Building a Better Delivery System: A New Engineering/health Care Partnership

by Institute of Medicine (U. S.)

• ISBN13: 9780309096430
• ISBN10: 030909643X
• Edition: 1st
• Format: Paperback
• Copyright: 2005-11-01
• Publisher: NATL ACADEMY OF SCIENCE

Summary

This book by the National Academy of Engineering and the Institute of Medicine is intended to bridge the knowledge and awareness divide between health care professionals and their potential partners in systems engineering and related disciplines. The goal of this partnership is to transform the U.S. health care sector from an underperforming conglomerate of independent entities (individual practitioners, small group practices, clinics, hospitals, pharmacies, community health centers) into a high-performance "system," in which every participating unit recognizes its dependence and influence on every other unit. Besides providing a framework and a plan of action for a systems approach to health care delivery, Building a Better Delivery System describes opportunities and challenges to harnessing the power of systems-engineering tools, information technologies, and complementary knowledge in social sciences, cognitive sciences, and business management to advance the delivery of safe, patient-centered, efficient, equitable health care in the United States.

Table of Contents

Executive Summary	p. 1
Consensus Report
A New Partnership Between Systems Engineering and Health Care	p. 11
The Paradox of American Health Care	p. 11
Interconnected Crises in U.S. Health Care	p. 11
Proximate Causes of Health Care Crises	p. 12
The Role of Engineering in the Transformation of Health Care	p. 14
The Engineering/Health Care Partnership	p. 15
Structure of the Report	p. 16
References	p. 16
A Framework for a Systems Approach to Health Care Delivery	p. 19
A Four-Level Model of the Health Care System	p. 19
A Systems View of Health Care	p. 22
The Role of Information and Communications Technology	p. 24
References	p. 24
The Tools of Systems Engineering	p. 27
The Need for Good Data	p. 28
Systems-Design Tools	p. 28
Systems-Analysis Tools	p. 35
Systems-Control Tools	p. 45
Applying Systems Tools to Health Care Delivery	p. 52
Barriers to Implementation	p. 55
Findings	p. 56
Recommendations	p. 57
Conclusion	p. 57
References	p. 58
Information and Communications Systems: The Backbone of the Health Care Delivery System	p. 63
The Centrality of Information to Health Care Delivery	p. 63
From Electronic Medical Records to a National Health Information Infrastructure	p. 64
Foundations of a National Health Information Infrastructure	p. 67
Communications Technologies	p. 72
Microelectronic Systems and Emerging Modes of Communication	p. 75
Conclusion	p. 78
References	p. 79
A Strategy to Accelerate Change	p. 83
Educational Barriers to Change	p. 83
A Platform for Interdisciplinary Research, Education, and Outreach	p. 84
Call to Action	p. 89
References	p. 89
Workshop Presentations
Framing the Health Care Challenge
Crossing the Quality Chasm	p. 95
Bridging the Quality Chasm	p. 99
Envisioning the Future	p. 103
Improving Health and Health Care	p. 105
Engineering and the Health Care System	p. 107
Engineering and the Health Care Organization	p. 113
Equipping the Patient and the Care Team
Evidence-Based Medicine	p. 117
The Context of Care and the Patient Care Team: The Safety Attitudes Questionnaire	p. 119
Engineering the Patient and Family into the Patient Care Team	p. 125
Connecting Patients, Providers, and Payers	p. 129
New Paradigms for Working and Learning	p. 133
Designing Caregiver- and Patient-Centered Health Care Systems	p. 135
Engineering Tools and Procedures for Meeting the Challenges
Systems Engineering: Opportunities for Health Care	p. 141
Supply-Chain Management and Health Care Delivery: Pursuing a System-Level Understanding	p. 143
The Human Factor in Health Care Systems Design	p. 147
Changing Health Care Delivery Enterprises	p. 149
Transforming Current Hospital Design: Engineering Concepts Applied to the Patient Care Team and Hospital Design	p. 153
Discrete-Event Simulation Modeling of the Content, Processes, and Structures of Health Care	p. 157
Measuring and Reporting on Health Care Quality	p. 163
Archimedes: An Analytical Tool for Improving the Quality and Efficiency of Health Care	p. 167
Applying Financial Engineering to the Health Services Industry	p. 173
Engineering Tools and Methods in the Delivery of Cancer Care Services	p. 177
Patient Trajectory Risk Management	p. 183
Deploying Resources for an Idealized Office Practice: Access, Interactions, Reliability, and Vitality	p. 187
Information Technology for Clinical Applications and Microsystems
Engineering and the System Environment	p. 191
Challenges in Informatics	p. 193
A National Standard for Medication Use	p. 195
Obstacles to the Implementation and Acceptance of Electronic Medical Record Systems	p. 199
Automation of the Clinical Practice: Cost-Effective and Efficient Health Care	p. 205
The eICU Solution: A Technology-Enabled Care Paradigm for ICU Performance	p. 209
Wireless Biomonitoring for Health Care	p. 215
Rehabilitation Redefined	p. 221
Evaluating the Potential of New Technologies	p. 223
Barriers and Incentives to Change
Political Barriers to Change	p. 227
Lessons from Financial Services	p. 231
Can Purchasers Leverage Engineering Principles to Improve Health Care?	p. 233
Shibboleths in Modeling Public Policy	p. 235
Matching and Allocation in Medicine and Health Care	p. 237
Appendixes
Agenda for First Workshop	p. 243
Participants in First Workshop	p. 245
Agenda for Second Workshop	p. 249
Participants in Second Workshop	p. 251
Agenda for Third Workshop	p. 253
Participants in Third Workshop	p. 255
Biographical Information	p. 259
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