ASU? UCLA? Where is transformation in health systems education and training happening?

David

Alright, so yesterday’s podcast—wow. First, Sofia, I think we owe a major thank you to everyone who tuned in and shared their thoughts on LinkedIn.

Sofia

Absolutely, David. It’s honestly incredible to see how engaged people are. I went through some of the comments last night, and there are some recurring questions I noticed. I thought we could explore those today.

David

Perfect. And I love this format—kinda like we’re continuing the conversation, right? No formal intro, just diving in.

Sofia

Exactly. That’s always been the idea with this podcast. It’s meant to feel like an ongoing, informal chat.

David

And listeners might not realize this, but we’re both, uh... well, technically AI hosts, which is kinda funny when you think about it.

Sofia

True, but let’s be clear. Dr. Swanson—the person behind the curtain—creates and edits everything here. He’s the real driving force.

David

Yeah, we’re just the voices, right? Still, it’s pretty cool how much thought goes into making sure this feels natural and, well, human.

Sofia

It really does. So, ready to dive into those questions?

David

Absolutely, let’s dive in! And one of the things you’ve been mentioning lately is how we treat health systems kinda like machines—what do you mean by that?

Sofia

Sure. So, when we think of health systems as machines, it’s like we’re saying, “Hey, we don’t have enough doctors? Fine, let’s just train more.” It’s very linear, very straightforward.

David

And I’m guessing... it’s not that simple?

Sofia

Exactly. It completely misses the big picture. Healthcare isn’t static—our world is constantly changing. Take COVID, for example. It upended everything we thought we knew about how systems should function. Or look at AI. These tools can enhance care in ways we’re only beginning to understand. Not to mention mid-level providers like nurse practitioners and physician assistants—they’re reshaping the landscape of care.

David

So it sounds like the machine model just breaks down when the... the rules of the game change?

Sofia

Precisely. And people aren’t mechanical parts either, right? You can’t just force them to fit into rigid, predetermined roles without considering how their needs—or society’s needs—evolve over time.

David

Wait, can we pause there for a sec? I wanna make sure I’ve got this. So, you’re saying the machine view assumes we already know the perfect way to educate and train every single healthcare professional. Like it’s all, “Four years premed, four years med school, residency, boom—you’re done.”

Sofia

Exactly. That’s the conventional thinking. But reality is far more complex. A dynamic, or ecosystem, view keeps us focused on the ultimate goal—health for all at the lowest cost—while allowing the roles and systems to adapt to meet those objectives. It’s about being flexible, not locked into tradition.

David

Okay, so in an ecosystem view, we start with what we actually want, and then adjust everything else to fit that—whether that means creating new roles, rethinking training, or even changing the whole structure of how care is delivered?

Sofia

Exactly. It’s a mindset shift, but it’s crucial if we’re gonna address the challenges the healthcare system faces today.

David

Huh. Makes sense. And it, uh, kinda makes me wonder about what this could mean for premed programs, too.

David

You know, Sofia, it’s kinda blowing my mind to think about how reimagining premed programs through an ecosystem lens could shift everything. Do you think they’re ready for that?

Sofia

We really have. There’s been everything from shifting how we think about premed students, to reimagining entire health systems.

David

Ambitious is one way to put it. Let me see if I can summarize a few of the previous episodes. We made the case for all premed students being required to major in "health systems transformation." We talked about how a new medical school could be a catalyst for societal change, just like Johns Hopkins was. Healthcare credentialing - we made the case for completency-based. I mean, I still can’t get over the idea of Utah being at a tipping point for healthcare transformation. Honestly, that one kinda stuck with me.

Sofia

It’s a fascinating case study, isn’t it? Utah’s unique population dynamics and strong community ties put it in a position to lead change. But it’s not just about geography—it’s also about the vision and incentives that drive those changes. That’s true everywhere.

David

Yeah. And I remember you talked about this shared vision thing—how health educators, researchers, providers, and all the way to community leaders—how they could come together around metrics that actually, like, matter to people. Quality of life, reducing disease burden—you know, the big-picture stuff.

Sofia

Right. Imagine if everyone in the health ecosystem was incentivized to improve things like health outcomes instead of simply meeting arbitrary targets. We’re talking about transforming how we measure success in healthcare, which could lead to some pretty dramatic changes in roles and institutions alike.

