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Understanding and Managing the Complexity of Healthcare

William B. Rouse

Publication Year: 2014

Breakthroughs in medical science, innovations in medical technologies, and improvements in clinical practices occur today at an increasingly rapid rate. Yet because of a fragmented healthcare delivery system, many Americans are unable to benefit from these developments. How can we design a system that can provide high-quality, affordable healthcare for everyone? In this book, William Rouse and Nicoleta Serban introduce concepts, principles, models, and methods for understanding, and improving, healthcare delivery. Approaching the topic from the perspectives of engineering and statistics, they argue that understanding healthcare delivery as a complex adaptive system will help us design a system that is more efficient, effective, and equitable.The authors use multilevel simulation models as a quantitative tool for evaluating alternate ways of organizing healthcare delivery. They employ this approach, for example, in their discussions of affordability, a prevention and wellness program, chronic disease management, and primary care accessibility for children in the Medicaid program. They also consider possible benefits from a range of technologies, including electronic health records and telemedicine; data mining as an alternative to randomized trials; conceptual and analytical methodologies that address the complexity of the healthcare system; and how these principles, models, and methods can enable transformational change.

Published by: The MIT Press

Title Page, Series Page, Copyright, Dedication

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pp. vii

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Series Foreword

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pp. ix-x

Engineering Systems is an emerging field that is at the intersection of engineering, management, and the social sciences. Designing complex technological systems requires not only traditional engineering skills, but also knowledge of public policy issues and awareness of societal norms and preferences. In order to meet the challenges of rapid technological change and of scaling systems...

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pp. xi

We both came to this topic having had many experiences, some of them profound, with the healthcare delivery system in the United States. These experiences have caused us to believe that the system could be much better. Indeed, we believe that high quality, affordable care for everyone is doubtlessly achievable. We inherently address this possibility from rather different perspectives, one being engineering...

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1 Introduction

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pp. 1-14

Breakthroughs in medical science along with innovations in clinical practices and related technologies offer enormous opportunities for impressive improvements in the health and well-being of society. Returns on investments in these endeavors have the potential to be substantial, sustainable, and broadly beneficial. However, we will not realize the greatest returns with our current fragmented...

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2 Complexity of Healthcare Delivery

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pp. 15-34

For several years, constituents of the National Academies have been engaged in a systemic study of the quality and cost of healthcare in the United States (Institute of Medicine, 2000, 2001; National Academy of Engineering & Institute of Medicine, 2005). Clearly, substantial improvements in the delivery of healthcare are needed and, many have argued, are achievable via value-based competition...

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3 Healthcare Costs and Their Causes

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pp. 35-56

The enormous cost of healthcare in the United States is often cited as a key national challenge ( Economist , 2004; CBO, 2008). Healthcare is consuming an increasing portion of the gross domestic product (GDP). At the same time, there are concerns that the quality of healthcare in the United States lags that of other countries (Institute of Medicine, 2000, 2001). It is clear that substantial...

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4 Effects of Healthcare Price Controls

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pp. 57-70

Government price controls might seem to be a good way to “ bend the curve ” of healthcare costs. As outlined later, this possibility has been raised often in the past and sometimes pursued in various areas of the economy. At this point in time, many think they might like the government to control the costs of healthcare as well as the costs of higher education, which over the past decade has...

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5 Prevention and Wellness

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pp. 71-92

Chapters 3 and 4 focused on the costs of healthcare delivery, particularly in terms of the cost per use of the system. Chapter 3 addressed the means to reducing cost per use, and chapter 4 considered the implications of simply capping cost per use. These possibilities focus on one element of the overall equation of total cost, which equals cost per use times the number of uses. Chapters 5 and 6 focus on reducing the number of uses. Chapter 5 considers prevention and...

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6 Chronic Disease Management

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pp. 93-106

In chapter 5, we discussed the huge burdens of chronic disease on the healthcare delivery enterprise in the United States. DeVol et al. (2007) estimate that more than $1 trillion is spent on healthcare costs and lost productivity for those with chronic diseases such as hypertension (HTN), diabetes mellitus (DM), and coronary heart disease (CHD). Chapter 5 addressed prevention of DM and CHD...

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7 Equity of Care

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pp. 107-138

In the previous chapters, we highlighted the complexity of the connectivity between the four levels in the healthcare system. Understanding the causes and effects of ever-increasing costs helps in projecting and evaluating efficiencies (e.g., decreasing costs per use or number of uses) in the healthcare system. Prevention, wellness, and chronic disease management are means to increase the effectiveness of health outcomes and healthcare delivery. Depending on the...

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8 Technologies for Care

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pp. 139-182

In Technopoly , Neil Postman observes, “ A new technology does not add or subtract something. It changes everything … . New technologies alter the structure of our interests: the things we think about. They alter the character of our symbols: the things we think with. And they alter the nature of community: the arena in which thoughts develop ” (Ball & Bierstock, 2007). Historically, technology has enabled a greater simplification of routine aspects of our...

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9 Data in Healthcare

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pp. 183-204

Two common denominators of all chapters in this book are data and methodologies for understanding and managing the complexity in the healthcare system. Healthcare transformation is driven by an aggregate of methodologies, whereas evidence of improvement is grounded in an aggregate of data. This chapter attempts to review briefly the domain of existing data resources that...

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10 Methodologies for Improvement

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pp. 205-232

Data have an operational role, but their translation into knowledge, decision making, and improvements provides the basis of promoting better health and healthcare for people; advancing efficient and effective processes; informing organizations about their overall progress, costs, and potential regulatory practices; and helping society in creating an ecosystem that is sustainable...

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11 Facilitating Change

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pp. 233-248

Chapter 1 initiated the discussion of the extent of fundamental change needed across our healthcare delivery enterprise. There is no doubt that incremental business process improvements can certainly yield measurable benefits. However, these types of changes will not be transformative. They will not be sufficient to result in the healthcare delivery...


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pp. 249-274


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pp. 275-284

E-ISBN-13: 9780262320733
E-ISBN-10: 0262320738
Print-ISBN-13: 9780262027519

Page Count: 296
Publication Year: 2014