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IE497B Biomedical Device Engineering

This agenda discusses opportunities for healthcare improvement, including supply chain management, healthcare research differences, and the impact of disruptive innovations. It also highlights the role of industrial engineers in healthcare and their proficiency in proven tools and applications.

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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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