computer lab will introduce SUDAAN survey procedures, particularly how to use them for analyzing complex survey data with sampling weights, such as NIS, KID, NHIS, or NAMCS/NHAMCS. This session will also demonstrate examples of SAS and SUDAAN output showing how statistical analyses differ when conducted with and without adjustment for survey weights. The second part of this session will be an open computer lab to provide students with another opportunity to analyze data for the course project with programming support. The session will run from 1:30-3:20. Students may attend the open portion of the lab for some or all of this session for feedback on their programming exercises or preliminary data analyses for course projects. Note: This class will be held in the large computer lab room LL6. No readings are assigned. Monday, July 20: Computer Lab 5 – Ellen McCarthy & Shimon Shaykevich This session is an open computer lab intended to provide students with an opportunity to begin to analyze data for the course project with input from class instructors. The session will run from 1:30-3:20, and students may attend the lab for some or all of this session for programming help and guidance on analyzing data for their course projects. Note: This class will be held in the large computer lab room LL6. No readings are assigned. Tuesday, July 21: Journal Club with Guest Authors – Ayal Aizer, John Mafi, Sushrut Waikar In this session we will have an interactive discussion of database studies published by former students from this course. Each article will be discussed for approximately 25 minutes. Each student should read one article in depth, and be prepared to present key methods and findings and pose questions to the relevant guest author. This will also provide an opportunity for students to ask questions about lessons learned in starting to work with large databases for research. Database Studies for Class Discussion: The readings below are available on the course website under the tab labeled course readings. *Aizer AA, Chen MH, McCarthy EP, Mendu ML, Koo S, Wilhite TJ, Graham PL, Choueiri TK, Hoffman KE, Martin NE, Hu JC, Nguyen PL. Marital status and survival in patients with cancer. J Clin Oncol 2013;31(31):3869-76. [SEER]
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*Mafi JN, McCarthy EP, Davis RB, Landon BE. Worsening trends in the management and treatment of back pain. JAMA Intern Med 2013;173(17):1573-81. [NAMCS/NHAMCS} *Waikar SS, Curhan GC, Wald R, McCarthy EP, Chertow GM. Declining mortality in patients with acute renal failure, 1988-2002. J Am Soc Nephrol 2006; 17:1143-50. [NIS] Full article Wednesday, July 22: Research with Big Biomedical Data – Griffin Weber This session will focus on biomedical data resources that integrate clinical repositories and administrative systems. Methods for identifying patients and collaborators using big biomedical data will be introduced. Methods Readings: The readings below are available on the course website under the tab labeled course readings. Weber GM, Mandl KD, Kohane IS. Finding the missing link for big biomedical data. JAMA 2014 Jun 25;311(24):2479-80. Weber GM, Murphy SN, McMurry AJ, Macfadden D, Nigrin DJ, Churchill S, Kohane IS. The Shared Health Research Information Network (SHRINE): a prototype federated query tool for clinical data repositories. J Am Med Inform Assoc 2009;(5):624-30. McMurry AJ, Murphy SN, MacFadden D, Weber G, Simons WW, et al. (2013) SHRINE: Enabling nationally scalable multi-site disease studies. PLoS ONE 8(3): e55811. Thursday, July 23: Database Research Roundtable - Faculty In this session we will have an interactive discussion with guest faculty. The Harvard faculty members will provide their perspectives on launching a research career and conducting research with large databases. Topics will include mentorship, statistical and programming support, funding, IRBs, and preparing manuscripts for publication. Students will have the opportunity to pose questions on these topics as well as other related topics. Friday, July 24: Computer Lab 6 – Ellen McCarthy & Shimon Shaykevich This session will provide another opportunity for students to analyze data and work on the course project with input from class instructors. The session will run from 1:30-3:20, and students may attend the lab for some or all of this session for feedback on their programming exercises or preliminary data analyses for course projects. Note: This computer lab will be held in LL-6. No readings are assigned.
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