This document provides an overview of medical simulation and its applications in healthcare delivery. It discusses how simulation can be used as a tool to systematically analyze complex healthcare systems and processes, identify bottlenecks, and test interventions to optimize quality and safety. Specific applications mentioned include using simulation to study workflows like sepsis care, test user interfaces on clinical tasks and performance, and evaluate new system designs before implementation. The goal is to move from traditional education-focused "Simulation 1.0" to a more integrated "Simulation 2.0" approach that leverages simulation throughout healthcare systems and daily practices.
Medical Simulation Market to Reach US$ 2.50 Billion by 2022Amy Williams
The medical simulation market is expected to exceed more than US$ 2.50 Billion by 2022; Growing at a CAGR of more than 15% in the given forecast period.
A Comprehensive Introduction to Medical SimulationRoger Smith
Introduction to the science and practice of medical and surgical simulation. Topics Covered: History, Taxonomy, Learning Processes, Standardized Patients, Patient Simulators, Team Training, Surgery Simulators, Best Practices.
Simulation training in medicine and technology managementMCH-org-ua
Presentation by the Ukrainian-Swiss Mother and Child Health Programme at 2nd Regional Health Technology Management Worskhop (April 10-11, 2014, Chisinau, Moldova)
Medical Simulation Market to Reach US$ 2.50 Billion by 2022Amy Williams
The medical simulation market is expected to exceed more than US$ 2.50 Billion by 2022; Growing at a CAGR of more than 15% in the given forecast period.
A Comprehensive Introduction to Medical SimulationRoger Smith
Introduction to the science and practice of medical and surgical simulation. Topics Covered: History, Taxonomy, Learning Processes, Standardized Patients, Patient Simulators, Team Training, Surgery Simulators, Best Practices.
Simulation training in medicine and technology managementMCH-org-ua
Presentation by the Ukrainian-Swiss Mother and Child Health Programme at 2nd Regional Health Technology Management Worskhop (April 10-11, 2014, Chisinau, Moldova)
Simulation is the imitation of the operation of a real-world process or system over time.
The act of simulating something first requires that a model be developed; this model represents the key characteristics or behaviors/functions
Scheduling Of Nursing Staff in Hospitals - A Case Studyinventionjournals
International Journal of Mathematics and Statistics Invention (IJMSI) is an international journal intended for professionals and researchers in all fields of computer science and electronics. IJMSI publishes research articles and reviews within the whole field Mathematics and Statistics, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This second interactive webinar in the series will draw upon Dr. Ian Graham's Knowledge to Action cycle and focus specifically on the central role of developing and synthesising evidence of what to implement and which knowledge translation and implementation strategies are most effective for promoting implementation, and developing the knowledge infrastructure to make best use of evidence.
This report summarizes the results of a campus-wide survey initiative, conducted by the Southern California Clinical and Translational Science Institute (SC CTSI), focused on the development of a clinical data warehouse for research (CDWR) and a clinical trials management system (CTMS) as well as general barriers to conducting clinical research at the University of Southern California (USC) and Children's Hospital Los Angeles (CHLA).
Learn more about SC CTSI http://www.sc-ctsi.org/
An excellent article that uses predictive and optimization methods to reduce hospital readmissions.
Another great article, "Reducing hospital readmissions by integrating empirical prediction with resource optimization" (Helm, Alaeddini, Stauffer, Bretthaur, and Skolarus, 2016) describes how Machine Learning modeling tools were used to determine the root-causes and individualized estimation of readmissions. The post-discharge monitoring schedule and workplans were then optimized to patient changes in health states.
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Medical Simulation Industry Overview (TechNet 2012)rheinl271
This presentation is intended to provide an introduction and overview of the medical simulation market domain for defense modeling, simulation, and training audiences interested in applying their capabilities, expertise and products to medical and healthcare training and education needs.
Presentation by Lucas Opitz at the International conference on Simulation-based training in medicine (Kyiv, Ukraine, March 19-20, 2015)
http://motherandchild.org.ua/eng/SimConf-2015
Simulation is the imitation of the operation of a real-world process or system over time.
