IE497B Biomedical Device Engineering
Dr. Richard A. Wysk
• Discuss first two paper opportunities
• Health Care and Traditional IE
• Stakeholders and metrics
• A bit of the landscape
Reporting on Health
Dana Gelb Safran
New England Medical Center
Measuring and Scott Shimp Jung Lim
reporting Larna Citron Richard
Supply Chain Management
and Health Care Delivery
Supply Chain Viren Parikh Michael Hunter
Reha Ulsoy Shane Allison Vu Tu
How Does the Healthcare
Research Context Differ?
• Mostly service model-based
• Analytical methods trail by a decade or more.
• Management engineers were phased out in the
• Healthcare is a complex system of delivery and
• Can you spell I-R-B (Institutional Review Board)?
• IE approach can represent ―disruptive innovation.‖
Healthcare is a Complex System of
Delivery and Stakeholders.
from various sources
is used to make decisions
on treatment for a patient
who cannot judge clinical quality.
Furthermore, the treating physician
is an independent contractor
paid by third parties (Medicare, BCBS, etc.).
Can You Spell I-R-B?
• Not just at PSU, but the hospital IRB, clinic
IRB, etc. Most won’t accept central IRB.
• Also, before you can conduct research
– Get your shots (Hep B series, MMR, TB)
– Attend mandatory orientation
• Get clinicians on board
• Next words: HIPAA, JCAHO
IE Approach Can Represent
• Hospitals are used to ―sustaining‖ innovations
– Specialized cancer treatments
– Clinical trials
• But, systems to improve processes are
– Noninvasive techniques, cure for common cold
– Portable x-ray in MD offices
– Low-tech, affect many patients with more ordinary
– Impact business processes, culture, MD status
Disruptive Innovations Come
Source: Will Disruptive Innovations Cure Health Care?
Christensen, C. M.; Bohmer, R.; Kenagy, John.
Case No. R00501. Harvard Business Review.
Dissecting a Disruptive
Source: The Innovator's Solution: Creating and Sustaining Successful
Growth by Clayton M. Christensen, Michael E. Raynor
What Makes IEs Suited to
• Proficient in Proven Tools Used in Other
• Focus on Systems Tools and Applications
• Consideration of the Human in Complex
• Conversant with IT
IEs are Proficient in Proven
Tools Used in Other Contexts.
• Lean, TPS, Six Sigma
• Work methods
• Performance measurement and
– What do they measure in the ED?
– Impact on pt flow, pt care
IEs Have a Focus on Systems
Tools and Applications.
• Failure Analysis (FMEA)
• Modeling and Simulation (MedModel)
• Enterprise Management Tools (supply
• System Dynamics
• Knowledge Discovery (data mining, neural
IEs Consider the Human in
• Team structures and processes (Mayo
• Decision making
• Fatigue and error
• Work scheduling (resident shifts)
IEs are Conversant with IT.
• Can coordinate projects with CS, IT
• Trained to identify system requirements for
each stakeholder (PDA Rx order)
• Drive IT toward objectives of vastly
improving access to necessary clinical,
system, and patient information (med
• Patterson (Ohio State/VA National Center for
Patient Safety)—HF and adverse events
• Stanford—Culture of Safety
• VA National Center for Patient Safety—HFMEA
• Cook & Rasmussen—System Dynamics,
lessons from nuclear energy
• Miller et al.—Six Sigma applications
• Banner Health (AZ)—Lean applications
• Pebble Partnership—Evidence-based design
What are Some Research
• Medical Error
– 100K Lives Campaign (IOM)
– Medication error
– Medication labeling
– Order entry and Rx (delays & wasted $$ in
―serious medication errors per
year‖ … ―illegible handwriting,
misplaced decimal points, and
missed drug interactions and
Source: tompeters.com from Wall Street Journal
/Institute of Medicine
―In a disturbing 1991 study, 110 nurses
of varying experience levels took a
written test of their ability to calculate
medication doses. Eight out of 10 made
calculation mistakes at least 10% of the
while four out of 10 made
mistakes 30% of the time.”
Source: tompeters.com from Demanding Medical Excellence: Doctors
and Accountability in the Information Age, Michael Millenson
What are Some Research
• Patient Flow
– ED (50% of pts), inter-unit, to/from ancillary
– Waiting times, queuing
– Essentially, Hammer’s ―reengineering‖ (pt
What are Some Research
• Healthcare Information Technology (HIT)
– Electronic medical record
– Service and provider integration
– Rx, treatment order entry and fulfillment
– Bed availability (HMED)
Become Familiar with IOM.
Read: To Err is Human and Crossing
the Quality Chasm
See IHI for Improvement Tools
"When I climb Mount Rainier, I face less risk of death than I'll face on the
operating table."—Don Berwick, M.D. Newsweek/12.12.2005
Study and Implement Now…
No Time to Wait for Optimal
Tools or Solutions
• IE tools have a place in medicine.
• Now is the time to use these tools.
• Lots of ―red tape‖.
• Two cultures.