Transcript IE497B Biomedical Device Engineering

IE497B Biomedical Device Engineering
Dr. Richard A. Wysk
Spring 2008
Agenda
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Discuss first two paper opportunities
Health Care and Traditional IE
Stakeholders and metrics
A bit of the landscape
Paper #1
Measuring and
Reporting on Health
Care Quality
Dana Gelb Safran
New England Medical Center
Group Members
Measuring and
reporting
heathcare
Quality
Safran
Proponents
Opponents
Scott Shimp
Larna Citron
Jung Lim
Richard
Delange
Paper #2
Supply Chain Management
and Health Care Delivery
Reha Ulsoy
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 information
from various sources
is used to make decisions
on treatment for a patient
who cannot judge clinical quality.
Furthermore, the treating physician
is an independent contractor
paid 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.
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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 Recent
IE-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
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IE tools have a place in medicine.
Now is the time to use these tools.
Lots of “red tape”.
Two cultures.