Systems Fundamentals at the Massachusetts Institute of Technology, introduced some principles of operations research (OR), a systems-oriented approach that draws on the principles of the scientific method to help frame, formulate, and solve difficult problems involving people and technology. Larson offered examples of the application of OR to health care, including work that used sophisticated optimization modeling and computational techniques to advance cancer therapeutics. He said that the techniques of OR have much to offer to the reengineering of systems and processes in health care. He further suggested that the applications of OR and engineering systems with the greatest potential to transform health care have not yet been identified and that further attention is needed to determine opportunities for future progress.

Discussing the engineering of systems design tools, James M. Tien, distinguished professor and dean of the College of Engineering at the University of Miami, observed that health care is a complex, integrated collection of human-centered activities that is increasingly dependent on information technology and knowledge. In particular, he explained, health care is a service system. By definition a service system combines three essential components—people, processes, and products—and Tien suggested that managing services means, in effect, managing an integrated and adaptive set of people, processes, and products. He outlined an alternative systems management view of services, discussing the increasing complexity of systems; the increasing need for real-time, adaptive decision making within these systems; and the reality that modern systems are becoming increasingly more human centered. One result is that products and services are becoming both more complex and more personalized or customized. Tien suggested that the methodologies he discussed can be applied to help improve basic services in health care.

Essential methodologies of systems engineering were also the focus of a paper by Harold W. Sorenson, professor of mechanical and aerospace engineering in the Jacobs School of Engineering at the University of California, San Diego. Sorenson discussed the principles of an “integrated perspective” for managing complex systems. He outlined the questions that typically apply in engineering complex enterprises, and he described typical approaches that a systems engineer might use to articulate the nature of a problem and to design an appropriate architecture to address it. He provided an overview of how systems engineers think about managing complexity, developing solutions, and assessing those solutions. For health care, Sorenson suggested, such an approach could allow a rapid enhancement of capabilities, the development of better working relationships among stakeholders, and the identification of new and more effective ways to deliver patient care—with the potential to lead ultimately to significant changes in healthcare culture, practice, and delivery.

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