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3 The Tools of Systems Engineering
Pages 27-62

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From page 27...
... Many of the tools described in this Understanding interactions and making trade-offs in such chapter are applicable to more than one level but generally a complex system is difficult, sometimes even impossible, address different questions or issues at each level. It will without mathematical tools, many of them based on opera- become obvious to the reader that each level of the system tions research, a discipline that evolved during World War II has different data requirements and a different reliance on when mathematicians, physicists, and statisticians were information/communications technology systems.
From page 28...
... The variables to be measured depend on the particular Organizations that use the concurrent-engineering process analysis and, because data collection is often time consuming, have realized substantial benefits: fewer design changes are TABLE 3-1 Systems-Design Tools Tool/Research Area Patient Team Organization Environment Concurrent engineering and quality function deployment X X Human-factors engineering X X X X Tools for failure analysis X X
From page 29...
... For other units of of a library system, the provision of fast food, the creation of a hospital (e.g., an intensive care unit [ICU] , a neonatal care a traffic-control system, or the delivery of health care unit, the business office, etc.)
From page 30...
... · Create electronic health records (EHRs) with decision support.
From page 31...
... It is system of interest may be organizing an intensive care area essential that all members of the QFD team continue to par to support cognitive and cooperative demands in various ticipate in this sometimes painful process. In the unusual anticipated situations, such as weaning a patient off a respievent that the objectives cannot be accomplished within the rator.
From page 32...
... . Medications information sheets must accommodate the characteristics and limitations of users to be effective." Improving information sheets will require the participation of health care professionals, insurance providers, and users.
From page 33...
... and JCAHO have taken several steps toward promation, the implementation of electronic health records moting the adaptation and application of FMEA, FMECA, [EHRs] , potential failures in the regional response to a public FTA, and related tools of proactive hazard analysis and health emergency, etc.)
From page 34...
... . In 2000, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
From page 35...
... fragmented nature of the health care system, interactions TABLE 3-4 Systems-Analysis Tools Tool/Research Area Patient Team Organization Environment Modeling and Simulation Queuing methods X X Discrete-event simulation X X X Enterprise-Management Tools Supply-chain management X X X Game theory and contracts X X X Systems-dynamics models X X X Productivity measuring and monitoring X X X Financial Engineering and Risk Analysis Tools Stochastic analysis and value-at-risk X X Optimization tools for individual decision making X X X Distributed decision making (market models and agency theory) X X Knowledge Discovery in Databases Data mining X X Predictive modeling X X X Neural networks X X X
From page 36...
... Queuing Theory For a single station with the probability distributions described above, the response time for the station (the aver Queuing theory deals with problems that involve waiting age time for a patient to pass through the station) is given by (queuing)
From page 37...
... decreasing. This situation requires new management But most system variables have a distribution of values, such approaches, methods of reducing waiting times and keeping as the differences in the number of nurses needed throughout emergency departments from turning away patients, such as the day in Surgical Ward 2 of the hospital.
From page 38...
... . The mathematical tools described below can Capacity and variability are at the heart of how compohelp health care managers maintain a system that balances nents of supply chains operate (see Uzoy, in this volume)
From page 39...
... Measures for allocation procedures include: medical utility, such as the number of transplants and the number of deaths; patient utility, such as the probabilities of a patient receiving a transplant or dying while waiting; system utility, such as distance an organ had to be transported; medical equity, such as the total number of transplants; patient equity, such as differences in the probability of specific patients receiving a transplant; and system equity, such as geographic differences in the length of the waiting list. A large-scale simulation model, ULAM for UNOS Liver Allocation Model, was developed to determine whether the allocation model used in the 1990s (SPF-Nat)
From page 40...
... develop causal relationships between system-performance Advanced modeling techniques are just now being applied measures and independent variables other than time are often to these problems, but a great deal more research in this area more enlightening but require much more detailed data. will be necessary.
From page 41...
... For the most part, health care and creating incentives for improving processes. Tools to providers are trained to focus on the unique characteristics assist in decision making in the presence of risks are as useand needs of individual patients; they have very little train- ful to individual patients and care teams as they are to orgaing or perspective on the characteristics (and needs)
From page 42...
... · environmental risk, such as the risk of damage by The following sections describe three major areas of forces external to the organization financial engineering that are most relevant to the risk · model risk, that is, the risk that the models used for analysis/management needs of health care organizations and evaluating other types of risk are not accurate environmental level actors. Risks at the political-economic environmental level are Predicting and Assessing Uncertain Outcomes: incurred not only by individual organizations, but can also Stochastic Analysis and Value-at-Risk arise from interactions among organizations, the lack of adaptability of organizations, and the misalignment of indi- To manage risk, it must first be quantified, analyzed, vidual and societal objectives.
From page 43...
... Optimization Tools for Individual Decision Making Financial engineering tools are not only descriptive (e.g., Market Models stochastic and statistical analyses) , but also prescriptive.
From page 44...
