Hospital Operating System: Part 1

Hospital Operating Systems can transform hospital operations... So, what's a Hospital Operating System?

I have argued that we ought to transform hospital operations because doing so will have dramatic financial and quality impact and may reduce the number of avoidable deaths due to medical and pharmaceutical errors.

I have also suggested that this transformation starts with installing a Hospital Operating System not with process improvement.

So, what exactly is a Hospital Operating System?
(Disclosure: my company develops and sells a Hospital Operating System solution)

A Hospital Operating System would be comprised of people, processes and software that work together to achieve the goal of optimal patient-flow: moving all patients from arrival through discharge with quality and efficiency. More specifically, an effective Hospital Operating System will

• be a human-machine system composed of people, IT systems, standard operating procedures, and executive mind-set
• interconnect all processes relevant to patient-flow
• be cybernetic

I will talk about the first two characteristics in future posts, but with respect to that last one - the really geeky sounding one - please consider the thermostat.

Thermostats are interesting. Actually I should say, the thermostat in your house is part of a system that controls the temperature in a very interesting way. It

• allows a goal temperature to be set 
• senses the temperature of the environment 
• utilizes heaters and air conditioners to change the temperature 
• contains simple rules describing what signals should be sent to the heaters and air conditioners when the temperature deviates from the goals 

The thermostat participates in a nice, self-correcting system which tweaks the environment through its effectors - heaters and coolers - based on comparing the goal temperature with the information it gets from its sensor (thermometer). It does its best to maintain the temperature despite fluctuations in the number of people in your house, the outside temperature, etc.

By way of contrast, consider the simplestat. The simplestat attempts to keep your house comfortable by turning the heat on from 5:00 a.m. to 9:00 a.m. and again from 7:00 p.m. to 11:00 p.m. While this device might work perfectly well in Atlanta in March, it will be a disaster in August. And, it will be a disaster precisely because it is not influenced by the environment - it completely ignores the ambient temperature, for example.

The simplestat is an example of a closed system and, as such, it is doomed to perish. The thermostat, on the other hand, is an example of a cybernetic system meaning it interacts continuously with its environment and is capable of self-regulation. And, this is really important, no system can persist if not cybernetic.

Hospitals often do the hard work of process improvement and craft excellent processes with respect to a moment in time. However, these optimized processes are typically embedded in closed systems that live in an inherently dynamic environment, so most often the efficacy of the processes degrades over time. The closed systems are brittle cracking under any type of environmental change and making any subsequent improvement costly.

Software and IT systems do not necessarily help. Significant attention has been paid to the idea that process improvements are not sustainable if they depend on manual procedures, so technology has been used to memorialize, support, facilitate and enforce processes. Ironically, the technology used is frequently itself a closed system. Perhaps because of its closed nature, the cost of changing an IT system's behavior is typically very high so responding to environmental change becomes prohibitively expensive. Thus, the IT system acts as a sort of digital cement unable to bend with change resulting in the degradation of process effectiveness.

Ideally one should use technology, but that technology should be cybernetic and be part of a larger hospital-wide cybernetic system that contains, orchestrates and provides visibility to the goal of moving all patients from admission through discharge. Instead of digital cement, the software component of a Hospital Operating System would be more like digital rubber allowing a wide-range of flex to accommodate a steadily changing environment

Such a system would regulate itself with respect to preserving its operational goals. Stated more formally (and in all of its geeky glory), a successful Hospital Operating System will be cybernetic. It will

1. allow operationally relevant goals to be set 
2. contain sensing mechanisms whereby information relevant to the operational goals is registered.
3. contain effector mechanisms whereby the system acts on its environment.
4. contain transformational rules or procedures whereby information received from the sensors is compared with information about the goals and error-correcting signals produced to modify the behavior or the effectors
   

Hospitals are too complex and dynamic not to have an operating system, and a Hospital Operating System needs to be cybernetic, adapting to the dynamic hospital environment and supporting future process improvement efforts.