The act of simulating something first requires that a model be developed; this model represents the key characteristics or behaviors/functions
Scheduling Of Nursing Staff in Hospitals - A Case Studyinventionjournals
International Journal of Mathematics and Statistics Invention (IJMSI) is an international journal intended for professionals and researchers in all fields of computer science and electronics. IJMSI publishes research articles and reviews within the whole field Mathematics and Statistics, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This second interactive webinar in the series will draw upon Dr. Ian Graham's Knowledge to Action cycle and focus specifically on the central role of developing and synthesising evidence of what to implement and which knowledge translation and implementation strategies are most effective for promoting implementation, and developing the knowledge infrastructure to make best use of evidence.
This report summarizes the results of a campus-wide survey initiative, conducted by the Southern California Clinical and Translational Science Institute (SC CTSI), focused on the development of a clinical data warehouse for research (CDWR) and a clinical trials management system (CTMS) as well as general barriers to conducting clinical research at the University of Southern California (USC) and Children's Hospital Los Angeles (CHLA).
Learn more about SC CTSI http://www.sc-ctsi.org/
An excellent article that uses predictive and optimization methods to reduce hospital readmissions.
Another great article, "Reducing hospital readmissions by integrating empirical prediction with resource optimization" (Helm, Alaeddini, Stauffer, Bretthaur, and Skolarus, 2016) describes how Machine Learning modeling tools were used to determine the root-causes and individualized estimation of readmissions. The post-discharge monitoring schedule and workplans were then optimized to patient changes in health states.
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Medical Simulation Industry Overview (TechNet 2012)rheinl271
This presentation is intended to provide an introduction and overview of the medical simulation market domain for defense modeling, simulation, and training audiences interested in applying their capabilities, expertise and products to medical and healthcare training and education needs.
Presentation by Lucas Opitz at the International conference on Simulation-based training in medicine (Kyiv, Ukraine, March 19-20, 2015)
http://motherandchild.org.ua/eng/SimConf-2015
Unlocking Technology Opportunities in Value-Based Healthcare | Parimal Shah |...UCICove
About UCI Applied Innovation:
UCI Applied Innovation is a dynamic, innovative central platform for the UCI campus, entrepreneurs, inventors, the business community and investors to collaborate and move UCI research from lab to market.
About the Cove @ UCI:
To accelerate collaboration by better connecting innovation partners in Orange County, UCI Applied Innovation created the Cove, a physical, state-of-the-art hub for entrepreneurs to gather and navigate the resources available both on and off campus. The Cove is headquarters for UCI Applied Innovation, as well as houses several ecosystem partners including incubators, accelerators, angel investors, venture capitalists, mentors and legal experts.
Follow us on social media:
Facebook: @UCICove
Twitter: @UCICove
Instagram: @UCICove
LinkedIn: @UCIAppliedInnovation
For more information:
cove@uci.edu
http://innovation.uci.edu/
Health device makers, to date, have primarily targeted consumers who are either fitness focused or chronically ill. But between these two extremes sits a large, fragmented and often overlooked population who seek better information to effectively manage their health. Our research suggests that successful solution providers will approach this market opportunity as an ecosystem of partners – with an integrated solution that extends beyond the device itself. By plugging the information gap for these consumers, solution providers can help fuel healthcare innovation.
Is Value-Based Healthcare Here to Stay? Looking for Answers in New PoliciesHealth Catalyst
Healthcare leaders are eager for a modicum of clarity when it comes to the industry’s shift to value-based healthcare given the uncertainties of Congress and the new Administration.
Fortunately, an analysis of three key pieces of information tells us value-based healthcare is likely here to stay:
The 21st Century Cures Act (Cures).
The Executive Order on reducing the “burden” of the Affordable Care Act (ACA).
Tom Price’s comments at his confirmation hearings.
It is a relatively safe bet that value-based healthcare delivery and payment programs will continue to be supported by federal law and regulation for several reasons:
Bipartisan support: The success of Cures indicates that bipartisan cooperation will continue on key healthcare issues.
Market-based innovation: The emerging evidence is that Congress and the Administration will support innovation in payment and delivery models.
Support for Existing ACA Innovation programs: Although highly uncertain, there are some indications that not all of the ACA will be scrapped.
The MD Anderson / IBM Watson Announcement: What does it mean for machine lear...Health Catalyst
It’s been over six years since IBM’s Watson amazed all of us on Jeopardy, but it has yet to deliver similar breakthroughs in healthcare. The headlines in last week’s Forbes article read, “MD Anderson Benches IBM Watson In Setback For Artificial Intelligence In Medicine.” Is it really a setback for the entire industry or not? Health Catalyst’s EVP for Product Development, Dale Sanders, believes that the challenges are unique to IBM’s machine learning strategy in healthcare. If they adjust that strategy and better manage expectations about what’s possible for machine learning in medicine, the future will be brighter for Watson, their clients, and AI in healthcare, in general. Watson’s success is good for all of us, but it’s failure is bad for all of us, too.
