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Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine and National Academy of Engineering. 2011. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12213.
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Appendix A


Workshop Agenda

ENGINEERING A LEARNING HEALTHCARE SYSTEM:
A LOOK AT THE FUTURE

A LEARNING HEALTHCARE SYSTEM WORKSHOP
ROUNDTABLE ON EVIDENCE-BASED MEDICINE
THE INSTITUTE OF MEDICINE (IOM)
in cooperation with
THE NATIONAL ACADEMY OF ENGINEERING (NAE)

APRIL 29–30, 2008
THE KECK CENTER OF THE NATIONAL ACADEMIES
WASHINGTON, DC 20001

Issues Motivating the Discussion

  1. Health care is substantially underperforming on most dimensions: effectiveness, appropriateness, safety, cost, efficiency, and value.
  2. Increasing complexity in health care is likely to accentuate current problems unless reform efforts go beyond financing to foster significant changes in the culture, practice, and delivery of health care.
  3. Extensive administrative and clinical data collected in healthcare settings are largely unused for new insights on the effectiveness of healthcare interventions and systems of care.
  4. If the effectiveness of health care is to keep pace with the opportunity of diagnostic and treatment innovation, system design and information technology must be structured to ensure application of the best evidence, continuous learning, and research insights generated as a natural by-product of the care process.
  5. Engineering principles are at the core of a learning healthcare system—one structured to keep the patient constantly in focus, while continuously improving quality, safety, knowledge, and value in health care.
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine and National Academy of Engineering. 2011. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12213.
×
  1. Impressive transformations have occurred through systems and process engineering in service and manufacturing sectors—e.g., banking, airline safety, automobile manufacturing.
  2. Despite the obvious differences that exist in the dynamics of mechanical vs. biological and social systems, the current challenges in health care necessitate an entirely fresh view of the organization, structure, and function of the delivery and monitoring processes in health care.
  3. Taking on the challenges in health care offers the engineering sciences an opportunity to test, learn, and refine approaches to understanding and improving innovation in complex adaptive systems.

DAY ONE

8:30 WELCOME AND INTRODUCTIONS
Denis A. Cortese, Mayo Clinic and Roundtable on
Evidence-Based Medicine (IOM)
William B. Rouse, Georgia Institute of Technology and Planning
Committee Chair (NAE)
   
8:45 KEYNOTES: 1. LEARNING OPPORTUNITIES FOR HEALTH CARE
                   2. TEACHING OPPORTUNITIES FROM ENGINEERING
Opening keynote speakers will address some of the key systemic shortfalls and challenges in health care today, reflecting on the changes needed and how systems engineering might help foster a healthcare system that delivers the care we know works and that learns from the care delivered.
Brent C. James, Intermountain Healthcare (IOM)
W. Dale Compton, Purdue University (NAE)
   
9:45 SESSION 1: ENGAGING COMPLEX SYSTEMS THROUGH ENGINEERING CONCEPTS
How do the various engineering disciplines (e.g., systems engineering, industrial engineering, operations research, human factors engineering, financial engineering, risk analysis) engage system complexity, and how might this perspective inform and improve health care? What can we learn from the contrasts?
Chair: Paul H. O’Neill, Value Capture, LLC

images   Systems engineering perspectives
William B. Rouse, Georgia Institute of Technology (NAE)

images   Engineering systems analysis tools
Richard C. Larson, Massachusetts Institute of Technology (NAE)

Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine and National Academy of Engineering. 2011. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12213.
×
[10:35–10:55 BREAK]
   

images   Engineering systems design tools
James M. Tien, University of Miami (NAE)

images   Engineering systems control tools
Harold W. Sorenson, University of California, San Diego

   
Panel discussion to follow
   
12:00 LUNCH
   
1:00 SESSION 2: HEALTHCARE SYSTEM COMPLEXITIES, IMPEDIMENTS, AND FAILURES
What are the multiple healthcare system components and processes that affect the generation and application of evidence, and which inefficiencies, impediments, structural barriers, and failures are most acutely in need of attention and correction? How might systems engineering address these issues?
Chair and Introduction: Cato T. Laurencin, University of Virginia Health Systems (IOM)

images   Healthcare culture
William W. Stead, Vanderbilt University Medical Center

(IOM)

images   Diagnostic and treatment technologies
Rita F. Redberg, University of California, San Francisco

images   Clinical data systems and clinical decision support
Michael D. Chase, Kaiser Permanente Colorado

images   Care coordination and linkage
Amy L. Deutschendorf, Johns Hopkins Hospital and Health System

images   Administrative and business systems
Ralph W. Muller, University of Pennsylvania Health System

images   Information and knowledge development
Eugene C. Nelson, Dartmouth–Hitchcock Medical Center

   
Panel discussion to follow
   
[3:15–3:30 BREAK]
   
3:30 SESSION 3: CASE STUDIES IN TRANSFORMATION THROUGH SYSTEMS ENGINEERING
How has systems engineering been successfully used in certain industries and sectors? Which key lessons best apply in the
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine and National Academy of Engineering. 2011. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12213.
×
transformation of a sociologically and technologically complex healthcare arena? Are there examples of successful applications to health care? What are some key lessons from other sectors and service industries in managing complexity?
      Chair: Carmen Hooker Odom, Milbank Memorial Fund

images   Airline safety
John J. Nance, formerly of National Patient Safety Foundation

images   Alcoa reorientation
Earnest J. Edwards, formerly of Alcoa

images   Veterans Health Affairs
Kenneth W. Kizer, Medsphere Systems Corporation (IOM)

images   Ascension Health
David B. Pryor, Ascension Health

   
Panel discussion to follow
   
5:15 DAYS SUMMARY AND FRAMEWORK DISCUSSION
What framework might illustrate ways in which lessons from engineering could map onto healthcare systems?
    Paul H. O’Neill, Value Capture, LLC, and
    William B. Rouse, Georgia Institute of Technology (NAE)
   
