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Strategic Partnership of Healthcare 
and Systems Engineering
in Turbulent Times
International Council on Systems Engineeri...
Quotes from the Report
• …”Systems Engineering know‐how
must be propagated at all levels [of 
healthcare]”
• “Implementati...
What MDs are saying about Systems Engineering…
• „It is surprising that many industries have used systems engineering to i...
Outline
1. The Current (Imperfect) State
2. Systems Engineering to the Rescue
3. What is Systems Engineering?
4. Added Val...
1. The Current (Imperfect) State
5
Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
Desired Characteristics of Healthcare
• Affordable & Accessible
• Safe
• Effective
• Patient centered
• Timely
• Efficient...
• $8,508 per capita (UK: $3,406)
• Millions still without medical insurance
• Medicines unaffordable to a hundred million
...
• Highly fragmented system, inefficient interfaces - in desperate need of integration in many
dimensions
• Bureaucratic ov...
2. Systems Engineering to the Rescue
9
Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
Super 
System
1
Super 
System
3
Super 
System
2
Super 
System
4
Complex System 1
Complex System 2
U.S. Healthcare = Dynami...
3. What is Systems Engineering?
11
Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
What is Systems Engineering?
• Beginnings in 1950s in the US Ballistic Missile Programs
• It is about rigorous integration...
Two Paths for Systems Engineers to Serve Healthcare
Traditional Systems Engineer
• Typically B.S. in engineering, science,...
What is Systems Engineering?
• Complex systems almost always fail at
the interdisciplinary interfaces‐
• or at the interfa...
Simplest system: N = 2
1 connection
Slightly more complex system: N = 5
10 one-to-one connections
becomes
Why do we need S...
Systems Engineering
An engineering discipline whose responsibility is creating and 
executing an interdisciplinary process...
4. Added Value from Systems Engineering in 
Healthcare
17
Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
• Managing Complexity and
Efficiently Navigating in Complex
Problem Space
• Systemic approach using Systems
Thinking (look...
• Powerful mathematical
modeling of operations in
Emergency Department,
Operating Room,
Pharmacy, Clinic, Clinical
Laborat...
Example of Stochastic Modeling of Emergency Department
20
Added Value from Systems Engineering in Healthcare
• Great for M...
Powerful Studies Using Huge Databases of Patients’ Records
Number of potential medical records:
• Kaiser Permanente:
• U.S...
Streamlining operations and removing waste using Lean
Added Value from Systems Engineering in Healthcare
Lean does not tel...
Added Value from Systems Engineering in Healthcare
Lean Improvements in Automated
Chemistry Laboratory
Current 
State
Idea...
Powerful Identification, Management and Mitigation of Risks in Healthcare, and Probabilistic Decision Making
Added Value f...
Good Electronics Records Transform Medicine
• Bad Electronic Records cause 
numerous troubles:
• Increase risks to patient...
Added Value from Systems Engineering in Healthcare
Preventing “Incidents” – HealthCare.gov
Good Systems Engineering would ...
Added Value from Systems Engineering in Healthcare
Finding the order in the chaos
• Systems Engineers are experts in findi...
Management of Life‐cycle System Properties (“–ilities”)
Added Value from Systems Engineering in Healthcare
• Safety
• Qual...
Everyone wants a positive outcome for the patient. The problem lies with picking the best
way to facilitate this in a high...
5. INCOSE is eager to partner with
Healthcare Professionals
39
• INCOSE lists 10,000 subject matter experts on systems engineering and hundreds on 
healthcare… who master integrating pe...
Technical Events and Contacts in INCOSE Healthcare Working Group (HWG)
Technical Events
January
International Workshop
htt...