Join Dale as he discusses:
The good news: Machine learning technology is accelerating at a rate beyond Moore’s Law. Dale believes that machine learning algorithms and models are doubling in capability every six months.
The bad news: The healthcare data ecosystem is not nearly as rich as many would believe, and certainly not as rich as that used to train Watson for Jeopardy. Without high-volume, high-quality data, Watson’s potential and the constant advances in machine learning algorithms will hit a glass ceiling in healthcare.
The best news: By adjusting strategy and expectations, there are still plenty of opportunities to do great things with machine learning by using the current data content in healthcare, while we build out the volume and breadth of data we need to truly understand the patient at the center of the healthcare picture… and you don’t need an army of PhD data scientists to do it.
Josephine Briggs, MD
Director
National Center for Complementary and Alternative Medicine
National Institutes of Health
Opening Keynote "Research in an IT Connected World: Building Better Partnerships – NIH and Health Care Systems"
The era of ‘Big Data’ has arrived for biomedical research, bringing with it immense challenges as well as spectacular opportunities. NIH is establishing major programs with the potential to transform the future of US biomedical research by building the capacities necessary for these challenges. These programs will strengthen research partnerships with health care systems and the IT networks that support them.
The Big Data to Knowledge (BD2K) initiative, to be launched in 2014, will implement a set of recommendations from the Data and Informatics Working Group to the Advisory Committee to the Director. Investments are planned to meet scientific needs to manage and utilize large complex datasets, including strengthening training, and investing in improved analysis methods and software development and dissemination. NIH is also evaluating strengthening data and software sharing policies, and the potential creation of catalogs of research data, and data/metadata standards.
The Common Fund’s Health Care Systems (HCS) Research Collaboratory program has the goal to strengthen the national capacity to implement cost-effective large-scale research studies by engaging major health care delivery organizations as research partners. The aim of the program is to provide a framework of implementation methods and best practices that will enable the participation of many health care systems in clinical research. Research conducted in partnership with health care systems is essential to strengthen the relevance of research results to health practice. Seven demonstration projects, currently in a feasibility phase, are developing detailed methods to implement rigorous randomized studies of questions of major public health impact. These studies, and the IT infrastructure that will make them possible, will be described in detail.
Patient safety is the cornerstone of high-quality healthcare services. In the presentation, A summary of the frameworks & practical approaches to improve safety of patient care.
Presented at "Hospital Management 2015" Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on August 18, 2015
Strengthening Health Systems through the application of Wireless TechnologyOPS Colombia
Presentación realizada por el Dr. Trishan Panch, de Harvard School of Public Health, el 20 de Septiembre en OPS Colombia, en el espacio de intercambio sobre e-health.
El Dr. Panch, participa, con el auspicio de esta Representación, como conferencista en el IV Congreso Colombiano de Bioingeniería e Ingeniería Biomédica que se realizará en Barranquilla del 21 al 24 de septiembre del 2011.
Similar to Medical Simulation 2.0: Improving value-based healthcare delivery (20)
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
6. Objectives
• Challenges facing healthcare professionals
to improve the healthcare delivery: Systems
Thinking and Patient Safety
• Summarize simulation and modeling tools
for systematic analysis and optimization
complex system processes and
interventions
• Describe common computer simulation
applications for quality improvement and
patient safety in ICU.
10. Health System Safety
• 33.6 million
admissions to U.S.
hospitals in 1997
• 44,000- 98,000
Americans die each
year as a result of
medical errors.
• Total cost $17- $29
billion
12. U.S. spends most, but lower life
expectancy relative to developed peers
Source: OECD Health Data, 2008
~$3 Trillion (~1/5 GDP)
~ 30% may be waste
USA
13. Green LW. Making research relevant: if it is an evidence-based practice, where's the practice-
based evidence? Family Practice 2008; 25: i20–i24
14. “Blue Highways” on the NIH Roadmap
Practice-based
research
Phase 3 and 4 clinical
trials
Observational studies
Survey research
Basic science
research
Preclinical studies
Animal research
Human clinical
research
Controlled
observational studies
Phase 3 clinical trials
T1
Case series
Phase 1 and 2
clinical trials
Clinical practice
Delivery of recommended
care to right pt at right time
Identification of new clinical
questions and gaps in care
T2
Translation
to humans
T2
Guideline
development
Meta-analyses
Systematic
reviews
Translation
to patients
T3
Dissemination
research
Implementation
research
Translation
to practice
Westfall JM et al: JAMA 297:403, 2007
Bench Bedside Practice
15. The fundamental problem with the quality of
American medicine is that we’ve failed to view
delivery of health care as a science.
