BCHlogo.png

Boston Children's Hospital

Screen Shot 2021-12-09 at 12.55.15 PM.png

Atrius Health

Picture1.png

Brigham and Women’s Hospital, part of  Mass General Brigham Health, is a world-class academic medical center based in Boston, Massachusetts that serves patients from New England, across the United States and from 120 countries around the world. BWH is a major teaching hospital of Harvard Medical School.

BILH-MA-Logo.jpeg

Mt. Auburn Hospital

Picture1.png

Center for Primary Care is part of the Harvard Medical School and is committed to uncovering, promoting, and fighting for the best and most efficient ways to deliver high-quality primary care around the world.

Screen Shot 2021-12-09 at 1.22.32 PM.png
Screen Shot 2021-12-09 at 1.22.44 PM.png
Screen Shot 2021-12-09 at 1.22.53 PM.png

Engineering High-Reliability Learning Lab
(EHRLL)

Motivation:

We endeavor to establish an Engineering High Reliability Learning Lab (EHRLL) within a well-established and highly functioning learning collaborative of Harvard-affiliated primary care practices to enhance capacity for innovation and to develop highly reliable systems that address communication and coordination challenges at the intersection of primary care and specialty practices that pose patient safety risks.

Specific Aims :

Aim 1: To build a reengineering and shared learning infrastructure that comprises an Administrative/Learning Core, an Engineering Core, and a multidisciplinary team comprised of investigators, engineers with expertise in healthcare challenges, and “Disrupters,” a cadre of innovators and experts from disciplines and industries outside of healthcare; and that stimulates a systematic approach for identifying, designing, developing, spreading, and evaluating patient safety innovations.

Aim 2: To engage in research projects that will apply systems engineering and operations management theory and methods to the development of innovative, cross-disciplinary team-based solutions for improving HIT-supported processes for high-risk patients, referrals, and tests and designing highly reliable systems that are generalizable. Currently, project teams are working to engineer a close the loop system for external primary to specialty referrals at Atrius Health (Project 1), coordination system for children with medical complexity undergoing surgery within Boston Children’s Hospital (Project 2), and reliably safe opioid medication management processes for adults with complex care needs (Project 3) at the Phyllis Jen Center for Primary Care within Brigham and Women’s Hospital.

 

Aim 3: To implement and spread redesigned systems across a range of hospital/community-based primary care practices; and to test systems’ generalizability in alternative settings and with other medical conditions.

 

Aim 4: To assess the impact of redesigned systems on practice, team, provider, and patient outcomes and disseminate findings as well as tools and resources to support national replication, as appropriate.

Partners:

Approach:

  • Safe Hospital to Home transitions, Mt. Auburn Hospital: This project uses systems engineering methods to understand, analyze, and redesign the hospital-to-homecare transition process at Mount Auburn Hospital. The objective is to improve health outcomes for patients receiving home health services post-hospitalization and in danger of re-hospitalization as measured by inpatient, emergency department, skilled nursing facility utilization, and patient satisfaction.

  • Perioperative Process Improvement, Boston Children's Hospital: 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.

  • Opioid Prescription Process, Brigham and Women's Hospital: Although prescription opioids are contributing to the epidemic, patients using and providers prescribing the medicines are often chastised, even though many factors were brought into consideration before prescribing long term. This project is working to improve opioid prescribing processes, specifically for patients using opioids to treat chronic pain, at the Phyllis Jen Center for Primary Care within Brigham and Women’s Hospital. Through use of systems engineering tools, the team aims to improve primary outcome measures related to safety, efficacy and efficiency of prescribing processes. Some examples include patient satisfaction and outcomes, provider burden and the accessibility of resources for all involved.

Results to Date:

Safe Hospital to Home transitions, Mt. Auburn Hospital: Swim Lane diagrams underscored the lack of communication between various healthcare providers during transitional care. This realization prompted the team to invite the Director of Case Management to join the interdisciplinary team as a permanent member. FMEA assisted the team in defining the most critical failures in the existing system. Due to the breadth and depth of stakeholders present for the FMEA, the team achieved a deeper understanding of existing failure types, effects, and probabilities of occurrence. Using this information, the team developed a FRAM model to design and vet a new hospital-to-homecare workflow for high-risk patients. Insights gained from effectively applied systems engineering approaches led to effective collaboration between multidisciplinary stakeholders involved in transitional care. Furthermore, these insights promoted dialogues that, when coupled with systems engineering tools, resulted in a new workflow design for high-risk patients that addressed the communication failings of the existing system.

Perioperative Process Improvement, Boston Children's Hospital: 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).

Opioid Prescription Process, Brigham and Women's Hospital: Process maps highlighted tasks that created inconsistencies in how processes were completed, guiding changes towards more reliable processes. Run charts illustrated the biggest areas for improvement of key performance indicators and helped assess the effectiveness of interventions. FMEA emphasized failures potentially most detrimental to patients, leading to more control actions being put in place to decrease the likelihood of those events. SEIPS made the system easy to understand on a macro level, and made it simple to identify components of the system that were not patient focused. FRAM analysis highlighted how variability in how tasks are completed can change outcomes, reinforcing the need for policies for certain processes. Usability testing made it so tools designed to help providers were intuitive and lead to adding features that providers found useful.

