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BRIDGE Linking Engin Ee Ring and Soci E T Y Spring 2008 HEALTH CARE The BRIDGE LINKING ENGIN ee RING AND SOCI E TY Adapting Process-Improvement Techniques in an Academic Medical Center Paul F. Levy Disruptive Innovation in Health Care: Challenges for Engineering Jerome H. Grossman Health Care as a Complex Adaptive System: Implications for Design and Management William B. Rouse The Convergence of Information, Biology, and Business: Creating an Adaptive Health Care System Christopher Meyer New Therapies: The Integration of Engineering and Biological Systems W. Mark Saltzman Promoting the technological welfare of the nation by marshalling the knowledge and insights of eminent members of the engineering profession. The BRIDGE NATIONAL ACADEMY OF EnGINEERING Craig R. Barrett, Chair Charles M. Vest, President Maxine L. Savitz, Vice President W. Dale Compton, Home Secretary George Bugliarello, Foreign Secretary William L. Friend, Treasurer Editor in Chief (interim): George Bugliarello Managing Editor: Carol R. Arenberg Production Assistant: Penelope Gibbs The Bridge (USPS 551-240) is published quarterly by the National Academy of Engineering, 2101 Constitution Avenue, N.W., Washington, DC 20418. Periodicals postage paid at Washington, DC. Vol. 38, No. 1, Spring 2008 Postmaster: Send address changes to The Bridge, 2101 Constitution Avenue, N.W., Washington, DC 20418. Papers are presented in The Bridge on the basis of general interest and time- liness. They reflect the views of the authors and not necessarily the position of the National Academy of Engineering. The Bridge is printed on recycled paper. © 2008 by the National Academy of Sciences. All rights reserved. A complete copy of The Bridge is available in PDF format at http://www.nae.edu/TheBridge. Some of the articles in this issue are also available as HTML documents and may contain links to related sources of information, multimedia files, or other content. The Volume 38, Number 1 • Spring 2008 BRIDGE LINKING ENGIN ee RING AND SOCI E TY Editor’s Note 3 Engineering and the Health Care Delivery System W. Dale Compton and Proctor Reid Features 6 Adapting Process-Improvement Techniques in an Academic Medical Center Paul F. Levy Systemic changes require cooperation between those who deliver care and administrators committed to the public disclosure of outcomes. 10 Disruptive Innovation in Health Care: Challenges for Engineering Jerome H. Grossman Innovative, “disruptive” changes in the way health care is organized, paid for, and delivered may lead to a transformation of the overall health system. 17 Health Care as a Complex Adaptive System: Implications for Design and Management William B. Rouse Management of complex adaptive systems requires leadership rather than power, incentives and inhibitions rather than command and control. 26 The Convergence of Information, Biology, and Business: Creating an Adaptive Health Care System Christopher Meyer As biology becomes an information science, health care will learn from nature how to accelerate change. 33 New Therapies: The Integration of Engineering and Biological Systems W. Mark Saltzman Engineering innovation will continue to improve the quality of life and increase life expectancy. NAE News and Notes 39 Class of 2008 Elected 43 NAE Newsmakers 43 2007 Japan-America Frontiers of Engineering Symposium (continued on next page) The BRIDGE 44 Call for 2008–2009 Award Nominations 45 Mirzayan Science and Technology Policy Fellows 47 A Message from NAE Vice President Maxine L. Savitz 48 List of Contributors 54 America’s Energy Future: Technology Opportunities, Risks, and Trade-offs 55 “News and Terrorism: Communicating in a Crisis” Workshops 55 China/U.S. Air Pollution Study 56 Launch of the Engineer Your Life Web Site 56 Grand Challenges for Engineering in the 21st Century 57 Calendar of Meetings and Events 57 In Memoriam 59 Publications of Interest The National Academy of Sciences is a private, nonprofit, self- The Institute of Medicine was established in 1970 by the National perpetuating society of distinguished scholars engaged in scientific Acad­my of Sciences to secure the services of eminent members of and engineering research, dedicated to the furtherance of science and appropriate professions in the examination of policy matters pertaining technology and to their use for the general welfare. Upon the author- to the health of the public. The Institute acts under the responsibility ity of the charter granted to it by the Congress in 1863, the Academy given to the National Academy of Sciences by its congressional char- has a mandate that requires it to advise the federal government on ter to be an adviser to the federal government and, upon its own scientific and technical matters. Dr. Ralph J. Cicerone is president of the initiative, to identify issues of medical care, research, and education. National Academy of Sciences. