Metrics For Social Mission
In today’s complex health care environment, given that stakeholders and policy experts commonly expect demonstrable evidence of quality, accountability and improvement, measurement has become an integral part of doing business. Now that social mission has been identified as part of the mission of health professions education, there is a desire to obtain and quantify data to advance health equity and reduce health disparities. The measurement of social mission performance in health professions schools is nascent. Various organizations such as THEnet and ASPIRE have pioneered the development of measurement tools. There is promising consistency in the philosophies that govern the measurement tools of these two organizations and leadership at schools using these tools have described great benefits in going through the assessment process. However, usage has been mostly limited to medical schools rather than health professions schools in general, and the tools themselves are primarily targeted to schools looking to excel in social mission, rather than all comers.
We took on this challenge at The George Washington University Health Workforce Institute (GWHWI) to create a system of standardized process measurement tools as key indicators of health professions schools’ social mission performance. After launching in 2016, we adopted the social mission definition from the Beyond Flexner Alliance (BFA) to guide the study. An interprofessional committee of advisors was selected to help develop a system of metrics designed for dental, medical, and nursing schools with the possibility of similar metrics being applied to other health professions education institutions. The Advisory Committee includes representatives from the national organizations of all three disciplines and provides content perspective, strategic guidance, and feedback on the metrics.
First, we identified “domains” of school activity—major areas of function common to all health professions schools. Ultimately, we chose six domains (governance, curriculum, community engagement, diversity and inclusion, institutional culture and climate, and research) that were judged to have high potential for enhancing social mission. Second, we selected measureable activities within each domain that were common to all health professions schools. We then constructed a survey based on questions about relevant activities in each domain using three inclusion criteria—relevance, data availability, and level of reporting.
Once constructed, the survey instrument required testing for validity, reliability, and reporting burden to see how well it worked in terms of providing information that was accurate, discriminatory, and could reasonably be produced by front offices of health professions schools. We pilot tested the survey at six cooperating schools—two schools per discipline—to assess data quality. As expected, there was some variability in the quality of the data given the interpretation of the questions. This initial instrument was refined and shortened following the pilot testing and debriefing of survey participants. We are now field-testing the second iteration of the survey in two phases at 60 schools of nursing, medicine and dentistry.
Our goal is to produce a system of metrics that is useful for schools in tracking 1) social mission data over time, 2) their level of performance in any given area of social mission, and 3) how their performance compares to similar schools and to national norms. We hope that social mission metrics will prove a useful tool for improving the level and quality of social mission engagement of teaching institutions in the health professions. This, in turn, will improve the awareness, skills and commitment of health professionals to health equity in our society.
Julie Orban is a research associate at The George Washington University Milken Institute School of Public Health.
Sonal Batra serves as the assistant program director for the GW Emergency Medicine Residency Program. Dr. Batra is a leader in the India Master’s in Emergency Medicine Program through the GW Ronald Reagan Institute of Emergency Medicine.
Fitzhugh Mullan is a Professor of Health Policy in the Milken Institute School of Public Health at George Washington University, Professor of Pediatrics in the School of Medicine and Health Sciences, and Co-Director of the George Washington University Health Workforce Institute.