Division of Healthcare Engineering
In December 2014, a new Division of Healthcare Engineering was established in the UNC Department of Radiation Oncology. The Division studies the interplay between people and their workplace environments, and how this information can be used to improve clinic efficiency and ensure patient safety.
Welcome to the Division of Healthcare Engineering. Our focus is broad as we implement and research the impact of management practices, design of physical spaces and processes, human and system factors, and cognitive factors that influence worker’s abilities to perform their job well, and directly influence reliability, safety and quality.
|Julie Ivy, PhD||Associate Professor of Industrial and System Engineering, North Carolina State University, Raleigh, NC
Areas of collaboration: Risk assessment, quality assurance, simulation and optimization methodologies
|John McCreery, PhD||Associate Professor of Operations and Innovation Management, North Carolina State University, Raleigh, NC
Area of collaboration: Lean implementation science
|Carlton Moore, MD, MS||Associate Professor of Medicine (Internal Medicine), University of North Carolina School of Medicine, Chapel Hill, NC
Areas of collaboration: usability, data visualization, workload, performance
Our program works within the context of a real clinical environment, within the department of Radiation Oncology at UNC HCS. We have initiatives that span across several of the clinical centers within UNC HCS, including UNCH, Rex, and High Point.
Our services and research portfolio include:
Implementation Science: The challenge for any care delivery facility is to develop highly efficient and reliable systems that deliver value to every patient.
Value from the patient’s viewpoint is the provision of service that provides maximum therapeutic benefit with the least amount of waste (cost, harm and effort). Value is tightly linked to efficiency and reliability of processes and thus the overall quality and cost of the care delivery system. We developed an improvement model mainly based on the ‘Good Catch’ Program and Toyota’s A3 Thinking for Problem Solvingthat engages all stakeholders into continuous quality improvement efforts using Plan-Do-Study-Act (PDSA) cycle (see Figure 1).
Our research efforts in this area are two-fold: a) continuous development, implementation, and assessment of our improvement model to enhance providers’ safety mindfulness, which in turn promotes ‘teamwork’ and the creation of a ‘culture of patient safety’; b) development and implementation of computer-based decision support models to analyze system capability and reliability to detect and prevent harm to patients. The computer-based model is based on ‘real’ data coming from ‘Good Catch’ reporting system (incident and near miss) and detailed process maps in order to analyze and propose the optimal number and location of quality assurance (QA) steps (i.e., checklists, huddles, time-out, etc.).
Physical spaces & processes: A key challenge in hospital facility design is the fact that hospital administrators and architects often make critical design decisions based upon experience-based intuition, sometimes neglecting to use process/system engineering when available. Seeking to improve the design process by integrating more rigorous findings, our group has embarked upon a new era of work that is centered around incorporating Lean exploration loops into design process. Our practical efforts in this area are focused on assisting design teams with Lean thinking during three key design phases: i) programming, ii) schematic, and iii) detailed design. Our research efforts in this area are focused on answering the fundamental question of when and how to best incorporate Lean exploration loops into the design phases to promote collaboration between architects and the Lean team.
Human Factors: There is an increasing reliance on computer-based systems to perform routine clinical tasks. Providers are required to continually interact with multiple computer screens (e.g. electronic medical record (EMR) systems, image repositories such as PACS, directories for paging, and the diverse informational offerings of the internet). There is no question that these computer-based systems afford unparalleled opportunities for improved patient care (e.g. more ready access to patient-specific information, data integration, decision support, etc.), and thus need to be vigorously embraced. Nevertheless, the need for providers to interact with computers also raises serious challenges that can hinder quality care. If human-computer interactions are sub-optimally designed and implemented they can increase provider workload, which may reduce individual performance and negatively impact patient safety. Our practical efforts in this area are focused on usability evaluations of EMRs. Currently, we are working with several projects focusing on:
- Development and assessment of standardized and generalizable simulation-based training on providers’ mental workload and performance; and
- Development and assessment of innovative usability enhancements on providers’ mental workload and performance
Cognitive Decline (New): Patients with brain metastases often experience problems with attention, concentration, memory, language, logical reasoning, sensory impulses, coordination, balance, and emotional well-being, collectively termed neurocognitive decline. Thus, we plan to evaluate the neurocognitive decline of patients with brain cancer brain metastases (BCBM) who receive treatment with stereotactic radiosurgery (SRS). To that end, participants will be given a series of tests to assess neurocognitive function before treatment, and then at follow-ups every three months following therapy. By combining neurocognitive tests with evaluations of performance status, quality of life, and functional independence, the study team will also be able to determine the effect of neurocognitive decline on quality of life. The proposed pilot study will provide the first opportunity to evaluate the effect of SRS for BCBM on quality of life, performance status, and functional independence measures. Furthermore, identification of changes in neurocognitive function could be critical to developing a treatment plan that accounts for quality of life factors in addition to disease control.
Neurofeedback as means to enhance cognitive skills: Overall, neurofeedback training aimed at enhancement and/or suppression of particular bandwidths of the electroencephalograph (EEG) have been mostly associated with positive results with regard to hyperactivity disorder (HD) and attention deficit hyperactivity disorder (ADHD). Neurofeedback has been also suggested as a potential intervention to improve cognitive skills of individuals including astronauts (in work done by NASA: National Aeronautics and Space Administration), physicians (microsurgical skills), athletes, dancers, and musicians. Thus, our research efforts in this area are focused on development and assessment of neurofeedback as i) means to improve cognitive states (e.g., attention, working memory) of healthcare professionals during routine computer-based tasks, and ii) means to increase theta over alpha activity levels during a wakeful eyes-closed condition for the purpose of relaxation training, based on the association between theta activity and meditative states.
DHE Organizational Chart