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Joint PhD/MD student utilizes anthropology to study hospital culture

For Howard Chiou, who will receive his PhD from Laney Graduate School, studying hospital culture through the lens of anthropology offers a way to understand and prevent medical errors. Chiou anticipates completing his MD at Emory School of Medicine next year.

Many aspiring doctors dread the words "medical error," but for Emory graduate student Howard Chiou, they have served to fuel a greater curiosity into hospital culture.

Like many graduate students, that curiosity set him upon a path of dedicated research and discovery, eventually becoming a launching pad for his doctoral dissertation, “Changing Culture in Healthcare.”

“My research topic basically developed itself after I learned about the enormity of the problem of medical error,” says Chiou, who will receive a PhD in anthropology through the Laney Graduate School on May 9.

Medical errors contribute to tens of thousands of preventable deaths in the United States each year. But through his research, Chiou found that the medical community was also “talking more and more about its culture and particularly its struggles to change.”

“I wondered if anthropologists might be able to help doctors and nurses, but also realized that understanding hospital cultures anthropologically might teach anthropologists about what that culture is and how it works,” he says.

Medical errors and the anthropologist

Interests in science and anthropology merged early for Chiou, who grew up in New York City. He was accepted to Stanford University for undergraduate studies, where he majored in human biology and also obtained a master’s degree in anthropology.

After deciding to pursue both a PhD in anthropology and an MD, Chiou began researching graduate programs. He discovered that Emory’s Laney Graduate School was, at the time, one of only a few institutions in the country that offered the joint MD/PhD in anthropology.

“I loved the strength and breadth of the MD/PhD Program, as well as its interdisciplinary connections with the School of Medicine and the Rollins School of Public Health,” says Chiou.

Under the direction of his advisers — Emory anthropology professors Peter Brown and Carol Worthman and physicians Melvin J. Konner, who is also an anthropology professor, and Timothy G. Buchman, director of the Emory Center for Critical Care — Chiou got to work.

The goal of his research has been to “to improve our understanding of hospitals as cultural and social systems undergoing dramatic change,” Chiou explains.

As a medical anthropologist, Chiou was embedded in hospital units implementing a new intervention that was meant to improve patient safety through checklists and improve teamwork between doctors and nurses.

“I combined tools from traditional cultural anthropology and healthcare quality improvement to study two hospital units in the U.S. and one in Australia,” he says.

“Although all sites received the same intervention, there was substantial variation between the sites in its implementation, and I argue that explaining this variation requires an anthropological understanding of healthcare.”

Hospitals as cultures

When considering the impact of his work, Chiou notes, “In healthcare, we tend to view hospital changes as technical, but I argue that even the simplest checklist requires complex social and cultural change.”

“I'm hoping that my work might provide those seeking to improve healthcare with new ways from which to think about creating their own changes,” he adds.

Ever the anthropologist, Chiou also has thoughts about how his work might impact the study of culture itself. “I think that the hospital offers a really neat laboratory for anthropologists,” he says. “Some of my professors have joked that my research interests are a bit old-school, as I'm interested in thinking about how to think about culture.”

But Chiou contends that understanding hospital cultures “not only tells us about an important part of our society, but also provides a useful lens from which we can draw insights on how to think about how cultures and organizations work more generally.”

After receiving his PhD, Chiou will continue his work towards earning an MD, with an anticipated graduation date of 2017. He’s now considering a career in public health and preventive medicine.

When asked what’s next, Chiou expresses excitement about the possibilities before him. “I have so much more to learn,” he says. “Although I'd like to stay involved in working to help improve health care, I'm also really excited about the idea that we should be doing more to prevent patients from becoming sick in the first place.”

Chiou’s research and ambitions embody the graduate student experience, says Laney Graduate School Dean Lisa Tedesco.

 “At the Laney Graduate School, we are dedicated to training tomorrow’s leaders,” she says. “We expect our students to do transformative work and to leave Emory prepared to engage complex problems in the full range of their complexities.”

“Howard has been an exemplary graduate student, and I look forward to seeing where his curiosity, ambition and dedication lead him next.”

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