Strategic Partnership of Healthcare and SE v.2.5.1
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Transcript of Strategic Partnership of Healthcare and SE v.2.5.1
Strategic Partnership of Healthcare and Systems Engineering
in Turbulent Times
International Council on Systems Engineering (INCOSE) Healthcare Working Group
March 28, 2015
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Quotes from the Report• …”Systems Engineering know‐howmust be propagated at all levels [of healthcare]”
• “Implementation of [systems engineering] bears potential not only to improve the efficiency of [health]care delivery, but also to improve its quality.”
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What MDs are saying about Systems Engineering…• „It is surprising that many industries have used systems engineering to improve reliability, safety, efficiency, and
effectiveness. Health care, however, has been late in embracing systems engineering despite the potential to help fix what is basically a non‐system of care. Although health care can do some amazing things, anyone working in health care has also seen examples of suboptimal patient outcomes, unaddressed patient safety issues, poor reliability, and inefficiencies. Traditional medical thinking is not well equipped to improve many of these problems. Much of this, however, can be addressed if systems engineers, physicians, and health care professionals could better collaborate and use wellknown systems engineering techniques such as queuing theory, Lean, Six Sigma, mathematical and computer simulationsand models, supply‐chain management techniques, and optimization techniques. A recent Presidential Council of Advisorson Science and Technology agreed with these finding in their report, Better Health Care and Lower Costs: AcceleratingImprovement through Systems Engineering. This really should create the burning platform for greater incorporation of systems engineering into medical care.” ‐ Michael Kanter, M.D., Regional Medical Director of Quality & Clinical Analysis, Southern California Permanente Medical Group
• „If we physicians are truly interested in improving medical care for our patients and in taking more control of our work, then it is vital for us to learn and apply the principles of systems engineering. Physicians already think in terms of bodily systems so it is not a great intellectual leap for us. I find it stimulating and rewarding to use my systems thinking skills and to work in teams with systems engineers who understand medical care. Everything we do is a process inside a larger system. If we want better outcomes, we need to roll up our sleeves and get to work using systems engineering principles as our indispensable tools." ‐ Stephen F. Tarzynski MD MPH FAAP, Pediatrics, Physician Director of Community Relations & Market Development, West Los Angeles Area, Kaiser Permanente Medical Care Program
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Outline
1. The Current (Imperfect) State2. Systems Engineering to the Rescue3. What is Systems Engineering?4. Added Value from Systems Engineering in Healthcare5. Follow up and Contacts
4Bohdan W. Oppenheim, [email protected]
1. The Current (Imperfect) State
5Bohdan W. Oppenheim, [email protected]
Desired Characteristics of Healthcare
• Affordable & Accessible• Safe• Effective• Patient centered• Timely• Efficient• Inclusive of Latest Science• Well integrated
6Bohdan W. Oppenheim, [email protected]
• $8,508 per capita (UK: $3,406)
• Millions still without medical insurance
• Medicines unaffordable to a hundred millionpeople
• Over 30% of U.S. adults skip a recommendedtest or treatment because of cost
• U.S. ranked #70 in wellness (mostly due to obesity)
• U.S. ranked last among 11 countries inpreventable deaths
The Present Imperfect State
7Bohdan W. Oppenheim, [email protected]
• Highly fragmented system, inefficient interfaces - in desperate need of integration in many dimensions
• Bureaucratic overhead robbing providers of useful time with patients• Wrong incentives (Cost curve still climbing, although much less with ACA)• Dramatic changes needed to accommodate the ACA shift from “pay per service” to “pay
per outcome”• Revolutions in big data mining and genetics open extraordinary evidence-based
opportunities for which knowledge of systems thinking, statistics and medicine must be integrated
• Huge progress in medical devices require solid engineering know-how and interoperability• Huge waste in all operations rob patients of quality care – needing Lean• Formerly routine operations such as Operating Room, Critical Care, Emergency
Department, Pharmacy – are becoming complex systems that exceed human management capability - requiring special simulators (like aircraft simulators for pilots)
• Shrinking budgets require exceptional efficiencies and streamlining – needing Lean• The growing complexity of the healthcare system – needing excellent risk analysis• Increasingly advanced medical devices and information technology needing greater
oversight• Unmanaged complexity leads to unpredictable results – needing special tools.
