The following article was written by John Wood and published by the San Diego chapter of INCOSE (the International Council on Systems Engineering). The article can also be found on page 4 of the June 2016 Newsletter.
Driven by the passage of the Patient Protection and Affordable Care Act in 2010, several publications were released as a call to arms for applying systems engineering fundamentals within the healthcare industry. These included the 2013 Institute of Medicine and the National Academy of Engineering’s “Systems Approaches for Improving Health Innovation Collaborative” and the President’s Council of Advisors on Science and Technology report titled, “Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering” in 2014. Systems Engineering is an interdisciplinary field that focuses on how to design and manage complex systems over their life-cycles. Systems engineers have proven their specialized tools and techniques with much success in several industries including manufacturing, education, and aeronautics. As such, leaders in these industries can now more effectively leverage their data to achieve improved reliability, quality, and efficiency. The aforementioned publications suggest that systems engineers may be able to similarly benefit healthcare leaders. Indeed, as healthcare leaders become more aware of the success cases occurring in other industries, the more often they query, “What is systems engineering and what can it do for me?” In response, systems engineers have a tendency to dive into a discussion on how they would “optimize” the efficiency of healthcare delivery. But one must ask, “To what end?”
To fully understand the impact of “optimization” in the healthcare domain, one must first appreciate that efficiency in this industry is notoriously difficult to measure. In 2009, a Health Services Research systematic review of efficiency measures identified only six measures out of 265 that contained evidence of their reliability and validity. Further, effectivity within healthcare requires discerning what patients need and want—both of which pose significant challenges to the current healthcare system. These challenges are exacerbated as the near-constant barrage of new tests and treatments are fielded alongside older ones with scarcely any regard for their full benefits and harms to patients. At the same time, patients often receive care they would not have selected had they been fully informed of the benefits and harms associated with each of the available treatment options. Facts such as these have led experts to estimate that as much as one-third of all medical care may be inefficiently allocated, with wide variation among resource inputs (e.g., hospital beds, diagnostic equipment, primary and specialty physicians per capita, etc.) and little to no consistent correlation between those inputs and the quality of patient outcomes.
In the face of these challenges, systems engineers would be irresponsible in attempting to “optimize” healthcare delivery under the (faulty) assumption that patient needs and wants are well-established signals. By doing so, systems engineers would increase the rate of wasteful spending occurring within the U.S. healthcare delivery system and simultaneously create ethical dilemmas for both patients and providers. Does that mean there is no place for systems engineering in healthcare? No, but prior to offering solutions, systems engineers must ensure they understand the unique aspects of the industry (e.g., general classes of treatment types, healthcare ethical values, reimbursement mechanisms, etc.). Only then will systems engineers be able to wield the tools of their trade judiciously and, as a result, maximize healthcare’s benefits while minimizing its harms.
To learn more about healthcare’s unique challenges and opportunities, please contact us and/or read more about GCorp Health Solutions
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