Controlling infectious diseases and binge drinking wouldn’t seem to call for the same strategies, but Jim Yong Kim thinks they might.
Before Dr. Kim became president of Dartmouth College, in 2009, he had a lengthy career in medicine and public health. Trained as a physician and an anthropologist, he worked to prevent the spread of HIV in Rwanda and to treat drug-resistant tuberculosis in Peru. Now he’s hoping that the public-health methodology he used in both places—an information-sharing and data-gathering approach known as a “learning collaborative"—will help colleges tackle an intractable public-health problem of their own: binge drinking among students.
The learning collaborative Dr. Kim convened, which holds its second meeting this week in Austin, Tex., is composed of 32 institutions that cut across a wide swath of the higher-education landscape: Ivy League universities, regional public institutions, liberal-arts colleges, and state flagships. Their charge is to identify innovative techniques to solve a persistent problem, what Dr. Kim calls “a pandemic of massive proportions,” then measure their effectiveness. The collaborative’s final meeting will be in June at Dartmouth, and he expects to publish the group’s findings afterward.
The Chronicle recently spoke with Dr. Kim about the project.
Q. What was your inspiration to do this?
A. Every year, about 2,000 college-aged students die from alcohol. I began asking the question, “Are we doing everything we possibly can in terms of taking the evidence that already exists, looking around at every other major institution of higher education, and seeing what’s effective?” Are we not committing malpractice when it comes to protecting students from alcohol-related injury and death? While there was a lot of literature, mostly institutions of higher education were making it up as they were going along. There was really no sense of, Here is the standard of practice when it comes to responding to alcohol.
Q. A “learning collaborative” is more than just a fancy way of saying that you’re talking about a particular issue, right?
A. I learned about this from a guy named Don Berwick, who just stepped down as the head of Medicare and Medicaid. He was shocked to see how many bad things happen in hospitals. He studied the best organizations in the world to look at how they remove errors and protect people. In situations where it’s very hard to know exactly what the best practice is, what companies do is set up methods by which an innovation that happens in any part of the company is spread immediately to other parts of the company. Every time they make a change, they measure to see if that change is an improvement. [In higher education], because market forces don’t really push us to quickly find the best practices and adopt them, we often are working in complete isolation.
Q. There have been many efforts over the years to understand and rein in binge drinking among college students. What makes this one different?
A. The most important thing is that the institutions are actually working together. They’re on the phone constantly, talking to each other, sharing insights, sharing innovations. I don’t think there was, in the past, a group of college presidents who said, “We want to take on binge drinking.” There were a lot of college presidents stating their commitment, but they didn’t work together like we’re doing right now. We have a shared methodology to study whether a change is an improvement.
From Day 1, I have been in close communication with the Department of Health and Human Services. What we’re hoping is that this experience will translate into many more collaboratives. We’re also going to try to take what we learned and get it online, so institutions of higher education across the country can take advantage of what we’re learning.
Q. Your background is in medicine and public health, and you’ve said in the past that this particular collaborative approach is aimed at narrowing the gap between what you know through research and what you do in practice. Has there historically been a disconnect between research on binge drinking and on-the-ground efforts to curb it?
A. Campuses are so different culturally that there’s no cut-and-paste solution to any of these problems. You’ve got to think hard on how to take a particular insight and make it work in context. And you have to know that it’s working by being able to measure something. Most student-affairs groups are not in the habit of routinely measuring whether an intervention they’re making is an improvement or not.
There are a lot of things that we now know are effective. One example is brief motivational interviews. We know that brief motivational interviews within 72 hours of the event—the intoxication—have an enormous impact on reducing the degree to which students will once again engage in that behavior. But the implementation is extremely limited.
We’re making no promises that these campuses are going to go from 50 percent [binge drinking] to none. Other than places like Brigham Young—which is, by definition, dry—the lowest levels are at some women’s colleges, at 30 percent.
Another thing that’s happened that’s really, really interesting is the homegrown little projects that seem to have worked.
Q. Can you give an example?
A. The Quaker Bouncers. What they realized [at Haverford College, the alma mater of a Dartmouth business-school student involved in this project] was that at a lot of parties, students were drinking to intoxication and having to be taken to the hospital. The administration trained a group of students to go to these parties and recognize the early signs of intoxication. They actually measured their outcomes, and the number of hospitalizations at the parties the Quaker Bouncers participated in went to zero. No hospitalizations.
So we enlisted the student. He taught our folks here at Dartmouth, and we call it the Green Team. It has also been quite effective. We’re still measuring our outcomes, but from preliminary results, it looks like the number of hospitalizations is very much reduced.
Q. Looking back on your experiences using learning collaboratives in Rwanda and Peru, do you see any similarities between those settings and this one?
A. Now that I’m in my third learning collaborative, it’s extraordinary to see how similar it is. When you say, “We’re going to make these efforts and measure the outcomes,” in every single environment I’ve been in, people have said, “Oh, we can’t do that, it’s impossible.” They all say that! But once they start measuring, and are able to show they came up with an idea, there’s tremendous excitement. We’ve had two very good experiences, and my expectation is that there will be a transformation in this group as well.
But here’s the thing that’s different. Alcohol is the most difficult problem I’ve taken on yet. For young people who want to release themselves, alcohol is the perfect designer drug. It’s so dangerous. What we’re hearing from neuroscientists is that the impact of alcohol on the developing brain is more serious than we know. It impairs your judgment. You are much more likely to go after immediate gratification.
But this is the best method I have ever seen to help a group of scientists tackle seemingly intractable health problems. This is also the most difficult nut to crack I’ve ever taken on. But knowing what we know about the number of deaths, injuries, and sexual assaults, and knowing what we know about the impact on the developing brain, we have no choice. We’ve got to attack this problem with the best tools we have. I’m not sure what’s going to happen. But after this learning collaborative, we will know much more than we ever knew before.