A Short list of Problems
In increasingly complex operations, with rapid change beyond our control ‐ traditional medicine andmanagement methods fail to fix the dynamic hyper‐system of healthcare – needing more advanced
approaches!8
Bohdan W. Oppenheim, [email protected]
2. Systems Engineering to the Rescue
9Bohdan W. Oppenheim, [email protected]
Super System
1
Super System
3
Super System
2
Super System
4
Complex System 1
Complex System 2
U.S. Healthcare = Dynamic Hyper System
Help from Systems
Engineering
Healthcare Stakeholders• Patients (300,000,000+ in U.S.)
• Medical professionals
• Medical facilities, hospitals, clinics, labs
• Medical Equipment
• Pharmaceuticals
• Researchers and academia
• Insurances
• Employers
• Federal & State Governments
• Military and Veterans Administration
• Fire Departments and Ambulances
• and more
Powerful Solution
10Bohdan W. Oppenheim, [email protected]
3. What is Systems Engineering?
11Bohdan W. Oppenheim, [email protected]
What is Systems Engineering?
• Beginnings in 1950s in the US Ballistic Missile Programs• It is about rigorous integration of highly complex pieces so that they work
together as a system, perfectly, as intended!• Technical management of complex systems, problems and projects
(healthcare, infrastructure, engineering, energy, education...)• Rigorous but mostly non-mathematical heuristic knowledge how to
analyze and construct complex systems.
12© 2014 Bohdan W. Oppenheim, [email protected]
Bohdan W. Oppenheim, [email protected]
Two Paths for Systems Engineers to Serve Healthcare
Traditional Systems Engineer• Typically B.S. in engineering, science, math• Graduate degree as above and/or or in Systems
Engineering, or equivalent experience• Often courses in statistics, management, modeling,
simulations• Exerienced in multidisciplinary design and
development of complex technical systems (spacecraft, rockets, ships, aircraft, weapon systems, nuclear plants, mega projects in infrastructure)
• Working as „coordinator” and „integrator” of millions of technical elements and interfaces, all of which must operate perfectly or the system fails.
• Fully prepared to assist healthcare professionals in addressing their complex challenges.
Healthcare Systems Engineer• Start with healthcare education (MD, nurse, pharmacist,
BS in bio or health sciences, healthcare management, administration, researcher…)
• MS degree in Healthcare Systems Engineering (HSE).g. LMU HSE curriculum:
• Systems Engineering• Project Management• Healthcare Delivery Systems• Lean Healthcare & Advanced Lean Management of Healthcare• Systems Thinking in Healthcare• Systems Modeling and Simulations in Healthcare• Data Mining in Healthcare (statistics on huge databses)• Patient Safety and Quality Systems• Finances and Accounting in Healthcare• Medical Devices and Integrated Systems• Healthcare Enterprise Informatics and Electronic Records• Project, Internship
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Serving Healthcare Professionals with SystemsEngineering Knowledge
Bohdan W. Oppenheim, [email protected]
What is Systems Engineering?• Complex systems almost always fail atthe interdisciplinary interfaces‐
• or at the interfaces with externalities(environment)
• or interfaces with humans
• Medical professionals, managers, evenspecialty engineers are not trained in dealing with such problems
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• SE is a rigorous time-proven process of management and coordination of all relevant details, and strong focus on the system integration and life-cycle performance.
Bohdan W. Oppenheim, [email protected]
Simplest system: N = 2
1 connection
Slightly more complex system: N = 5
10 one-to-one connections
becomes
Why do we need Systems Engineering in Healthcare?
