deborah nightingale

7/31/2019 Deborah Nightingale

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A Lean Enterprise Systems Approach toHealthcare Transformation

Professor Deborah NightingaleMIT Conference on Systems Thinking for Contemporary Challenges

Massachusetts Institute of TechnologyOctober 23, 2009


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MIT Conference on Systems Thinking for Contemporary Challenges 2009 Massachusetts Institute of Technology D. Nightingale 10/23/09- 2 http://lean.mit.edu

Agenda

Research Motivation Cross-Industry Knowledge on Enterprises

Case Examples Ongoing Research

LAI Enterprise Healthcare Vision


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Quality

98,000 deaths attributed to medical errors Adults on average only receive 55% of recommended careEmergency Departments are overcrowded nationwideProvider fragmentation unable of creating sufficient volume

Cost

Over 16% of US GDP spent in healthcare expenses

Hospital care represents 30.8% of total expenditure49% of expenditure concentrated in only 5% of populationIndividuals over 65 years old expected to increaseover 50% by 2020

Access

45 million Americans are uninsuredFragmented provider network, 75% being small or single practicesRecent survey indicated 40% of Americans received uncoordinated careFragmented payment systems, health plans, information systems, etc

Research Motivation

Life Expectancy at Birthand GDP Per Capita

2005 OECD Data


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Agenda





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The Challenges of Complex Enterprises

Requires a Systems Approach

New strategic systems perspective

Viewing enterprises as holistic and highly networkedsystems

Integrating leadership processes, lifecycle processes and

enabling infrastructure systems Balancing needs of multiple stakeholders working across

boundaries

MOVING FROM THE PAST(hierarchical) enterprise

TOWARDS THE FUTURE(networked) enterprise


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LAI - A Consortium Dedicated ToCross Industry Enterprise Performance

Enable Enterprises to effectively, efficiently and reliablycreate value in a complex and dynamic environment

Enable focused and accelerated transformation of complex enterprises

Collaborative engagement of all stakeholders inGovernment, Industry and Academia

Understand, develop, and institutionalize principles,processes, behaviors and tools


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MIT Studies on Industrial Productivity

1989

Identified sources of major weaknesses in

US productivity,including commercialaircraft & education.

1990

Identified Lean,based upon ToyotaProduction Systemas a successor tomass production.

2002

Translated Leanprinciples to

aerospace andenterprise context.


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Cross Industry

Enterprise Challenges

Overarching commitment to ensureglobal peace and security

Incumbent higher, faster, farther mindset

Declining defense dollars after ColdWar (fewer military aircraft programs;industry consolidation)

Inherently complex industry: Multiple stakeholders with misaligned

objectives and numerous constraints Capital Intensive Complex product development

Uncertain outcome in contract awarding

Aerospace Healthcare

Overarching commitment to provideworld class medical care

Incumbent overuse, underuse, andmisuse mindset

Overburdened healthcare expenditureas a % of GDP (proliferation of fragmented disjointed providers)

Inherently complex industry Multiple stakeholders with misaligned

objectives and numerous constraints Capital Intensive Complex service provision

Uncertain outcome in value sharing


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Source: D. Nightingale and J.K Srinivasan, MIT 2008

7.Emphasize

organizationallearning.

6.Cultivate

leadership tosupport and drive

enterprisebehaviors.

5.Ensure stability

and flow withinand across the

enterprise.

4. Address internal

and externalenterpriseinterdependencies.

3.Focus onenterprise

effectivenessbefore efficiency.

2.Identify relevantstakeholders anddetermine their

value propositions.

1. Adopt a holisticapproach toenterprise

transformation.

