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Understanding and Managing the Complexity of Healthcare

Understanding and Managing the Complexity of Healthcare

William B. Rouse
Nicoleta Serban
Copyright Date: 2014
Published by: MIT Press
Pages: 296
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  • Book Info
    Understanding and Managing the Complexity of Healthcare
    Book Description:

    Breakthroughs in medical science, innovations in medical technologies, and improvements in clinical practices occur today at an increasingly rapid rate. Yet because of a fragmented healthcare delivery system, many Americans are unable to benefit from these developments. How can we design a system that can provide high-quality, affordable healthcare for everyone? In this book, William Rouse and Nicoleta Serban introduce concepts, principles, models, and methods for understanding, and improving, healthcare delivery. Approaching the topic from the perspectives of engineering and statistics, they argue that understanding healthcare delivery as a complex adaptive system will help us design a system that is more efficient, effective, and equitable.The authors use multilevel simulation models as a quantitative tool for evaluating alternate ways of organizing healthcare delivery. They employ this approach, for example, in their discussions of affordability, a prevention and wellness program, chronic disease management, and primary care accessibility for children in the Medicaid program. They also consider possible benefits from a range of technologies, including electronic health records and telemedicine; data mining as an alternative to randomized trials; conceptual and analytical methodologies that address the complexity of the healthcare system; and how these principles, models, and methods can enable transformational change.

    eISBN: 978-0-262-32073-3
    Subjects: Technology, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Series Foreword
    (pp. ix-x)

    Engineering Systems is an emerging field that is at the intersection of engineering, management, and the social sciences. Designing complex technological systems requires not only traditional engineering skills, but also knowledge of public policy issues and awareness of societal norms and preferences. In order to meet the challenges of rapid technological change and of scaling systems in size, scope, and complexity, Engineering Systems promotes the development of new approaches, frameworks, and theories to analyze and design these systems.

    This new academic field seeks to expand the set of problems addressed by engineers, and draws on work in the following fields...

  4. Preface
    (pp. xi-xii)
  5. 1 Introduction
    (pp. 1-14)

    Breakthroughs in medical science along with innovations in clinical practices and related technologies offer enormous opportunities for impressive improvements in the health and well-being of society. Returns on investments in these endeavors have the potential to be substantial, sustainable, and broadly beneficial. However, we will not realize the greatest returns with our current fragmented system of healthcare delivery (Reid et al., 2005; Rouse & Cortese, 2010). Many see a need to engineer or design a system that can provide high quality, affordable healthcare for everyone. Engineering healthcare delivery will require that the current nondesigned enterprise be substantially transformed (Rouse, 2006a)....

  6. 2 Complexity of Healthcare Delivery
    (pp. 15-34)

    For several years, constituents of the National Academies have been engaged in a systemic study of the quality and cost of healthcare in the United States (Institute of Medicine, 2000, 2001; National Academy of Engineering & Institute of Medicine, 2005). Clearly, substantial improvements in the delivery of healthcare are needed and, many have argued, are achievable via value-based competition (e.g., Porter & Teisberg, 2006). Of course, it should be kept in mind that our healthcare system did not get the way it is overnight (Stevens et al., 2006).

    Many studies by the National Academies and others have concluded that a...

  7. 3 Healthcare Costs and Their Causes
    (pp. 35-56)

    The enormous cost of healthcare in the United States is often cited as a key national challenge (Economist, 2004; CBO, 2008). Healthcare is consuming an increasing portion of the gross domestic product (GDP). At the same time, there are concerns that the quality of healthcare in the United States lags that of other countries (Institute of Medicine, 2000, 2001). It is clear that substantial improvements in the delivery of healthcare value are needed and, it is argued, achievable via value-based competition (Porter & Teisberg, 2006). Of course, it should be kept in mind that our healthcare system emerged as it...

  8. 4 Effects of Healthcare Price Controls
    (pp. 57-70)

    Government price controls might seem to be a good way to “bend the curve” of healthcare costs. As outlined later, this possibility has been raised often in the past and sometimes pursued in various areas of the economy. At this point in time, many think they might like the government to control the costs of healthcare as well as the costs of higher education, which over the past decade has become the new poster child for runaway costs.