With millions of patients, doctors, nurses, administrators, andother stakeholders, thousands of cooperating system elements,hospitals, clinics, laboratories, pharmacies, equipment makers and users, devices, specimen, procedures, laws andregulations, in hundreds of cooperating organizations ...neither traditional medicine nor traditional management are sufficient.
J.Thomas, INCOSE
N(N‐1)/2
15Bohdan W. Oppenheim, [email protected]
Systems Engineering
An engineering discipline whose responsibility is creating and executing an interdisciplinary process to ensure that the customerand stakeholder's needs are satisfied in a high quality, trustworthy, cost efficient and schedule compliant manner throughout asystem's entire life cycle.
INCOSE
What is Systems Engineering?
16Bohdan W. Oppenheim, [email protected]
4. Added Value from Systems Engineering in Healthcare
17Bohdan W. Oppenheim, [email protected]
• Managing Complexity and Efficiently Navigating in Complex Problem Space
• Systemic approach using Systems Thinking (looking at problems in their context, seeing the big picture, understanding emerging properties and unintended consequences)
• Systems Architecting and Interoperability
• Interface Management
• Coordination with numerous stakeholders
Added Value from Systems Engineering in Healthcare
Cured,stablepatients
Patient mortality
More careneeded
Budgets Stakeholders
Patients
Regulations Culture 18Bohdan W. Oppenheim, [email protected]
• Powerful mathematical modeling of operations in Emergency Department, Operating Room, Pharmacy, Clinic, Clinical Laboratory, Medical Administration, Supply Chain…
• Stochastic (probabilistic) modeling of operations for studies of capacity, throughput, resources and costs
• Logical and functional modeling of complex operations, including state-of-the art “Model Based Systems Engineering” which captures, manages, and allocates requirements tosubsystems, and provides effective system integration and verification
• Computer simulators of operations (like flight simulator)
Added Value from Systems Engineering in Healthcare
www.123RF
www.flickr.com
Washington Post
campar.in.tum.de
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Example of Stochastic Modeling of Emergency Department
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Added Value from Systems Engineering in Healthcare
• Great for Monte Carlostudies of capacity, cost and throughput
• Resource values are input• Random factors are
modeled probabilistically
Bohdan W. Oppenheim, [email protected]
Tonya Premsrirath, KP
Powerful Studies Using Huge Databases of Patients’ Records
Number of potential medical records:• Kaiser Permanente:• U.S.• World
10,000,000300,000,0007,000,000,000
Added Value from Systems Engineering in Healthcare
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Huge data „mining” now permits powerfulstudies of simultaneous effects of numerousfactors and complex interations. We are nolonger constrained to simplistic clinicalstudies that filter out confounding andinteraction effects. This yields rich medical knowledge and potent treatments.
Bohdan W. Oppenheim, [email protected]
Streamlining operations and removing waste using LeanAdded Value from Systems Engineering in Healthcare
Lean does not tell MDs how totreat patients – it frees the
MDs to do it more and better
Lean Principles
22Bohdan W. Oppenheim, [email protected]
Added Value from Systems Engineering in Healthcare
Lean Improvements in AutomatedChemistry Laboratory
Current State
Ideal State
FutureState
Throughput Time (Olympus)
733.5minutes
36minutes
140.5minutes
Cost Savings Baseline$1,570,976 $994,876
.50 .50
Quality Mod High High
Frustration of Lab Staff HIGH Low Moderate
Frustration of MD Mod Low Mod
Frustration of Patient High Low Mod
Throughput Time (Virology)
57 hours 13.5 hours (76%)
Test Quality Optimal Optimal
Patient Complaints
↑ ↓
ProviderComplaints
↑ ↓
Employee Morale
↓ ↑
Lean Improvements inMicrobiology Lab
Current Future StateState
All examples from Kaiser Permanente
Value Stream Mapping
Streamlining operations in Clinical Laboratories using Lean
23Bohdan W. Oppenheim, [email protected]
Powerful Identification, Management and Mitigation of Risks in Healthcare, and Probabilistic Decision Making
Added Value from Systems Engineering in Healthcare
https://www.google.com/?gws_rd=ssl#q=risk+matrix
https://www.google.com/?gws_rd=ssl#q=normal+curve
Regulations and compliance
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Good Electronics Records Transform Medicine
• Bad Electronic Records cause numerous troubles:
• Increase risks to patients• Overwhelm with needless alerts• Poor workflows• Unfriendly user interface• Ineficient data entry
• Systems Engineering provides expertise for IT projects
• „Millions lines of code” is bread‐ and‐butter of Systems Engineering
Added Value from Systems Engineering in Healthcare
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Added Value from Systems Engineering in Healthcare
Preventing “Incidents” – HealthCare.gov
Good Systems Engineering would prevent the imperfect rollout.
