Reflecting on what’s going on at Northwestern Health Sciences University and other similar institutions, there’s a lot to question. So what can or should be done?
For many schools, especially in professional education, there is probably a choice between two basic types of options–two paradigms, if you will, about what is needed and/or likely to be successful. And in today’s marketplace it’s possible to look at one set of environmental conditions and draw two different conclusions.
A challenging reality in today’s higher- and professional education industries is that ‘legacy’ models of educational program delivery are increasingly unsustainable. Historical, hierarchical educational cultures, linear and vertical curriculum processes are challenged to respond to a combination of escalating costs, changing students’ generational needs and interests, job markets undergoing substantial disruption as well as other factors. One only has to Google ‘unbundling higher education’ to get a sense of the degree and extent of unrest, confusion and pressures institutions and their cultures are needing to navigate. Northwestern Health Sciences University is being forced to confront professional educational versions of these same stresses and pressures.
One response, being used by many, is to double down on the legacy model of institutional function and identity, seeking to modernize some aspects of their organization and delivery. Many take steps such as adding programs, seeking to mature the host institution into a more orthodox identity and market presence, and using growth to ensure viability. The dependencies here include that along the way the institution must be able to either slow the (comparative) rate of tuition increases, offer differentiation from competitors, create an inescapably ‘magnetic’ brand experience, or otherwise fend off the increasingly crippling challenge of creating discernible value for a student’s tuition dollar. This path isn’t easy. It’s getting harder to establish an appealing return on investment for students of professional programs; job compensation isn’t keeping pace with the increasing costs of education (see the challenges PTs have with their DPT numbers). That’s not to say it can’t be done; Northwestern appears to be choosing this path, and everyone should hope they are successful.
Alternatively, a different approach may be important–even critical–to consider at some point. This alternative uses a fundamentally different view, one based on a strategic goal that does not include becoming a ‘regular’ university, but is rather based on goals of differentiation and distinction. This requires an understanding and respect of (if not reverence for) the view that non-medical professions’ cultures, philosophical and clinical paradigms are inescapably part of not just their identity but their contributions and success. It is one that holds that if any therapy is extracted (viewed in isolation, such as in comparative research) from a specific professional context that it tends to weaken both the therapy and profession.
This approach sorts itself into four areas of action. It may be possible to blend aspects of this and the orthodox approach, but there are inherent conflicts that suggest that isn’t easily achieved across the board.
Diversify content delivery. The ‘butts in seats’ model of education serves one segment of students well, but not others. It demands compliance instead of seeking to create engagement. This approach serves the legacy revenue engine of schools, but is inherently limited, chafes other types of student learners, and creates tensions from its asymmetry with the lifestyle requirements and realities of many, and often imposes unrealistic enrollment targets. Where program accreditation permits, institutions should redesign the delivery of information to depend less on ‘brick and mortar cohorts’ that require physical learning environments. Where accreditation requirements prevent this, they should be challenged to evolve. Programs need to use efficiencies to lower and customize tuition, giving students optional paths with corresponding cost choices and alternatives.
Align business and clinical success with marketplace realities. There is no reason why professional education shouldn’t start with business education, instead of finishing with it as has commonly been the case. Students should be required from the beginning to use business goals and marketplace realities as a constant check against their choices of tuition paths, specialization interests, equipment purchases, etc.
Foster professional cultures’ capacities for autonomous stewardship. One of the striking unintended consequences of tactics many have used for systemic integration is that the system seems uninterested in utilizing large numbers of any non-medical profession. Since at this point medical settings dominate employment circumstances for doctors of chiropractic and naturopathic medicine, acupuncturists and others, efforts to groom providers to fit in such a dominant medical ‘host’ culture do not seem likely to benefit a large proportion of any profession. This approach is likely to create winners and losers, and rarely creates space culturally for non-medical contributors to fully express an intact professional paradigm.
There are benefits to treating a non-medical profession’s culture as an asset. One under-appreciated area is that the context for care currently is limited in payers’ eyes to ‘medical necessity.’ Indications for ‘medically necessary’ care in non-medical professions do not fit neatly or appropriately into their clinical and philosophic paradigms. Symptoms and signs are viewed differently in non-medical professions, their philosophies and clinical practices. If these differences aren’t supported and reinforced in the context of a distinctive culture, it also increases the potential and likelihood that clinical strategies can be abstracted and co-opted by other professions. And in a health care marketplace that is increasingly driven by ‘value-based’ purchasing decisions, the value (outcomes over costs) of a given profession’s clinical approach and contributions is less able to be reduced to a simplistic contrast between therapies.
Develop a mandate for data stewardship. The medical side of health care delivery is already dominated by data as a context for making decisions about therapeutic strategies, and the significance of this trend cannot be overstated. Bluntly, non-medical professions have neither the data, appropriate data acquisition/management models, nor a widely-established sense of responsibility as professional citizens for contributing the clinical data needed to establish and maintain relevance in the new harsh light of big data and machine learning. Non-medical professional education needs to quickly develop an appreciation for the importance of this phenomenon and embed solutions in their programs or risk increasing and persistent marginalization of their graduates.
There are significant dependencies for this approach to be successful. It requires a commitment to revise legacy perspectives and practices, retaining those that foster growth and transitioning away from processes and perspectives that do not. It requires a commitment to cultural stewardship. It requires visionary leadership that is both solicitous of the cultures under their management and capable of clearly defining strategic goals that are aligned with the realities of our changing world.
The notion that health sciences schools with strong professional identities in their histories need to act or function more like a ‘real’ university or college needs to be thoughtfully challenged, so that implied elements of that goal are vetted against what the school really wants to accomplish. Chasing after a legacy model that is showing signs of collapsing is likely to be self-limiting. Institutions must be careful if they think that functioning as for-profit (rather than not-for-profit) organizations brings the right perspective to change: as higher education becomes unbundled, putting energy into wrapping old bundles in new clothes may not be rewarded in the long run.
It is intriguing to imagine what non-medical professional education institutions might do with concerted and intentional commitments to developing work in these four areas, accepting that an unbundled, more nimble institutional culture and functional processes can stay aligned with marketplace realities more easily. Locally, Northwestern could quickly re-establish a leadership position and marketplace differentiation as a result of this kind of effort. In contrast, however, it’s also easy to imagine what is increasingly likely to happen if schools maintain their current directions without this taking place.