Closing the Loop by Operationalizing Systems Engineering and Design (CLOSED)
Motivation:
Specific Aims :
Aim 1:​Use systems engineering and patient engagement to design, develop, and refine a highly reliable “closed loop” system for diagnostic tests and referrals that ensures diagnostic orders and follow-up occur reliably within clinically- and patient-important time-frames.
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Aim 2: Use systems engineering and patient engagement to design, develop, and refine a highly reliable “closed loop” system for symptoms that ensures clinicians receive and act on feedback about evolving symptoms and physical findings of concern to patients or clinicians.
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Aim 3: Design for generalizability across health systems more broadly so that the processes created in Aims 1 and 2 are effective in (1) a practice in an underserved community, (2) a large tele-medicine system, and (3) a representative range of simulated other health system settings and populations.
Partners:
Sunday, June 2, 2019
Sunday, June 2, 2019
Approach:
Sunday, June 2, 2019
Results to Date:
Perioperative Process Improvement, Boston Children's Hospital
Purpose
Children with medical complexity (CMC) are a challenging patient population with intricate, multisystem health needs. The perioperative environment has significantly advanced over the last two decades, especially due to technological advancements, which also has introduced greater system complexity and associated safety and cost issues. In this project, we apply industrial engineering methods to understand, measure, analyze, and improve the perioperative processes associated with CMC undergoing spinal fusion surgery at Boston’s Children Hospital. The
objective is to improve health outcomes, patient safety, and family satisfaction while reducing hospitalization costs.
Methods
A multidisciplinary team of systems engineers, organization experts, primary care pediatricians, other healthcare professionals, and patient representatives meet on a weekly basis as part of an interdisciplinary patient safety learning lab. Conventional process mapping such as cross-functional maps and more contemporary systems analysis methods such as Functional Resonance Analysis Method (FRAM) are utilized to thoroughly understand process flow and stakeholder interactions in the preoperative phase. Failure Modes and Effects Analysis (FMEA) and Contrast Analysis point out to the systems critical junctures at risk for failure. All the methods help derive a more robust perioperative process that is capable of being spread in different clinical settings.
Results
Process understanding through cross functional process maps and FRAM revealed that there is a lack of standardization and non-linearity in the preoperative phase. FMEA showed that most failures occurring in this phase are due to lack of communication between stakeholders, and CA underscored that patient and family involvement in this transition of care play a major role in making the system more resilient to process changes and able to sustain potential failure modes. This has prompted the multi-disciplinary team to focus on risk stratifying prospective spinal fusion patients at early stages, in order to address critical health issues and consequently reduce adverse events in subsequent perioperative phases (intraoperative and postoperative).
Partners & Research Team
Joseph Salem, BE, HSyE
Margaret R. O’Neill, BS, Boston’s Children Hospital
Jay G. Berry, MD, MPH, Boston’s Children Hospital
Joanne Cox, MD, Boston’s Children Hospital
Nathan Holler, HSyE
Tiago B.C. Jabur, BS, HSyE
Charis Crofton, BA, Boston’s Children Hospital
Connor Johnson, BS, Boston’s Children Hospital
Erin Ward, MS, Patient and Family Representative
Sara J. Singer, PhD, Harvard School of Public Health
James C. Bnneyan, PhD, HsyE