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.
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.
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:
Understanding and Addressing Community Health Center Burden, Resiliency, and Burnout – Systems Engineering Analyses and Approaches
James C. Benneyan, PhD (PI), Healthcare Systems Engineering Institute, Northeastern University, Boston MA
Agency for Healthcare Research and Quality (grant #: R01 HS030271-01)
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Background
The HSyE Institute has received a five-year $2 million R01 research grant from the Agency for Healthcare Research and Quality to study and address burnout in community health centers by following a systems engineering approach. This grant was just recently received and this web page will be further developed over time.
Excessive burnout and burden are complex and increasing problems affecting nearly all healthcare workers (physicians, nurses, staff) with significant consequences on provider well-being, patient safety, and care quality, especially in primary care and under-resourced community health settings serving challenging patient populations. While the broad adoption of asynchronous care technology (patient portals, EHR email, text messaging) can significantly improve care and patient experience, it also contributes significantly to time stresses, work-after-work, and burnout – further exacerbated by (and contributing to) staff shortages, inefficient processes, and non-resilient systems. This project integrates systems science, engineering, and health service research methods, as recommended by National Academy of Medicine and US Surgeon General burnout reports, to better understand and address the relative impacts, etiology, effective strategies, and dynamics of these interrelated issues on caregiver burnout and patient safety.
Research Objectives
Specific research objectives are to:
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Understand and characterize the degree, nature, and dynamics of system inefficiency, suboptimized processes, and poor system resiliency associated with asynchronous care processes in 4 community health centers with varied populations, staffing, and resources;
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Investigate key research questions about (a) relationships between work burden, system resiliency, inefficiency, and burnout and (b) their associations with and impact on care quality, safety, and inequity via statistical, data science, model-fitting, and qualitative methods; and
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Estimate potential impacts and feasibility of various types of interventions on safety, burnout, and equity, as well as generalizability of results to other practice settings, patient populations, and care teams, via a combination of pilot testing, retrospective analysis, modeling, safety science (e.g. resiliency analysis), and qualitative methods.
Anticipated impacts benefit both healthcare workers and patients in three important manners. (1) By redesigning inefficient burdensome processes, we will reduce non-value work contributing to time pressures, “work after work”, time away from direct care, and depersonalization and detachment. (2) These improvements also will translate to reduced burnout associated with redesigned processes and (3) associated improvements in quality and safe care, as well as reducing disparities by which female and older healthcare personnel experience 20-60% greater burnout.
Specific outcomes combine workflow, resiliency, burnout, and safety measures, including provider-reported outcomes (e.g. ability to spend more time providing quality care), systems safety science methods, and modeling-based analyses. Expected impacts include more resilient efficient processes, reduced burden and burnout, and better care that, if scaled to 20% of US primary care, could benefit 209,000 practices and 472,560 PCPs serving 133 million patients.
Research Team and Partners
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Dr. James Benneyan (Principal Investigator), Professor of Industrial Engineering and Operations Research and Director of the Healthcare Systems Engineering Institute at Northeastern University.
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Dr. Talya Salant (Co-Investigator), Director of Community Health Research, Bowdoin Street Health Center
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Co-Investigator from each participating CHC site
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Stakeholder Advisory Committee (to be determined)
Project Sites
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Bowdoin street health center
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2-4 additional community health centers (to be determined)