    Classic treatises on this topic include Galbraith’s (1954)A Theory of Price Controlsand, more recently, Rockoff’s (1984)Drastic Measures: A History...

  9. 5 Prevention and Wellness
    (pp. 71-92)

    Chapters 3 and 4 focused on the costs of healthcare delivery, particularly in terms of the cost per use of the system. Chapter 3 addressed the means to reducing cost per use, and chapter 4 considered the implications of simply capping cost per use. These possibilities focus on one element of the overall equation of total cost, which equals cost per use times the number of uses.

    Chapters 5 and 6 focus on reducing the number of uses. Chapter 5 considers prevention and wellness to, hopefully, eliminate uses of the healthcare system, albeit via use of the “wellness system.” Chapter...

  10. 6 Chronic Disease Management
    (pp. 93-106)

    In chapter 5, we discussed the huge burdens of chronic disease on the healthcare delivery enterprise in the United States. DeVol et al. (2007) estimate that more than $1 trillion is spent on healthcare costs and lost productivity for those with chronic diseases such as hypertension (HTN), diabetes mellitus (DM), and coronary heart disease (CHD). Chapter 5 addressed prevention of DM and CHD. This chapter focuses on managing these three chronic diseases after their onset.

    Chronic diseases can be managed in ways that retard the progression of these diseases and, thereby, decrease the costs of healthcare. The increased cost of...

  11. 7 Equity of Care
    (pp. 107-138)

    In the previous chapters, we highlighted the complexity of the connectivity between the four levels in the healthcare system. Understanding the causes and effects of ever-increasing costs helps in projecting and evaluating efficiencies (e.g., decreasing costs per use or number of uses) in the healthcare system. Prevention, wellness, and chronic disease management are means to increase the effectiveness of health outcomes and healthcare delivery. Depending on the means of delivery, it can also increase efficiencies and lower costs. However, promoting these processes alone will not ensure equal opportunity to health and healthcare. If equity is not considered, the system’s operations...

  12. 8 Technologies for Care
    (pp. 139-182)

    InTechnopoly, Neil Postman observes, “A new technology does not add or subtract something. It changes everything …. New technologies alter the structure of our interests: the things we think about. They alter the character of our symbols: the things we think with. And they alter the nature of community: the arena in which thoughts develop” (Ball & Bierstock, 2007).

    Historically, technology has enabled a greater simplification of routine aspects of our lives but also has added complexity to socioeconomic dynamics at both lower and higher levels of our ecosystem. Technology has entered every space of our lives from how...

  13. 9 Data in Healthcare
    (pp. 183-204)

    Two common denominators of all chapters in this book aredata and methodologiesfor understanding and managing the complexity in the healthcare system. Healthcare transformation is driven by an aggregate of methodologies, whereas evidence of improvement is grounded in an aggregate of data. This chapter attempts to review briefly the domain of existing data resources that can be used to facilitate improvements in healthcare; this is followed in the next chapter by an overview of a subset of methodologies involved in this process.

    Data in healthcare is a two-edged sword: It can help to promote better health and healthcare, but...

  14. 10 Methodologies for Improvement
    (pp. 205-232)

    Data have an operational role, but their translation into knowledge, decision making, and improvements provides the basis of promoting better health and healthcare for people; advancing efficient and effective processes; informing organizations about their overall progress, costs, and potential regulatory practices; and helping society in creating an ecosystem that is sustainable while providing equal opportunity for healthcare and wellness. The means for translating the data into knowledge and decisions are what we often refer to asmethodologies. Methodologies in healthcare span a wide range of domains from technologies (e.g., m-healthcare, telemedicine) to data-driven modeling of healthcare processes and organizations. Methodologies...

  15. 11 Facilitating Change
    (pp. 233-248)

    Chapter 1 initiated the discussion of the extent of fundamental change needed across our healthcare delivery enterprise. There is no doubt that incremental business process improvements can certainly yield measurable benefits. However, these types of changes will not be transformative. They will not be sufficient to result in the healthcare delivery system we seek—high quality, affordable care for everyone.

    Most people think that the healthcare system in the United States is broken and that we need to get about the business of fixing it. The truth is that the system cannot be fixed in the sense that an engineered...

  16. References
    (pp. 249-274)
  17. Index
    (pp. 275-284)