Richard Biehl

Q&A with Richard Biehl; The challenges facing health care systems engineers

June 23, 2017
HealthCare Business News caught up with Richard Biehl, instructor and program director of Healthcare Systems Engineering at the University of Central Florida, who discussed the role of health care systems engineers and the challenges they face.

HCB News: What is a health care systems engineer?
Richard Biehl: Systems, in the sense we’re discussing, are fairly large-scale collections of interacting parts, the combination of which produces outcomes or results that would be beyond the capabilities of individual component parts. Systems engineers work to design and optimize those systems with an emphasis on the interactions as well as the components. A health care systems engineer does that work across the societal-scaled system that is our health care system. Unlike a mechanical systems engineer who works with system components of mechanical systems, the health care systems perspective encompasses large-scale institutions, facilities, knowledge, professions, regulatory models, supply chains, social services, biomedical research and education, and the general public. Whatever might affect the delivery of health care to patients could be within the focus of a health care systems engineer.

HCB News: What are some of the most pressing issues that systems engineers are helping to address?
RB: There are so many, with the highest number involving economics and the most important dealing with safety. Everyone talks about reducing health care costs, and costs are often the business justification for a systems engineering project, but cost is rarely the focus of our engineering efforts. We know that an efficient optimized system will operate at its lowest cost. Our focus is on that efficiency and optimization, even if our management teams only want to talk about cost.

To improve systems, we usually look for disruptions at the system level. As we find ways to provide health care access to more people, we have to address disruptions in supply. We know that there won’t be enough doctors in the future to meet the demand, particularly in some geographic locations and some clinical specialties. Making sure there’s an adequate supply of health care in the right places, in the right specialties, and at the right times, is a health care systems engineering challenge.

Among the safety concerns that systems engineers focus on are medication errors and continuity of care, as well as the general overuse, underuse or misuse of key health care procedures. We address these by improving specific aspects of the practice of health care in organizations, including increasing the use of evidence-based practices, improvements in the capture and flow of patient information and an increased focus on population-level trends and patterns. Improving health care requires even rethinking what we mean by a health care organization as we include more and broader stakeholders in our initiatives.

HCB News: Why are we facing a doctor shortage and how can we prepare for this growing crisis?
RB: The problem of doctor supply is very complex and has many dimensions. The number of new doctors entering the field is limited by the capacity of our medical schools. Of those entering practice, many choose to work in geographic locations or clinical specialties that don’t address the actual patient demand curves adequately. Many doctors leave the field because of economic pressures, liability concerns or simply the pursuit of more advantageous opportunities. Many doctors are baby boomers who will simply reach retirement over the next decade. All of these factors combine to cause the supply of doctors not to keep up with the ever-growing demand for care.

There are many opportunities to address this problem at the system level. Policy changes can reduce some of the burdens of being a doctor and cause more to stay in practice. Incentives can be designed to shift some practices to higher-demand specialties in underserved geographic areas. We can make it easier for immigrants to obtain medical licenses in states. These options represent system tinkering that can have a short- or medium-term effect, but won’t fix the problem long-term.

University of Central Florida

Systemically, we’re already addressing the problem in several ways. First, we’re rethinking the provision of care so that more of it can be provided by professionals not traditionally seen as doctors. This is one reason we use the term provider rather than physician (or doctor), because increasingly the person providing care isn’t a physician. This spreading of care across a broader sector that includes stakeholders outside of hospitals and physician practices dramatically increases the system’s capacity even though the number of doctors is declining.

Additionally, we’re working to engineer out waste. Unnecessary procedures take up valuable capacity without improving health outcomes. Reapplying that capacity can increase the yield of our system with the same supply. Ultimately, we make health information more broadly available so that patients make better life choices, further reducing the demand on doctors to provide care. A patient developing a disease that could have been prevented is even more wasteful to our system than a doctor ordering an extra blood test. Waste of any kind reduces useful capacity, and systems engineering looks at all of these dimensions.

HCB News: Why do we need to have health care systems engineers for all of this?
RB: Health care systems engineers are specialists, bringing knowledge, skills and tools to bear in distinct ways that are unlikely to be included in many organizational change initiatives otherwise. Many health care organizations include quality or process improvement activities that work to address many of the problems being encountered across the system. These initiatives can successfully improve efficiency and effectiveness in meaningful ways. The people conducting these activities are well-meaning and hardworking, but they often concentrate too easily on symptoms of problems rather than causes of problems. They fix components of systems, and problems often then pop out in other components. Systems engineers are educated and trained to focus on the system as a whole, and to implement changes in components that actually optimize the whole system. The people in the system need to be involved because they know their patients, processes and interfaces better than any engineer could. It’s the synthesis of all of that knowledge with systems thinking that will improve our health care system for the future.