• understanding disease
biology
• finding effective therapies
• insuring those therapies are delivered effectively
Peter Pronovost http://www.letstalkhealthcare.org/health-care-costs/how-a-checklist-can-improve-health-care/
16.
17. Temporal Trends in Rates of Patient Harm
Resulting from Medical Care
Temporal Trends in Rates of Patient Harm Resulting from Medical Care. Landrigan, et al, N Engl J Med 2010 ; 363 : 2124 - 2134
21. Health care as a complex
adaptive system
W. B. Rouse. Health care as a complex adaptive system: Implications for design and management. The Bridge, 38(1), Spring 2008.
22. Complex adaptive systems
• nonlinear and dynamic, system behaviors may appear to be
random or chaotic.
• composed of independent agents whose behavior is based on
physical, psychological, or social rules rather than the demands
of system dynamics.
• agents’ needs or desires, their goals and behaviors are likely to
conflict. In response to these conflicts or competitions, agents
tend to adapt to each other’s behaviors.
• agents are intelligent. As they experiment and gain experience.
• adaptation and learning tend to result in self-organization.
Behavior patterns emerge rather than being designed into the
system.
• no single point(s) of control.
Rouse, 2000
24. The world is a complex system of systems
Communication
$ 3.96 Tn
Transportation
$ 6.95 Tn
Leisure / Recreation /
Clothing
$ 7.80 Tn
Healthcare
$ 4.27 Tn
Food
$ 4.89 Tn
Infrastructure
$ 12.54 Tn
Govt. & Safety
$ 5.21 Tn
Finance
$ 4.58 Tn
Electricity
$ 2.94 Tn
Education
$ 1.36 Tn
Water
$ 0.13 Tn
Global system-of-systems
$54 Trillion
(100% of WW 2008 GDP)
Same Industry
Business Support
IT Systems
Energy Resources
Machinery
Materials
Trade
Legend for system inputs
IBM analysis based on OECD data.
Note: Size of bubbles represents systems’ economic values. Arrows represent the strength of systems’ interaction.
Source: IBM Institute for Business Value analysis of Organisation for Economic Co-operation and Development (OECD) data.
28. Human beings make mistakes because
the systems, tasks and processes they
work in are poorly designed.
Dr. Lucian Leape
Every system is perfectly designed
to get the results it gets.
Dr. Donald M. Berwick
Systems approach to improve
patient safety
31. Outcome + Safety + Service
Value =
Cost over time
Leveraging for Highest Value
Smoldt RK, Cortese DA. Pay-for-performance or pay for value?
Mayo Clinic Proceedings 2007;82:210-3
33. “ Simply educating and training more physicians will not be enough to address these
shortages. Complex changes such as improving efficiency, reconfiguring the way some
services are delivered and making better use of our physicians will also be needed.”
The Complexities of Physician Supply and Demand: Projections Through 2025. 2008 AAMC http://www.aamc.org/workforce
34. 2011, Health IT and Patient Safety: Building Safer Systems for Better
Care, Committee on Patient Safety and Health Information Technology; Institute of Medicine
35. Adjust structure and process to eliminate or
minimize risks of health care-associated
injury, before they have an adverse event-
impact on the outcomes of care
Donabedian. Evaluating of Medical Care. The Milbank Memorial Fund Quarterly,
Vol. 44, No. 3, Pt. 2, 1966 (pp. 166–203)
36. System Interventions
Systems Engineering Initiative for Patient Safety (SEIPS) Work system design for patient safety: the SEIPS model.
Carayon P, et al . Qual Saf Health Care. 2006 Dec;15 Suppl 1:i50-8. Review.
37. WHO Global Priorities for Patient Safety Research
Bates DW, et al. Global priorities for patient safety research. BMJ 2009;338:b1775
38. Structure, process or outcome: which
contributes most to patients' overall
assessment of healthcare quality?
