The Lessons and The Legacy of the Pew Health Policy Program (1997) / Chapter Skim
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Part 4: Summarizing the Legacy: Some Conclusions and Thoughts for the Future
Part 4: Summarizing the Legacy: Some Conclusions and Thoughts for the Future
Pages 95-132
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From page 95... ...
The first section develops (with the aid of an anaTytic framework) strategic guidelines to help foundations and The Pew Health Policy Program evolved from a unique, ambiguous idea to a highly successful, highly sought after, and wellrespected academic program.
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there are four basic elements for success in implementing any service. They are targeting markets, well-defined service concepts, focused operating strategies, and well-designed service delivery systems.
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From page 97... ...
~aevelop~h' Ache 24"C~ttOh~t COW: ~`C Phi ~hte§~ttUe 2te~eht~ To launch an educational program, there is a need to do internal faculty recruitment and external fellow recruitment. There is a synergy between the two types of recruitment.
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From page 98... ...
In doctoral and postdoctoral programs, the attrition rates are surprisingly high (Bowen and Rudenstine, 1992~. PHPP hypothesized that attrition may be related to the abil ity to recruit high-quality students.
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From page 99... ...
At BU, the Center for Industry and Health Care aimed at increasing the involvement of the business community in health policy by establishing corporate coalitions, so they targeted students who were planning careers in business and public service. Over time, Brandeis singled out people who were interested in issues of social justice for vulnerable populations-violence, people with AIDS, chronic disease populations, veterans, and so on.
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From page 100... ...
The predoctor al and management programs, although highly successful, were (liscontinue(1 so that resources could be concentrate on (leveloping a strong postdoctoral program. The e(luca tional concept was a multidisciplinary postdoctoral health policy program in which fellows worke(1 with faculty on research projects.
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From page 101... ...
The (loctoral program require(1 course work in the basic social sci Each of the programs developed a strong core curriculum that taught students to appreciate and synthesize the clinical, sociological, political, economic, and behavioral implications of the policy process. Baby 1991, it was decided that three educationa1 concepts should loe maintained: postdoctoral education in ~ policy-rich environment, an accelerated doctoral program, and ~ doctora1 program for people with full time jolts.
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From page 102... ...
However, to ensure academic survival and success in postdoctoral work, midcareer programs, and the accelerated doctoral program, new mechanisms were needed. The dis sertation seminars at BU/Brandeis and Michigan became a pedagogical mechanism not only to help students structure and manage the dissertation process early on but also to pro vide the psychological support to build and connect the fel lows into a committed group of mature scholars.
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From page 103... ...
But every program did create a small, effective staff usually involving one faculty member as program director, one or two key faculty, and one or two support staff to serve faculty and fellow needs. Program champions also emerged at each site.
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From page 104... ...
lo deliver on the strategy of a service-oriented culture, each of the programs needed an incredibly dedicated program staff to serve faculty, students and program leadership. At RAND/UCLA, Kate Korman was cited as "an indispensable linchpin with respect to tying together diverse interests and activities." Throughout the interviews, Marion Ein Lewin, Steve Crane, Ted Benjamin, and David Periman were all mentioned as being extraordinarily supportive.
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what other health services research doctoral programs were offering, (2) the needs of potential employers in the policy world and (3 ~ how to serve the educational needs of the students.
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From page 106... ...
In general, doctoral education is plagued by low completion rates, often 50 to 60 percent in the social sciences and those who complete all but the disser tation have an 80 percent chance of obtaining the PhD. The median time between entry to graduate school and being awarded the PhD is 6.7 years (Bowen and Rudenstine, 1992~.
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From page 107... ...
The positioning required a focused operating strategy on unlearning ol(1 ways of (1oing things and organizing for innovation. For PHPP to succeed, it had to change He nature of academia and break some of the rules of traditional doctoral education.
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From page 108... ...
For this to happen, niche programs must leverage program value over cost. That means that educational service concepts and operating strategies must be (levelope(1 in ways that strongly appeal to faculty an(1 fellows in the program, while keeping costs to provide the program reasonable (Heskett, 1986)
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From page 109... ...
Since the Brandeis Pew program targeted and attracted students interested in vulnerable populations, social justice, and social change, a strong curriculum in social policy had airea(ly been (levelope(l. Now a very strong curriculum in health policy was needed.
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From page 110... ...
Although the sites ranged from a Tock-step structure at Michigan to near complete academic freedom at BU, each of the programs took steps in which a highly in(livi(lualize learning program could be offered. The programs learne that too much leniency and flexibility hampered the stu (lents' ability to finish the program.
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From page 111... ...
