© Copyright 2008, Health Systems Institute Health Systems Engineering in the Design Process David Cowan Health Systems

© Copyright 2008, Health Systems Institute 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

© Copyright 2008, Health Systems Institute Engineering Thinking  Systems  Process  Causation  Variation / Outcomes

© Copyright 2008, Health Systems Institute Engineering Thinking  Quantitative  Optimization  Engineering Economy  Design of Experiments

© Copyright 2008, Health Systems Institute Engineering Thinking  Models  Simulations  Optimization  Representations  Descriptive

© Copyright 2008, Health Systems Institute Engineering Methods  Process  Flow charts  Transitions  Swim Lanes  Spaghetti

© Copyright 2008, Health Systems Institute Engineering Methods  Measures  Direct  Proxy  Complex (RVUs)  Charts  Statistics

© Copyright 2008, Health Systems Institute Engineering Methods  Models  Simulation  Optimization  Descriptive  Flexible

© Copyright 2008, Health Systems Institute Engineering Goals  Solutions  Improvement  Predictive  Quality  Productive - Effiecient  Outcomes – Effective  Practical

© Copyright 2008, Health Systems Institute 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

© Copyright 2008, Health Systems Institute Healthcare  Healthcare process  Prevent  Diagnose  Treat  Rehab  Palliative

© Copyright 2008, Health Systems Institute Healthcare  IOM – 6 Aims  Effective  Efficient  Equitable  Timely  Safte  Patient Centered

© Copyright 2008, Health Systems Institute Healthcare  Ambulatory  ER  Physician  Clinic  Specialty  Procedures  X-ray, Lab, Ekg  Invasive – Surgery,  Rehab  Pharmacy

© Copyright 2008, Health Systems Institute Healthcare  Preventive  Annual Screening and health planning  Episodic  “I don’t feel good…”  Chronic  Diabetes, Hypertension, COPD, Arthritis  Behavioral Health  Rehabilitative

© Copyright 2008, Health Systems Institute Preventing Readmissions Understanding 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.

© Copyright 2008, Health Systems Institute Preventing Readmissions Understanding 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,

© Copyright 2008, Health Systems Institute Preventing Readmissions Understanding 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?

© Copyright 2008, Health Systems Institute Preventing Readmissions Understanding the Problem  But Why?  Did the Patient Follow through?  Medications  See their physician  Do their therapy

© Copyright 2008, Health Systems Institute Preventing Readmissions Understanding the Problem  Some things we do  Discharge orders and instructions  Organize Home Nurse visits  Follow up Calls

© Copyright 2008, Health Systems Institute Preventing Readmissions Understanding 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.

© Copyright 2008, Health Systems Institute So give us your impressions of the Problem

© Copyright 2008, Health Systems Institute 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…

© Copyright 2008, Health Systems Institute Some Key Concepts  Protocols  Surge  EMR  PHR  Electronic Prescription  Patient Scheduling  Staff Scheduling  Hours of operations  Nurses  MidLevels  Doctors  Telemedicine

© Copyright 2008, Health Systems Institute Time is a most precious commodity  Patient  Doctor  Facility  Successful outcomes  Cost of Care is tied to time  Communication

© Copyright 2008, Health Systems Institute 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

© Copyright 2008, Health Systems Institute 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.

© Copyright 2008, Health Systems Institute Multi-disciplinary  Working in teams  “Pivot the Room”  Group Processes  Brainstorming

© Copyright 2008, Health Systems Institute Transdisciplinary  Synergy - Beyond blending into a new thought  Leadership  Elegance – not Sophisticated

© Copyright 2008, Health Systems Institute 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.

© Copyright 2008, Health Systems Institute three key concepts of Transdisciplinary Thinking  transformative praxis,praxis  constructive problem-solving andproblem-solving  real-world engagement. real-world