• Experiences regarding process aspects explained
most of the variance in the global rating (16.4–
23.3%), followed by structure aspects (8.1–21.0%).
Experiences regarding outcome did not explain
much variance in the global rating in any of the
patient groups (5.3–13.5%).
• What is patient-centered care?
BMJ Qual Saf doi:10.1136/bmjqs.2010.042358
43. • designing the system to prevent
errors
• designing procedures to make errors
visible when they do occur so that
they may be intercepted
• designing procedures for mitigating
the adverse effects of errors when
they are not detected and intercepted
Nolan, 2000 BMJ Department of Health and the Design Council in England 2003
44. Common patient safety
improvement efforts
• Culture
• Crew resource
management
• Event reporting:
close-claim; near-
miss
• Root cause
analysis
• Human factor
design
• Simulation
• Technology
• Lean, six-sigma
• Etc.
45. Terminology
• Model vs. Simulation (noun)
Model can be used WRT conceptual,
specification, or computational levels
Simulation is rarely used to describe the
conceptual or specification model
Simulation is frequently used to refer to the
computational model (program)
• Model vs. Simulate (verb)
To model can refer to development at any of
the levels
To simulate refers to computational activity
Steve Park and Larry Leemis
47. • Simulation is the imitation or representation of
one act or system by another.
• Healthcare simulations can be said to have four
main purposes – education, assessment,
research, and health system integration to
facilitate patient safety...
• Simulations may also add to our understanding of
human behavior in the true–to–life settings in
which professionals operate.
50. Medical Education
• Study the effectiveness of
simulation based medical education
(SBME)
• Developing valid outcome
assessment instrument, stretch
measurement endpoints from the
simulation lab into clinical practice
(association studies)
• Provide highly reliable data for
decision support and high-stakes
testing.
53. Skill Acquisition Curve
Impact of Zero-Risk Training
CP1345275-1
Clinical competence
Metricassessment
(e.g.,compositescore)
Time
Traditional training
Safety standard
Simulation-based training
Dong et al, Chest 2010
54. The First Research Consensus Summit of the
Society for Simulation in Healthcare
• Simulation for Learning and Teaching Procedural Skills: The State of the
Science
• Simulation-Based Team Training in Healthcare
• A Path to Better Healthcare Simulation Systems: Leveraging the Integrated
Systems Design Approach
• The Study of Factors Affecting Human and Systems Performance in
Healthcare using Simulation
• Literature Review: Instructional Design and Pedagogy Science in
Healthcare Simulation
• Evaluating the Impact of Simulation on Translational Patient Outcomes
• Research Regarding Methods of Assessing Learning Outcomes
• Research Regarding Debriefing as Part of the Learning Process
• Simulation-Based Assessment of the Regulation of Healthcare
Professionals
• Reporting Inquiry in Simulation
Simul Healthc. 2011 Aug;6 Suppl:S1-9.
56. Simulation in Healthcare
Simulation 1.0
• Simulation as subject
• At simulation center
• Education
Training effectiveness
Psychometric qualities
Ecological validity
Simulation 2.0
• Simulation as tool
• Everywhere
• Daily practices
System integration
Human factors
Usability of device,
process, etc.
57. Military Simulation Spectrum
J G Taylor, Modeling and Simulation of Land Combat, ed L G Callahan, Georgia Institute of Technology,
Atlanta, GA, 1983
58. Human factor and Usability research
• Using simulation as a tool to study human
performance variation under different “stress
conditions” (fatigue, cognition, workload, etc.)
• Investigating provider behaviors/tasks
Observation “in the wild” (Ethnography)
Simulation environment
• Conduct usability testing of devices instrument
and processes, using information driven
approach for new system design
• Evaluation of the impact on clinical practices
59. The effect of drug concentration expression on
epinephrine dosing errors: a randomized trial
Wheeler DW, Carter JJ, Murray LJ, Degnan BA, Dunling CP, Salvador R, et al.. Ann Intern Med 2008;148:11-4.
(1 mg in 1 mL) (1 mL of a
1:1000 solution)
60. Ahmed, et al. Critical Care Medicine, 39(7) 1626-1634
The effect of two different electronic health record user interfaces on
intensive care provider task load, errors of cognition, and performance
61.
62. Complexity of Sepsis Resuscitation in ICU
Adopted from: Network medicine--from obesity to the "disease". Barabási AL., N Engl J Med. 2007 Jul 26;357(4):404-7.
