Introduction to system redesign sr and operational systems engineering ose l.jpg
This presentation is the property of its rightful owner.
Sponsored Links
1 / 51

Introduction to System Redesign (SR) and Operational Systems Engineering (OSE) PowerPoint PPT Presentation


  • 670 Views
  • Uploaded on
  • Presentation posted in: General

Introduction to System Redesign (SR) and Operational Systems Engineering (OSE). Heather Woodward-Hagg, MS, CQE, CSSBB Isa Bar-On, PhD Peter Woodbridge, MD, MBA Diana Ordin, MD. Lean. Step 3. Materials. System Redesign Methods.

Download Presentation

Introduction to System Redesign (SR) and Operational Systems Engineering (OSE)

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Introduction to system redesign sr and operational systems engineering ose l.jpg

Introduction to System Redesign (SR) and Operational Systems Engineering (OSE)

Heather Woodward-Hagg, MS, CQE, CSSBB

Isa Bar-On, PhD

Peter Woodbridge, MD, MBA

Diana Ordin, MD

Lean


Slide2 l.jpg

Step 3

Materials

System Redesign Methods

Identifying and Eliminating Operational Barriers within Patient Treatment Processes


Slide3 l.jpg

Reducing sources of variation…

  • Every step in the patient treatment process contributes to the:

  • Patient Outcome

  • Patient Satisfaction

  • Cost of Treatment

Every caregiver and staff member must be active in reducing variation.


Va tammcs framework l.jpg

VA-TAMMCS Framework


What is systems redesign l.jpg

What is Systems Redesign?

Industry vs. Craft Paradox

Systems Redesign/Engineering

Professionalism

Adapted from Peter Woodbridge, Brenda Zimmerman, 2002


Evidence based practice l.jpg

Evidence Based Practice

  • Clinical Practice Bundles

    • “a structured way of improving the processes of care and patient outcomes: a small, straightforward set of practices - generally three to five - that, when performed collectively and reliably, have been proven to improve patient outcomes.”

  • IHI – Institute for Healthcare Improvement

    • IHI.org

    • 100,000 lives campaign

    • 5 million lives campaign


Rubenstein pugh model for trip l.jpg

Rubenstein, Pugh Model for TRIP

Rubenstein & Pugh, JGIM 2006; 21:S58-64


Ventilator associated pneumonia vap bundle l.jpg

Ventilator Associated Pneumonia (VAP bundle)

  • Ventilator Associate Pneumonia Bundle

    • Head of bed elevation 30-45o

    • Daily assessment for weaning

    • Peptic Ulcer Disease (PUD) Prophylaxis

    • Deep Vein Thrombosis (DVT) Prophylaxis


Vap bundle implementation l.jpg

VAP Bundle Implementation

What does this process

look like at week 15?


Sustainability l.jpg

Sustainability

What

happened?

Woodward-Hagg, H., El-Harit, J., Vanni, C., Scott, P., (2007). Application of Lean Six Sigma Techniques to Reduce Workload Impact During Implementation of Patient Care Bundles within Critical Care – A Case Study. Proceedings of the 2007 American Society for Engineering Education Indiana/Illinois Section Conference, Indianapolis, IN, March 2007.


Slide11 l.jpg

Average Daily % of ED stat orders (Order to Verify)

returned within 60 minutes through April, 2006


Repenning qi model l.jpg

Repenning QI Model *

* Repenning, N. and J. Sterman (2001). Nobody Ever Gets Credit for Fixing Defects that Didn't Happen:

Creating and Sustaining Process Improvement, California Management Review, 43, 4: 64-88


Repenning qi model13 l.jpg

Repenning QI Model *

delay

* Repenning, N. and J. Sterman (2001). Nobody Ever Gets Credit for Fixing Defects that Didn't Happen:

Creating and Sustaining Process Improvement, California Management Review, 43, 4: 64-88


The work harder loop l.jpg

The “Work Harder” Loop

delay


The work smarter loop l.jpg

The “Work Smarter” Loop

delay


Systems redesign applications l.jpg

Systems Redesign Applications

delay

16


Systems redesign applications17 l.jpg

Systems Redesign Applications

Reducing

Reliability

Erosion

Improving

Reliability

Identification of

Performance

Gaps

Effectiveness/Timeliness

of “Work Smarter” Loop

delay

  • - Intrinsic pressure

  • - Extrinsic pressure

  • Organizational

  • Microsystem

17


Isolation sign l.jpg

Isolation Sign

By permission: LSSHC


Complexity in healthcare l.jpg

Complexity in Healthcare

Social

Adapted from Ralph Stacey “Complexity and Creativity in Organizations”