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Strategic Partnership of Healthcare and SE v.2.5.1

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Strategic Partnership of Healthcare and SE v.2.5.1

  1. 1. Strategic Partnership of Healthcare  and Systems Engineering in Turbulent Times International Council on Systems Engineering (INCOSE)  Healthcare Working Group March 28, 2015 1
  2. 2. Quotes from the Report • …”Systems Engineering know‐how must be propagated at all levels [of  healthcare]” • “Implementation of [systems  engineering] bears potential not  only to improve the efficiency of  [health]care delivery, but also to  improve its quality.” 2
  3. 3. What MDs are saying about Systems Engineering… • „It is surprising that many industries have used systems engineering to improve reliability, safety, efficiency, and  effectiveness.  Health care, however,  has been late in embracing systems engineering despite the potential to help fix what  is basically a non‐system of care.   Although health care can do some amazing things, anyone working in health care has   also seen examples of  suboptimal patient outcomes, unaddressed patient safety issues, poor reliability, and inefficiencies.   Traditional medical thinking is not well equipped to improve many of these problems.   Much of this,                          however,  can be addressed if systems engineers, physicians, and health care professionals could better collaborate and use well known systems engineering  techniques such as queuing theory, Lean, Six Sigma, mathematical and computer simulations and models, supply‐chain management techniques, and optimization techniques.   A recent Presidential  Council of Advisors on Science and Technology agreed with these finding in their report, Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering. This really should create the burning platform for greater  incorporation of systems engineering into medical care.” ‐ Michael Kanter, M.D., Regional Medical Director of Quality &  Clinical Analysis, Southern California Permanente Medical Group • „If we physicians are truly interested in improving medical care for our patients and in taking more control of our work,  then it is vital for us to learn and apply the principles of systems engineering.  Physicians already think in terms of bodily  systems so it is not a great intellectual leap for us.  I find it stimulating and rewarding to use my systems thinking skills and  to work in teams with systems engineers who understand medical care.  Everything we do is a process inside a larger  system.  If we want better outcomes, we need to roll up our sleeves and get to work using systems engineering principles  as our indispensable tools." ‐ Stephen F. Tarzynski MD MPH FAAP, Pediatrics, Physician Director of Community Relations &  Market Development, West Los Angeles Area, Kaiser Permanente Medical Care Program 3
  4. 4. Outline 1. The Current (Imperfect) State 2. Systems Engineering to the Rescue 3. What is Systems Engineering? 4. Added Value from Systems Engineering in Healthcare 5. Follow up and Contacts 4 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  5. 5. 1. The Current (Imperfect) State 5 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  6. 6. Desired Characteristics of Healthcare • Affordable & Accessible • Safe • Effective • Patient centered • Timely • Efficient • Inclusive of Latest Science • Well integrated 6 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  7. 7. • $8,508 per capita (UK: $3,406) • Millions still without medical insurance • Medicines unaffordable to a hundred million people • Over 30% of U.S. adults skip a recommended test or treatment because of cost • U.S. ranked #70 in wellness (mostly due to obesity) • U.S. ranked last among 11 countries in preventable deaths The Present Imperfect State 7 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  8. 8. • Highly fragmented system, inefficient interfaces - in desperate need of integration in many dimensions • Bureaucratic overhead robbing providers of useful time with patients • Wrong incentives (Cost curve still climbing, although much less with ACA) • Dramatic changes needed to accommodate the ACA shift from “pay per service” to “pay per outcome” • Revolutions in big data mining and genetics open extraordinary evidence-based opportunities for which knowledge of systems thinking, statistics and medicine must be integrated • Huge progress in medical devices require solid engineering know-how and interoperability • Huge waste in all operations rob patients of quality care – needing Lean • Formerly routine operations such as Operating Room, Critical Care, Emergency Department, Pharmacy – are becoming complex systems that exceed human management capability - requiring special simulators (like aircraft simulators for pilots) • Shrinking budgets require exceptional efficiencies and streamlining – needing Lean • The growing complexity of the healthcare system – needing excellent risk analysis • Increasingly advanced medical devices and information technology needing greater oversight • Unmanaged complexity leads to unpredictable results – needing special tools. A Short list of Problems In increasingly complex operations, with rapid change beyond our control ‐ traditional medicine and management methods fail to fix the dynamic hyper‐system of healthcare – needing more advanced approaches! 8 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  9. 9. 2. Systems Engineering to the Rescue 9 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  10. 10. Super  System 1 Super  System 3 Super  System 2 Super  System 4 Complex System 1 Complex System 2 U.S. Healthcare = Dynamic Hyper System Help from  Systems  Engineering Healthcare Stakeholders • Patients (300,000,000+ in U.S.) • Medical professionals • Medical facilities, hospitals, clinics,  labs • Medical Equipment • Pharmaceuticals • Researchers and academia • Insurances • Employers • Federal & State Governments • Military and Veterans Administration • Fire Departments and Ambulances • and more Powerful Solution 10 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  11. 