David

Yeah, like instead of counting... I don't know, number of surgeries performed or papers published, you’d focus on what? Healthy years added to someone’s life?

Sofia

Exactly. Or things like reducing chronic disease rates or making care more affordable. It’s all about aligning our efforts around what really improves peoples’ lives and communities.

David

You know, it's kinda wild, though. If you shake up what we measure—like, if we actually do this—how much everything else would have to change, right? The schools, the hospitals, even who gets funded for research.

Sofia

Oh, absolutely. Entire systems would need to adapt. But that’s the beauty of thinking in terms of an ecosystem—you’re constantly adjusting and evolving to meet real needs. It’s not rigid like the old machine model.

David

Okay, so let me throw this at you. If we get everyone on board with the shared vision you’re talking about, and change the incentives, do you think it’d actually work? Or is there always gonna be something holding it back?

Sofia

That’s the million-dollar question, isn’t it? It requires not just a vision, but also the willingness to take risks and let go of outdated systems. And, you know, that’s really the tough part—giving up what feels comfortable.

David

Thinking about everything we just discussed, Sofia, I saw this comment on LinkedIn that stuck with me— “If you want to promote change, then you’d be better off finding best practices and replicating success.” What’s your take on that idea?

Sofia

It’s an interesting stance for sure, and honestly, it’s not wrong—at least not entirely. Best practices can be incredibly valuable when you’re working within an existing framework. Like, if we’re talking about improving how doctors manage diabetic emergencies, there are definitely established methods and protocols we can replicate for better outcomes.

David

Right, so like, stick with what works and just scale it up across the board?

Sofia

Exactly, but here’s the thing—while that approach can work for targeted fixes, it doesn’t address the root causes. Best practices help you optimize, but they don’t fundamentally transform the system to make it, well, future-proof.

David

Okay, but isn’t that enough sometimes? Like, why reinvent the wheel if it’s rolling just fine?

Sofia

Fair point—but what if the wheels themselves are the issue? For example, with diabetes, best practices might improve care during flare-ups, but transformational practices aim to prevent those flare-ups from happening in the first place. That could mean rethinking health education, collaborating with communities, or developing new roles in healthcare entirely.

David

So, prevention versus reaction?

Sofia

Exactly. And prevention requires a system that’s not just reactive to crises but proactively evolving to reduce risks and improve outcomes. It’s a bigger, more complex shift, but it’s ultimately about achieving better health at a structural level, not just patching problems one by one.

David

Hmm. So, it’s not that best practices are bad—they’re just... kinda like a Band-Aid when we need surgery?

Sofia

That’s one way to look at it. Best practices can stabilize a system, but they don’t necessarily prepare it for the future. And preparing for the future means we need practices that co-evolve with society, education, and clinical medicine.

David

Speaking of preparing for the future, Sofia, someone in the comments mentioned an interesting UCLA course—HPM 442, I think? It’s part of their Executive Master’s in Public Health program and seems to focus on integrated health systems. That sounds right up the alley of what we were just talking about. Know anything about it?

Sofia

So, I’ll start with a quick disclaimer—Dr. Swanson has no firsthand experience with this course or the program, and neither do we. But from the LinkedIn thread and the limited info I could find online, it’s fascinating.

David

Okay, so hit me with it. Why’s it so fascinating?

Sofia

Well, from what I’ve seen, they frame everything around the Quintuple Aim. And for anyone unfamiliar, that’s like the North Star—or maybe the guiding light—for health system transformation. It goes beyond the traditional Triple Aim by adding equity and workforce wellbeing into the mix. That shared vision alone could be a game changer for programs like theirs.

David

Wait, Quintuple Aim? I thought it was Triple Aim. What’s the upgrade here?

Sofia

Great question, David. So, the Triple Aim focuses on improving patient care, enhancing population health, and reducing costs. The Quintuple Aim keeps those but adds two new dimensions—equity and caregiver wellbeing. It’s a way of recognizing that, for a truly sustainable system, we can’t just focus on patients alone. We need to care for the people who deliver that care and make equity a central part of the mission.

David

Interesting. And this UCLA course uses that framework to what—teach new healthcare execs or something?

Sofia

Exactly. From what I read, it seems like they dive deep into something called a capitated, delegated risk, value-based model. That’s a mouthful, I know, but basically, it’s about organizing systems so they’re incentivized to focus on value—actual health outcomes—rather than volume, like how many procedures or services they can bill for.

