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Institute of Medicine (US) and National Academy of Engineering (US) Roundtable on Value & Science-Driven Health Care. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington (DC): National Academies Press (US); 2011.

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Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary.

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Engineering a Learning Healthcare System: A Look at the Future focuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward one of continuous improvement—a learning healthcare system. The Institute of Medicine's (IOM's) Roundtable on Value & Science-Driven Health Care (formerly the Roundtable on Evidence-Based Medicine) envisions that such a system will be the product of collaboration across major healthcare stakeholders and could draw significant benefits from insights from the field of engineering. Thus this workshop is a product of a collaboration between the IOM and the National Academy of Engineering (NAE) and investigates the interfaces and synergies between the engineering and medical sciences. The workshop convened experts to identify and discuss issues related to healthcare system improvement and how lessons learned from engineering might inform current thinking about the different components of healthcare delivery, from research and knowledge generation to clinical care at the bedside.

The Roundtable has outlined important crosscutting issues in healthcare system transformation through the Learning Health System set of workshops. These provide a framework for working toward the Roundtable's goal that by the year 2020, 90 percent of clinical decisions will reflect and be supported by accurate, timely, and up-to-date evidence. A reworking of the current healthcare delivery system to one that ensures that the right patient receives the right care at the right time is essential to this transformation, and insights from the systems engineering field, such as those discussed during these 2 days, will be crucial in making progress toward that goal.

Workshop presentations and discussions surveyed the potential for greater interaction between the disciplines of medicine and engineering. Presentations covered various opportunities for learning on the part of health care as well as teaching opportunities for engineering fields. Participants heard accounts of how engineering engages complex systems, such as health care; case studies of how systems engineering has transformed other industries and sectors; and ways in which the application of engineering principles can foster changes toward continuous learning in health care. Presentations and discussions also identified current healthcare system complexities, impediments, and failures; identified opportunities for capturing more value in health care; and considered ideas about how to initiate the necessary systems changes and align policies and leadership opportunities with them.

Numerous themes emerged over the course of the 2-day workshop, and they centered on the issue of how to transform the current healthcare system into one that learns throughout the continuum of care. These themes included the need to center the system's processes on the right target—the patient experience, the notion that system excellence is created by the reliable delivery of established best practices, the idea that complexity compels reasoned allowance for tailored adjustments, the need to emphasize interdependence of different components and to address the interfaces of the different components, the importance of communication through teamwork, the need for cross-checking, transparency and feedback as engines for system improvement, the acknowledgment and management of human error, the alignment of rewards to foster continuous improvement, the enhancement of opportunities for sustained learning and research from different perspectives, and the need to foster a leadership culture that reinforces teamwork and results.

In addition to these themes, a number of cross-sector follow-up actions were identified that may be pursued by the Roundtable. These actions may include further collaboration between the IOM Roundtable and the NAE to clarify terminology in order to prompt healthcare professionals to draw more naturally upon relevant and helpful engineering principles for system improvement. Actions may also include greater focus on identifying and disseminating best practices in order to improve patient outcomes; exploring the possibility of changing the education of health professionals to advance skills in knowledge navigation, teamwork, patient–provider partnerships, and process awareness; advancing the notion of paying for value; and exploring the elements of inefficiency in health care and developing a science of waste assessment and how to mobilize resources to eliminate it.

We would like to acknowledge those individuals and organizations that donated their valuable time toward the development of this workshop summary. In particular, we acknowledge the contributors to this volume for their presence at the workshop and their efforts to further develop their presentations into the manuscripts contained in this publication. We would also like to acknowledge those who provided counsel by serving on the planning committee for this workshop, including William B. Rouse (Chair) (Georgia Institute of Technology), the late Jerome H. Grossman (Harvard University), Brent C. James (Intermountain Health Care, Inc.), Helen S. Kim (Gordon and Betty Moore Foundation), Cato T. Laurencin (University of Virginia), and the Honorable Paul H. O'Neill (Value Capture, LLC).* Although not a formal member of the planning committee, Proctor Reid of the NAE contributed to the planning and execution of the workshop. Roundtable staff, including Katharine Bothner, Kiran Gupta, W. Alexander Goolsby, LeighAnne Olsen, Daniel O'Neill, Ruth Strommen, and Catherine Zweig, helped to translate the workshop proceedings and discussion into this workshop summary. Stephen Pelletier also contributed substantially to publication development. We would also like to thank Lara Andersen, Greta Gorman, Jackie Turner, Michele de la Menardiere, Vilija Teel, and Bronwyn Schrecker for helping to coordinate the various aspects of review, production, and publication. This book is dedicated to the memory of Jerry Grossman, who was a stellar planning committee member, with lifelong dedication to and leadership in the bridging of medicine and engineering.

Engineering a Learning Healthcare System: A Look at the Future offers important insights to the field of medicine from the field of engineering concerning the development of a learning healthcare system. It also provides an example of how collaboration across diverse disciplines can lead to vast improvements in healthcare delivery. The hope is that, by making major stakeholders more aware of the importance of the delivery system, it will prompt the development of strategies for applying the insights from this workshop to health system improvements and that these strategies will ultimately transform the current healthcare system into one that smoothly operates to both generate and apply evidence to improve the health of Americans.

Denis A. Cortese

Chair, Roundtable on Value & Science-Driven Health Care

J. Michael McGinnis

Executive Director, Roundtable on Value & Science-Driven Health Care



Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

Copyright © 2011, National Academy of Sciences.
Bookshelf ID: NBK61958


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