Tuesday, November 20, 2007

Kaiser - Systems Engineering and Individualism: Is There Room for Both in Health Care?

The question posed in the title isn’t trivial. It’s a very large question. To some, it’s about safety and quality; to others it’s simply unnecessary meddling; to still others, it’s the essence of health reform.

But systems, no matter how well designed, are limiting. Then the question becomes: how much slack, initiative, responsibility, and freedom to act are we going to give the individual? These too aren’t small questions.

Systems engineering promises a systematic, organized, and purposeful approach to minimizing variation, maximizing outcomes, and measuring results. Furthermore, it lends itself to deploying information technologies to guide doctors and inform patients.

The trouble is that system applications may impinge upon individualism – a characteristic that distinguishes America from other cultures. We believe, above all else, in individual autonomy – in the ability of individual patients and individual physicians having freedom to make health care choices.

Systems engineering is an interdisplinary field of engineering. It focuses on developing and organizing complex systems. It disciplines groups into a team effort Systems engineering considers the business and the technical needs of customers to provide a quality product meeting user needs.

Clinical protocols, paying only for care based on scientific evidence, paying -for-performance, measuring process and outcome metrics, and making electronic medical records mandatory are examples of systems engineering. Physicians in independent practice might prefer to the term “social engineering” to “systems engineering” and object to thinking of health care in systems terms because “systems” may violate the freedom-loving Americans.

Perhaps the most ardent proponent of systems engineering in health care is George Halvorson, CEO of Kaiser. Halvorson pushes the idea of electronic medical records to achieve consistency, standardization, quality tracking, and diagnostic support for following patients outside the exam room to see if they’re complying with instructions and improving outcomes. The key to this, says Halvorson is e-support – e-visits, e-scheduling, e-reminders, and e-care.

Halvorson feels we can overcome our system’s lapses and improve “systems” thinking. By systematically applying data, we can organize teams to provide answers, tamp down variables, strive for zero defects, coordinate everyone through e-systems and put all relevant data at physicians’ fingertips in the exam room.”

Halvorson maintains room exists for both systems engineering and individualism, and the final clinical judgment rests with the individual physician.

Does the health system need the discipline of systems engineering? Or is it simply an unnecessary clinical impediment? Let me know what you think.

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