A systems approach to healthcare efficiency improvement

摘要

Healthcare patient outcomes and healthcare costs, in the context of the healthcare delivery system, is a prominent societal issue for the U.S. Although improvements have been achieved, they are silo-centric, specific to a single area or discipline. It is clear that improvements need to be transferred across the healthcare delivery system in a broader sense. To that end, the ability to measure a change in the system is paramount in determining progress and in what parts of the system are impacted. The research work presented describes a case of how an Electronic Medical Record (EMR) system implementation can be measured within a systems or systems engineering context. In the first phase, time motion study has been employed to assess physician workflow. In this manner, data collection, analysis, and inferences elicited can be quickly assessed by subject matter experts for effectiveness. The objective of this collaborative work is that it demonstrates a systems engineering driven application of the improvement of an orthopaedic office that may then be generalized to a broader context. This works employs a phased approach which allows for synchronization between one set of tools or methodologies from one phase that inform and provide insight for the next. Additionally it facilitates an iterative effort as each phase will assess and reassess the key stakeholders and take into account the process/product life cycle thus allowing refinement of the previous phase and its results. The progression from one phase to another provides the means of measuring the progress and impact. The partnership between the Department of Orthopaedics and the Department of Systems and Industrial Engineering at the University of Arizona, provides a real-life setting for testing our hypotheses. All of the features described in this implementation make up a methodological framework that will render implications for engineers, physicians, patients, and policy makers.