Leveraging LAIs

Cross Industry Experience7 Principles of Lean Enterprise Thinking


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UnderstandCurrent

State

PLANNING CYCLE

DetermineStrategic

Imperative

Capabilities & Deficiencies Identified

Lean Enterprise Vision

Long-TermCorrectiveAction

Short-TermCorrective

Action

Strategic Implications of Transformation

Envision & DesignFuture

Enterprise

Nurture,Process & EmbedLean Enterprise

Thinking

A Committed Leadership Team

Implementation Results

Implement &Coordinate

TransformationPlan

AlignEnterprise

Infrastructure

Source: Nightingale, Srinivasan and Mize

Pursue &Sustain

EnterpriseTransformation

EngageLeadership

in Transformation

STRATEGICCYCLE

AlignmentRequirements

Identified

EXECUTION CYCLE

CreateTransformation

Plan 2009 Massachusetts Institute of Technology D. Nightingale - MM/DD/YY- 10

Lean Enterprise Transformation Roadmap

http://lean.mit.edu


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MIT Conference on Systems Thinking for Contemporary Challenges 2009 Massachusetts Institute of Technology D. Nightingale 10/23/09- 11http://lean.mit.edu

Agenda





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Healthcare Case Examples

Case 1

Case 2

An Emergency Department of a Hospital Provider Non profit Hospital Provider contracts with 11 primary caresatellites and owns 3 hospitalsProblem statement:

Emergency Department waiting time is considerableStaff low moral leading to churningPatients leaving without being seen

A Primary Care Satellite of a Hospital Provider For profit Hospital Provider owns 5 primary care satellites that refer patientsto main hospitalProblem statement:

Considerable amount of patient no showsBacklog of patients scheduled for appointmentsCapacity constraints

Case 3 The New England Veterans Affairs Medical Center


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Case 1: A Primary Care Satellite of

a Hospital ProviderWho is the customer? Satellite administration concerned with

attracting physicians and patients Physicians concerned with patient care

Hospital concerned with insurers

Primary Care Satellite Owned by main hospital provider Refers patients to main hospital services Physicians are not salaried

Hospital Provider Has patients from multiple insurance

companies Has multiple referral primary care

satellites

Insurer A

Insurer B

Insurer C

Satellite A

SatelliteB

Patients

Physi-cians

Hospital

What are the metrics? Insurers focus on different sets of metrics

related to costs & preventive care Hospital focuses on total patient visits per

satellite Satellite focuses on total patient waiting

time and physician utilization

What are some of the systemic issues? Hospital attempts to satisfy different

metrics from different insurers Hospital sets quality of care at a minimum

(i.e. what insurance wants) and foregoescontinuous improvement

Satellite focuses on total throughput andneglects departmental variability

Patients dont feel the burden of carecosts, are unhappy with wait times, and

contribute to no show rate


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Case 1: Key Process InteractionsDynamics of Patient No-Shows

Pat ient Timein Syst em

PatientSatisfaction

No-Shows

SystemVariability

Factors Bedside Manner Comp assion ofSuppor t St aff

Factors DemandSmoothing Wait ListMethods

Factors Hire Doct ors Limit New Pat ient s Floor level improvement s

Factors Transport at ion Convenience Socio-Economic Fact ors Pat ient Compr ehension of Scheduli ng Impact s

No Show Polici es


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Case 1: Satellite as a Lean EnterpriseRecommendation

Objectives should bewell understood,actionable, andmeasurable

Objectives should beObjectives should bewell understood,well understood,actionable, andactionable, andmeasurablemeasurable

No clear strategic objectives No clear strategic No clear strategic objectives objectives

Lean Lean Transition Transition

Strategic Strategic

Direction Direction Setting Setting

Metrics need to beconsistent andstandard

Metrics need to beMetrics need to beconsistent andconsistent andstandardstandard

Current metrics do not gauge enterprise performance

Current metrics do Current metrics do not gauge enterprise not gauge enterprise performance performance

Measurement Measurement

Shift focus fromshareholders to

stakeholders

Shift focus fromShift focus fromshareholders toshareholders to

stakeholdersstakeholders

Focus is primarily on enterprise

shareholders

Focus is primarily on Focus is primarily on enterprise enterprise

shareholders shareholders

Stakeholder Stakeholder

Focus Focus

Cross functional /Cross departmentalknowledge reviewforums

Cross functional /Cross functional /Cross departmentalCross departmentalknowledge reviewknowledge reviewforumsforums

Infrastructure for cross-department knowledge sharing not in place today

Infrastructure for Infrastructure for cross cross - - department department knowledge sharing knowledge sharing not in place today not in place today

Knowledge Knowledge Management Management


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Case 2: Greater Boston Hospital Case(Jorge Fradinho Oliveira, ESD PhD Candidate)

Leading multi specialty physician led group practicewith national and international recognition (i.e.neuro, liver, heart & vascular, etc)

Emergency Visits: 38,631 Total Beds: 293 Total Staff: 4263 Total Income: $679,454,000 Total Expenses: $628,525,000

Operating Income: $50,929,000

2006 Highlights

Emergency Department (ED)struggling to keep up with demand

Long wait times in the ED andpatient leaving without being seen

ED staff blame inpatient staff andvice versa

ED staff turnover levels significant

Problem Statement

What can be done to speed patient flow in the ED?Where should a process improvement initiative focus?