11. 3. What is Systems Engineering? 11 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  12. 12. What is Systems Engineering? • Beginnings in 1950s in the US Ballistic Missile Programs • It is about rigorous integration of highly complex pieces so that they work together as a system, perfectly, as intended! • Technical management of complex systems, problems and projects (healthcare, infrastructure, engineering, energy, education...) • Rigorous but mostly non-mathematical heuristic knowledge how to analyze and construct complex systems. 12© 2014 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  13. 13. Two Paths for Systems Engineers to Serve Healthcare Traditional Systems Engineer • Typically B.S. in engineering, science, math • Graduate degree as above and/or or in Systems Engineering, or equivalent experience • Often courses in statistics, management, modeling, simulations • Exerienced in multidisciplinary design and development of complex technical systems (spacecraft, rockets, ships, aircraft, weapon systems, nuclear plants, mega projects in infrastructure) • Working as „coordinator” and „integrator” of millions of technical elements and interfaces, all of which must operate perfectly or the system fails. • Fully prepared to assist healthcare professionals in addressing their complex challenges. Healthcare Systems Engineer • Start with healthcare education (MD, nurse, pharmacist, BS in bio or health sciences, healthcare management, administration, researcher…) • MS degree in Healthcare Systems Engineering (HSE). g. LMU HSE curriculum: • Systems Engineering • Project Management • Healthcare Delivery Systems • Lean Healthcare  & Advanced Lean Management of Healthcare • Systems Thinking in Healthcare • Systems Modeling and Simulations in Healthcare • Data Mining in Healthcare (statistics on huge databses) • Patient Safety and Quality Systems • Finances and Accounting in Healthcare • Medical Devices and Integrated Systems • Healthcare Enterprise Informatics and Electronic Records • Project, Internship 13 Serving Healthcare Professionals with Systems Engineering Knowledge Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  14. 14. What is Systems Engineering? • Complex systems almost always fail at the interdisciplinary interfaces‐ • or at the interfaces with externalities (environment) • or interfaces with humans • Medical professionals, managers, even specialty engineers are not trained in  dealing with such problems 14 • SE is a rigorous time-proven process of management and coordination of all relevant details, and strong focus on the system integration and life-cycle performance. Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  15. 15. Simplest system: N = 2 1 connection Slightly more complex system: N = 5 10 one-to-one connections becomes Why do we need Systems Engineering in Healthcare? With millions of patients, doctors, nurses, administrators, and other stakeholders, thousands of cooperating system elements, hospitals, clinics, laboratories, pharmacies, equipment makers and users, devices, specimen, procedures, laws and regulations, in hundreds of cooperating organizations ...neither traditional medicine nor traditional management are sufficient. J.Thomas, INCOSE N(N‐1)/2 15 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  16. 16. Systems Engineering An engineering discipline whose responsibility is creating and  executing an interdisciplinary process to ensure that the customer and stakeholder's needs are satisfied in a high quality, trustworthy,  cost efficient and schedule compliant manner throughout a system's entire life cycle. INCOSE What is Systems Engineering? 16 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  17. 17. 4. Added Value from Systems Engineering in  Healthcare 17 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  18. 18. • Managing Complexity and Efficiently Navigating in Complex Problem Space • Systemic approach using Systems Thinking (looking at problems in their context, seeing the big picture, understanding emerging properties and unintended consequences) • Systems Architecting and Interoperability • Interface Management • Coordination with numerous stakeholders Added Value from Systems Engineering in Healthcare Cured, stable patients Patient  mortality More care needed Budgets Stakeholders Patients Regulations Culture 18 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  19. 19. • Powerful mathematical modeling of operations in Emergency Department, Operating Room, Pharmacy, Clinic, Clinical Laboratory, Medical Administration, Supply Chain… • Stochastic (probabilistic) modeling of operations for studies of capacity, throughput, resources and costs • Logical and functional modeling of complex operations, including state-of-the art “Model Based Systems Engineering” which captures, manages, and allocates requirements to subsystems, and provides effective system integration and verification • Computer simulators of operations (like flight simulator) Added Value from Systems Engineering in Healthcare www.123RF www.flickr.com Washington Post campar.in.tum.de 19
  20. 20. Example of Stochastic Modeling of Emergency Department 20 Added Value from Systems Engineering in Healthcare • Great for Monte Carlo studies of capacity, cost and  throughput • Resource values are input • Random factors are modeled probabilistically Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu Tonya Premsrirath, KP