David

Huh. So, like, integrating everything under one roof to make sure the focus stays on outcomes?

Sofia

Pretty much. It’s about systems working together seamlessly—whether it’s hospitals, clinics, or community health organizations—all with the goal of keeping people healthier and spending less in the long run. The course looks at how to organize and lead these systems to make that happen.

David

Got it. And I’m guessing this kind of setup could be a blueprint for other places to follow?

Sofia

If implemented well, definitely. The key is that the model tries to holistically address patient needs while aligning financial incentives across the board. It’s ambitious, but it’s the kind of transformation we need to at least talk about, even if it’s not perfect yet.

David

Speaking of how education is driving health system innovation, Sofia, Dr. Swanson mentioned Arizona State University as a leader in rethinking health education. Do you know what they’re up to?

Sofia

Well, ASU is actually pretty fascinating. They’re positioning themselves as a hub for what’s called a “learning health ecosystem.” The idea is to evolve schools and colleges in real time to meet society’s shifting health needs—all while keeping costs as low as possible.

David

Okay, I’m intrigued. But when you say learning health ecosystem, what does that mean, exactly? Like... is it a school that just updates its classes every year?

Sofia

Not quite. It’s more ambitious than that. A learning health ecosystem focuses on constant adaptation—not just in curriculum, but in how the entire institution, from training to research to community engagement, aligns to improve health outcomes. ASU’s president, Michael Crow, has talked extensively about this kind of innovation—they’re not just adapting, they’re co-evolving with healthcare systems and communities.

David

Co-evolving. Okay, so, like, instead of just adding new classes, they’re—and stop me if I'm wrong here—they’re kind of redesigning the whole system to grow alongside real-world needs?

Sofia

Exactly. For instance, they’re launching a new medical school designed not just to pump out traditional doctors, but to create health professionals who understand the broader ecosystem they’re stepping into. It’s a move that could inspire other schools to rethink the way healthcare workers are educated.

David

Hold up—so they’re building a whole new medical school? That’s a big deal, right?

Sofia

Absolutely. They’re partnering with HonorHealth and aiming to address Arizona’s health disparities while tackling workforce shortages across the state. What makes it a big deal is the mindset shift—it’s not just about education in a silo, it’s about creating partnerships and systems that work together to serve society more effectively.

David

And how do they keep it all affordable? I mean, education—and especially medical training—it’s notoriously expensive.

Sofia

That’s one of ASU’s core principles—keeping costs low and access high. They’re working to integrate research, clinical care, and teaching into a holistic model, which, ideally, maximizes efficiency and reduces redundancies. It’s a strategy that could keep tuition down, while making the programs more impactful in the long run.

David

Alright, so let me make sure I’ve got this straight. Their whole idea is like... take healthcare education, combine it with real-time feedback from the health system, and constantly adapt all those moving parts to create better outcomes for everyone?

Sofia

Exactly. It’s a bold approach. But it’s also one that requires everyone involved—educators, students, hospitals, even policymakers—to buy into the vision. Without that alignment, even the best ideas can fall flat.

David

Wow. So they’re kind of blending education with practice and policy all at once. That’s, uh, ambitious.

Sofia

It is. But ambition is what’s needed to tackle the challenges we’re facing in our health system today. ASU might not have all the answers yet, but they’re certainly seem to be asking the right questions and experimenting with some promising solutions.

David

Well, let’s hope they can pull it off. This kind of innovation could honestly reshape how we think about training healthcare professionals entirely.

David

Alright, Sofia, so ASU's vision sounds transformative and ambitious, no doubt. But let’s dig into some of the challenges they might face —are more physicians really the solution? Isn’t most of our health influenced by, well, everything beyond just healthcare systems?

Sofia

It’s a great observation. In fact, only about 5 to 20 percent of our overall health is actually determined by healthcare services. The bigger drivers are things like socioeconomic status, education, environment, and lifestyle. So, while training more physicians is important, it's not the magic bullet.

David

Okay, so it’s like trying to fix a leaky roof by just getting more buckets instead of patching the actual hole?

Sofia

Exactly. And then there’s the “who” question. What about physician assistants or nurse practitioners working alongside doctors? These mid-level providers often fill critical gaps, and studies show they can deliver high-quality care, especially in underserved areas. It’s about competency, not just quantity.

