Robert Fangmeyer
Published: Monday, June 9, 2014 - 19:34 What does healthcare in the United States need? Well, according to a report released May 29, 2014, by the President’s Council of Advisors on Science and Technology (PCAST), U.S. healthcare organizations need “systems engineering.” In their letter to President Obama, PCAST co-chairs John Holdren and Eric Lander state that “systems engineering, widely used in manufacturing and aviation, is an interdisciplinary approach to analyze, design, manage, and measure a complex system in order to improve its efficiency, reliability, productivity, quality, and safety.” In other words, healthcare organizations, including hospitals and community-based providers, need to manage their operations as an integrated whole rather than as a set of discrete components. They need to design, implement, measure, analyze, and manage their operations as one system if they want to simultaneously improve their operations, finances, and patient outcomes. Holdren and Lander go on to say, “[Systems engineering] has often produced dramatically positive results in the small number of healthcare organizations that have incorporated it into their processes. But in spite of excellent examples, systems methods and tools are not yet used on a widespread basis in U.S. healthcare.” To increase the use of systems methods and tools, they recommend that “Health and Human Services and the Department of Commerce build on the Baldrige awards to recognize healthcare providers successfully applying systems engineering approaches.” They note that the Malcolm Baldrige National Quality Award provides the opportunity to raise awareness of performance excellence in U.S. healthcare. It is gratifying that the council recognizes the unique role that the Baldrige Award has been playing in healthcare. The Baldrige Criteria, in fact, provide exactly the holistic, systems approach to excellence that the PCAST report recommends. Seventeen healthcare organizations have received the Baldrige Award since 1999. These role-model organizations manage to simultaneously provide outstanding patient, operational, and financial outcomes. What may be surprising to a healthcare leader or any organizational leader not familiar with the Baldrige Program is that it’s more than “just a presidential award.” In fact, the Baldrige Program is an educational program with an award component, not the other way around. Thousands of organizations use the Baldrige Criteria as their integrated performance management framework without ever applying for the award. Healthcare organizations are experiencing a true sea change in expectations from their stakeholders, including the payors, patients, and workforce they depend on for their survival and financial well-being. We wholeheartedly agree with PCAST members that a systems approach can help any healthcare organization adapt and thrive despite rapidly changing demands. The national payoff when more organizations heed the council’s call and systematically work toward performance excellence will be healthier citizens and communities—and a healthier economy. First published June 2, 2014, on Blogrige. Robert Fangmeyer is the director of the Baldrige Performance Excellence Program (BPEP) at the National Institute of Standards and Technology (NIST).
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Robert Fangmeyer
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Comments
The healthcare solutions are on their way...
Robert is correct: Systems Engineering will be able to vastly improve health care delivery. But the missing element is the data needed to apply those systems. Our healthcare system is based on trying to improve the outcomes of already sick people and the aggregated data starting point is when people get sick. On the horizon is a non-invasive diagnostic tool that will test the breath of healthy as well as sick people to develop Big Data which will allow identification of disease precursors. As this diagnostic test screens the many chemicals in exhaled breath at very low cost, test results can be accumulated into databases for analysis to determine who might be developing diseases long before actual symptoms appear. This testing can reveal numerous diseases from cancer to diabetes.
The device that can do the breath analysis is the Owlstone Lonestar which is a miniature FAIMS Mass Spectrometer developed by Owlstone Nanotech. You can read about the development of this technology here: http://www.owlstonenanotech.com/applications/medical
With the creation of Big Data on a large population, preventative medicine will allow our heathcare system to get ahead of disease and serve primarily prevention rather than only remediation. That we know is the primary path to quality improvement.
With all due respect, what
Systems Engineering in Healthcare is Overkill
When I think of Systems Engineering, I think of my college degrees in operations research and all of the crazy analysis we did.
Having worked with numerous hospitals over the last decade, I have found that a little Value Stream Mapping or Spaghetti Diagramming will quickly discover ways to cut nurse travel time by 50% in almost any nursing unit and lab turnaround times by 30-50%. They can shorten turnaround times from admission to imaging to lab to discharge.
And it only takes an hour or two with a pad of Post-it Notes to figure out what to change and how.Implementation, of course, may take a little longer, but sometimes machines and materials can be moved immediately.
I worked with an architecture firm to design Lean rural hospitals from the ground up. Many existing hospitals were not designed well, but can be optimized.
Systems Engineering is overkill for Healthcare. Value Stream Maps and Spaghetti Diagrams are simple solutions to what ails Healthcare today.