  21. 21. Powerful Studies Using Huge Databases of Patients’ Records Number of potential medical records: • Kaiser Permanente: • U.S. • World 10,000,000 300,000,000 7,000,000,000 Added Value from Systems Engineering in Healthcare 21 Huge data „mining” now permits powerful studies of simultaneous effects of numerous factors and complex interations. We are no longer constrained to simplistic clinical studies that filter out confounding and interaction effects. This yields rich medical  knowledge and potent treatments. Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  22. 22. Streamlining operations and removing waste using Lean Added Value from Systems Engineering in Healthcare Lean does not tell MDs how to treat patients – it frees the MDs to do it more and better Lean Principles 22 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  23. 23. Added Value from Systems Engineering in Healthcare Lean Improvements in Automated Chemistry Laboratory Current  State Ideal  State Future State Throughput  Time (Olympus) 733.5 minutes 36 minutes 140.5 minutes Cost Savings Baseline $1,570,976  $994,876 .50 .50 Quality Mod High High Frustration of  Lab Staff HIGH Low Moderate Frustration of  MD Mod Low Mod Frustration of  Patient High Low Mod Throughput  Time  (Virology) 57 hours 13.5 hours  (76%) Test Quality Optimal Optimal Patient  Complaints ↑ ↓ Provider Complaints ↑ ↓ Employee  Morale ↓ ↑ Lean Improvements in Microbiology Lab Current Future State State All examples from Kaiser Permanente Value Stream Mapping Streamlining operations in Clinical Laboratories using Lean 23 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  24. 24. Powerful Identification, Management and Mitigation of Risks in Healthcare, and Probabilistic Decision Making Added Value from Systems Engineering in Healthcare https://www.google.com/?gws_rd=ssl#q=risk+matrix https://www.google.com/?gws_rd=ssl#q=normal+curve Regulations and compliance 24
  25. 25. Good Electronics Records Transform Medicine • Bad Electronic Records cause  numerous troubles: • Increase risks to patients • Overwhelm with needless alerts • Poor workflows • Unfriendly user interface • Ineficient data entry • Systems Engineering provides  expertise for IT projects • „Millions lines of code” is bread‐  and‐butter of Systems Engineering Added Value from Systems Engineering in Healthcare 25
  26. 26. Added Value from Systems Engineering in Healthcare Preventing “Incidents” – HealthCare.gov Good Systems Engineering would prevent the imperfect rollout. 26
  27. 27. Added Value from Systems Engineering in Healthcare Finding the order in the chaos • Systems Engineers are experts in finding patterns in what other people see as chaos. They analyze the chaos by seeing patterns of processes or procedures or steps, group them, and quantify what success is for each of the steps. Seeing the whole picture and narrowing down to the details • Systems Engineers are experts at looking at a complex system and breaking it down into the details at multiple levels and points of view without losing track of the big picture. They are experts at breaking things down from the top level picture into the smallest details at the lowest levels where other  disciplines can address the problems in their area of expertise. 27
  28. 28. Management of Life‐cycle System Properties (“–ilities”) Added Value from Systems Engineering in Healthcare • Safety • Quality • Interoperability • Sustainability • Reliability • Survivability • Maintainability • Testability • Resilience • Robustness • Reparability • Flexibility/Adaptability • Modularity • Scalability • Durability • Evolvability • Manufacturability • Agility 28 Bohdan W. Oppenheim, bohdan.oppenheim@lmu.edu
  29. 29. Everyone wants a positive outcome for the patient. The problem lies with picking the best way to facilitate this in a high value way. The field of Systems Engineering offers a wide array of proven methods and scalable approaches that foster a holistic way of examining and solving complex problems in repeatable ways. Added Value from Systems Engineering in Healthcare As the leading professional society and global promoter of Systems Engineering, the International Council on Systems Engineering (INCOSE) is in the best position to help your organization provide this value today. 29
  30. 30. 5. INCOSE is eager to partner with Healthcare Professionals 39
  31. 31. • INCOSE lists 10,000 subject matter experts on systems engineering and hundreds on  healthcare… who master integrating people, tools, and process. • Over 60 years of practice • We speak the language of Systems Engineering in the Context of Healthcare • We handle both the hard and soft aspects of systems engineering and healthcare, leading to  greater success rates • We provide university‐level education in Healthcare Systems Engineering • INCOSE enables cross‐industry sharing of best practices.  We are a forum for meeting world class  experts in Systems Engineering and Healthcare INCOSE at service to Healthcare We invite all Healthcare Professionals: physicians and nurses; hospital, clinic, laboratory and  pharmacy employees; healthcare administrators and managers; medical researchers and scholars;  and all others ‐ to contact us. We are ready to help you take better care of your patients and make your life quality better! 31
  32. 32. Technical Events and Contacts in INCOSE Healthcare Working Group (HWG) Technical Events January International Workshop http://www.incose.org July International Symposium http://www.incose.org Monthly or Bi‐Monthly Informal web conferences https://new.incose.org/wg/biomedical/content/event Throughout the Year Healthcare events at regional INCOSE meetings HWG Leadership Overall Working Group Leads Chris Unger Christopher.Unger@med.ge.com Bob Malins rjmalins@eaglesummittech.com Plus Regional leads for Europe, Australia, and East/Midwest/West coasts Healthcare SE Applications Chris Unger Christopher.Unger@med.ge.com Healthcare MBSE Challenge Ajay Thukral ajay.thukral@cientivegroup.com http://omgwiki.org/MBSE/doku.php?id=mbse:drugdelivery Healthcare Problem/Solution Database Mike Celentano mike.celentano@roche.com Healthcare Education Strategy Rachel Leblanc rbowers@WPI.EDU Jack Stein jstein@me.com, Ajay Thukral  ajay.thukral@cientivegroup.com Lean Bo Oppenheim boppenheim@lmu.edu http://www.lean‐systems‐engineering.org/ Safety 32

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