Publications:

Bargal B, Benneyan J, Eisner J, Alev A, Singer S (2018), Use of systems-theoretic process analysis to design safer opioid prescribing processes, IISE Transactions on Occupation Ergonomics and Human Factors, 6:3-4, 200-208, doi: 10.1080/24725838.2018.1521887.

 

Bargal B, Benneyan J Eisner J, Ergai A, Chen K, Chari S. Alternate safety methods to root cause analysis for learning from retrospective healthcare adverse events, working paper.

 

Benneyan J, Shutt A, Ramirez N (2017). A human-centered approach to improving healthcare: The SEIPS model, Proceedings of the 2017 Industrial and Systems Engineering Conference.

 

Benneyan J, Bargal B, Chen K, Singer S, others tbd (2021), Development and evaluation of a systems engineering high reliability patient safety learning lab, working paper.

 

Atkinson M, Benneyan J, Schiff G, Phillips R, Singer S (2021). Evaluating a patient safety learning lab intervention to create an interdisciplinary ecosystem for healthcare innovation, Health Care Management Review, accepted for publication.

 

Atkinson M, Benneyan J, Schiff G, Phillips R, Hunt L, Singer S (2021). Patient engagement in system redesign teams: a process of social identity, Journal of Health Organization and Management, https://doi.org/10.1108/JHOM-02-2021-0064

 

Carayon P, Wooldridge A, Hose B, Salwei M, Benneyan J (2018). Improving patient safety through human factors and systems engineering: experiences, opportunities, and challenges, Health Affairs, 37, 1862-1869.

 

Carlile N, Fuller T, Benneyan J, Bargal B, Schiff G, Hunt L, Singer S (2021). Lessons learned in implementing a chronic opioid therapy management system, Journal of Patient Safety, accepted for publication.

 

Das P, Benneyan J, Powers L, Carmody M, Kerwin J, Singer S (2018), Engineering safer care coordination from hospital to home: lessons from the USA, Future Healthcare Journal, 15(3): 164-170.

 

Bargal B, Benneyan J, Jacobson M, Atalay A (2018). Using systems-theoretic process analysis (STPA) to design safer opioid prescribing processes, James Benneyan (Healthcare Systems Engineering Inst.), Human Factors in Healthcare annual symposium.

 

Bargal B, Benneyan J, Eisner J, Atalay A, Singer S (2018). Use of systems-theoretic process analysis (STPA) to design safer opioid prescribing processes, MIT STAMP Annual Workshop.

 

Bargal B, Eisner J, Chen K, Chari S, Ergai A, Benneyan J (2017). Alternatives to root cause analysis for understanding healthcare adverse events, The International Conference on Applied Human Factors and Ergonomics.

 

Benneyan J, Phillips R, Singer S (2017). An AHRQ patient safety learning laboratory for primary care – The engineering high reliability learning lab (EHRLL), Improving Primary Care Through Systems and Industrial Engineering (I-PrACTISE) annual conference.

 

Benneyan J, Phillips R, Singer S (2018). Exploring new approaches to patient safety: The AHRQ engineering high reliability learning lab (EHRLL), Society for Health Systems Healthcare Process Improvement annual conference.

 

Benneyan J, Taffe K (2020). The AHRQ patient safety learning labs: panel discussion (What are we learning?), Society for Health Systems Healthcare Process Improvement annual conference.

 

Benneyan J, Shutt A, Atalay A, Sherritt K, Singer S (2018). Designing safer opioid prescribing processes in primary care through use of systems engineering, Society for Health Systems Conference (best poster award).

 

Benneyan J, Shutt A, (2018). A systems approach to designing safer opioid prescribing processes in primary care, Human Factors in Healthcare annual symposium.

 

Benneyan J, Holmes A (2018). From safety-I to safety-II: using systems engineering to redesign a hospital care to home care transition process, Human Factors in Healthcare annual symposium.

 

Benneyan J, Holmes A, Lemonias D, Cyr M (2018). Examples and experiences using FMEA to design better healthcare processes, Human Factors in Healthcare annual symposium.

 

Benneyan J (2018). The AHRQ patient safety learning laboratories: What are we learning?, Human Factors in Healthcare annual symposium.

 

Salem J, Benneyan J (2018). Designing high reliability processes for coordinating perioperative care for medically complex children, Human Factors in Healthcare annual symposium.

 

Hunt L, Benneyan J, Salem J (2018). Engaging students as levers in improvement work, Institute for Healthcare Improvement Annual Forum.

 

Smith C, Holmes A, Nehls N, Junod C, Benneyan J, Carmody M, Powers L, Kerwin J, Singer S (2018). Understanding transitions from hospital care to home care: An industrial engineering approach, Society for Health Systems Annual Conference.

 

Salem J, Berry J, Cox J, O’Neill M, Comstack C, Holler N, Crofton C, Singer S, Benneyan J (2018). Designing high reliability processes for coordinating perioperative care for medically complex children, Society for Health Systems Annual Conference.

 

Ward E, Benneyan J, Hunt L (2018). Reaping rewards, overcoming barriers: Partnering with patients in care redesign, 20th National Patient Safety Annual Congress.

Our synergistic projects will engage health system-based re-engineering and design (R&D) of highly reliable (1) closed loop systems for high priority primary to external specialty referrals; (2) coordination systems for children with medical complexity undergoing surgery; (3) management systems for patients on chronic opioids; and (4) coordination systems for patients between hospital and homecare.

Conference Presentations: