Health Care Systems Engineering

  • Jeanne M. Huddleston, M.D.
    • Director
    • Health Care Systems Engineering Program

Jeanne M. Huddleston, M.D.: Hi, I'm Jeanne Huddleston. I work in the Health Care Systems Engineering Program in the Center for the Science of Healthcare Delivery. I think one of the best benefits for using engineering in healthcare could be very aptly described by one of my mentors at Arizona State. He told me that health care now reminds him of what industry was like in the '70s in the United States. Projects were late, everything came in over budget, nothing was done efficiently, lots of errors and lots of safety problems. That pretty much describes part of how health care is being delivered in the United States now. So I believe that we can translate those principals that were used to improve manufacturing and make us competitive again in the '70s and the '80s, apply those to health care, we ought to be able to get some of the benefits that we received decades ago, only improve the health of our population.

There's a couple of examples of systems engineering that's been applied even before we called it systems engineering in health care. One is our unified medical records. So, Henry Plummer was the first internist at Mayo Clinic. He also happened to be an engineer and an architect. So he actually engineered our medical record that we still use today that allows us to combine our outpatient record, our hospital record, our nursing home records, and everything from the time that you're born until you die here. So it's one of the only places in the world where you can actually have everything all at one time when you're taking care of somebody, which as a provider and a patient, being both here, is phenomenal.

Another example is one that probably people don't think about very much, but it's actually the whole development of anesthesia and anesthesiology here in the hospitals. It is the only specialty and the only profession in the hospital that is actually functioning at a reliability level that we would be proud of in manufacturing. Very few errors, very few problems, because as they developed their field, they watched for errors and they engineered equipment, and policies, and they used checklists like our airline industry does to make sure everything would go as smoothly as possible during a relatively dangerous period of time for patients. We're putting them to sleep, we're doing surgeries, and so they have perfected that at a level in health care that we haven't been able to do anywhere else. And it's all the engineering principles that have been applied along the way.

So there's a few examples of what we've been doing recently. One that I'm incredibly passionate about, because it has come out of the mortality work that I've been doing in the hospitals for the last eight years, is called bedside patient rescue. Our number one preventable cause of death here in Rochester is a clinician's inability to recognize when a patient's become sick, when their care or their condition has, all of a sudden, gone a different direction than we thought it was going. So that change in course is difficult for providers, physicians, nurses alike, to recognize when that change happens. A delay in that recognition can have serious consequences for patients.

Dr. Huddleston: So we're actually doing a full systems engineering approach to this from doing a failure modes effect analysis, literally going in and talking to every discipline from nurses, respiratory therapists, physicians, surgeons, residents, students, engineering students, patients, etc., to find out how this actually works from everyone's perspective. All the people who are involved. And then where are we missing from each of their perspectives. We're doing really sophisticated analytics in terms of trying to understand what the actual physiology, what conditions are happening to the patients so that we can recognize it in our electronics to tell the providers when something's changing, but that has to be done at a way so there aren't false alarms. Because if I tell you the patient is deteriorating and you go and they're not, then that hasn't been good for anybody involved. So we have to figure out how to do that better than we currently do, and then bring all of that together with our electrical engineers and our mechanical engineers to actually design equipment that will make this change in condition to patients obvious to everybody and make the recovery obvious to everybody from a visual perspective and a intellectual perspective. So it's a project that's going to take a little bit of time to pull all of this together, but ultimately we'll save lives, and our guess is that we'll save at least 50 lives a year just in Rochester by doing the math that the engineers can do and understanding the cognitive and the workflow pieces that are involved in, too.

In the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Health Care Systems Engineering Program aims to improve health care delivery systems — as well as increase the efficiency and effectiveness of health care delivery — by applying principles from engineering, management and translational science.

By applying such principles to health care, the program's four components aim to improve patient care, enhance patient satisfaction, and contain or reduce costs.

Systems Engineering and Operations Research

The Systems Engineering and Operations Research component is composed of a multidisciplinary group of faculty with expertise in systems engineering, operations research, human factors, clinical research, statistics, sociology and cognitive psychology.

These faculty members have scientific and methodological expertise in a wide variety of systems engineering areas, enabling them to work across many different health care delivery settings and on multiple simultaneous projects.

Among other responsibilities, they are deeply involved in the design of research methodologies and oversee the analysis of research conducted by the Health Care Systems Engineering Program.

Other members of this component include postdoctoral research fellows and various allied health staff, such as master's-level health systems engineering analysts, statistical programming analysts, computer programmers, R.N. study coordinators, design engineers and student interns.

Inpatient Clinical Engineering Laboratory

To conduct hospital-focused health care delivery research and test ideas before bringing them to patients, the Health Care Systems Engineering Program is establishing the Inpatient Clinical Engineering Laboratory. Specialized technology will allow round-the-clock electronic data collection, enabling high-fidelity advanced computer modeling of health care delivery systems.

This "living laboratory" will be unique in its ability to link patient and health care delivery data. By creating models using these data, it will be possible to conduct "what if" evaluations of new health care delivery methods.

The unit will be available for use by physicians and researchers at Mayo Clinic, as well as external organizations and universities interested in carrying out health care delivery research or testing new patient care processes and devices.

Systems Engineering and Operations Research Collaborative

This internal Mayo Clinic collaborative, which began in 2005, brought together Mayo staff with expertise in areas such as business analysis, health care policy and research, and quality management to study how systems engineering and operations research could be used to improve health care.

Over the past few years, the collaborative has sponsored a number of educational opportunities for Mayo staff, including a monthly seminar, discussion forum, conference on health care systems engineering and operations research, computer-based simulation workshop, and a master's- level Mayo Graduate School course.

With the creation of the Center for the Science of Health Care Delivery, the Health Care Systems Engineering Program is now overseeing this collaborative in an effort to increase awareness and promote coordination of systems engineering and operations research activities at Mayo.

Engineering Coordination Council

The work of many Mayo Clinic departments and divisions includes an engineering aspect. To enhance communication among these departments and develop common infrastructure, Mayo formed the Engineering Coordination Council.

Now led by the Health Care Systems Engineering Program, this council is being used to convene Mayo leaders and spur discussions about how engineering intersects with research, patient care and the science of health care delivery.

It is also promoting engineering collaborations, facilitating more efficient and effective applications of multidisciplinary engineering methods and tools, and improving coordination and utilization of engineering resources.