Applying Systems Engineering Principles in Improving Health Care Delivery

BackgroundIn a highly publicized joint report, the National Academy of Engineering and the Institute of Medicine recently recommended the systematic application of systems engineering approaches for reforming our health care delivery system. For this to happen, medical professionals and managers need to understand and appreciate the power that systems engineering concepts and tools can bring to redesigning and improving health care environments and practices.ObjectiveTo present and discuss fundamental concepts and tools of systems engineering and important parallels between systems engineering, health services, and implementation research as it pertains to the care of complex patients.DesignAn exploratory, qualitative review of systems engineering concepts and overview of ongoing applications of these concepts in the areas of hemodialysis, radiation therapy, and patient flow modeling.ResultsIn this paper, we describe systems engineering as the process of identifying the system of interest, choosing appropriate performance measures, selecting the best modeling tool, studying model properties and behavior under a variety of scenarios, and making design and operational decisions for implementation.ConclusionsWe discuss challenges and opportunities for bringing people with systems engineering skills into health care.

[1]  C. Marano,et al.  To err is human. Building a safer health system , 2005 .

[2]  W. Art Chaovalitwongse,et al.  Seizure warning algorithm based on optimization and nonlinear dynamics , 2004, Math. Program..

[3]  Peter J. Haas,et al.  Stochastic Petri Nets , 2002 .

[4]  D. Safran,et al.  The quality of physician-patient relationships. Patients' experiences 1996-1999. , 2001, The Journal of family practice.

[5]  M. Kaye,et al.  Two year sequential haemodynamic data on polytetrafluoroethylene (PTFE) grafts used for haemodialysis. , 1979, Proceedings of the European Dialysis and Transplant Association. European Dialysis and Transplant Association.

[6]  Wil vanderAalst,et al.  Workflow Management: Models, Methods, and Systems , 2004 .

[7]  Margaret J. Robertson,et al.  Design and Analysis of Experiments , 2006, Handbook of statistics.

[8]  Eric Rosow,et al.  Knowledge management system for benchmarking performance indicators using statistical process control (SPC) and Virtual Instrumentation (VI). , 2003, Biomedical sciences instrumentation.

[9]  Barbara Starfield.  Deficiencies in US Medical Care—Reply , 2000 .

[10]  Randall P. Sadowski,et al.  Simulation with Arena , 1998 .

[11]  Peter Radford,et al.  Petri Net Theory and the Modeling of Systems , 1982 .

[12]  K. Kowalski,et al.  Appreciative inquiry. , 2008, Journal of continuing education in nursing.

[13]  Xuanming Su,et al.  Patient Choice in Kidney Allocation: A Sequential Stochastic Assignment Model , 2005, Oper. Res..

[14]  Alan S. Perelson,et al.  Optimization of Influenza Vaccine Selection , 2005, Oper. Res..

[15]  Peter J. Haas,et al.  Stochastic Petri Nets: Modelling, Stability, Simulation , 2002 .

[16]  Ronald L. Rardin,et al.  Column generation for IMRT cancer therapy optimization with implementable segments , 2006, Ann. Oper. Res..

[17]  Jammalamadaka.  Introduction to Linear Regression Analysis (3rd ed.) , 2003 .

[18]  J. Grossman,et al.  Building a Better Delivery System: A New Engineering/Health Care Partnership , 2005 .

[19]  J. Pecora.  Deficiencies in US medical care. , 2000, JAMA.

[20]  Steven J. Landry,et al.  Introduction to Human Factors and Ergonomics for Engineers , 2007 .

[21]  P. Basch.  Quality of health care delivered to adults in the United States. , 2003, New England Journal of Medicine.

[22]  Salih N. Neftci,et al.  Principles of financial engineering , 2004 .

[23]  Alexander Kossiakoff,et al.  Systems Engineering Principles and Practice , 2020 .

[24]  Andrew J. Schaefer,et al.  Determining the Acceptance of Cadaveric Livers Using an Implicit Model of the Waiting List , 2007, Oper. Res..

[25]  Michael C. Ferris,et al.  Optimizing the Delivery of Radiation Therapy to Cancer Patients , 1999, SIAM Rev..

[26]  L. Kohn,et al.  To Err Is Human : Building a Safer Health System , 2007 .

[27]  Sj Wu,et al.  A Projection of Chronic Illness Prevalence and Cost Inflation , 2000 .

[28]  Samson W. Tu,et al.  Application of Information Technology: Translating Research into Practice: Organizational Issues in Implementing Automated Decision Support for Hypertension in Three Medical Centers , 2004, J. Am. Medical Informatics Assoc..

[29]  Douglas C. Montgomery,et al.  Introduction to Linear Regression Analysis, Solutions Manual (Wiley Series in Probability and Statistics) , 2007 .

[30]  Stephen J. Wright,et al.  Modeling Participation in the NHII: Operations Research Approach , 2005, AMIA.

[31]  Averill M. Law,et al.  Simulation Modeling and Analysis , 1982 .

[32]  Kees M. van Hee,et al.  Workflow Management: Models, Methods, and Systems , 2002, Cooperative information systems.

[33]  Elizabeth A. Peck,et al.  Introduction to Linear Regression Analysis , 2001 .

[34]  A Endress,et al.  The critical path method to analyze and modify OR‐workflow: Integration of an image documentation system , 2006, Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy.

[35]  A. Wall,et al.  Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95 , 2000 .

[36]  J. Nitzkin.  Barriers to patients seeking emergency care for acute coronary heart disease. , 2000, JAMA.

[37]  H. D. de Vet,et al.  Economic Evaluation of a Multi-Stage Return to Work Program for Workers on Sick-Leave Due to Low Back Pain , 2006, Journal of Occupational Rehabilitation.

[38]  Xiaohua Xia,et al.  When to initiate HIV therapy: a control theoretic approach , 2003, IEEE Transactions on Biomedical Engineering.

[39]  Craig O'Neill,et al.  Computer Modeling of Patient Flow in a Pediatric Emergency Department Using Discrete Event Simulation , 2007, Pediatric emergency care.

[40]  Ronald L. Rardin,et al.  A coupled column generation, mixed integer approach to optimal planning of intensity modulated radiation therapy for cancer , 2004, Math. Program..

[41]  M. Moritz,et al.  Hemodynamics of Failing Dialysis Grafts , 1993, Radiology.

[42]  Sheldon M. Ross.  Introductory Statistics , 1995 .

[43]  Kiyosi Itô,et al.  Essentials of Stochastic Processes , 2006 .

[44]  S. Yusuf,et al.  Capacity planning for cardiac catheterization: a case study. , 2007, Health policy.

[45]  Milos Hauskrecht,et al.  Planning treatment of ischemic heart disease with partially observable Markov decision processes , 2000, Artif. Intell. Medicine.

[46]  Andrew J. Schaefer,et al.  The Optimal Timing of Living-Donor Liver Transplantation , 2004, Manag. Sci..

[47]  Mike Reynolds,et al.  The development of a theoretical framework and design tool for process usability assessment , 2003, Ergonomics.