SHOCK
DIC AKI
ALI
Physician RT
Pharmacist
Nurse
Time
Baseline
PatientOutcome,
ProviderSatisfactions
67. Simulation in manufacturing and business: A review
M. Jahangirian, T. Eldabi, A. Naseer, L.K. Stergioulas and T. Young, Simulation in manufacturing and business: a review, European Journal of
Operational Research 203 (2010), pp. 1–13
71. System Engineering Tools for Healthcare Delivery
Proctor P. Reid, W. Dale Compton, Jerome H. Grossman, and Gary Fanjiang, Editors, Committee on Engineering and the Health
Care System, Institute of Medicine and National Academy of Engineering, 2005
75. Sepsis Care Optimization by Discrete Event Simulation
(S-CODES)
Place Central
Line
Central
Line
Approval
Etc, etc,
etc
Dong Y, Lu H, Rotz J, et al. Simulation Modeling of Healthcare Delivery During Sepsis
Resuscitation. Critical Care Medicine 2009;37:A334
76. Project 2: Scheduling for Critical Care Fellows using Modeling and
Simulation: The Trade Off Between Duty Hours and Hand-offs
Fellow A Fellow B Fellow C
7 am 7 pm
Patient 1
Patient 2
Patient 3
Patient 4
Patient 5
Handoffs
0
2
1
0
1
4
Provider
Transfer
Patient
Handoff
78. Project 3: Time-motion observational study of
multidisciplinary ICU rounding in a teaching hospital
• To describe the current practice, and structure of the morning
multidisciplinary round in the ICU practices (MICU, SICU)
• Prospective field observation of ICU provides task (consultant,
fellow, resident/intern, nurse, pharmacist) based on systems
engineering approach
• Task categories defined based on provider survey
• Purpose strategies (work-flow redesign, new EMR interface) to
improve
the efficiency of ICU round, reduce MEOW
patient outcome
provider satisfaction
83. Challenges and opportunities
• Fragmentation of
care delivery
• Access
information from
various sources
• Clinical
implementation
• System integration
• Health IT (mobile,
cloud, social
networking, big
data)
• Provider education
and change culture
84. • 1920’: BME, Biophysics, Medical Physics
• 1943: German Biophysical Society
• 1948: Annual Conference of Engineering in
Medicine and Biology/Radiation Research
Society
• 1961: International Federation of Medical
and Biological Engineering
• 1968:Biomedical Engineering Society
86. Road map for
better healthcare delivery
Dong Y, et al. ICU Operational Modeling and Analysis. In: Kolker A, Story P, eds. Management Engineering for
Effective Healthcare Delivery: Principles and Applications. Hershey, Pennsylvania, USA: IGI Global; 2011.
87. Key Messages
• The complexity of healthcare delivery
systems contributes to preventable
medical error and insufficient quality
• Computer modeling/simulatio coupled with
realistic patient simulation represents a
potent catalyst in adapting systems
engineering principles to healthcare
• The medical community needs partnership
with the systems engineering community
to best deliver high value care
Key FindingsThe nation is likely to experience a shortage of physicians which will grow over time.Though the supply of physicians is projected to increase modestly between now and 2025, the demand for physicians is projected to increase even more sharply.Aging of the population may drive demand sharply upward for specialties that predominantly serve the elderly (e.g., oncologists).The US Census Bureau projects that the US population will grow by more than 50 million (to 350 million) between 2006 and 2025. This alone will likely lead to a considerable increase in the demand for physician services.Growth in future demand could double if visit rates by age continue to increase at the same pace they have in recent years – with the greatest growth in utilization among those 75+ years of age.Universal health care coverage could add 4 percent to overall demand for physicians; this would increase the projected physician shortfall by 31,000 physicians (25 percent).Even a modest increase in physician productivity could do more to alleviate the projected gap between supply and demand than any other supply-side change but productivity improvements in health care have been hard to achieve as care has become more complex.Future demand for physicians would be significantly reduced if physician assistants and nurse practitioners play a larger role in patient care.Even a robust expansion of GME capacity (from 25,000 new entrants per year to 32,000) would only reduce the projected shortage in 2025 by 54,000 physicians (43 percent). Future physician workforce planningchanges in medical school capacity and the availability of GME positions as part of a broader strategymake more effective use of the limited physician supply, and to improve productivity;Recognize and respond to physician life-style concernsImprove data collection and workforce studies and expand collaboration among health professions organizations on data and workforce policies.