Global Health - High Tech and High Touch

As Industrial Engineers in the healthcare arena we have the privilege to improve the healing experience of great number of people.  So I find it really exciting to learn about advances in global health, as the impact factor of those improvements can be so drastic in terms both of advances in quality of life and in the number of people affected.

We often view initiatives in global health as projects that take the best of "western" medicine and translate it to a population or region that has less resources than regions with "advanced" health systems.  However, two global health projects I encountered recently have gotten me to think about global health in a different light and see how we can take learnings back from global health projects and improve our "advanced" healthcare systems.

This is the first post in a series of two where I'll go over the projects that shifted my thinking.  The first was  a Ted Talk by Joel Selanikio about the process of capturing world health survey data and bringing in a high tech solution.

In his talk Joel talks about the arduous process of collecting data for global health purposes - almost all the data is collected by workers who go from town to town on foot and write the results down on paper.  This data then languishes on paper for years at a time till someone collects it goes over it again and does data entry into a computer, at which point it may be analyzed and may be become useful.  This data languishing period disturbed him and as a result he set out to clear this process of its waste.

His work focused mainly on coming up with solutions to help automate the collection and collation of global health project data.  Simple things like electronic forms on PDAs that emailed their data to a central hub helped cut down on the data's non-value add time, all the while not being too difficult for global health employees throughout the world to use and deploy.  Its a good lesson in technology implementation, going high tech can really improve system performance if implemented correctly.  The successful adoption of technology through out global health organizations relied on it being:

1. Design addressed Key Root Problem
2. Worked as Designed
3. Simple to use

These three points are really the crux of any technology implementation process.  You need to be able to define a problem, understand how the use of technology is going to solve that problem, all the while ensuring ease of use for all users of the system... easy, right?  Nope, definitely not an easy task - its a topic that I'm sure we'll delve into in the future.

Next week I'll dive into the concept of high touch with an awesome article from Dr. Atul Gawande.

Managing Complex Change Diagram

I came across a useful diagram at work the other day while working on a big project at the largest hospital in our system.  While working there we were up against a staff that was very change averse.  An organizational psychologist was recommended by the administration team to talk with us regarding the hospitals work culture and we were given this diagram below to help us determine what our project was missing to get it on the right track.

The diagram shows high level pieces that need to be addressed in order to successfully help the person accept change.  Following the flow diagram from left to right, change will not happen as desired if any piece is missing.  The person going through change will then experience the far right outcome depending on the missing piece.

Right Care - Right Patient, Not Just About Improved Clinical Outcomes

Nearly everyone in the field of health care by now has read or seen a reference of the report "To Err is Human", which in 1999 brought to light the high amount of medical errors that lead to death in this country.  Stemming from that was an onslaught of quality improvement initiatives, root cause analyses, and overall shift in how we as a society went about providing health care.  That study is probably the main reason the four of us blog contributors got to where we are today, trying to continue improving our health care system from as many facets as possible.

Providing the right care to the right patient, which seems simple enough at a high level, was not being followed on a patient level and it was costing United States health care facilities millions in malpractice suits and worse costing lives. Over a decade later, right care to the right patient is still something health care facilities may struggle with or even worse may not even realize an error is happening.  My first official project as an Operations Improvement Specialist was at a small town hospital in southern Wisconsin that was experiencing decreasing patient volumes and was struggling to meet the budget set last fall.  Having only one inpatient unit spread on two floors, with roughly 30 inpatient beds total, improvement options from the outset appeared minimal.  The goal of the project was to cut cost of operations in any way possible in order to secure the viability of the hospital in the future.

Patient satisfaction and clinical outcomes were never an issue at this location, but they were important to the project in that any recommendations made would need to ensure those high marks still were met.  However, being in a rural area, patient volumes were a real problem and a cause of poor labor efficiency.  To help minimize the effects of high staffing, patients were in many cases allowed to be roomed on the intensive care unit to give them the patient volume they needed.  After examining the acuity of these patients that were housed on the ICU, it was very apparent this was a case of over treatment, and it was costing the hospital double what was needed in wages alone.  Couple the wage discrepancy with nurse to patient ratios being much higher in the ICU and the total cost was nearly $250,000 to the organization.  The care being given in this case was not worse in terms of nursing care, but from an operations standpoint the cost to provide this service outweighed the benefits.

Since our look at the hospital, a move has been made to absorb the excess capacity that was treated in the ICU on the med/surg floor.  In order to accomplish this other initiatives were needed to reduce their patient volumes such as discharging patients earlier in the day and holding their observation patients in a different location.  Work is being done to better understand the data through our electronic medical record and provide weekly data updates to track progress on discharging earlier and better patient assignments.  The goal is by budgeting process of 2013 to accurately forecast volumes with changes in place.

To Err is Human