Technical


Approaches to improvement l.jpg

Approaches to Improvement

RCC PDSA

Within a clinical microsystem

Microsystem is capable

Deep Dive

Defined charter

Little analysis required

Motivated team

Rapid Process Improvement Workshop (RPIW)

Defined charter

Many RCC PDSA

A lot of progress likely in one week

100 Day Project

Analysis required

Ambiguous charter

Follows DMAIC

20


Rcc pdsa l.jpg

RCC PDSA

RCC PDSA

Use small tests of change

Test each idea for quantifiable impact

No charter

“Improvement” is charter

Success depends on

Motivated team

Capable team

Use when there is good “agreement” but weak evidence as to best practice

21


Deep dive project l.jpg

Deep Dive Project

One day “mini-blitz” followed by weekly meetings

First day:

Process map

Isolate problems

Identify RCC PDSA

Up to 6 weeks

Analyze results RCC PDSA

Additional RCC PDSA

Has charter

Progress tracked at monthly milestone meetings

Best used for “simple” problems that may require a structured environment for “negotiation”

22


Rapid process improvement workshop rpiw l.jpg

Rapid Process Improvement Workshop (RPIW)

Weeklong (40 hour) event + 90 day weekly follow-up

Combine education and improvement

Highly structured

Day 1-2 analysis

VOC & PD

Process map

Isolate problems

Day 3-5 RCC PDSA

20-30 small tests of change in one week

Best used for “complicated” but well defined problems

23


100 day project l.jpg

100 Day Project

Advanced SR Tools

Based on TAMMCS cycle

Define  Measure  Analyze  Implement  Control

2-3 hour meetings weekly for 8 weeks followed by 1 hour meetings for 4-6 weeks

Just in time training of team

Formal “go / no-go” milestones

Often requires value stream mapping

Use for “complex” problems

May spin off other project teams

24


Introduction to operational systems engineering ose l.jpg

Introduction to Operational Systems Engineering (OSE)


Operational systems engineering l.jpg

Operational Systems Engineering*

  • Academic discipline where researchers and practitioners treat health care industry as complex systems, and further identify and apply engineering applications in health care systems.

  • Professionals in this field are often called hospital engineers, management engineers, industrial engineers, or health systems engineers.

  • Incorporates many engineering applications, such as Industrial engineering, human factors engineering, quality engineering, informatics and implementation research

* http://en.wikipedia.org/wiki/Health_systems_engineering


Ose tools methods l.jpg

OSE Tools/Methods*

  • Discrete Event Models

  • Stochastic Models

  • Lean Six Sigma

  • Measurement System Analysis (MSA)

  • Value Stream Mapping

  • Time and Motion Studies

  • Process Observation

  • Process Mapping

  • PDSA Cycles

Increasing

Level

Of

Complexity

80% of issues can be resolved

with lower complexity tools


Slide28 l.jpg

Why Systems Engineering?Healthcare has people from different disciplines interact with each other and with Technology


Slide29 l.jpg

Origins of Systems Thinking…

“A fault in the interpretation of observations,

seen everywhere, is to suppose that every event is attributable to

someone (usually the one closest at hand), or is related to some special event.

The fact is that most troubles…

lie in the system and not the people”.

- Deming, The New Economics

“A fault in the interpretation of observations,

seen everywhere, is to suppose that every event is attributable to

someone (usually the one closest at hand), or is related to some special event.

The fact is that most troubles…

lie in the system and not the people”.

- Deming, The New Economics


Medication delivery l.jpg

Medication Delivery

  • Estimated 30% of all medical errors occur during medication delivery processes

  • Average litigation expense = $680,000

  • Technology available to prevent errors:

    • BCMA – Bar Code Medication Administration

    • Pyxis – Automated Medication Delivery

    • Infusion (Alaris) pumps – regulates IV flow


Bcma background l.jpg

BCMA Background

  • BCMA introduced to reduce medication errors in 1999

  • Bypassing / workarounds persist

    • 94 incidents since 10/2002

    • 10/13 aggregate RCA related to BCMA


Bcma medication pass l.jpg

BCMA Medication Pass

Supply

Area

Supply

Area

Pyxis

Steps per patient: 181 steps

Attempts: 3.3

Total time per patient: 18 mins

Supply time per patient: 9 mins

Med administration time: 9 mins


Med isolation carts current state l.jpg

Med/Isolation Carts – Current State


Slide34 l.jpg

14 minutes in the life of a Pharmacy Tech

34


Vamc emr implementation l.jpg

VAMC EMR Implementation

8 feet of paper

per week


Incoming documentation by type unit l.jpg

Incoming Documentation by type/unit


Sds paper generation l.jpg

SDS Paper Generation


Conversion to e documentation l.jpg

Conversion to e-documentation


Other challenges to technology implementation l.jpg

Other Challenges to Technology Implementation

  • Technology is not effectively integrated in clinical workflow.

