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IE497B Biomedical Device Engineering

IE497B Biomedical Device Engineering. Dr. Richard A. Wysk Spring 2008. Agenda. Discuss first two paper opportunities Health Care and Traditional IE Stakeholders and metrics A bit of the landscape. Measuring and Reporting on Health Care Quality Dana Gelb Safran New England Medical Center.

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IE497B Biomedical Device Engineering

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  1. IE497B Biomedical Device Engineering Dr. Richard A. Wysk Spring 2008

  2. Agenda • Discuss first two paper opportunities • Health Care and Traditional IE • Stakeholders and metrics • A bit of the landscape

  3. Measuring and Reporting on Health Care QualityDana Gelb SafranNew England Medical Center Paper #1

  4. Group Members

  5. Supply Chain Management and Health Care DeliveryReha Ulsoy Paper #2

  6. Group Members

  7. How Does the Healthcare Research Context Differ? • Mostly service model-based • Analytical methods trail by a decade or more. • Management engineers were phased out in the 1990s. • Healthcare is a complex system of delivery and stakeholders. • Can you spell I-R-B (Institutional Review Board)? • IE approach can represent “disruptive innovation.”

  8. Healthcare is a Complex System of Delivery and Stakeholders. Fragmented information from various sources is used to make decisions on treatment for a patient who cannot judge clinical quality. Furthermore, the treating physician is an independent contractor paid by third parties (Medicare, BCBS, etc.).

  9. Can You Spell I-R-B? • Not just at PSU, but the hospital IRB, clinic IRB, etc. Most won’t accept central IRB. • Also, before you can conduct research • Get your shots (Hep B series, MMR, TB) • Attend mandatory orientation • Get clinicians on board • Next words: HIPAA, JCAHO

  10. IE Approach Can Represent“Disruptive Innovation.” • Hospitals are used to “sustaining” innovations (clinical, usually) • Specialized cancer treatments • Clinical trials • But, systems to improve processes are typically “disruptive” • Noninvasive techniques, cure for common cold • Portable x-ray in MD offices • Low-tech, affect many patients with more ordinary health problems • Impact business processes, culture, MD status

  11. Disruptive Innovations Come From Below. Source: Will Disruptive Innovations Cure Health Care? Christensen, C. M.; Bohmer, R.; Kenagy, John. Case No. R00501. Harvard Business Review.

  12. Dissecting a Disruptive Innovation. Source: The Innovator's Solution: Creating and Sustaining Successful Growth by Clayton M. Christensen, Michael E. Raynor

  13. What Makes IEs Suited to Healthcare Improvement? • Proficient in Proven Tools Used in Other Contexts • Focus on Systems Tools and Applications • Consideration of the Human in Complex Systems • Conversant with IT

  14. IEs are Proficient in Proven Tools Used in Other Contexts. • Lean, TPS, Six Sigma • Work methods • Quality • Performance measurement and improvement • What do they measure in the ED? • Impact on pt flow, pt care

  15. IEs Have a Focus on Systems Tools and Applications. • Failure Analysis (FMEA) • Modeling and Simulation (MedModel) • Enterprise Management Tools (supply chain) (incineration) • System Dynamics • Knowledge Discovery (data mining, neural networks)

  16. IEs Consider the Human in Complex Systems. • Team structures and processes (Mayo model) • Decision making • Fatigue and error • Work scheduling (resident shifts)

  17. IEs are Conversant with IT. • Can coordinate projects with CS, IT • Trained to identify system requirements for each stakeholder (PDA Rx order) • Drive IT toward objectives of vastly improving access to necessary clinical, system, and patient information (med recon)

  18. Some RecentIE-Related Efforts • Patterson (Ohio State/VA National Center for Patient Safety)—HF and adverse events • Stanford—Culture of Safety • VA National Center for Patient Safety—HFMEA • Cook & Rasmussen—System Dynamics, lessons from nuclear energy • Miller et al.—Six Sigma applications • Banner Health (AZ)—Lean applications • Pebble Partnership—Evidence-based design

  19. What are Some Research Opportunities? • Medical Error • 100K Lives Campaign (IOM) • Medication error • Medication labeling • Order entry and Rx (delays & wasted $$ in dupe tests)

  20. 1,000,000“serious medication errors per year” … “illegible handwriting, misplaced decimal points, and missed drug interactions and allergies.”Source: tompeters.com from Wall Street Journal/Institute of Medicine

  21. “In a disturbing 1991 study, 110 nurses of varying experience levels took a written test of their ability to calculate medication doses. Eight out of 10 made calculation mistakes at least 10% of the time, while four out of 10 made mistakes 30% of the time.”Source: tompeters.com fromDemanding Medical Excellence: Doctors and Accountability in the Information Age, Michael Millenson

  22. What are Some Research Opportunities? • Patient Flow • ED (50% of pts), inter-unit, to/from ancillary services • Waiting times, queuing • Essentially, Hammer’s “reengineering” (pt admission in-room)

  23. What are Some Research Opportunities? • Healthcare Information Technology (HIT) • Electronic medical record • Service and provider integration • Rx, treatment order entry and fulfillment • Bed availability (HMED)

  24. Become Familiar with IOM. www.iom.edu Read: To Err is Human and Crossing the Quality Chasm

  25. See IHI for Improvement Tools and Publications. "When I climb Mount Rainier, I face less risk of death than I'll face on the operating table."—Don Berwick, M.D. Newsweek/12.12.2005

  26. Study and Implement Now…No Time to Wait for Optimal Tools or Solutions

  27. Summary • IE tools have a place in medicine. • Now is the time to use these tools. • Lots of “red tape”. • Two cultures.

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