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.