Engineers build high rises, design factories and develop rockets. Now they are getting their chance in health care management with support from the University of Texas System Board of Regents.
UTMB received $560,000 in May from the University of Texas System to examine how systems engineering might improve patient care. The money will fund two separate studies of patients; those getting elective surgery and others who are being treated for COPD, or chronic obstructive pulmonary disease.
The UT System awarded a total of $3 million in grants to UTMB and the system’s five other health institutions. The studies will last for three years.
“The mantra from the grant steering committee was to make clinical systems safer, faster and cheaper, with the emphasis on safer,” said Susan Seidensticker, industrial engineer in the COPD project. She is a quality management specialist in UTMB’s Department of Quality and Healthcare Safety.“As industrial engineers,” Seidensticker said, “we look at work processes and say, ‘You have good systems; we think they could work better.’”
UTMB’s funding will go to projects headed by:
- Dr. Gulshan Sharma, pulmonologist and associate professor and director of the Division of Pulmonary and Critical Care Medicine, Internal Medicine, who is the lead author for the COPD project. The project will receive $300,000 over three years.
- Adam Spieker, quality management specialist in the Department of Quality and Healthcare Safety, who is the lead author for the elective-surgery project. The project will receive $50,000 over three years. In addition, the UT System grant earmarks $210,000 for support services that both programs will need.
Dr. Gulshan Sharma, pulmonologist and grant recipient.
Grants to other UT institutions will focus on infection prevention, laboratory processes, housestaff scheduling, and other issues. Engineers from sister institutions including UT components in Austin, Arlington and Dallas will join in the projects.
“A well-designed system always outperforms individual efforts to improve care,” Dr. Sharma said. The COPD grant will re-engineer the electronic health record system to provide coordinated care across the UTMB Health system for patients with COPD, he said.
Systems engineering is an interdisciplinary field that documents how work is carried out and find ways to improve work processes. The healthcare studies will involve engineering consultants along with physicians, nurses and a wide array of specialists in support positions. In the UTMB projects, the scope of work includes computer systems, clinical-care procedures and ways to emphasize the acknowledged best practices for treatment.
“The heart of the project is putting together a cross-functional team from the clinical side, administration, finance, IT and others. The goal is to design a systematic pathway for elective surgery patients to achieve better coordination of care that increases patient and staff satisfaction,” said Spieker, who also is an industrial engineer. “From there we try to ‘hardwire,’ or embed, the procedures and practices as a way to sustain the system,” he said.
Hospitals and other health care institutions have welcomed engineering principles because the results have been good. UTMB will collaborate with Virginia Mason Medical Center in Seattle, noted for its use of LEAN process-improvement methodology, on the elective-surgery project. LEAN is term associated with the philosophy of kaizen, a Japanese word for “improvement,” which has been applied to business practices at UTMB since 2011.
In both UTMB projects, data collection is the first job to complete, then engineers and clinicians set goals and establishes processes to make them work. The COPD project already has vital information gathered under a previous grant. The elective-surgery project is just beginning so the team will use LEAN methodology to map processes in an effort to understand where breakdowns occur.
Engineering tasks within COPD care, for example, will attempt to remedy shortcomings identified earlier. They include:
- Setting a standard dose of corticosteroid, an anti-inflammatory drug
- Assuring that patients receive a pulmonary function test to confirm the diagnosis of COPD
- Modifying the electronic medical records system so that it suggests management methods based on a patient's medications, exacerbations, symptoms and lung function
- Changing the patient scheduling system to directly communicate to primary-care physicians about the need for follow-up visits
In the elective surgery project, leaders will identify existing clinical pathways and try to improve the continuity of care. “There is currently no system of linkage for departments and services involved in the elective surgical admission process, a process that involves many microsystems. In and of themselves, these microsystems perform competent, efficient care, but make up an inefficient and awkward system secondary to this lack of linkage,” said Dr. Brian Smith, associate professor of orthopaedic surgery
and co-author in the elective-surgery grant.