© Copyright 2008, Health Systems Institute Health Systems Engineering in the Design Process David Cowan Health Systems

© Copyright 2008, Health Systems Institute

Health Systems Engineeringin the Design Process

David Cowan

Health Systems


Engineering Thinking

As apposed to… Scientific thinking

Still Quantitative butHypothesis – studyClassify – Organize to understandOne Best solution

Intuitive thinkingQualitativeArtistic – CreativeEnvisioning



Systems Process Causation Variation / Outcomes



Quantitative Optimization Engineering Economy Design of Experiments



Models Simulations Optimization Representations Descriptive


Engineering Methods

Process Flow charts Transitions Swim Lanes Spaghetti


Engineering Methods

Measures Direct Proxy Complex (RVUs) Charts Statistics


Engineering Methods

Models Simulation Optimization Descriptive Flexible


Engineering Goals

Solutions Improvement Predictive Quality Productive - Effiecient Outcomes – Effective Practical


What to expect from your Engineer

Practical / Structured Will it work Can we make it How do we overcome these problems Who will do what when


Healthcare

Healthcare process Prevent Diagnose Treat Rehab Palliative


Healthcare

IOM – 6 Aims Effective Efficient Equitable Timely Safte Patient Centered


Healthcare

Ambulatory ER Physician Clinic Specialty Procedures

X-ray, Lab, EkgInvasive – Surgery, Rehab

Pharmacy


Healthcare

Preventive Annual Screening and health planning

Episodic “I don’t feel good…”

Chronic Diabetes, Hypertension, COPD, Arthritis

Behavioral Health Rehabilitative


Preventing Readmissions

Understanding the Problem

The patient gets worse, or does not get better, or is afraid, or is complicated and needs to come back to the hospital.




But Why? Did the patient leave the hospital before getting

on the mend… Did the hospital not prepare the patient before

they left Did something else happen at the hospital that

did not develop until the patient leftHAI,



Understanding the Problem But Why?

Did we manage the transition home?Moving fragile patients is problematiceGetting them set up at home

Is the home ready? Is there anybody there to help Do they know what they are doing?




But Why? Did the Patient Follow through?

MedicationsSee their physicianDo their therapy




Some things we do Discharge orders and instructions Organize Home Nurse visits Follow up Calls




But it doesn’t work well… Patients are sick so some just don’t get better

but get worse – it doesn’t matter that we missed something

Other patients don’t follow through and get worse

Patients are scared when they feel funny Drugs misbehave.


So give us your impressions of the

Problem



Key Issues Discharging patient at the right time Preparing the Patient for the next 30 days Preparing those caring for the patient for the

next 30 days Transition to Home Preparing the Home environment Follow through at Home This is where the experiments occur…


Some Key Concepts

Protocols Surge EMR PHR Electronic Prescription Patient Scheduling Staff Scheduling Hours of operations

Nurses MidLevels Doctors Telemedicine


Time is a most precious commodity

Patient Doctor Facility Successful outcomes Cost of Care is tied to time Communication


Transdisciplinary

The significant problems we have cannot be solved at the same level of thinking with which we created them. AE

The role of a consultant is to take a situation which appears as a problem and move it to the next level to solve it.

Leland Kiaser


A New Discipline

The Science of Healthcare Delivery Healthcare as a complex adaptive system Global Health

Seeing Healthcare from a new, bigger, and broader perspective

A single or even a multidisciplinary focus will not solve our system problems.


Multi-disciplinary

Working in teams “Pivot the Room” Group Processes Brainstorming


Transdisciplinary

Synergy - Beyond blending into a new thought

Leadership Elegance – not Sophisticated


Transdisciplinary

transdisciplinary studies is a particular emphasis on engagement, investigation, and participation in addressing present-day issues and problems in a manner that explicitly destabilizes disciplinary boundaries while respecting disciplinary expertise.


three key concepts of Transdisciplinary

Thinking transformative praxis, constructive problem-solving and real-world engagement.

Documents

© Copyright 2008, Health Systems Institute Health Systems Engineering in the Design Process David Cowan Health Systems