Transcript Slide 1
Health Systems Engineering in the Design Process David Cowan Health Systems © Copyright 2008, Health Systems Institute Engineering Thinking As apposed to… Scientific thinking Still Quantitative but Hypothesis – study Classify – Organize to understand One Best solution Intuitive thinking Qualitative Artistic – Creative Envisioning © Copyright 2008, Health Systems Institute Engineering Thinking Systems Process Causation Variation / Outcomes © Copyright 2008, Health Systems Institute Engineering Thinking Quantitative Optimization Engineering Economy Design of Experiments © Copyright 2008, Health Systems Institute Engineering Thinking Models Simulations Optimization Representations Descriptive © Copyright 2008, Health Systems Institute Engineering Methods Process Flow charts Transitions Swim Lanes Spaghetti © Copyright 2008, Health Systems Institute Engineering Methods Measures Direct Proxy Complex (RVUs) Charts Statistics © Copyright 2008, Health Systems Institute Engineering Methods Models Simulation Optimization Descriptive Flexible © Copyright 2008, Health Systems Institute Engineering Goals Solutions Improvement Predictive Quality Productive - Effiecient Outcomes – Effective Practical © Copyright 2008, Health Systems Institute 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 © Copyright 2008, Health Systems Institute Healthcare Healthcare process Prevent Diagnose Treat Rehab Palliative © Copyright 2008, Health Systems Institute Healthcare IOM – 6 Aims Effective Efficient Equitable Timely Safte Patient Centered © Copyright 2008, Health Systems Institute Healthcare Ambulatory ER Physician Clinic Specialty Procedures X-ray, Lab, Ekg Invasive – Surgery, Rehab Pharmacy © Copyright 2008, Health Systems Institute Healthcare Preventive Annual Screening and health planning Episodic “I don’t feel good…” Chronic Diabetes, Hypertension, COPD, Arthritis Behavioral Health Rehabilitative © Copyright 2008, Health Systems Institute 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. © Copyright 2008, Health Systems Institute Preventing Readmissions Understanding the Problem 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 left HAI, © Copyright 2008, Health Systems Institute But Why? Preventing Readmissions Understanding the Problem Did we manage the transition home? Moving fragile patients is problematice Getting them set up at home Is the home ready? Is there anybody there to help Do they know what they are doing? © Copyright 2008, Health Systems Institute Preventing Readmissions Understanding the Problem But Why? Did the Patient Follow through? Medications See their physician Do their therapy © Copyright 2008, Health Systems Institute Preventing Readmissions Understanding the Problem Some things we do Discharge orders and instructions Organize Home Nurse visits Follow up Calls © Copyright 2008, Health Systems Institute Preventing Readmissions Understanding the Problem 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. © Copyright 2008, Health Systems Institute So give us your impressions of the Problem © Copyright 2008, Health Systems Institute Preventing Readmissions 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… © Copyright 2008, Health Systems Institute Some Key Concepts Protocols Surge EMR PHR Electronic Prescription Patient Scheduling Staff Scheduling Hours of operations © Copyright 2008, Health Systems Institute Nurses MidLevels Doctors Telemedicine Time is a most precious commodity Patient Doctor Facility Successful outcomes Cost of Care is tied to time Communication © Copyright 2008, Health Systems Institute 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 © Copyright 2008, Health Systems Institute 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. © Copyright 2008, Health Systems Institute Multi-disciplinary Working in teams “Pivot the Room” Group Processes Brainstorming © Copyright 2008, Health Systems Institute Transdisciplinary Synergy - Beyond blending into a new thought Leadership Elegance – not Sophisticated © Copyright 2008, Health Systems Institute 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. © Copyright 2008, Health Systems Institute three key concepts of Transdisciplinary Thinking transformative praxis, constructive problem-solving and real-world engagement. © Copyright 2008, Health Systems Institute