The Lessons and The Legacy of the Pew Health Policy Program (1997) Chapter:Part 4: Summarizing the Legacy: Some Conclusions and Thoughts for the Future
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This fourth and final section of the report attempts to draw the many loose threads together. Based on archival work, the external evaluations, the 25 interviews and narrative accounts, the roundtable discussions and focus groups, and the authors' observations, the Pew Health Policy Program (PHPP) evolved from a unique, ambiguous idea to a highly successful, highly sought after, and well-respected academic program. The demographics are mesmerizing: hundreds of graduates have been placed into a wide variety of health policy jobs and they are now university professors, researchers, consultants, federal and state policy makers, and health care managers.
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The Pew Health Policy Program evolved from a unique, ambiguous idea to a highly successful, highly sought after, and well-respected academic program.
Some questions remain. From a strategic standpoint, what are the elements of successful programs? How are the collective accomplishments summarized? What lessons have been learned about niche educational programs in health policy? Where do we go from here?
Part four of this report addresses these questions in four sections. The first section develops (with the aid of an analytic framework) strategic guidelines to help foundations and
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Academic institutions to implement niche educational programs. The second section highlights the lessons for other academic institutions learned from the Pew experience. The third section summarizes (in a nonscientific way) impressions of the collective accomplishments and program impacts. To accomplish these three final tasks, the focus is shifted away from the voice of the participants to a more conceptual plane that makes sense of the Pew legacy as a ''lived experience.
As Hal Luft, Stuart Altman, Marion Ein Lewin, and others have said, we have learned how to do this, and this work needs to continue. Therefore, it is appropriate for this section to consider the future not only in terms of knowledge creation and vision but also the degree of future participation in policy making and policy training. It is unlikely that market forces will mobilize the loosely coupled community of Pew scholars into an active network. There is a need for a few leaders in the group to create a strong organization. The fourth, and final section concludes by offering the Pew fellows thoughts about a path for the future.
According to Heskett (1986) 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. Heskett also argues that the four basic elements mentioned above are mediated by three integrative elements: positioning, leveraging, and integrating the operating strategy with the service delivery system. In fact, each of the PHPP sites spent the last dozen or so years honing health policy programs around these basic and integrative elements.
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Each of the sites assembled its programs around the four basic elements for strategic success (Heskett, 1986). Sites targeted internal (faculty) and external (fellows) market segments and focused on understanding their needs. Each site also carefully crafted a distinct educational service concept in terms of the results that they could produce for fellows and faculty. A third basic element during implementation was developing a focused operations strategy, and the fourth element was designing a system (pedagogy and methodology) for providing educational services.
Each program eventually developed a distinct market niche in health policy by positioning itself to serve faculty, students, and the health policy world. Irrespective of how programs position their educational concept, they must leverage their activities so that the education is valued by the fellows. This was especially important for the midcareer and on-job/on-campus students. Finally, all of the programs in varying degrees, had to integrate and coordinate their operating strategies with their other educational programs (delivery systems) to insure a high quality education at reasonable costs, an engaged faculty, and internal consistency (Heskett, 1986). These ideas are portrayed in Figure 2.
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. To have a successful program, a strong and committed core faculty had to be enlisted and deployed. To attract a strong faculty, excellent students are needed.
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Involving faculty members in new activities is difficult, requiring resources and resourcefulness. Two examples illustrate the idea. At the University of Michigan program, they found
That running an off-site weekend program required obtaining an up-front commitment of faculty willing to teach adult learners on Saturdays and Sundays for 5 months of the year. Traditional ways of hiring faculty did not work, because a new breed of faculty member was needed. According to Richardson (1990), the faculty selected to teach this group of adult learners had to be carefully screened and oriented because many Pew fellows were experts in their work domains. Over time Michigan learned how to develop and deploy an outstanding faculty.
At the University of California at San Francisco (UCSF), for example, the problem of engaging the faculty required selling them on the benefits of working with postdoctoral fellows. When the program began attracting exceptional Pew fellows, a committed faculty quickly surfaced. RAND/University of California at Los Angeles (UCLA) was able to build on the strengths of the faculty at each school to create a singularly rich training program.
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The faculty selected to teach this group of adult learners had to be carefully screened and oriented because many Pew follows were experts in their work domains. PHPP averaged students with 12 to 14 years of work experience before they came to the Pew program.
Targeting excellent fellows to keep the faculty interested and involved was not unique to UCSF but occurred at every site. There is strong evidence that all of the program sites managed to attract high-quality fellows from a strong applicant pool. Throughout the program, the outside evaluators found the quality of the fellows to be very strong; moreover, there were noticeable improvements in the quality of fellows from 1982 to 1985, 1985 to 1989, and 1989 to 1994. PHPP averaged students with 12 to 14 years of work experience before they came to the Pew program. The postdoctoral fellows were PhDs, and clinicians. The predoctoral fellows often had Master's degrees or professional graduate degrees from excellent schools.
In doctoral and postdoctoral programs, the attrition rates are surprisingly high (Bowen and Rudenstine, 1992). PHPP hypothesized that attrition may be related to the ability to recruit high-quality students. Therefore, the Pew program focused on quality students along two dimensions: (1) finding the best and brightest candidates and (2) finding people motivated to complete these challenging programs.
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Recruitment of high-quality, highly motivated fellows was not the only recruitment characteristic. Each program also had to discover ways to single out groups of applicants (i.e., student segments) with common characteristics whose educational needs could best be met by a particular program in terms of the results they could deliver. So, in recruiting fellows, each program had to learn how to screen for fellows motivated and capable of completing the degree and who fit well with the educational services that the program could deliver.
Discovering ways to single out segments of applicants was not a trivial problem for a niche program in health policy. The Michigan program, for example, was a nonresidential doctoral program in health policy for working people. This meant locating prospective fellows who wanted to pursue a full-time doctoral program without giving up their full-time professional lives.
To increase the chances of locating highly qualified fellows, schools need to select from a large applicant pool. Recruiting from a national (as opposed to a local) market yields a larger pool. Michigan learned that its program had great appeal to high-profile, midcareer professionals from government and health care management, which offered a large, national segment to draw from. Recruiting Michigan fellows from this pool, however, was tricky because Michigan fellows had to be good at both work and school. To complete a doctoral degree, Michigan had to identify fellows who could master the craft of being a good student. By and large, great leaders are not great students; moreover, older students do not do well on standardized tests. To insure that fellows who were selected would complete the program, Michigan used college grades, past work accomplishments, and Graduate Record Examination (GRE) scores as criteria for final selection.
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To increase the chances of locating highly qualified fellows, schools need to select from a large applicant pool. Recruiting from a national (as opposed to a local) market yields a larger pool.
Each of the programs found different ways to group applicants into segments with common characteristics. At first, Boston University (BU)/Brandeis sought people who had had some governmental or health care management experience and who wanted advanced training in health policy. 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
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