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Health Systems Engineering in the Design Process

Health Systems Engineering in the Design Process. David Cowan Health Systems. Engineering Thinking. As apposed to… Scientific thinking Still Quantitative but Hypothesis – study Classify – Organize to understand One Best solution Intuitive thinking Qualitative Artistic – Creative

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Health Systems Engineering in the Design Process

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  1. Health Systems Engineeringin the Design Process David Cowan Health Systems

  2. Engineering Thinking • As apposed to… • Scientific thinking • Still Quantitative but • Hypothesis – study • Classify – Organize to understand • One Best solution • Intuitive thinking • Qualitative • Artistic – Creative • Envisioning

  3. Engineering Thinking • Systems • Process • Causation • Variation / Outcomes

  4. Engineering Thinking • Quantitative • Optimization • Engineering Economy • Design of Experiments

  5. Engineering Thinking • Models • Simulations • Optimization • Representations • Descriptive

  6. Engineering Methods • Process • Flow charts • Transitions • Swim Lanes • Spaghetti

  7. Engineering Methods • Measures • Direct • Proxy • Complex (RVUs) • Charts • Statistics

  8. Engineering Methods • Models • Simulation • Optimization • Descriptive • Flexible

  9. Engineering Goals • Solutions • Improvement • Predictive • Quality • Productive - Effiecient • Outcomes – Effective • Practical

  10. What to expect from your Engineer • Practical / Structured • Will it work • Can we make it • How do we overcome these problems • Who will do what when

  11. Healthcare • Healthcare process • Prevent • Diagnose • Treat • Rehab • Palliative

  12. Healthcare • IOM – 6 Aims • Effective • Efficient • Equitable • Timely • Safte • Patient Centered

  13. Healthcare • Ambulatory • ER • Physician • Clinic • Specialty • Procedures • X-ray, Lab, Ekg • Invasive – Surgery, • Rehab • Pharmacy

  14. Healthcare • Preventive • Annual Screening and health planning • Episodic • “I don’t feel good…” • Chronic • Diabetes, Hypertension, COPD, Arthritis • Behavioral Health • Rehabilitative

  15. Preventing ReadmissionsUnderstanding the Problem • The patient gets worse, or does not get better, or is afraid, or is complicated and needs to come back to the hospital.

  16. Preventing ReadmissionsUnderstanding the Problem • But Why? • Did the patient leave the hospital before getting on the mend… • Did the hospital not prepare the patient before they left • Did something else happen at the hospital that did not develop until the patient left • HAI,

  17. Preventing ReadmissionsUnderstanding the Problem • But Why? • Did we manage the transition home? • Moving fragile patients is problematice • Getting them set up at home • Is the home ready? • Is there anybody there to help • Do they know what they are doing?

  18. Preventing ReadmissionsUnderstanding the Problem • But Why? • Did the Patient Follow through? • Medications • See their physician • Do their therapy

  19. Preventing ReadmissionsUnderstanding the Problem • Some things we do • Discharge orders and instructions • Organize Home Nurse visits • Follow up Calls

  20. Preventing ReadmissionsUnderstanding the Problem • But it doesn’t work well… • Patients are sick so some just don’t get better but get worse – it doesn’t matter that we missed something • Other patients don’t follow through and get worse • Patients are scared when they feel funny • Drugs misbehave.

  21. So give us your impressions of the Problem

  22. Preventing Readmissions • Key Issues • Discharging patient at the right time • Preparing the Patient for the next 30 days • Preparing those caring for the patient for the next 30 days • Transition to Home • Preparing the Home environment • Follow through at Home • This is where the experiments occur…

  23. Some Key Concepts • Protocols • Surge • EMR • PHR • Electronic Prescription • Patient Scheduling • Staff Scheduling • Hours of operations • Nurses • MidLevels • Doctors • Telemedicine

  24. Time is a most precious commodity • Patient • Doctor • Facility • Successful outcomes • Cost of Care is tied to time • Communication

  25. Transdisciplinary • The significant problems we have cannot be solved at the same level of thinking with which we created them. AE • The role of a consultant is to take a situation which appears as a problem and move it to the next level to solve it. Leland Kiaser

  26. A New Discipline • The Science of Healthcare Delivery • Healthcare as a complex adaptive system • Global Health • Seeing Healthcare from a new, bigger, and broader perspective • A single or even a multidisciplinary focus will not solve our system problems.

  27. Multi-disciplinary • Working in teams • “Pivot the Room” • Group Processes • Brainstorming

  28. Transdisciplinary • Synergy - Beyond blending into a new thought • Leadership • Elegance – not Sophisticated

  29. Transdisciplinary • transdisciplinary studies is a particular emphasis on engagement, investigation, and participation in addressing present-day issues and problems in a manner that explicitly destabilizes disciplinary boundaries while respecting disciplinary expertise.

  30. three key concepts of Transdisciplinary Thinking • transformative praxis, • constructive problem-solving and • real-world engagement.

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