21st Century Healthcare: Engineers Wanted
In 1980, the Russian Institute of Eye Microsurgery pioneered the ‘conveyer surgery method’ (1)- wherein several surgeons perform different parts of the operation with the hardest part taken by the most experienced specialist. Treating the patient process as an inventory scenario, and then working to reduce the inventory load and keep it moving faster, resulted in a high quality, high output and low defect process. This method, not an original, breakthrough concept, proved successful in helping manage patient supply and demand for popular surgical procedures. Discoveries in the field of medicine don’t always feature a new technology. Sometimes, a time-tested process in another industry applied to medical use results in a better service model for that intervention.Although new technology doesn’t need to be at the center of innovation, great technological advancements are, in fact, being made. Healthcare related products and services are deeply rooted in the creation of new technology. Recent Manufacturing Engineering Magazine articles and editorials highlight emerging trends in these areas including medical manufacturing, robotics, growth in new technologies for an aging population, and the application of lean principles bettering services to patients and reducing costs. Technological advancement in medical applications is accelerating. The resultant standard of care will be quite astonishing in the next 20 years. Innovations targeting acute or chronic disease will change the nature of medical interventions as we know them. Portions of hospital centric services can be rendered via home-based care; the consumer centric healthcare, including wellness management programs, is on the rise. The author has been involved with the creation of a mobile, battlefield-based operating room, seen multiple surgical suites and ICUs managed like an air traffic control system, and observed various diagnostics and interventions take place at a distance via remotely applied telemedicine. More and more, the IT and process productivity gains prevalent in other industries have become a part of medical innovation.
What do these trends mean for the numerous product design and manufacturing companies gearing products and services toward healthcare applications? SME Editor, Brian J. Hogan, describes the opportunities with these comments, “Manufacturing serving the medical market continues to enjoy almost constant growth…. Much of this is due chiefly to an aging population as ‘baby boomers’ reach retirement age and experience normal physical deterioration. They need hearing aids, replacement teeth, and eyeglasses. At the same time there is a need for products that assist conventional living and mobility such as automatic wheel chairs, and special devices for the home. This growth market for manufacturers requires new levels of precision and quality.” (2) It is worthwhile to discuss current and future trends that will welcome innovative approaches from the manufacturing engineering community in addressing the medical technology and healthcare challenges of the 21st century. Engineers have a rich history in delivering innovation that impact patient care. It’s an important tradition to carry on for the profession.
These approaches aren’t just about being prepared for new business opportunities. Much more is at stake. According to Curtis Carlson – head of Stanford Research Institute, “I predict that millions of jobs will be destroyed in our country, like in the 1980s when American firms refused to adopt total-quality management techniques while the Japanese surged ahead.” The only way out, he insists, is ‘to learn the tools of innovation’ and forge entirely new, knowledge-based industries in energy technology, biotechnology and other science-based sectors. Opportunities exist to participate in a growth market and to apply wealth-creation leadership that will bring new jobs to this country.
The introduction of new tools is already taking place, especially in trying to simplify access to medical information. In discussing information technology growing pains inherent in healthcare, Dr. Carolyn Clancy, director for the Agency for Healthcare Research and Quality, once stated, “we are trying to reengineer that which was never engineered.” These kinds of comments are made within the context of national electronic health record standardization and hospital IT system optimization in response to the oft cited annual death rate from medical errors (wrong-side surgeries, misread prescriptions, miscommunications, paper based errors, broken systems, etc.) Nearly 100,000 deaths per year has led to the analogy of two airplane crashes per day in the U.S. This urgency fuels the ramp up IT-related medical innovations to cure the problems in healthcare. The analogy, however, is flawed. The human to human interaction in healthcare replete with variations in patient medical history, care determinations, and healing processes doesn’t quite compare to controlled, system-based norms of the aviation industry. Safety in the airline industry is based on ‘engineered predictability’, thus it’s unfair to judge them both from an error-free perspective. However, quality, transparency, process improvement, and error reduction trends show that engineered predictability is gaining ground in healthcare. (4)
Predictability is a norm in the engineering field. The average college engineering student is immersed in the culture of the scientific method, mainly by studying failure. Memories go back to the classroom viewing of the 1940 Tacoma Narrows Bridge collapse: a cautionary tale about the price paid for non-exact planning relating to wind and mechanical resonance. Lesson learned: engineering precision norms require a keen eye and applied competence from the study of failure and the promotion of quality and error preventability.
