Happy New Year from the Singing Pen. I'd like to kick off the 2012 blogging year with a guest post by my father, Mr. Victor Middleton, who is, in fact, an engineer....
Dr. Jen, a Star Trek fan,
has been known to quote Dr. McCoy’s dictum (lament or boast depending on your
point of view) to her brother James whenever she requires assistance with
recalcitrant computers. I am an engineer, and I
find this plaint typical of the gulf between our respective professions.
Doctors tend to view us as overseers of useful but often-wayward tools. Doctors practice the art of medicine;
engineers are mechanics who help take care of support details.
I’m writing this piece to
try and modify that point of view and to urge a closer interaction between
medicine and my particular flavor of engineering. What I do can be classified as systems
engineering or industrial engineering, or, as I prefer, operations research
(OR) engineering.
OR practitioners are
dedicated to improving the operation of systems of all sorts, whether they are
organizational practices and procedures, manual processes, mechanical controls
and devices, computer software, or combinations of all of these. OR as a discipline traces its origins back to
World War II when engineers and mathematicians were asked to help optimize
resources, including personnel and materiel, for maximum military effect. OR
groups attached to the British Anti-Aircraft Command were charged with the
improvement in deployment and use of Britain’s new radar network and helped win
the Battle of Britain; similar groups developed novel submarine search and
engagement procedures to defeat German U-boats in the North Atlantic.
The key phrase above is
the “optimize resources, including personnel and materiel.” It is incontrovertible that the health care
system in the US today needs to do a much better job with respect to
utilization of resources on virtually all fronts, from matters of national
policy to local hospitals and health care providers. We OR engineers can help.
Even a cursory Internet search on health care
and operations research will display a wide spectrum of ways in which OR can
help docs and other health care providers, saving money through more efficient
operation, but, more importantly, helping to optimize patient health care outcomes. It would be futile for me to try to describe
the extent of OR applications to health care here, but I would like to mention
a few overarching principles.
First, OR is a systems
science that seeks to integrate local capabilities into more global
solutions. How do emergency room
practices affect operating room availability?
How does scheduling for elective procedures affect overall hospital bed
occupancy? How must vaccination and
treatment protocols be adjusted to deal with the differences between local
disease outbreaks and the potential for deliberate terrorist attack? Perhaps the best example for Dr. Jen and her colleagues
would be: how does the family practice doctor help coordinate general health
issues with specialist care?
Next, OR and industrial
engineering seek to look at the role of systems in preventing errors. The medical profession tends to view error as
attributable to mistakes by individual practitioners. Since we have as yet been unsuccessful in
developing fail-proof individuals, a far more fruitful ground for eliminating
errors is developing systems that first help avoid errors and that help identify
them and mitigate them when they do occur.
Such a systems approach encompasses everything from human factors design
of automated data entry and retrieval, to computer diagnostic aids, to more
efficient training and re-training, and to the development of redundant
procedures that check and double-check the appropriateness of treatment.
Finally,
I would like to note that as engineers we share an ethical bond with physicians
and their mandate: “Primum non nocere.” As engineers, we are not impartial scientists objectively studying natural
phenomena to see what makes the world tick.
Our job is to make changes to that world, and thus our ethical
responsibility is to ensure that we change it for the better. I can think of no better way to meet this
responsibility than joining with medical community to address the health care
needs of our country and each individual in it.
Interested
readers are urged to search the Internet.
A small sample includes:
(This last, while strictly
speaking not OR, certainly expresses an OR perspective on the problems with the
health care system in the U.S.
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