Healthcare Systems Engineering

Paul M. Griffin, Harriet B. Nembhard, Christopher J. DeFlitch, Nathaniel D. Bastian, Hyojung Kang, David A. Munoz

• Publisher: Wiley
• Year: 2016
• ISBN:
  9781118971093
• Edition: 1
• Topic: Technology & Engineering
• Subtopic: Industrial Engineering
• Index: Technology & Engineering

Apply engineering and design principles to revitalize the healthcare delivery system

Healthcare Systems Engineering is the first engineering book to cover this emerging field, offering comprehensive coverage of the healthcare system, healthcare delivery, and healthcare systems modeling. Written by leading industrial engineering authorities and a medical doctor specializing in healthcare delivery systems, this book provides a well-rounded resource for readers of a variety of backgrounds. Examples, case studies, and thoughtful learning activities are used to thoroughly explain the concepts presented, including healthcare systems, delivery, quantification, and design. You'll learn how to approach the healthcare industry as a complex system, and apply relevant design and engineering principles and processes to advance improvements. Written with an eye toward practicality, this book is designed to maximize your understanding and help you quickly apply toward solutions for a variety of healthcare challenges.

Healthcare systems engineering is a new and complex interdisciplinary field that has emerged to address the myriad challenges facing the healthcare industry in the wake of reform. This book functions as both an introduction and a reference, giving you the knowledge you need to move toward better healthcare delivery.

• Understand the healthcare delivery context
• Use appropriate statistical and quantitative models
• Improve existing systems and design new ones
• Apply systems engineering to a variety of healthcare contexts

Healthcare systems engineering overlaps with industrial engineering, operations research, and management science, uniting the principles and practices of these fields together in pursuit of optimal healthcare operations. Although collaboration is focused on practitioners, professionals in information technology, policy and administration, public health, and law all play crucial roles in revamping health care systems. Healthcare Systems Engineering is a complete and authoritative reference for stakeholders in any field.

Chapter 1
The Healthcare Delivery System

“In nothing do men more nearly approach the gods than in giving health to men.”

—Cicero

Overview

Health care (or healthcare) is the maintenance or restoration of the human body by the treatment and prevention of disease, injury, illness and other physical and mental impairments. Healthcare is delivered by trained and licensed professionals in medicine, nursing, dentistry, pharmacy, and other allied health providers. The quality and accessibility of healthcare varies across countries and is heavily influenced by the health policies in place. It is also and dependent on demographics, social and economic conditions.

A health system (healthcare system or health care system) is organized to facilitate the delivery of care. The World Health Organization (WHO) defines health systems as follows:

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A health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities. A health system is therefore more than the pyramid of publicly owned facilities that deliver personal health services. It includes, for example, a mother caring for a sick child at home; private providers; behavior change programs; vector-control campaigns; health insurance organizations; occupational health and safety legislation. It includes inter-sectoral action by health staff, for example, encouraging the ministry of education to promote female education, a well-known determinant of better health. (Everybody's Business: Strengthening Health Systems to Improve Health Outcomes. WHO's Framework for Action, 2007)

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WHO goes on to say that:

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A good health system delivers quality services to all people, when and where they need them. The exact configuration of services varies from country to country, but in all cases requires a robust financing mechanism; a well-trained and adequately paid workforce; reliable information on which to base decisions and policies; well-maintained facilities and logistics to deliver quality medicines and technologies. (“World Health Organization. Health Systems,” n.d.)

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1.1 Healthcare Delivery Components

The delivery of healthcare to a patient population depends on the systematic provision of services. WHO suggests that “People-centered and integrated health services are critical for reaching universal health coverage. People-centered care is care that is focused and organized around the health needs and expectations of people and communities, rather than on diseases. Whereas patient-centered care is commonly understood as focusing on the individual seeking care (the patient), people-centered care encompasses these clinical encounters and also includes attention to the health of people in their communities and their crucial role in shaping health policy and health services. Integrated health services encompass the management and delivery of quality and safe health services so that people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease-management, rehabilitation and palliative care services, through the different levels and sites of care within the health system, and according to their needs throughout the life course.”

Table 1.1 summarizes the major types of levels and sites of care components and gives some examples of providers and the conditions they address. While there is no universal definition of each type, there is some consensus in usage (except where specifically noted). Improvement of the healthcare system will depend on the provider professionals performing as a team that can act and influence patients as they may transition from one care delivery mode to another.

Table 1.1 Delivery of Healthcare Services

Type	Delivery Focus	Providers	Conditions/Needs
Primary care	Day-to-day healthcare Often the first point of consultation for patients	Primary care physician, general practitioner, or family or internal medicine physician Pediatrician Dentist Physician assistant Nurse practitioner Physiotherapist Registered nurse Clinical officer Ayurvedic	Routine check-ups Immunizations Preventive care Health education Asthma Chronic obstructive pulmonary disease Diabetes Arthritis Thyroid dysfunction Hypertension Vaccinations Oral health Basic maternal and child care
Urgent care	Treatment of acute and chronic illness and injury provided in a dedicated walk-in clinic For injuries or illnesses requiring immediate or urgent care but not serious enough to warrant an ER visit Typically do not offer surgical services	Family medicine physician Emergency medicine physician Physician assistant Registered nurse Nurse practitioner	Broken bones Back pain Heat exhaustion Insect bites and stings Burns Sunburns Ear infection Physicals
Ambulatory or outpatient care	Consultation, treatment, or intervention on an outpatient basis (medical office, outpatient surgery center, or ambulance) Typically does not require an overnight stay	Internal medicine physician Endoscopy nurse Medical technician Paramedic	Urinary tract infection Colonoscopy Carpal tunnel syndrome Stabilize patient for transport
Secondary or acute care	Medical specialties typically needed for advanced or acute conditions including hospital emergency room visits Typically not the first contact with patients; usually referred by primary care physicians	Emergency medicine physician Cardiologist Urologist Dermatologist Psychiatrist Clinical psychologist Gynecologist and obstetrician Rehabilitative therapist (physical, occupational, and speech)	Emergency medical care Acute coronary syndrome Cardiomyopathy Bladder stones Prostate cancer Women's health
Tertiary care	Specialized highly technical healthcare usually for inpatients Usually patients are referred to this level of care from primary or secondary care personnel	Surgeon (cardiac, orthopedic, brain, plastic, transplant, etc.) Anesthesiologist Neonatal nurse practitioner Ventricular assist device coordinator	Cancer management Cardiac surgery Orthopedic surgery Neurosurgery Plastic surgery Transplant surgery Premature birth Palliative care Severe burn treatment
Quaternary care	Advanced levels of medicine that are highly specialized and not widely accessed Experimental medicine Typically available only in a limited number of academic health centers	Neurologist Ophthalmologist Hematologist Immunologist Oncologist Virologist	Multi-drug-resistant tuberculosis Liver cirrhosis Psoriasis Lupus Myocarditis Gastric cancer Multiple myeloma Ulcerative colitis
Home and community care	Professional care in residential and community settings End-of-life care (hospice and palliative)	Medical director (physician) ...