Healthcare: A complex service system

James M. Tien1, Pascal J. Goldschmidt-Clermont2
1College of Engineering, University of Miami, Coral Gables, USA
2Miller School of Medicine, University of Miami, Coral Gables, USA

Tóm tắt

Healthcare is indeed a complex service system, one requiring the technobiology approach of systems engineering to underpin its development as an integrated and adaptive system. In general, healthcare services are carried out with knowledge-intensive agents or components which work together as providers and consumers to create or co-produce value. Indeed, the engineering design of a healthcare system must recognize the fact that it is actually a complex integration of human-centered activities that is increasingly dependent on information technology and knowledge. Like any service system, healthcare can be considered to be a combination or recombination of three essential components — people (characterized by behaviors, values, knowledge, etc.), processes (characterized by collaboration, customization, etc.) and products (characterized by software, hardware, infrastructures, etc.). Thus, a healthcare system is an integrated and adaptive set of people, processes and products. It is, in essence, a system of systems which objectives are to enhance its efficiency (leading to greater interdependency) and effectiveness (leading to improved health). Integration occurs over the physical, temporal, organizational and functional dimensions, while adaptation occurs over the monitoring, feedback, cybernetic and learning dimensions. In sum, such service systems as healthcare are indeed complex, especially due to the uncertainties associated with the human-centered aspects of these systems. Moreover, the system complexities can only be dealt with methods that enhance system integration and adaptation.

Từ khóa


Tài liệu tham khảo

Aspinall, M.G. & Hamermesh, R.G. (2007). Realizing the promise of personalized medicine. Harvard Business Review, 85(10): 108–117 Donofrio, N. (2008). Global Innovation Outlook: Security and Society. IBM Corporation, Armonk, NY Friedman, T. L. (2005). The World Is Flat: A Brief History of the Twenty-First Century. Farrar, Strauss & Giroux, New York, NY Goldschmidt-Clermont, P.J., Dong, C., Rhodes, N.M., McNeill, D.B., Adams, M.B., Gilliss, C.L., Cuffe, M.S., Califf, R.M., Peterson, E.D. & Lubarsky, D.A. (Undated). Autonomic care systems for hospitalized patients. Submitted for publication in Academic Medicine Grossman, J.H. (2008). Disruptive innovation in health care: challenges for engineering. National Academy of Engineering: The Bridge, 38(1): 10–16 Hipel, K.W., Jamshidi, M.M., Tien, J.M. & White, C.C. (2007). The future of systems, man and cybernetics: application domains and research methods. IEEE Transactions on Systems, Man, and Cybernetics Part C, 30(2): 213–218 Kaplan, E.H., Craft, D.L. & Wein, L.M. (2002). Emergency response to a smallpox attack: the case for mass vaccination. Proceedings of the National Academy of Sciences, 99(16): 10935–10940 Maglio, P., Srinivasan, S., Kreulen, J. & Spohrer, J. (2006). Service systems, service scientists, SSME, and innovation. Communications of the ACM, 49(7): 81–85 Mendonca, D. & Wallace, W.A. (2004). Studying organizationally-situated improvisation in response to extreme events. International Journal of Mass Emergencies and Disasters, 22(2): 5–29 Meyer, C. (2008). The convergence of information, biology, and business: creating an adaptive health care system. National Academy of Engineering: The Bridge, 38(1): 26–32 Mitragotri, S. (2008). Recent developments in needle-free drug delivery. National Academy of Engineering: The Bridge, 38(2): 5–12 National Academies. (2006). Engineering the Health Care System. National Academies Press, Washington, DC Porter, M.E. & Teisberg, E.O. (2006). Redefining Health Care: Creating Value-Based Competition on Results. Harvard Business School Press, Boston, MA Quinn, J.B., Baruch, J.J. & Paquette, P.C. (1987). Technology in services. Scientific American, 257(6): 50–58 Rouse, W.B. (2007). Complex engineered, organizational and natural systems. Wiley InterScience Online: Systems Engineering, 10(3): 260–271 Rouse, W.B. (2008). Health care as a complex adaptive system: implications for design and management. National Academy of Engineering: The Bridge, 38(1): 17–25 Sussman, J.M. (2008). Intelligent transportation systems in a real-time, customer-oriented society. National Academy of Engineering: The Bridge, 38(2): 13–19 Tien, J.M. (2000). Individual-centered education: an any one, any time, any where approach to engineering education. IEEE Transactions on Systems, Man, and Cybernetics Part C: Special Issue on Systems Engineering Education, 30(2): 213–218 Tien, J.M. (2003). Towards a decision informatics paradigm: a real-time, information-based approach to decision making. IEEE Transactions on Systems, Man, and Cybernetics, Special Issue, Part C, 33(1): 102–113 Tien, J.M. (2008). On integration and adaptation in complex service systems. Journal of Systems Science and Systems Engineering, 17(4): 385–415 Tien, J.M. & Berg, D. (1995). Systems engineering in the growing service economy. IEEE Transactions on Systems, Man, and Cybernetics, 25(5): 321–326 Tien, J.M. & Berg, D. (2003). A case for service systems engineering. Journal of Systems Science and Systems Engineering, 12(1): 13–38 Tien, J.M. & Berg, D. (2006). On services research and education. Journal of Systems Science and Systems Engineering, 15(3): 257–283 Tien, J.M. & Berg, D. (2007). A calculus for services innovation. Journal of Systems Science and Systems Engineering, 16(2): 129–165 Tien, J.M. & Cahn, M.F. (1981). An Evaluation of the Wilmington Management of Demand Program. National Institute of Justice, Washington, DC Tien, J.M. & Goldschmidt-Clermont, P.J. (2009). On designing an integrated and adaptive healthcare system. In: Engineering a Learning Healthcare System: A Look to the Future. Institute of Medicine, Washington, DC Tien, J.M., Krishnamurthy, A. & Yasar, A. (2004). Towards real-time customized management of supply and demand chains. Journal of Systems Science and Systems Engineering, 13(3): 257–278 U.S. President. (2001). Executive Order on Critical Infrastructure Protection. The White House, Washington, DC, October 16 World Health Organization (WHO). (2000). Why Do Health Systems Matter? World Health Organization, Geneva, Switzerland Yasar, A. (2005). Real-Time and Simultaneous Management of Supply and Demand Chains. Ph.D. Thesis. Rensselaer Polytechnic Institute, Troy, NY Zadeh, L.A. (1996). The evolution of systems analysis and control: a personal perspective. IEEE Control Systems Magazine, 16(3):95–98