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Emergency Department Analysis

Description of patient time spent in ED Description of patient arrivals and departures

Simulation Modeling

Average time for each step of the patient process

Source: Jorge Fradinho Oliveira, MIT


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Processes

Policy

Information

Knowledge

Services

Strategy

Organization

EnterpriseArchitecting

Multi-Attribute Model Provides Framework

for Evaluating Emergency Department

Products

Source: Nightingale/Rhodes, MIT 2007


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Enterprise Findings

EmergencyDepartment

Policy/ External Issues : Uninsured population Primary care unavailability Safety net compromised Fee for service payment

Result in: 6% of expenses not covered 30% non urgent care patients

Lack of continuous care monitoringoften resulting in poorer health andgreater expenditure

Encounter based patient carementality vs. continuous care

Strategy Issues: Focus on revenue generating

elective surgery 16 strategic objectives (trying to be

all things to all people) ED absent of strategic plan

Result in: Lack of strategic focus ED competing for internal

resources sought by electivesurgery

ED neglected

HospitalLeadership

ElectiveSurgery

Units



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EmergencyDepartment

Process Issues : Non standardized admitting

process

InpatientSpecialty

# 1

InpatientSpecialty

# N

Result in: Variability that leads to waste and

compromises provision of timely care

Patient boarding (admittedpatients without inpatient bedremain in ED)

Costly process bolt ons

(pharmacy dispensing units) andcostly care (ED cost structure)and image deterioration

AncillaryServices(lab, etc)

Silo process definitions

Lost opportunity to speed patientthroughput

Enterprise Findings



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EmergencyDepartment

Organization Issues : Low staff morale Salaried physicians Physician cultural rifts

Result in: High staff turnover volume Lack of productivity incentive Finger pointing between ED

and elsewhere

Knowledge Issues: Vast amount of evidence basedmedicine

Reliance on heroes and bed czars

Incomplete patient records

Result in: Less than ideal recommended

care provision Prone to staff exhaustion and

waste (i.e. empty bed goes

unnoticed) Patient health put at risk due to

unknown medical history

Enterprise Findings



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EmergencyDepartment

Information Technology Backbone Issues : Fragmented information systems Proprietary legacy software

Result in: Redundant human data entry tasksprone to error

Frustrated patients requested toprovide same information over andover again

Expensive IT integration consultingfees

Silo based view of informationacross the hospital (i.e. unable tosee end to end value)

Enterprise Findings



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Policy / External FactorsPolicy / External Factors

ProcessProcess

OrganizationOrganization

StrategyStrategy

Info/InfrastructureInfo/Infrastructure

AProducts /Services

Products /Services

KnowledgeKnowledge

Focus on revenue generatingelective surgery; 16 strategic

objectives; ED absent of strategicplan

Non standardized admitting process;patient boarding (i.e. admittedpatients held in ED due to lack ofinpatient beds); costly bolt ons

Timely provision of carecompromised; overall hospital imagecompromised

Uninsured population; primary careunavailability; safety net compromised;fee for service payment model

Reliance on heroes and bedczars; incomplete patientrecord; high variation ofevidence based medicine withinand across providers

Low staff morale; physician cultural rifts; high volumeof staff turnover; lack of productivity; finger pointingbetween ED and elsewhere

Fragmented information systems; costly proprietarysoftware

Hospital Enterprise Architecture

Diagnostic

Source: Jorge Fradinho Oliveira, adapted from Nightingale/Rhodes 2007, MIT


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Preliminary Findings

The problem of redesign gets harder and the evidence weaker as onemoves from the microsystem to the organization.Donald Berwick, President of Institute for Healthcare Improvement, 2002

QuestionsFor

FurtherStudy

MainFindings

ED average length of stay considered problematic, but non-admitted

patients took 4 hours, whereas admitted patients took over 8 hoursED interacted well with some patient wards but not with othersED heroic employee efforts said to be common rather than sporadicED metrics and strategic goals misaligned with overall hospital (X-Matrix)

Why was the ED managed as a silo rather than end-to-end?Was the varying performance of ED interactions due to the payment model?Could it be that different observed EA configurations were directly related tothe different observed performance levels ?



