Chui SAMS Lab
Although many health care advocates encourage systems thinking, there continues to be a scarcity in systems engineering in relation to diagnostic and patient safety projects. In 2005, The National Academy of Engineering and the Institute of Medicine called into action The Building a Better Delivery System – A New Engineering/Health Care Partnership. The partnership entails the combination of professionals within the engineering and health care communities to produce a consensus report that addresses the critical role information/communications technologies, systems engineering tools, and other innovations play in quality and productivity in health care systems. The report provides a framework for a systems approach to health care with healthcare professionals and engineers. Another 2014 report, The President’s Council of Advisors on Science and Technology (PCAST) issued an accelerated action towards improvement in health care delivery and lower costs through systems engineering. Strikingly, both reports had limited effect on improvements in health care delivery.
With previous challenges of implementing systems engineering within healthcare, the American Healthcare Research and Quality (AHRQ) created a Funding Opportunity Announcement (FOA) for Patient Safety Learning Laboratories (PSLL). The AHRQ is motivated to providing funding opportunities to the creation of innovative approaches to diagnostics and patient care to create broad system-wide improvements that uses a systems engineering approach.
A PSLL is a learning laboratory where a network of interdisciplinary professionals identifies potential threats to work systems in relation to harm and cost. The lab follows a system engineering methodology to allow cross-disciplinary teams to evaluate clinical processes and work systems to improve patient safety. This systems approach includes identifying the physical environment, technological factors, and clinical workflow processes that work in support of one another within the system. By emphasizing the system-level and the multiple factors that influence patient safety, PSLLs work to discover innovative approaches to healthcare delivery. Through the Agency’s patient safety program, the AHRQ supports and funds the PSLLs.
The AHRQ’s PSLLs purpose is to improve the safety of healthcare by allowing healthcare professionals to acquire experience in various clinical settings, reducing adverse risks and improving patient safety. Through PSLLs, these learning laboratories will provide valuable information to providers, educators, policy makers, and the public about systems engineering approaches and its effectiveness in improving patient safety.
Problem Analysis. The problem analysis will entail a comprehensive understanding of the healthcare work systems through repeated trips to the clinical setting. During these trips, records, risk assessments, and relevant documentation will be reviewed as well as clinical processes and procedures performed. Project teams will need to learn through unit leaders, health care staff, and other stakeholders through interviews to understand the socio-technical factors that influence the clinical experience. The problem analysis will enable cross-disciplinary teams to identify issues within the system and set clear goals and direction to improve workflow processes and performance.
Design. Design objectives is a critical step within the methodology of PSLLs. Objectives address the needs to accomplish a new and improve system through problem analysis, goals and necessary tasks to be performed. Through capturing unique perspectives and ideas from diverse disciplinary teams, design workshops, brainstorming, rapid prototyping can be identified and undergo further testing and development if innovating to the system. Designs put into great specificity the capabilities of the system along with inputs and expected outputs. Not to mention, integration of devices and separate components of the work system can be produced and evaluated as well.
Development. Promising prototypes undergo further develop-test-revise iterations, and subsequent integration as a working system. During this phase, testing and evaluation of subsystem components and users, such as healthcare professionals is critical. Transdisciplinary teams work together to ensure the system requirements are fulfilled with the consideration of human factors. After further improvements are made to the integrated working system, its efficacy is evaluated in a realistic simulated or clinical setting. The end goal of this phase is the completion of subsystem components and their integration into the overall system.
Implementation. The implementation phase provides the opportunity to evaluate the full work system in action within the clinical setting. The project team can verify the success in the integration of the work system and reveal socio-technological factors that were not originally identified.
Evaluation. Effectiveness is rigorously evaluated within this phase after implementation. Within realistic conditions, evaluations of the integrated system should be of sufficient scope and duration to ensure an objective and realistic assessment on the work system was completed.