  • Healthcare professionals (clinicians, administrators) lack the tools for assessing and addressing potential ‘side effects’

  • Result  more workarounds and ambiguity


Slide40 l.jpg

‘Side Effects’ = Limitations of Mental Models

“ There are no ‘side effects’…only ‘effects’ ….those that we thought of in advance we call the ‘main effects’ and take credit for...the ones that came around and bit us the in the rear….those are the ‘side effects’…

…in effect we are highlighting the limitations of our mental models.”

- J. Sterman, “All models are wrong…(some are useful)….reflections on becoming a systems scientist”

“A fault in the interpretation of observations,

seen everywhere, is to suppose that every event is attributable to

someone (usually the one closest at hand), or is related to some special event.

The fact is that most troubles…

lie in the system and not the people”.

- Deming, The New Economics


Current vha systems engineering applications l.jpg

Current VHA Systems Engineering Applications


Examples of systems engineering projects in the vha l.jpg

Examples of Systems Engineering Projects in the VHA

  • Discrete Event Simulation Models created by Health Systems Engineers to optimize patient throughput:

    • Outpatient Clinic Patient Flow Models

    • Radiology Capacity Models

    • ER Throughput Models

    • Surgical Flow Models

Highest Level of Technical Complexity


Examples of systems engineering projects in the vha43 l.jpg

Examples of Systems Engineering Projects in the VHA

  • Health System Engineers incorporate HSE tools/methods (process mapping, process observation, visual controls) w/in Systems Redesign Projects

    • Optimize Medication Administration Processes

    • Discharge Process Optimization

    • Clinical Practice Guideline Implementation

      • Dysphagia, Post-op Glycemic Control, VAP Bundle, MRSA Bundle

Moderate/Low Level of Technical Complexity


Supply organization l.jpg

Supply Organization


How does hse contribute to effective systems redesign l.jpg

How does HSE contribute to effective systems redesign?

  • Improving Reliability/Reducing Reliability Erosion:

    • Discrete Event Simulation Models

    • Stochastic Models

    • Value Stream Analysis

    • Lean Tools – 5S, Visual Controls

  • Identifying the Performance Gap

    • Measurement System Analysis (MSA)

    • Dashboards

    • Predictive Analytics


How does hse contribute to effective systems redesign46 l.jpg

How does HSE contribute to effective systems redesign?

  • Improving Effectiveness of “Work Smarter” Loop

    • Training/Facilitation to enable front line staff and clinicians to apply HSE tools to improve processes:

      • Lean Six Sigma

      • Value Stream Mapping

      • Process Mapping

      • Process Observation


Health systems engineering in the vha next steps l.jpg

Health Systems Engineering in the VHA – next steps


Health systems engineering in the vha l.jpg

Health Systems Engineering in the VHA

  • Systems Engineering solutions must have IMPACT in improving patient care:

    • Integration with current system redesign programs

    • Integration with Health Services Researchers to create level of generalizable knowledge:

      • Implementation Research

      • Evidence Based Management

    • Design/creation of support infrastructure for HSE application in VAMCs


Vha engineering resource centers vercs l.jpg

VHA Engineering Resource Centers (VERCs)

  • Primary Mission:Development, testing, and deployment of innovative methods of operational systems engineering (OSE) to transform VA healthcare delivery system

  • VERCs Funded:

    • VISN1 VERC: New England Healthcare Engineering Partnership (NEHCEP)

    • VISN11 VERC: VA Center for Applied Systems Engineering (VA-CASE)

    • VAPHS VERC

    • Mid-West Mountain Region VERC (MWM VERC)

      • VISN12,18,19,23


Conclusions l.jpg

Conclusions

  • Health Systems Engineering (HSE) provides systematic, multi-disciplinary approaches to optimization of healthcare systems

  • Health Systems Engineering methods are tools within systems redesign to enable:

    • Improved Process Reliability/Reduced Erosion

    • Improve Identification of Performance Gaps

    • Improved Effectiveness of Systems Redesign efforts


Questions l.jpg

Questions?


  • Login