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Payer Patient

Provider

Regulator

InterestGroups

Insurer

Supplier

Labs Pharmacy

Hospital

HomeCare

NursingHome

Flu Clinic

Ancillary

Services

SpecialistCare

PrimaryCare

OperatingRooms

InpatientUnits

EmergencyDepartment Radiology

PrimaryCare

Nurse Physician

SupplyTechnician

Cleaning

Admin staff

Studentresident

Psychologist

Health Care is a Complex

Socio-Technical System

Labs Pharmacy


Simply stated, the U.S.does not have a

healthcare system.William Brody,

President of Johns Hopkins University, 2007


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Emergency Services

VA Urgent Care Transfer

VA ER Transfer

Non VA ER Transfer

Inpatient Treatment

Chronic Care

Acute Care

Residential Programs

Substance Abuse

PTSD

General Mental Health

Women

Community Residential

Domiciliary

Bedford Stabilization Program

Enabling Infrastructure

Purchasing

Patient Data Mgmt

Research

Quality Assurance

Payroll

Human Resources

Outpatient Treatment

Treatment

Scheduling

Non Emergency

Walk In to Outpatient

Referral from Primary Care

Outpatient ClinicsWest RoxburyJamaica PlainBrockton Outside the Enterprise

Case 3: New England Veterans Affairs

Partnership and Preliminary Insights

Richness of VA enterprise dataset which is shared across multiple regions Ability to control for potential misaligned behavior induced by traditional

commercial and public healthcare payment models

Evolving recent partnership between LAI and theNew England Veterans Administration (VISN 1)

Rationale

It is not impossible to get your head around the processes and activities in

health care. Performance, demand, and structure can be modeled and can beused to improve the enterprise.

Context

Enterprise Strategic Analysisfor Transformation

(ESAT) Analysis YieldedMultiple Insights

Even if profit is not a significant factor, it is still worthwhile creating andunderstanding your strategic goals and using them to drive your enterpriseforward.

It is not enough just to serve patients as they enter, we must also plan aheadin health care, and work towards being proactive rather than re-active.

We must align the enterprise on all levels and empower management on alllevels with an understanding of the greater strategic goals.

Insights


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Case 3: X-Matrix

MetricsStakeholder

Values

KeyProcesses

StrategicObjectives

MetricsStakeholder

Values

KeyProcesses

StrategicObjectives

StakeholderValues

K e y

P r o

c e s s e s

EnterpriseMetrics

S t r a

t e g

i c

G o a

l sVery strong alignmentwith most metrics ontarget

Goals are not formal or documentedResearch is a goal butnot measured locally

Very strong alignmentwith most metrics ontarget

Goals are not formal or documentedResearch is a goal butnot measured locally

Metrics vs. Objectives

Values vs. Goals

Strong alignment withareas in service, care, &research

Gap lies in aligninggoals to values such as:

Operating within budget Well-documented

monetary transactions

Strong alignment withareas in service, care, &research

Gap lies in aligninggoals to values such as:

Operating within budget Well-documented

monetary transactions

Strong alignment inareas of service,research, & quality

Processes addressingthe least stakeholder values are primarilypatient movement

Strong alignment inareas of service,research, & quality

Processes addressingthe least stakeholder values are primarilypatient movement

Processes vs. Values

Strong alignment withoutpatient treatment andclinic wait times

Missing metrics for key

processes Transfers to inpatient Program referrals

Strong alignment withoutpatient treatment andclinic wait times

Missing metrics for key

processes Transfers to inpatient Program referrals

Metrics vs. Processes

Strong AlignmentWeak Alignment


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Case 3: X-Matrix

s w s w 4 2 2

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s w s s s s w 7 5 29 16 15 7 1 3 3 2 9 2 13 3 3 21 2 37 9 5 5 1 1 3 2 5 1 10 1 1 4 2 12 7 10 2 0 2 0 0 4 1 3 2 2 17 0 2

