Sunday, October 11, 2009

SDM has Rx for MD seeking health systems perspective - SDM Pulse Fall 2009

By Dr. Sahar Hashmi, SDM ’09

Dr. Sahar Hashmi, right, meets with Pat Hale, director of the
SDM Fellows Program, during a break from SDM activities.
Watching President Obama and Congress grapple with health-care reform this summer highlighted for me the challenges faced by healthcare systems around the world. The complexities of increasing costs, a scarcity of qualified personnel, and demanding governmental regulations are universal. Yet, everyone focuses on issues within their own country, hospital, or practice rather than approaching the whole problem from an international systems-based perspective.

Some might argue that this broader perspective adds an unnecessary, even insurmountable, layer of complexity, but I would disagree. As a physician, I have seen limited thinking affect every level of medical care. Hospital CEOs argue that their hospital is unique and what will work in one hospital would not work in another. Doctors argue that disease prevalence varies from one country to another and from one patient to another. Standards of treatment vary. And yet, I can’t help but think of a quote from one of my colleagues: "After a while, all knee replacements look the same."

When I decided to join MIT’s System Design and Management (SDM) Program, my goal was to better understand the health-care system and to find ways to improve it as a whole. Six months into the program, I am confident I made a wise decision.

SDM has drawn me away from the tunnel vision of the medical profession and taught me to look at the world from many different angles. Each class I’ve taken has contributed to broadening my perspective.

For example, SDM’s course in product design and development revealed to me the enormous challenges involved in bringing new products to market. Pat Hale, director of the SDM Fellows Program, and Assistant Professor Maria Wang not only taught the class but arranged for successful business leaders to share their product development stories with us. From this class, I have come to appreciate the technical and business factors that need to be considered in evaluating a product’s overall effectiveness—not just its direct medical features.

But what impressed me was the practical experience of going through the process of developing and marketing a product. In our PDD class, students were required to work in teams to develop a viable product. My team designed and developed an efficient pill box for the elderly but we were all delighted to find it was appreciated by younger potential customers who have diabetes as well. The elder patients liked the timer and the flickering light that served as a silent reminder for their pills. All patients appreciated the privacy we provided via bar codes on the pill box, which could be read from cell phones to gain access to prescription details.

Generally, doctors who prescribe medications for chronic diseases like diabetes or hypertension are rightfully concerned with how well patients follow their treatment regimens. But, few doctors delve deeper into ways of solving this problem. Attempting to tackle this problem myself, even in a small way, helped me see the critical importance of the broader, systems perspective in the health care.

SDM also taught me to appreciate technological innovation. By studying technology strategy with Senior Lecturer Michael Davies, I realized that it’s necessary to work with whole systems to adopt change—not just the administration but the physicians, nurses, technicians, and the patients themselves.

For example, our project in this class focused on developing system-wide strategies for the faster adoption of robotic surgery. We spoke with the product manager of the robotics company, Intuitive Surgical, as well as a few surgeons and patients to understand the system and develop a better adoption strategy. This helped us comprehend the whole system—not just one customer and one operation—and our project was deemed to have the best strategy policy in the class. (The details are proprietary.)

Finally, physicians can sometimes understate the significance of communications and relationships in their work—yet this social aspect is perhaps one of the most important elements of excellent medical service and care. Professor Tom Allen’s class, Organizing for Innovative Product Development, pointed out the importance of decreasing distance as a method to building relationships and increasing problem-solving.

Few hospitals consider using architectural designs to increase communication among physicians, nurses, and technicians from different departments. Yet many existing designs are counterproductive. Increasing the communication interdepartmentally could potentially help treat patients with complex or multiple problems more effectively. This class helped me to appreciate networks and designs that help increase face-to-face communications in health care systems.

Many of the technical skills taught in SDM can also be used in the medical and pharmaceutical world. The class in system dynamics, for one, taught me how to draw and simulate infectious disease models. Such models could help us predict and prepare for a pandemic. In fact, I’m planning to focus my thesis on the recent spread of the H1N1 flu virus, examining how the use of non-pharmaceutical interventions and vaccines might be applied to compact it from a healthcare systems view.

Understanding the health-care system better and improving it in whatever way we can is a great way to start to make the world a better place. I’m pleased to report that SDM has already helped me begin to formally and systematically analyze the broader health-care system. I look forward to taking other classes, such as Innovations in the Health Care System with Dr. Stan N. Finkelstein and Senior Lecturer Joseph F. Coughlin, and building up my understanding and perception of how to bring about innovation in health care using a systems approach.

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