Building a better medical school

Clay Johnston, dean of the new Dell Medical School, is working to fix what’s wrong with health care from the ground up. He’ll deliver a keynote address at Medicine X | ED 2017.

Consider the hospital gown.

Clay Johnston, MD, PhD, sees it as a symbol of much of what’s wrong with health care in the United States. People hate wearing it. It serves little purpose. And no one ever improves it.

As the inaugural dean of the new Dell Medical School at the University of Texas, Austin, Johnston — a neurologist and epidemiologist by training — is trying to change this way of operating. Innovation in the U.S. health care system happens very slowly, he says. Where great processes of care exist, they often don’t spread from one institution to the next.

Before taking his current position, Johnston served as the associate vice chancellor for research at the University of California, San Francisco.

He describes it as “a fabulous institution.” But as he worked to find ways to speed up innovation, he found everything took too long.

“This wasn’t just a research problem,” he says. “This was a whole health care system problem.”

The best way to have an impact, he decided, was to start from scratch. Accepting the job at Dell was an easy decision.

Dell selected its inaugural class of 50 students from an applicant pool of 4,500. They started classes this past summer. In the months since, the school has begun forging a new path — focusing on human-centered design and compensation based on outcomes instead of traditional methods of generating revenue through fee-for-service payments.

“We’re educating physicians to get them to take responsibility and leadership over the system of health care,” he says.

Susan Skochelak, MD, the American Medical Association’s vice president for medical education, considers Johnston instrumental in efforts to transform medical education.

“We believe that collaborating with schools like Dell Medical School will lead to the type of seismic shift that the medical education system needs so that future physicians can better care for their patients,” she says.

Johnston is especially excited about one clinical program in particular, in which the new medical school was able to take a wait list for uninsured and underinsured patients that was 14 months long and reduce it to less than 28 days.

In so doing, they also improved outcomes and reduced costs by at least half — “just by thoughtfully redesigning how people access the system and were treated,” he says.

Students and faculty are working on a variety of innovative products, including one that uses automation to reduce the burden of documentation in electronic health records.

Fixing the hospital gown hasn’t been a priority — yet. But Johnston says it’s a matter of time.

“It’s so emblematic of the problems in our system,” he says. “If we don’t solve it, it’s sort of like having tagged graffiti on the wall and not scrubbing it away.”

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