U p s

t a n d

i n g

m e m

b e r o f

l o c a

l

c o m m u n

i t y

Transfer from VA ER to Inpatient

C o r r e c t n e s s o f

d i a g n o s i s a n

d

t r e a

t m e n

t

T i m e l

i n e s s o f

d i a g n o s i s a n

d

t r e a

t m e n

t

R e s e a r c

h A d v a n c e m e n

t

K n o w

l e d g e T r a n s

f e r

Q u a

l i t y o f p a t

i e n t e x p e r i e n c e

( m i n i m a l

d i s c o m

f o r t , r e s p e c

t f u l , e t c .

)

T i m e l y a n d a c c u r a

t e i n f o r m a t

i o n

f l o w

S a f e t y /

S e c u r

i t y o f p r e m

i s e s

C l e a n , H

i g h Q u a

l i t y

F a c

i l i t y

R e a s o n a

b l e e x p e c t a t

i o n s a n

d

r e s p e c

t f u l t r e a t m e n

t o f e m p l o y e e s

C o m m u n

i c a t

i o n a n

d I m p l e m e n

t a t i o n

o f V A c u

l t u r e a n

d v a

l u e s

E f f i c i e n

t R e s o u r c e

M a n a g e m e n

t

A c c u r a t e a n d w e l

l - d o c u m e n

t e d

m o n e t a r y t r a n s a c

t i o n s

Transfer from Urgent Care to Inpatient

O p e r a

t i n g w

i t h i n b u d g e t

F a i r W a g e s

f o r s e r v

i c e s

S u f

f i c i e n t I n p a t

i e n t a n

d O u t p a

t i e n t

C a p a c

i t y

A c c u r a t e P a t

i e n t

R e c o r

d s

A v a

i l a b i l i t y o f m e d

i c a t

i o n s , s

u p p l

i e s ,

a n d e q u i p m e n

t

Referral to Inpatient

Transfer from Outside ER to Inpatient

Inpatient Treatment

Transfer from Inpatient to Residential

Discharge from Inpatient

Residential Treatment

Transfer from Residential to Inpatient

Discharge from Residential

Transfer to Outside Facility

Outpatient Treatment

Referral to Residential

Walk-in to Outpatient

Human Resources

Purchasing (Supplies & Services)

Patient Data Management

Research

Facilities and Maintance

Quality Assurance

Payroll

MetricsStakeholder

Values

Key Processes

StrategicObjectives

MetricsStakeholder

Values

Key Processes

StrategicObjectives

Key Processes vs. Stakeholder Values Key Processes are primarily focused onsatisfying specific stakeholders however allare taken into account.


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Agenda

Research Motivation

Cross-Industry Knowledge on Enterprises

Case Examples

Ongoing Research



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Ongoing Research

High Performing Hospital Enterprise Architecture

(Jorge Oliveira) New England Veteran Affairs: Ongoing Research in

Process Classification(Jordan Peck)

NEWDIGS Drug Development Enterprise Systems Analysis(Center for Biomedical Innovation)

Impact of Advanced DNA Sequencing Technologies onClinical Microbiology Processes(Rob Nicol)


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High Performing Hospital Enterprise Architectures

(Jorge Oliveira, ESD PhD Candidate) Two multi-method exploratory cases conducted at leading US and

UK hospitals identified the following research questions andemergent phenomena:

How is hospital enterprise performancecurrently measured?

How could hospital enterpriseperformance measurement beimproved using lean enterpriseprinciples?

What are different internalorganizational design configurationscapable of supporting higher performance for different service unitcomplexities?

Nightingale/Rhodes 2007


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Ongoing Research




NEWDIGS Drug Development Enterprise Systems Analysis(Center for Biomedical Innovation)



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New England Veteran AffairsOngoing Research in Process Classification

(Jordan Peck, ESD Ph.D.)

