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High-Risk Operations in Health Care


Margaret V. Stringfellow, Ph.D. Candidate, Complex Systems Research Lab, MIT

Meghan Dierks, M.D., Assistant Professor of Medicine at Harvard Medical School, Faculty in the Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Director of Clinical Systems Analysis, Beth Israel Deaconess Medical Center

The complexity of the health care system has made achieving system goals, including safety, clinical effectiveness, cost-effectiveness, and accessibility, increasingly challenging. Our examination of patient safety in an ambulatory surgical care setting has revealed a state of high-risk operations. Risk migration has occurred as hospitals have pursued strategies to simultaneously achieve all system goals that paradoxically fail to achieve any. Due to the effects of time delays and complex feedbacks in the healthcare system, the undesirable interactions of policies is not clear to decision-makers and has led to a failure to make significant gains in any dimension.

Risk is an inherent part of healthcare, particularly in large referral centers, where some of the most complex cases are managed. While risk cannot be eliminated from the clinical activities, it is believed that some practices involving necessary risk can be mitigated without impacting overall performance. However, our ability to identify these vulnerable practices, and develop durable preventative or mitigating strategies is hampered by outdated models of risk and an inadequate approach to the analysis of risk.

As healthcare delivery models change over the next several years, the challenge for clinicians and decision-makers is to understand how decisions or policies about system operations may shift an individual patient’s position on the continuum of low-to-high risk during their hospitalization. A case for how this innovative approach to risk modeling and analysis specifically addresses this challenge is presented.

The presentation is based on Ms. Stringfellow’s Ph.D. research and research conducted in conjunction with Dr. Meghan Dierks and MIT Professor Nancy Leveson.

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