Toyota is one company that has been very successful at mastering quality competencies and serving as a model of cross-industry best practices and culture sharing. In the article, “Decoding the DNA of the Toyota Production System” ,(3) the success of the company culture is explained in this adage – by inculcating the scientific method at all levels of the workforce, the company ensures that people will clearly state the expectations they will be testing when they implement the changes they have planned. This allows for process control and continuous, innovation-based improvement to occur at the same time. Rules for the company’s workforce output is assured to be:
• defect free (that is, it has the features and performance the customer expects)
• delivered immediately
• produced without wasting any materials, labor, energy, or other resources
• produced in a work environment that is safe, physically, emotionally, and professionally for every employee
Much of the ‘reengineering’ of healthcare is beginning to incorporate these rules proven through quality tracking. The nation’s healthcare system is the best place in the world, in terms of quality, to receive medical intervention, but chronic diseases are experienced at a greater rate than in many modern countries. Still, there are too many safety and error infractions impacting morbidity and mortality. As the manufacturing production world has attempted to copy the Toyota way, they’ve found it difficult to duplicate the culture. Engineer, flight surgeon and astronaut, James Bagian of the Veterans Affairs Department, has taken on the mission to infuse a culture of quality into a system serving hundreds of thousands. Bagian’s mission, as chief patient safety officer, is to develop and nurture a culture of safety. From a background studying and avoiding catastrophic failure, he has set out to create fault-tolerant systems that can withstand inevitable human errors. This is exactly what is needed to reduce and prevent inadvertent harm to patients as a result of their care.
Quality can also be applied through a data-centric service model for chronic care issues facing the growing senior population. An example of this is professional engineer, Dexter Klock, whose work started with a doctor of science research project at a senior care hospital facility. Looking at outcomes data and extrapolating behavioral trends that could improve quality of care, he found that caregivers and administrators responded with uncertainty to the usefulness of such information. In 2006, he started a company, CareData Trak, which enables identification of syndromes (dementia, depression, falls, hypertension, incontinence) not previously detected by an individual or their healthcare professional via computer-assisted interviewing on medical kiosks. His work, along with other emerging programs, assist in the transformation of the healthcare industry through technology that helps consumers become more engaged and ownership-driven. Solutions in patient-driven diagnostics and the wellness management market lessen the massive economic burden of end-of-life, chronic care costs.
Or innovation could take the form of multiple products promising convenience and augmented functionality. Dean Kamen, inventor famous for the introduction of the Segway Human Transporter, has been successful at creating medical applications for the masses. His inventions include a wearable infusion pump that revolutionized drug delivery, a portable dialysis machine that makes it easier for patients to undergo dialysis in their own homes and a robotic wheelchair able to climb stairs and stand upright. Most recently, he’s led research on a new ‘bionic’ hand project, featuring neuro-prosthetic technology for helping wounded warrior amputees.
Applied technology, especially in hospitals, can eliminate repetition and mundane tasks. Plus the emergence of remote care takes away the need for centralized medical service in some cases. This is where we may see the most dramatic shift in delivery of care. In response to the question, “will hospitals as we know them become extinct?” the CEO of INOVA Health System believes to some extent there will be disaggregation of service since 40-60% of what hospitals can do today will be done via technology outside of the hospital. Whether in promoting remote care, creating medical applications for the masses, promoting wellness through syndrome tracking, or infusing a culture of safety, these examples provide ideas on how to address the medical technology and healthcare challenges of the 21st century.
The best way to understand emerging trends in a market is to “follow the money”. Former national health IT coordinator, Dr. David Brailer, has initiated a $700 million private equity fund, called Health Evolution Partners with an investment initiative focused on the health care industry. This group reflects national funding trends that should catch the attention of manufacturing executives who seek to apply their resources to emerging opportunities. Entrepreneurial ventures to be funded include companies developing:
• Affordable home monitoring devices to keep more people out of nursing homes and residential care facilities;
• Telemedicine services that link rural patients at retail drug clinics with specialists
Next generation health care companies will succeed by increasing value through products and services that improve:
• Quality, safety and prevention
• Utilization and compliance with medical evidence
• Collection and use of personal and population-based health information
• Efficiency and cost competitiveness
• Individual control and personal customization of health care services (5)
From the Economist SPECIAL REPORT: Innovation, Oct 11, 2007, “In the age of mass innovation, the world will find profitable ways to deliver solutions to the 21st century’s greatest needs, including sustainable clean energy, affordable and universal healthcare for aging populations and quite possibly entirely new industries – human ingenuity will drive it.” The message to executive and engineer alike is to take stock of the value of core competencies and find ways to understand the greatest needs of the masses. The scientific method and ingenuity applied will promote profitable ways to deliver solutions for the 21st century. Engineers that innovate contribute back to the viability of the profession and meet the medical challenges of our times.
Reprinted with permission from the Society of Manufacturing Engineers 2008 Yearbook.
1 http://russiatoday.ru/news/news/12137 August 8, 2007
2 Society of Manufacturing Engineers , October 2007, p. 12
3 Bowen, H. K. and S. Spear, September-October 1999, “Decoding the DNA of the Toyota Production System.” Harvard Business Review.
4 Pulley, John L. July 2007. “Safety Prone.” Government Health IT
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