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They speak a different language, and the lore in society is they are completely otherworldly, but engineers may be the missing tool in you quality toolbox, the thing that makes you see a problem in a novel way, approach its solution differently.
Six years ago, Spartanburg (SC) Regional Hospital implemented Lean-Six Sigma management, and created three engineer positions as a part of it, says Heather Bendyk, MBA, corporate director and master black belt of quality services for the 588-bed hospital and the health system of which it is a part.
The rationale was simple: Healthcare is far behind other industries in the science of quality. "We talk about quality in terms of regulatory compliance, but that should be a minimum. We should be talking about designing the best workflows, so that compliance is always met." The ultimate goal, then, is a high-reliability organization, with little to no variability in work.
That’s where the engineers come in: with an expertise in designing workflows, seeing bottlenecks, and acting as the plunger to push the clogs out and reroute them in a better way. "They are looking at efficiency all the time," she says.
Bendyk herself is a former engineer and knows it can be a tough transition — she took medical terminology and acronym courses, as well as an anatomy and physiology class to help learn the terminology. Because she knows how long it can take to get up to speed when you come from outside healthcare, she highly recommends finding someone in your organization and training him or her into the role. They don’t have to have a clinical background — they can learn what they need, as she did.
One thing she values in engineers is their ingrained habit of solving problems by going to the source. "In other industries, if they have an issue, they go to the floor and talk to the operator. In healthcare, that means that when I have a problem, I go to the floor and talk to the front-line staff. What do they do? How do they take care of the patient? Why are they doing something in a particular order? What are the problems they see? That front-line staff isn’t often engaged in conversation, but no one can tell you more."
"There are a lot of people who would argue that engineers come up with terrible solutions," says Alan Card, PhD, MPH, CPH, CPHQ, president and CEO of Evidence-Based Health Solutions, a research and consulting firm based in Notre Dame, IN, that works in healthcare risk management and patient safety. "But they shouldn’t be coming up with the solutions; rather, they should be facilitating the process, breaking it down into components, and doing the things that they do so very well."
Card, who did his doctorate with engineers to learn about patient safety through their eyes, says the structured approach they use to determine if a solution is valid is of particular interest. "What we used to do in healthcare when there was a patient safety problem was the blame and shame approach. A lot of tools and techniques we have used to move away from that — like failure mode analysis — are from engineering. But most of the people using them are not engineers. They leave off at risk assessment. They stop with tools that were not designed specifically for healthcare."
Card developed an active risk control kit for testing, which draws from those very risk management tools that engineers value so much (the tool is available free at activeriskcontrol.com).
Card says that since healthcare is a system, and it has been designed, it follows it can be redesigned to be more safe. "We don’t think of it like that, though. If we sit down to look at a problem, typically, no one has spent any protected time thinking about the processes and systems they work in. They don’t see how what they are doing fits in with what others are doing and how the patients perceive it."
Engineers do. And while it’s possible to have someone in quality trained to think that way, it’s unlikely. Most quality staff are clinically trained. "They use the tools of the engineer, like root cause analysis, which has been used for 20 years, but we haven’t budged the pandemic of harm in a decade and a half," Card says.
One reason, he says, is that the tools help us understand, but they don’t help us understand the solutions that we create in response to the problems. If people aren’t trained in the techniques that spawned the tools, we will keep coming back to "person-focused solutions, like signage, alerts, training, rather than system-focused ones."
Engineers would be great process facilitators to foster the kind of thinking that can move beyond the "short-sighted solutions that we have come up with so far," Card says.
While he understands the idea of getting an engineer into the department — and applauds organizations like Spartanburg for taking a leap of faith and embracing the benefits of embedding engineers in quality — he also thinks there is value to having an outsider’s perspective. "If you bring an engineer in and say, Solve this,’ you’ll get rubbish. But if you ask one to help you think something through, you’ll get some great help. They need to know how healthcare works. They don’t need to know the clinical stuff, although that should be in the room. They need to understand how nurses and physicians work, how the departments fit together, and how they interact together. Beyond that, they don’t need to be too much of an insider."
He sees all the quality department ads looking for nurses. And if it’s a small quality department, of course, that’s what you need to do your chart review. But if you are a large organization and have room for something else, you could do worse than hire an engineer, Card says. "We are missing a lot by focusing on only the domain-area expertise and not the process expertise."
For more information, contact:
Heather Bendyk, MBA, Corporate Director and Master Black Belt, Quality Services, Spartanburg Regional Healthcare System, Spartanburg, SC. Email: Hbendyk@srhs.com
Alan Card, PhD, MPH, CPH, CPHQ, President and CEO, Evidence Based Health Solutions, Notre Dame, IN. Email: firstname.lastname@example.org