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Academy of Engineering was established in 1964, The National Research Council was organized by the National under the charter of the National Academy of Sciences, as a parallel Academy of Sciences in 1916 to associate the broad community of organization of outstanding engineers. It is autonomous in its adminis- science and technology with the Academy’s purposes of furthering tration and in the selection of its members, sharing with the National knowledge and advising the federal government. Functioning in Academy of Sciences the responsibility for advising the federal gov- accordance with general policies determined by the Academy, the ernment. The National Academy of Engineering also sponsors engi- Council has become the principal operating agency of both the neering programs aimed at meeting national needs, encourages edu- National Academy of Sciences and the National Academy of Engi- cation and research, and recognizes the superior achievements of neering in providing services to the government, the public, and the engineers. Charles M. Vest is president of the National Academy scientific and engineering communities. The Council is administered of Engineering. jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org Fall 2006 3 Editor’s Note at the 2007 NAE Annual Meeting, address several of these issues. Changing the Health Care Environment Industries, particularly large, entrenched industries, often find it difficult to change, even when they recog- nize that change is in their best interest. Therefore, a key driver of change is crisis, a situation that forces an industry either to change or, to put it bluntly, go under. Unlike other industries, however, health care cannot W. Dale Compton Proctor P. Reid simply go under, so it must change. Like other industries, health care must become more efficient, more respon- Engineering and the Health Care sive to patients’ (i.e., customers) needs, more flexible, safer, and of higher quality. Industries around the world Delivery System aspire to achieve the same characteristics. The suggestion that engineers join in the strug- gle to improve the health care system almost always Health Care as a Cottage Industry elicits surprise, even though engineers have been In a so-called cottage industry, many components actively involved in bioengineering and biomaterials of the overall system operate as independent agencies. engineering for years. In addition, publications on To an engineer, this indicates that the overall system using operations-research techniques to model hospital was not designed as a system and does not operate as a operating rooms and schedule personnel and materials system, that no single entity is in charge of the overall in various medical facilities date back more than three system, and that no cost objectives, standards of effi- decades. Today, however, the participation of engi- ciency, or safety goals have been established for the neers is more important than ever before. overall system. In addition, there is little, if any, feed- Health care delivery today is in turmoil. Despite back in terms of measuring overall operating goals. rapid advances in medical procedures and the under- As systems engineers know, you cannot optimize standing of diseases and their treatment, the efficiency, a large, complex system by optimizing its individual safety, and cost-effectiveness of the delivery of health parts, because this does not take into account inter- care have not kept pace. Improvements in the deliv- actions among the parts. Nevertheless, in the short ery of services in other industries have simply not been run, improvements in some components can be made transferred to health care. and should be encouraged. For example, systems engi- The question is why not. Here are a few of the neering principles were critical to improving clinical most obvious reasons. For one thing, the third-party operations—and quality of care—at the Mayo Clinic. reimbursement system is not conducive to a competi- Another example is described by Paul Levy, the director tive environment in which customers (i.e., patients) of Beth Israel Deaconess Medical Center, who details can seek out the most cost-effective treatment or how process-improvement techniques that have been provider. Second, health care delivery is still a “cot- used in other industries can be applied to some aspects tage industry.” Third, very little has been invested in of health care in an academic medical center. information technology.
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