Engineering mindset could transform NHS, claims report

This is the key message of a newly published cross-disciplinary report from the Royal Academy of Engineering (RAEng), the Royal College of Physicians and the Academy of Medical Sciences.

The NHS is one of the UK’s largest and most complex organisations, and faces a number of well-known challenges, from the impact of real-term reductions in government spending to the pressure of a growing ageing population. The RAEng-led report “Engineering better care: a systems approach to health and care design and continuous improvement” claims that it will only be able to effectively meet these challenges by applying the kind of systems-level approach common to engineering, an approach that gives careful consideration to the way every element of the system- in this case patients, carers, clinicians and other staff – interacts.

In engineering we are well used to dealing with things that are complex - the question is can we help deal with the complexity that emerges in healthcare?

Prof John Clarkson, Cambridge University

Cambridge University’s Professor John Clarkson, who chaired the working group behind the report, told The Engineer that whilst a number of studies over the years have pointed to the healthcare benefits of systems engineering, the new study represents one of the most detailed efforts yet to describe what it is and how it might work in practice. “Healthcare is a complex system,” he said. “In engineering, we are well used to dealing with things that are complex and we’ve evolved a way of thinking to help us to cope with that -  the question is can we help deal with the complexity that emerges in healthcare?”

Graphic from the report illustrating the questions at the heart of a systems engineering approach for healthcare

The report was based on the findings of series of workshops led by the Royal Academy of Engineering but involving more than sixty leading engineers and clinicians. Clarkson said that despite the size and cross-disciplinary nature of the group, there was a real appetite amongst all involved to come up with practical solutions. “You’d think it would have been a difficult thing to do but when we raised the topic with people in both communities we weren’t short of people who stood forward and wanted to take part,” he said.

Clarkson added that bringing different areas of expertise together was not only key to identifying the challenges but also in finding a way to describe the systems approach in a language that’s accessible to healthcare workers.

"The key output of the report is a series of questions that healthcare providers and clinicians could potentially use to improve the service they offer. A systems approach made up of four key perspectives: system, design, risk, people and they’re all inextricably linked,” explained Clarkson. “We worked hard to think of how to describe each of those four most simply in terms of a set of very straightforward questions. If you leave someone with a question, it challenges the way they think and has the potential to change what they do. Rather than give them tenets of systems engineering.”

The result is a series of 13 project related questions – such as “What is the problem?”, “Who will use the system?” and “Where is the system?” which, said Clarkson, can be applied in an iterative way to any process.

Whilst many of these questions appear to be common sense, this is a quality that’s apparently in worryingly short supply. “One of the comments that came out of the end of this process is that common sense is not common,” said Clarkson. “We’re not putting across anything that’s brand new, and you do find islands of excellence where people are inspired and do things in a very systems-like way, but it’s not everywhere, and that’s where we think we can add some value.”

The group now plans to work together to look at how to put its findings into action. If it’s successful, Clarkson believes it could have a fundamental impact on the quality of healthcare in the UK. “As soon as you take a complex system like healthcare and take a holistic view of how you can make active change, it opens a wide range of possibilities for improving care, taking cost out of the system, and making it easier for clinicians to provide care.”

https://www.theengineer.co.uk/issues/april-2015-online/can-technology-save-the-nhs/