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IE497B Biomedical Device Engineering. Dr. Richard A. Wysk Spring 2008. Agenda. Discuss first two paper opportunities Health Care and Traditional IE Stakeholders and metrics A bit of the landscape. Measuring and Reporting on Health Care Quality Dana Gelb Safran New England Medical Center. - PowerPoint PPT Presentation
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IE497B Biomedical Device Engineering
Dr. Richard A. Wysk
Spring 2008
Agenda
• Discuss first two paper opportunities
• Health Care and Traditional IE
• Stakeholders and metrics
• A bit of the landscape
Measuring and Reporting on Health
Care QualityDana Gelb Safran
New England Medical Center
Paper #1
Group Members
Proponents Opponents
Measuring and reporting heathcare Quality
Safran
Scott Shimp
Larna Citron
Jung Lim
Richard Delange
Supply Chain Management and Health Care Delivery
Reha Ulsoy
Paper #2
Group Members
Proponents Opponents
Supply Chain management
Viren Parikh Michael Hunter Robert Burkholder
Reha Ulsoy Shane Allison Vu Tu
How Does the Healthcare Research Context Differ?
• Mostly service model-based• Analytical methods trail by a decade or more.• Management engineers were phased out in the
1990s.• Healthcare is a complex system of delivery and
stakeholders.• Can you spell I-R-B (Institutional Review Board)?• IE approach can represent “disruptive innovation.”
Healthcare is a Complex System of Delivery and Stakeholders.
Fragmented informationfrom various sourcesis used to make decisionson treatment for a patientwho cannot judge clinical quality.
Furthermore, the treating physicianis an independent contractorpaid by third parties (Medicare, BCBS, etc.).
Can You Spell I-R-B?
• Not just at PSU, but the hospital IRB, clinic IRB, etc. Most won’t accept central IRB.
• Also, before you can conduct research– Get your shots (Hep B series, MMR, TB)– Attend mandatory orientation
• Get clinicians on board
• Next words: HIPAA, JCAHO
IE Approach Can Represent“Disruptive Innovation.”
• Hospitals are used to “sustaining” innovations (clinical, usually)– Specialized cancer treatments– Clinical trials
• But, systems to improve processes are typically “disruptive”– Noninvasive techniques, cure for common cold– Portable x-ray in MD offices– Low-tech, affect many patients with more ordinary
health problems– Impact business processes, culture, MD status
Disruptive Innovations Come From Below.
Source: Will Disruptive Innovations Cure Health Care? Christensen, C. M.; Bohmer, R.; Kenagy, John. Case No. R00501. Harvard Business Review.
Dissecting a Disruptive Innovation.
Source: The Innovator's Solution: Creating and Sustaining
Successful Growth by Clayton M. Christensen, Michael E. Raynor
What Makes IEs Suited to Healthcare Improvement?
• Proficient in Proven Tools Used in Other Contexts
• Focus on Systems Tools and Applications
• Consideration of the Human in Complex Systems
• Conversant with IT
IEs are Proficient in Proven Tools Used in Other Contexts.
• Lean, TPS, Six Sigma
• Work methods
• Quality
• Performance measurement and improvement– What do they measure in the ED?– Impact on pt flow, pt care
IEs Have a Focus on Systems Tools and Applications.
• Failure Analysis (FMEA)
• Modeling and Simulation (MedModel)
• Enterprise Management Tools (supply chain) (incineration)
• System Dynamics
• Knowledge Discovery (data mining, neural networks)
IEs Consider the Human in Complex Systems.
• Team structures and processes (Mayo model)
• Decision making
• Fatigue and error
• Work scheduling (resident shifts)
IEs are Conversant with IT.
• Can coordinate projects with CS, IT
• Trained to identify system requirements for each stakeholder (PDA Rx order)
• Drive IT toward objectives of vastly improving access to necessary clinical, system, and patient information (med recon)
Some RecentIE-Related Efforts
• Patterson (Ohio State/VA National Center for Patient Safety)—HF and adverse events
• Stanford—Culture of Safety• VA National Center for Patient Safety—HFMEA• Cook & Rasmussen—System Dynamics,
lessons from nuclear energy• Miller et al.—Six Sigma applications• Banner Health (AZ)—Lean applications • Pebble Partnership—Evidence-based design
What are Some Research Opportunities?
• Medical Error– 100K Lives Campaign (IOM)– Medication error– Medication labeling– Order entry and Rx (delays & wasted $$ in
dupe tests)
1,000,000 “serious
medication errors per year” … “illegible handwriting, misplaced decimal points, and missed drug
interactions and allergies.”
Source: tompeters.com from Wall Street Journal/Institute of Medicine
“In a disturbing 1991 study, 110 nurses of varying experience levels took a
written test of their ability to calculate medication doses. Eight out of 10 made calculation mistakes at least 10% of the
time,
while four out of 10 made mistakes 30% of the time.”
Source: tompeters.com from Demanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson
What are Some Research Opportunities?
• Patient Flow– ED (50% of pts), inter-unit, to/from ancillary
services– Waiting times, queuing– Essentially, Hammer’s “reengineering” (pt
admission in-room)
What are Some Research Opportunities?
• Healthcare Information Technology (HIT)– Electronic medical record– Service and provider integration– Rx, treatment order entry and fulfillment– Bed availability (HMED)
Become Familiar with IOM.
www.iom.edu
Read: To Err is Human and Crossing the Quality Chasm
See IHI for Improvement Tools and Publications.
"When I climb Mount Rainier, I face less risk of death than I'll face on the operating table."—Don Berwick, M.D. Newsweek/12.12.2005
Study and Implement Now…No Time to Wait for Optimal
Tools or Solutions
Summary
• IE tools have a place in medicine.
• Now is the time to use these tools.
• Lots of “red tape”.
• Two cultures.