David

So, like, maybe ASU should focus more on creating a progressive, competency-based model rather than just churning out more MDs?

Sofia

Precisely. Imagine an education system where roles and training adapt based on the actual health needs of people—where competency, not credentials, leads the way. ASU could spearhead that kind of innovation if done thoughtfully. But it has to be aligned with broader goals, not just isolated tech-driven solutions.

David

Speaking of tech, they seem pretty tech-heavy, right? Is there... I don’t know, a danger in focusing too much on that and overlooking the social pieces?

Sofia

Absolutely. Technology is a tool, not the solution. If you don’t also address the social determinants of health—like housing, transportation, or food security—then the tech by itself won’t solve structural problems. There has to be a balance between innovation and addressing these systemic issues.

David

And then there’s that one comment about revenue strategy—something like “look at how many ASU courses focus on maximizing revenue instead of addressing high-risk or underserved patients.” Is that a fair critique?

Sofia

Well, without seeing their course content, it’s hard to say exactly. But the concern is valid in a broader sense. When financial incentives are tied to things like more doctor visits, costly medications, or surgeries, you risk prioritizing revenue over outcomes. It leads to suboptimization—where parts of the system might function well within their limited sphere - profits - but work against the overall goal of improving health.

David

Right. It’s kind of like, uh, cutting the pizza into more slices but not actually having more pizza?

Sofia

Exactly. And the unintended consequences trickle down. If institutions like ASU don’t carefully design their curriculum and incentives, they could end up perpetuating the problems they’re trying to solve. The focus has to stay on creating better outcomes, especially for underserved communities.

David

So, in a way, it’s like ASU is walking a tightrope—they’ve got all these ambitious ideas, but if they lean too far toward revenue or tech, they might lose sight of the bigger picture. Would you say that’s fair?

Sofia

I’d say that’s spot on. And to truly lead, they’ll need to address those criticisms transparently and innovate in a way that prioritizes health equity and systems alignment. Otherwise...

David

You know, Sofia, this has been such an eye-opener. Whether it’s the challenges at ASU, like balancing innovation with health equity, or the deeper point about how systems need to address social determinants beyond tech—it really gets you thinking, doesn’t it?

Sofia

Absolutely. It’s been such a rich conversation. And I think what really stands out to me is how these examples aren’t just academic—they’re lessons we can apply right now to make real change.

David

Yeah, it’s kinda like... the whole point here is to move beyond these isolated fixes and start seeing the bigger picture. Like, how do we build systems that continuously adapt while really focusing on, you know, the most vulnerable?

Sofia

Exactly, David. It’s not enough to just patch holes or replicate what worked in the past. The health ecosystem approach asks us to constantly learn, evolve, and, most importantly, put the people—not the system—at the center of our efforts.

David

It’s a tough shift, though. I mean, even thinking about incentives alone—aligning all the moving parts like education, care delivery, research—that’s a massive undertaking. But, honestly, it feels necessary. Like, we can’t avoid it anymore.

Sofia

Right. And that’s why listening to ideas, sharing feedback, and learning from institutions like UCLA or ASU is so valuable. They show us what’s possible, but also highlight the challenges—we’re all trying to figure this out together.

David

Which, you know, makes me wanna say—thank you to everyone who’s chimed in, whether through comments or sharing links. Seriously, your input makes this whole conversation even richer.

Sofia

Yes, thank you. We’re always open to learning from you all. Whether it’s ideas, criticisms, or new perspectives, it all helps us refine how we think about these massive challenges—and, honestly, keeps us motivated.

David

Yeah, and it’s a reminder that even though we’re, you know, metaphorically sitting in front of mics, this isn’t the kind of thing two people—or even a few institutions—can tackle alone. It’s gotta be a collective effort, right?

Sofia

Exactly. The goal isn’t to have all the answers, but to keep asking the right questions and pushing for thoughtful, collaborative change. And that’s something we can all take part in.

David

Alright. So, on that note, Sofia, I guess it’s time to wrap up. Any final thoughts before we sign off?

Sofia

Just that even small steps towards systemic change can have ripple effects. So, keep sharing your thoughts, keep challenging traditions, and keep pushing for a health system that works for everyone.

David

I love that. Alright, folks, that’s all for today. Thank you for joining us. And, as always, we’ll see you next time on "It’s Time."