5:30 RECEPTION

DAY TWO

8:00 WELCOME AND RECAP OF THE FIRST DAY
William B. Rouse, Georgia Institute of Technology and Planning Committee Chair (NAE)
   
8:15 SESSION 4: FOSTERING SYSTEMS CHANGE TO DRIVE CONTINUOUS LEARNING IN HEALTH CARE
The IOM Learning Healthcare System workshop publication identified several common characteristics of a learning healthcare organization, including culture that emphasizes transparency and learning through continuous feedback loops, care as a seamless team process, best practices that are embedded in system design, information systems that reliably deliver evidence and capture results, and results that are bundled to improve the level of practice and the state of the science. What do feedback and
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine and National Academy of Engineering. 2011. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12213.
×
performance improvement look like for each topic below, and how can impediments be turned into enablers?
Chair: Richard C. Larson, Massachusetts Institute of Technology (NAE)

images   Learning-, team-, and patient-oriented culture
Steven J. Spear, Massachusetts Institute of Technology

images   Knowledge development, access, and use
Donald E. Detmer, American Medical Informatics Association (IOM)

images   Technologies management
Stephen J. Swensen, Mayo Clinic

images   Information systems organization and management
David C. Classen, Computer Sciences Corporation

   
Panel discussion to follow
   
[10:00–10:30 BREAK]
   
10:30 BREAKOUT SESSION: CAPTURING MORE VALUE IN HEALTH CARE
Five groups to meet and discuss three questions:

images   At a macro level, what’s your best guess on how much more value (health returned for money invested) could be obtained through application of systems engineering principles in health care?

images   If you had to identify one area in which the greatest value could be returned, what would that be?

images   What are the actions, taken by whom, that could do the most to facilitate the needed changes?

Breakout Chairs

images   Kenneth Boff, Room 205

images   Richard C. Larson, Room 206

images   William B. Rouse, Room 204

images   Harold W. Sorenson, Room 208

images   James M. Tien, Room 213

   
11:45 LUNCH AVAILABLE (OUTSIDE ROOM 100)
   
1:00 BREAKOUT SESSION REPORTS
   
1:45 SESSION 5: OBSERVATIONS ON INITIATING SYSTEMS CHANGE IN HEALTH CARE
Donald M. Berwick, Institute for Healthcare Improvement (IOM)
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine and National Academy of Engineering. 2011. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12213.
×
2:15 SESSION 6: NEXT STEPS: ALIGNING POLICIES WITH LEADERSHIP OPPORTUNITIES
What are the key policy priorities if the best and most applicable lessons from the engineering sciences are to be applied in bringing about the necessary transformational changes? A panel of leaders from key settings will offer brief (5-minute) reflections on the policy and related culture changes necessary, followed by an interactive discussion.
Chair: Donald M. Berwick, Institute for Healthcare Improvement (IOM)

images   Academic medical centers
Denis A. Cortese, Mayo Clinic (IOM)

images   Community hospital settings
Paul F. Conlon, Trinity Health

images   Integrated healthcare delivery organizations
Louise L. Liang, Kaiser Permanente

images   Small ambulatory care settings
Douglas W. Lowery-North, Emory University

images   Skilled nursing facilities
Mary Jane Koren, The Commonwealth Fund

   
Panel discussion to follow
   
4:30 CONCLUDING SUMMARY REMARKS AND ADJOURNMENT
Denis A. Cortese, Mayo Clinic and Roundtable on
Evidence-Based Medicine (IOM)
J. Michael McGinnis, IOM
   
Planning Committee:
William B. Rouse. Ph.D., M.S. (Chair), Georgia Institute of Technology
Jerome H. Grossman, M.D., Harvard University
Brent C. James, M.D., M.Stat., Intermountain Healthcare, Inc.
Helen S. Kim, M.B.A., Gordon and Betty Moore Foundation
Cato T. Laurencin, M.D., Ph.D., University of Virginia
The Honorable Paul H. O’Neill, Value Capture, LLC
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine and National Academy of Engineering. 2011. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12213.
×
Page 285
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine and National Academy of Engineering. 2011. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12213.
×
Page 286
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine and National Academy of Engineering. 2011. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12213.
×
Page 287
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine and National Academy of Engineering. 2011. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12213.
×
Page 288
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine and National Academy of Engineering. 2011. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12213.
×
Page 289
Suggested Citation:"Appendix A: Workshop Agenda." Institute of Medicine and National Academy of Engineering. 2011. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12213.
×
Page 290
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Improving our nation's healthcare system is a challenge which, because of its scale and complexity, requires a creative approach and input from many different fields of expertise. Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system--one that increasingly is more effective, more efficient, safer, and higher quality--is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the Institute of Medicine's Roundtable on Value and Science-Driven Health Care and the National Academy of Engineering, hosted a workshop on lessons from systems and operations engineering that could be applied to health care.

Building on previous work done in this area the workshop convened leading engineering practitioners, health professionals, and scholars to explore how the field might learn from and apply systems engineering principles in the design of a learning healthcare system. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary focuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward a learning healthcare system.

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