Health Care Professionals are starting to recognize predictability

T 1 5

T 1 6

T 1 7

T 1 8

T 1 9

T 2 0

T 2 1

T 2 2

T 2 3

T 2 4 W

1 W 2

W 3

W 4

W 5

W 6

W 7

W 8

W 9

W 1 0

W 1 1

W 1 2

W 1 3

W 1 4

W 1 5

W 1 6

W 1 7

W 1 8

W 1 9

W 2 0

W 2 1

W 2 2

W 2 3

W 2 4 T

1 T 2

T 3

T 4

T 5

Wednesday

1 2 3 4 5

Emergency Severity Index (ESI)a five-level emergency department triage algorithm that provides clinically relevantstratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resource needs.

0

50

100

150

200

250

300

350

ESI 1 ESI 2 ESI 3 ESI 4 ESI 5 S p r e a

d o

f T i m e i n

E R ( M e a n +

/ - S t a n

d a r d

D e v

i a t i o n

)

Mean

-

+

0

50

100

150

200

250

300

350

ESI 1 ESI 2 ESI 3 ESI 4 ESI 5 S p r e a

d o

f T i m e i n

E R ( M e a n +

/ - S t a n

d a r d

D e v

i a t i o n

)

Mean

-

+


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New England Veteran AffairsSimulation and Modeling

How can we model Control Options and Interventions?

How well can solutions cross between hospitals?

Source: www.va.gov

Source: Jordan Peck, MIT

How do the people fit in?

VAManchester, NH

VATogus, ME

VABoston, MA


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Ongoing Research




NEWDIGS Drug Development - Enterprise Systems Analysis(Center for Biomedical Innovation)



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NEW D rug Development Parad IGmS

(NEWDIGS )


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Providers

Patient

Advocacy

MIT Center for

BiomedicalInnovation

FDA & Other

HHS Agencies

NGOs

Biotechs &

PharmasPayers

Diagnostics

SystemsIntegrators

CBIs NEWDIGS Drug DevelopmentEnterprise Strategic AnalysisConsortium of Stakeholders


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Mission:Improve therapeutic product innovation in healthcare

Preliminary Objectives Develop products that are more effective than existing therapeutic

options Reduce time to market, cost, and late stage attrition Improve knowledge about benefit/risk profile of new products

Additional strategic objectives: Catalyze change across the industry Transformational, not incremental Strategic, not just tactical Global, not just US Cross-stakeholder, not just pharma

CBIs NEWDIGS Drug DevelopmentEnterprise Strategic Analysis

Mission and Strategic Objectives


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May June July August September October November

Meeting #1May 28

Washington, DC

BeginCurrent State

Assessment

Meeting #2July 14

MIT

ContinueCurrent State

Assessment

Meeting #3August 19 & 20

Washington, DC

CreateFuture State

Vision

Meeting #4October 15

MIT

Create ActionPlan

Research teamsynthesizes outputs,

performs interviews, &

customizes methodology


Timeline

Meeting #5November 5

MIT

StakeholdersMeeting

Share findingsand solicit input

from CBIMembers


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An organization that: is lean and highly collaborative with all stakeholders from across the entire value chain;

is not tied to developing one particular product (i.e., responsive to market need, flexible,adaptive) and rather focuses on integrated healthcare solutions; has expertise to understand market and customer(s) health needs and to design potential

solutions that intervene earlier in the disease continuum than currently occurs; is informed by knowledge generated internally and externally (through pre-competitive,

cross-stakeholder data sharing/collaboration) and processes that enable rapid-cyclelearning (e.g., Learning Healthcare System);

has relationships with best-in-class providers of solution components (industry, academia,non-profits), and collaborates effectively with them to develop solutions;

operates successfully in an outcomes-based reimbursement environment; delivers dramatically increased value over the current approach (faster, more efficient,

reduced resource expenditure without compromise in outcomes); and find solutions focused on patient outcomes driven by patient and payor value as well as

scientific/medical community value.


Draft High Level Future Vision


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NEWDIGS

Process Knowledge ITPolicy &ExternalFactors

Products &Services Organization

DemonstrationProjects

(TBD)

What decisions must be made, when, and by whom? What evidence is required to inform these decisions? What data is required to generate the necessaryevidence? What can we do in NEWDIGS to optimize all of theabove?

#1

#2

Workstreams1) New Paradigms: Modeling, Simulation,

& Decision Support2) Data, Evidence, and

Decision-making3) Policy Design4) Organizational Design5) Others TBD .