... Customer surveys often ask questions that seem unrelated to the purchase of a Once a set of independent variables is identified, the particular item, and that information may be a rich source of analysis can then continue to determine the relationship to a insight. If, for example, a company determines that a large dependent variable: fraction of a group of customers regularly purchases both its product A and another manufacturer's product B, the com- · Is a patient with symptoms A and B likely to develop pany can use this knowledge to reach selected potential symptom C?
From page 45...
... Examples include prediction and control in neurosurgical intensive care, decision support in acute Predictive Modeling abdominal pain, automatic detection of emphysema, diag If a causal relationship has been established between sets nosis of acute appendicitis, and predicting clinical outcomes of variables by data mining, and if the statistical significance for neuroblastoma patients (Eich et al., 1997; Friman et al., of these relationships is high, a predictive model can be con- 2002; Pesonen, 1997; Swiercz et al., 1998; Wei et al., 2004)
From page 46...
... Many patient variables must be man- When data vary within that range, the variation is typiaged over time, such as blood glucose level, blood pressure, cally due to common causes. Data points outside the control and prothrombin time.
From page 47...
... Scheduling can help a system make · inpatient scheduling in acute and long-term care settings the best use of its personnel, facilities, and inventories. · outpatient and clinic scheduling Scheduling can also help "smooth out" demands, such as · workforce scheduling in hospitals, home health care, inpatient arrivals, outpatient arrivals, requests for testing, long-term care facilities, and clinics and so on.
From page 48...
... From 1997 through 2000, the Institute for Health care Improvement worked with emergency departments at 91 hospitals, representing a total of 2.6 million visits per Personnel Scheduling year, to reduce waiting times and delays and increase patient In many ways, planning and scheduling health care per- satisfaction (IHI, 2003)
From page 49...
... Balanced workloads are important in neonatal intensive care for several reasons. First, and perhaps most important, every nurse needs time to talk with parents and concerned relatives.
From page 50...
... . Outpatients Improving Overall Organizational Performance Scheduling of patients in clinics for outpatient services is one of the earliest documented uses of operations research to In addition to the tools described above, businesses, comimprove health care delivery.
From page 51...
... Motorola introduced Care Model developed by Dr. Ed Wagner of the Group the concept of Six Sigma quality with the objective of creat- Health Cooperative of Puget Sound identifies six areas ing a manufacturing operation that generates only two of interconnected activity necessary for the management of defective parts per billion; a defective part is defined as one patients with chronic disease.
From page 52...
... APPLYING SYSTEMS TOOLS TO of using these tools should be to improve patient care and HEALTH CARE DELIVERY ensure that the system is responsive to patients' needs and wishes. Concurrent engineering tools like QFD can be used The systems tools described in this chapter can be applied most effectively in the design/redesign of care delivery systo all four levels of the health care system, with the caveat tems in the hospital and ambulatory clinics and, as information/ that they must be adapted to the specific conditions and cir communications technologies advance, in virtual settings, cumstances of this unique patient-centered environment.
From page 53...
... where a system can fail, either by predicting errors or by Modeling and simulation tools can be used to improve identifying inefficiencies, generally depend more on interpatient access to care providers (e.g., more efficient schedul- actions among individuals who work in the system and ing of appointments) , reduce patient waiting times in care understand all of its aspects and components than on large centers, and ensure that laboratory test results are available amounts of data.
From page 54...
... . Up to now, most health care professionals have not under Health care provider organizations have the large, com- stood the relevance of systems-engineering tools to the safety plex task of providing all of the support functions for both and quality of patient-centered care.
From page 55...
... zation, multi-organization, and environmental levels to the In recent years, several experiments with new reimbursestrategic implementation of tools for modeling and simula- ment approaches have been tried to change the prevailing tion, enterprise management, financial engineering and risk practice of reimbursing discrete units by a "reasonable cost" analysis, and knowledge discovery in databases. The use of method to include fixed-price reimbursement for a definable these tools requires integrated clinical, administrative, and bundle of services or a care episode.
From page 56...
... Systems-engineering tools for the design, Students of engineering and management are much more analysis, and control of complex systems and processes likely to be trained in systems thinking and the uses and could potentially transform the quality and productivity of implications of systems-engineering tools and information/ health care. Statistical process control, queuing theory, communications technologies for the management and opti- human-factors engineering, discrete-event simulation, QFD, mization of production and delivery systems.
From page 57...
... Recommendation 3-2. Outreach and dissemination efforts CONCLUSION by public- and private-sector organizations that have used systems-engineering tools in health care delivery (e.g., Information/communications systems will be critical to Veterans Health Administration, Joint Commission on the effectiveness of existing and emerging systems-design, Accreditation of Healthcare Organizations, Agency for -analysis, and -control tools in the transformation of health Healthcare Research and Quality, Institute for Healthcare care delivery.
From page 58...
... Joint Commission Journal on Quality gust, 2002. Available online at: http://www.imt.liu.se/mi/Publications/ Improvement 25(6)
From page 59...
... Joint Commission Journal on Quality and Safety 29(9) : in Operations Research and Health Care: A Handbook of Methods and 452­459.
From page 60...
... ing the complexity behind a medication error: generic patterns in Designing patient safety into the microsystem. Joint Commission communication.
From page 61...
... care. Joint Commission Journal on Quality and Safety 29(5)


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