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Clinical Consulting: Healthcare Planning – An Engineering Perspective

| Debbie Gregory

Many people consider it ironic that a nurse works at an engineering firm. The experience has turned out to be quite serendipitous for me. The growing role of the executive nurse as a true partner in healthcare strategy requires systems thinking and an engineering-based approach. During a keynote address, BYU professor Margaret J. Wheatley Ed. D. said that “people who have made enormous contributions to organizational strategy all came from engineering backgrounds.”

The constant evolution and resulting complexity of the U.S. healthcare system produces what sometimes seems to be a chaotic mess. Here are four issues facing today’s healthcare strategists where systems thinking and engineering-based approaches can facilitate healthcare strategy and begin to create order out of the chaos.

Learning From Chaos – Professor Wheatley discussed three important lessons to be learned related to chaos. Systems thinking and engineering can be used to offer navigational aids to healthcare strategy:

  1. Wheatley said that you “cannot see order in chaos on a moment-by-moment basis. Therefore you have to stand back, wait, and observe to find patterns to be addressed.” Once patterns have been discovered, healthcare professionals can apply engineering principles to optimize systems and performance.
  2. Wheatley says that “chaos breeds self-organization and creativity.” She goes on to say that “self-organization and creativity foster true opportunities for organizational transformation.” Organization and creativity are both hallmarks of systems thinking and engineering.
  3. Finally Wheatley postulates that “complexity arises from simplicity. Simple patterns that build upon one another produce complexity.” Understanding complex patterns is not only a challenge to engineers, but it is their inspiration. By using engineering principles, healthcare leaders can develop strategies that address complex patterns in their own system that can be used to improve outcomes for all.

Systems Engineering – According to the Massachusetts Institute of Technology, systems engineering is an interdisciplinary approach and means to enable the realization of successful systems. This subject highlights the critical linkage of systems engineering to fundamentals of decision theory, statistics, and optimization. In healthcare, systems engineering can be used to define customer needs and required functionality early in the development cycle. Once these requirements are documented, insights can be drawn that lead to design synthesis and system validation while considering issues that include operations, performance, test, manufacturing, cost, and schedule.

Quantum Physics and Leadership – In their book Quantum Leadership: Advancing Innovation, Transforming Health, Tim Porter O’Grady and Kathy Malloch describe complexity science. They also discuss the need for a new type of healthcare industry leader that can guide organizations effectively through periods of innovation and transformation. They describe these leaders as agents of change who are responsible for providing others with a vision of challenges that will arise, as well as teachers who prepare others for the changes ahead. Whether they are analyzing quantum physics or car engines, engineers are trained to identify and develop solutions to challenges. An engineering approach provides the tools needed by healthcare leaders to guide their organizations in today’s environment.

A Partnership Framework – In their book, Transforming Inter-professional Partnerships: A New Paradigm for Nursing and Partnership-Based Health Care, Reisler and Potter describe a partnership paradigm as having: mutually respectful and caring relationships, no need to maintain rigid rankings of control, conflict as an opportunity to learn and be creative, equal value for all, and power used to empower. They advocate a partnership framework where nurses share power with their healthcare colleagues. They call for collaborative care models highlighted by inclusivity and diversity in health care. They present a framework that recommends shifting healthcare relationships from hierarchies of domination and isolated professions to high-performing, collaborative teams.

Their concept is supported by Peter Senge, of the Society for Organizational Learning and author of The Fifth Discipline. Senge discusses how systems thinking must create a new way to solve problems. He advises that different people, from different points of view, who see different parts of systems, need to come together and collectively envision something that individually none can see.

The growing role of the nurse executive as a true partner in the development of healthcare strategy is a prime example of the partnership framework concept.  Nurses and other healthcare professionals have the tools to reassess the current state of interdisciplinary partnerships in order to build a more effective, caring, and sustainable healthcare system. Engineering tools can also be employed to support development of more effective collaborations. As Reisler and Potter recommend, healthcare professionals need to work collaboratively and collectively to engineer future changes in healthcare facilities.

The common threads for leading through complexity and chaos are the foundational principles of engineering. These principals provide a logical sequence of activities and decisions that transform operational needs into descriptions of system performance parameters and preferred system configurations. Using engineering principles, we can become better leaders in healthcare transformation and change. Who knew that a nurse could collaborate with an engineering firm to create change that improves healthcare? Like I said….serendipitous!

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