#3

OrganizationalDesign

NEWDIGS andthe broader

LearningHealthcare

System

Policy asenabler of

scientifically& ethically

soundinnovation

New Paradigms:Modeling,Simulation,

Decision-Support

#4


Proposed Initial Workstreams


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Ongoing Research

High Performing Hospital Enterprise Architecture(Jorge Oliveira)

New England Veteran Affairs: Ongoing Research inProcess Classification(Jordan Peck)

NEWDIGS Drug Development - Enterprise Systems Analysis(Center for Biomedical Innovation)


Mot iva t ion / Problem Rob Nicol


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2009 Robert Nicol, Engineering Systems Division, Massachusetts Institute of Technology

Antibiotic Resistance Surveillance: Key Healthcare Problem Rapidly increasing resistance Few effective antibiotics remain Limited system level surveillance

Process improvement difficult

Complex Healthcare Processes Large number of tasks and rapidly changing technology

Numerous disconnected stakeholders Vast technical design space Highly distributed information (tacit and explicit)

Severe Health and Cost Impacts 2 Million hospital acquired infections per year $5 Billion (est.) and over 90,000 deaths per year (source: IDSA)

Mot iva t ion / Problem

Source: CDC; MRSA =methicillin-resistant Staphylococcus aureus ; VRE=Vancomycin-resistant enteroccoci ; FQRP =Fluoroquinolone-resistant Pseudomonas aeruginosa

K ey Ques t ions Rob Nicol


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How can the true system levelcomplexity of healthcare processesbe modeled and measured?

How does this system level processmodel and complexity measureswork on a real world healthcareprocess design and implementationeffort?

How does process complexityimpact change and adoption inhealthcare?

K ey Ques t ions

Cont r ibu t ions Rob Nicol


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Novel Network Based Process Representation andComplexity Analysis Methodology (model)

Novel Theory for Process Innovation Adoption as a

Function of Process Complexity (model observations) First Specification of a Whole Genome Clinical Microbiology

Process for MRSA Surveillance (test case for model)

First Operational Demonstration of a Whole GenomeClinical Microbiology Process for MRSA Surveillance(test case for model and complexity measures)

First Whole Genome MRSA Diversity Study(real biological results showing policy change needed)

Contributions (Significant Biology Too) Rob Nicol


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MRSA Surveillance Process designed and implemented aspart of thesis yielded significant insight into MRSA biologywhich in turn suggests system policy changes needed

( g gy )

Multiple Genome Alignment of BWH SamplesCompared to Reference at the Top

50 Genomes Sequenced(


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Agenda

Research Motivation Cross-Industry Knowledge on Enterprises Case Examples Ongoing Research LAI Enterprise Healthcare Vision


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In 1992 US Air Force asked:Can the concepts, principles and practices of the Toyota Production System (TPS) be applied to the military aircraft industry?

MIT answered: YES!Over a decade of significant research was conducted well beyond TPS to the Enterprise system level and ultimately delivering superior results for aerospace commercial and governmental sectors

In 2009 the Healthcare Community asks:Can the concepts, principles and practices of Lean Enterprise Value be applied to the

healthcare industry?

Our Research to date says: YES!?


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What processes arerequired to support

the enhancement,shortening, andimprovement of technology and

pharma innovation ?

What role shouldInformation Technology

play in improvinginformation accessibility

and flow?

What can belearned from other

industries withregards to holisticenterprise analysis

and redesign?

What are enhancedmethods for evaluating

and assessing futurestate health care

systems?(e.g., simulation,)

Relevant Research Questions

What are keyknowledge and

decision support toolsthat enable healthcaresystem effectiveness?

How doeshospital enterpriseperformance relate

to its enterprisearchitecture ?


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Relevant Research Questions

What are thekey incentives

that drivestakeholder behavior?

What areappropriatehealth careenterprisemetrics?

How canlong-term value

propositionsbe created

across multipleproviders?

What are newcollaborativestakeholder

models?

What are thestrategies capableof achieving and

sustaining multiplestakeholder alignment?

Metrics and Stakeholder Alignment

How shouldhospital/healthcareservice complexity

be measured?


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Questions and Answers

Deborah [email protected]

http://lean.mit.edu

deborah nightingale

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