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Added Value from Systems Engineering in Healthcare
Finding the order in the chaos• Systems Engineers are experts in finding patterns in what other people see aschaos. They analyze the chaos by seeing patterns of processes or proceduresor steps, group them, and quantify what success is for each of the steps.
Seeing the whole picture and narrowing down to the details• Systems Engineers are experts at looking at a complex system and breaking itdown into the details at multiple levels and points of view without losing trackof the big picture. They are experts at breaking things down from the toplevel picture into the smallest details at the lowest levels where other disciplines can address the problems in their area of expertise.
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Management of Life‐cycle System Properties (“–ilities”)
Added Value from Systems Engineering in Healthcare
• Safety• Quality
• Interoperability• Sustainability
• Reliability• Survivability
• Maintainability• Testability
• Resilience• Robustness• Reparability
• Flexibility/Adaptability• Modularity
• Scalability• Durability
• Evolvability• Manufacturability
• Agility28
Bohdan W. Oppenheim, [email protected]
Everyone wants a positive outcome for the patient. The problem lies with picking the bestway to facilitate this in a high value way.The field of Systems Engineering offers a wide array of proven methods and scalableapproaches that foster a holistic way of examining and solving complex problems in repeatable ways.
Added Value from Systems Engineering in Healthcare
As the leading professional society and global promoter of SystemsEngineering, the International Council on Systems Engineering(INCOSE) is in the best position to help your organization provide this value today.
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5. INCOSE is eager to partner withHealthcare Professionals
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• INCOSE lists 10,000 subject matter experts on systems engineering and hundreds on healthcare… who master integrating people, tools, and process.
• Over 60 years of practice
• We speak the language of Systems Engineering in the Context of Healthcare
• We handle both the hard and soft aspects of systems engineering and healthcare, leading to greater success rates
• We provide university‐level education in Healthcare Systems Engineering
• INCOSE enables cross‐industry sharing of best practices. We are a forum for meeting world class experts in Systems Engineering and Healthcare
INCOSE at service to Healthcare
We invite all Healthcare Professionals: physicians and nurses; hospital, clinic, laboratory and pharmacy employees; healthcare administrators and managers; medical researchers and scholars; and all others ‐ to contact us. We are ready to help you take better care of your patients and makeyour life quality better!
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Technical Events and Contacts in INCOSE Healthcare Working Group (HWG)
Technical EventsJanuary
International Workshophttp://www.incose.org
JulyInternational Symposiumhttp://www.incose.org
Monthly or Bi‐MonthlyInformal web conferenceshttps://new.incose.org/wg/biomedical/content/event
Throughout the YearHealthcare events at regional INCOSEmeetings
HWG LeadershipOverall Working Group Leads
Chris Unger [email protected] Malins [email protected] Regional leads for Europe, Australia, and East/Midwest/West coasts
Healthcare SE ApplicationsChris Unger [email protected]
Healthcare MBSE ChallengeAjay Thukral [email protected]://omgwiki.org/MBSE/doku.php?id=mbse:drugdelivery
Healthcare Problem/Solution DatabaseMike Celentano [email protected]
Healthcare Education StrategyRachel Leblanc [email protected]
Jack Stein [email protected],Ajay Thukral [email protected]
LeanBo Oppenheim [email protected]://www.lean‐systems‐engineering.org/
Safety
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