For a niche health policy program to be successful, the operating strategy must be integrated with the delivery system. Integration occurred in three ways: learning how to match faculty and fellows, creative uses of technology, and use of integration mechanisms developed by the Institute of Medicine (IOM)
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1 his section summarizes the implications of the Pew Legacy as a new educational niche programs in health policy. Three questions are addressed: To create a niche educational program, what kind of planning
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What lessons were learned from the four Pew programs over the last decade? Answering these questions may provide some useful insights for schools attempting to develop niche educational programs in health policy and other areas.
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From page 114... ...
There is very little evidence that there was much systematic planning and goal setting before the start of the Pew program. In 1982 the Pew Charitable Trusts launched the health policy program and made its first awards in 1983.
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From page 115... ...
Although efficiency is an important criterion for a mature program, the Pew Charitable Trusts displayed great wisdom in its tolerance for ambiguity and its realization that a premature focus on the total cost per fellow in a niche educational program would be a misreading indicator of program success. Had the program directors' meetings or the annual reports focused on efficiency, attention would have been refocused on ways to save money rather than on learning how to run an effective program.
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From page 116... ...
The Pew program had no historical precedent, so it was guided by ongoing adaptive choices. Ambiguity allowed active experimentation and adjustments when strategic intent and program activities veered away from the core competency of a school.
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From page 117... ...
Now one can appreciate the wisdom of having multiple program sites with very (lifferent program concepts. Although none of the program sites could claim a program that could do it all produce great academic researchers, teachers, great policy makers, and great practitioners collectively the Pew program sites were able to serve the needs of the health policy world.
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From page 118... ...
Some of the mechanisms that helped to set expectations in the Pew predoctoral programs were competency examina .
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From page 119... ...
Thus they provi(le(1 the program sites with a type of feedback, unavailable when programs monitor their own behavior. Over time the programs focused their efforts on the needs and perceptions ofthe fellows and building on the internal core competence of each school.
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From page 120... ...
Each Pew fellow had very different professional backgrounds and experiences. Since the programs wanted the participants to create an identity that transcended the boundaries of their program sites, there was a need to meet and talk about
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From page 121... ...
All interviewees felt that they had acquired the knowledge and skills to analyze, make, and implement decisions affecting the policy system. The 1994 survey revealers that for many fellows, the Pew program "launched them into better and more influential pro inns organized by Marion Ein Lewin.
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From page 122... ...
The key indicators of knowledge and experiences are faculty publications, faculty involvement in major policy issues and initiatives, and a strong faculty record in basic and applied funded research. The second competency for niche creation is "flexible program development." When compared with the lengthy time periods for completion of traditional pro- and postdoc toral programs, niche programs require shorter time periods, higher completion rates, and an ability to accommodate diverse student interests against diverse faculty research interests.
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From page 123... ...
In creating new educational programs, success can be paradoxical (Kimberly, 1981~. The problems of getting started and the problems of institutionalization lead to very different attention structures.
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From page 124... ...
and Pew fellows' migration paths before and after attending The degree to which an the program. Although the entire program has helped to educational program has achieved place many people into a variety of health policy positions, institutionalization is each of the program sites has had different impacts.
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From page 125... ...
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From page 126... ...
Today UCSF has a health policy specialty that would not have existed without Pew support; it now has seminars and courses that would not have existe(1 otherwise. For example, at UCSF a writing seminar and a health policy seminar that met every week built on the experience of the Pew program to develop an Agency for Health Policy Research training program, and interdisciplinary scholarly work came as a result of Pew.
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From page 127... ...
Whether this potential network is used to help in major health reform or restructuring efforts in the future remains to be seen.
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From page 128... ...
Envisioning a role for Pew fellows in the future is the subject of the final section. These estimates are loused on self-reported fi,gures,given to the Pro ~m Office at IOM.
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From page 129... ...
If the health care system needs more health policy scholars, doctoral education and postdoctoral programs focused health policy will remain important social investments. More well-educated people evils be needed.
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From page 130... ...
For several reasons there is an onnortunitv for a col lective rather than an individual role for Pew fellows. First, the difficulty of concentrating attention on more than a few policy issues at a time is a severe limitation for the health policy world.
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From page 131... ...
Launch a "virtual Pew program" in which Pew fel lows will continue to share their collective knowledge, ideas, and other resources through distance learning technology, electronic networking, formally organized conferences and colloquia and possibiv new policy publication outlets. Maintain current information about Pew fellows and their locations in academia, federal and state government agencies, corporate organizations and the delivery system via a home page on the World Wide Web, newsletters, and phone directories.
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From page 132... ...
The only possible conclusion that can be reached is that health policy has just begun to be studied. We believe that Pew fellows will continue to play a critical role in leading the effort.
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