Closing the Loop by Operationalizing Systems Engineering and Design (CLOSED)
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.
Sunday, June 2, 2019
Sunday, June 2, 2019
Sunday, June 2, 2019
Results to Date:
What is Systems Engineering?
Healthcare Systems Engineering (HSE) methods range from lean six-sigma tools to advanced mathematical models used in many other industries to study, improve, and optimize process quality, delays, cost, efficiency, and effectiveness - national priorities also identified by the IOM. Recent healthcare applications include improvements in scheduling, readmissions, cost reductions, cancer care, and health services planning.
Systems engineers use a variety of methods to model, analyze, predict, improve, and optimize the performance of complex systems, sometimes supported by informatics to harness information in new and innovative ways. While these methods have a long but periodic history of use within clinical, operations, and administrative healthcare processes, their focus has been insignificantly positioned to dramatically move the U.S. healthcare system forward. Within healthcare, systems engineering applications span the spectrum from local "micro-system" process improvement activities to more global "macro-system" optimization problems, ranging methodologically from simple process improvement methods to advanced mathematical and computer modeling.
Although Healthcare is the largest industry in the United States, it is riddled with system problems. These complications cost over $2.3 trillion per year, comprise 16-18% of our gross domestic product, and are increasing steadily at twice the rate of inflation. Numerous studies agree that roughly 30% of total U.S. healthcare costs are attributable to inefficient poorly designed processes, prompting publications by the National Academy of Engineering (NAE) and Institute of Medicine (IOM) to advocate much greater application of systems engineering, operations research, management science, and related methods used in other industries. Each IOM dimensions of the care system - efficiency, effectiveness, safety, access, equity, patient-centered - can be improved by systems engineering, with examples including patient flow, appointment and staff scheduling, facility layout, disease screening, treatment optimization, regional planning, and pandemic response problems.
Davis, et al., The Commonwealth Fund, 2004-2009 (1 = best, 5 = worst)
The estimated national impact of adverse events and medical errors due to poor processes are staggering, including 1.4 million injured patients, millions of hospital days, 98,000 deaths, and almost $9 billion annually. Significant practice and process variability abounds, a far cry from "six sigma" aspirations in manufacturing and with estimates that 57,000 additional patients would survive and $9.5 million would be saved annually if all U.S. hospitals simply performed as well as the current best. The increasing interest within many hospitals in such manufacturing engineering approaches as lean, quality control, and others underscore the pressure to produce higher quality care, more efficiently, at lower costs. Yet progress remains frustratingly slow.