A strategy most often applied to industries such as manufacturing and aviation might unlock the potential for better care at lower cost, according to a recent report from the President's Council of Advisors on Science and Technology.
Systems engineering, common in other sectors of the economy, is an interdisciplinary approach to analyzing, designing and managing complex systems, with the aim of improving their efficiency, reliability and productivity.
For example, the PCAST report, "Better Health Care and Lower Costs: Accelerating Improvement Through Systems Engineering," points out that, "by using tools such as alerts, redundancies, checklists, and systems that adjust for the human factor, U.S. commercial airlines have reduced fatalities from hundreds in the 1960s to approaching zero now, with the risk of dying now at 1 in 45 million flights. They have also been used in fields as diverse as manufacturing, space stations and satellites, and education."
As Atul Gawande wrote in a landmark 2007 New Yorker article – the inspiration for his 2009 best seller, The Checklist Manifesto – certain forward-thinking intensive care physicians have embraced checklists with the same devotion as airline pilots.
"Researchers found that simply having the doctors and nurses in the I.C.U. make their own checklists for what they thought should be done each day improved the consistency of care to the point that, within a few weeks, the average length of patient stay in intensive care dropped by half," wrote Gawande.
The PCAST study makes the case that similar improvement strategies – so far only applied in a limited way in healthcare thanks largely to the structures of the existing fee-for-service model – will be key to smarter use of data for better care delivery.
"The ability to look at high-quality data, measurement and analytics in real time is key to systems engineering in any sector of the economy but particularly in healthcare," said Christine K. Cassel, MD, president and CEO of the National Quality Forum and co-chair of the PCAST Systems Engineering in Health Care Working Group, in a press statement.
"To improve healthcare, good, relevant, standardized and patient-centered measures and data must be more readily available in order for patients and providers to make more informed decisions and to drive improvements in care," she added.
The PCAST report outlines several steps for applying systems engineering principles to healthcare, including increasing and improving the nationwide data sharing infrastructure, providing technical assistance to providers and training health professionals in systems engineering approaches.
Systems engineering has "often produced dramatically positive results in the small number of health care organizations that have incorporated it into their processes," according to PCAST.
A fundamental change in payment policies is essential to spurring wider adoption of these strategies, according to the report. Also critical will be higher-quality data measurement and analysis – with electronic health records and other health IT as essential tools.
PCAST recommends seven steps toward a systems engineering approach:
• Accelerate the alignment of payment incentives and reported information with better outcomes for individuals and populations.
• Accelerate efforts to develop the nation's health data infrastructure.
• Provide national leadership in systems engineering by increasing the supply of data available to benchmark performance, understand a community's health, and examine broader regional or national trends.
• Increase technical assistance (for a defined period of 3-5 years) to healthcare professionals and communities in applying systems approaches.
• Support efforts to engage communities in systematic healthcare improvement.
• Establish awards, challenges and prizes to promote the use of systems methods and tools in health care.
• Build competencies and workforce for redesigning health care.
With healthcare spending nearly 20 percent of U.S. gross domestic product, with so much of that money not going toward better care, now is the time – especially in light of the Affordable Care Act – to try a new approach to care delivery, according to PCAST.
Systems engineering, with an emphasis on high-quality data to measure progress, gauge challenges and opportunities and enable patients and providers to make better decisions, is one way to get there, according to the report.
Such cross-industry cooperation is already at work in some places. Speaking at HIMSS13 in New Orleans, Robert Szczerba, corporate director of global healthcare initiatives at Lockheed Martin, described the aerospace giant's ICE STORM initiative: it stands for Integrated Clinical Environment; Systems, Training, Operations, Research, Methods.
The project's system engineering-based works to apply the technologies and ideas that revolutionized aerospace to healthcare transformation, such as flight simulators.
"Why can't you have simulation-based training in healthcare?" asks Szczerba. The technology exists these days to "create virtual worlds that are so realistic they are indistinguishable form the actual thing."
Simulated environments modeled on hospitals or doctors' office can allow caregivers, via avatars, to virtually learn optimal workflows and explore new technologies and clinical scenarios.
Systems engineering should play a more widespread role in healthcare, PCAST argues. In the meantime, interoperability of disparate technologies is one big hurdle.
Training a healthcare workforce – clinicians, administrators, public-health officials – in these concepts must also be a priority, according to the report, which makes the case that "the benefits of systems engineering can be realized," and that engaging with these principles "can enhance the quality of care and the health of communities."
