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A Medical Need: The Demand For Systems Engineering Is Growing

Dr. Gary Sieck is dean of research and academic affairs and Vernon T. and Earline D. Dale professor and chair of the department of physiology and biomedical engineering at Mayo Clinic’s College of Medicine. He also directs the Biomedical Engineering program in the Mayo Graduate School. Sieck received the Mayo Research Educator Award from 2001 to 2004 and was named Mayo Distinguished Investigator in 2007. He is a past president of the American Physiological Society and a fellow of the American Institute of Medical and Biological Engineering.  Before joining Mayo in 1990, Sieck served on the biomedical engineering faculty at the University of Southern California. In January, he was elected chair of the industry leadership board of Lehigh’s Healthcare Systems Engineering program.
Q: Your research specialties include cell behavior, protein expression and the effects of anesthesiology.
What notable research have you led?
A: My research interests for the past 35 years have focused on neural control of respiratory
muscles, particularly the diaphragm muscle and airway smooth muscle. Patients with weak
breathing muscles might be placed on mechanical ventilators or run the risk of pneumonia and
respiratory complications. Our research has given us a much clearer
understanding of how the nervous system controls these muscles. We’re able to target
therapies either to motor neurons or to muscle fibers. A current project is looking at spinal cord
injury and how it affects the diaphragm muscle. We’re developing therapies that could potentially
restore the ability to breathe in patients with upper cervical spinal cord injury.
Q: Mayo Clinic is widely praised for offering quality care while controlling costs, and it is ranked third
in U.S. News & World Report’s 2011-12 issue of America’s Best Hospitals. Tell us about the evolution
of team medicine at Mayo.
A: Founder William Worrall Mayo established a practice in Rochester, Minn., at the end of the
Civil War. His two sons, William and Charles, both physicians, later joined him. They introduced the
idea of medical group practice and specialization in medicine. They understood the importance
of academic training and partnered with the University of Minnesota. This was the start of the
Mayo Clinic team medicine approach, which continues today and is essential to our success.
Research has been an integral part of the Mayo Clinic since 1914, when Mayo founded
the Institute of Experimental Medicine. Today we have a wide range of research activities.
In particular, we’re taking advantage of our extensive patient clinical records, which are very relevant
to the Healthcare Systems Engineering concept for improving clinical practice. The patient-focused
nature of our medical research has been vital to our success.
Q: Mayo has for four years hosted an international Conference on Systems Engineering (SE) and
Operations Research (OR) in Healthcare. When did Mayo begin implementing SE practices?
A: Mayo has been involved in innovation and in the application of engineering principles to medical
practices since 1901, when Henry Plummer joined Mayo as a physician. Plummer is widely
regarded as the architect of modern medicine. He implemented a wide range of innovations to clinical
practice that improved efficiency in patient care. In 1907, he introduced standardized, individualized
medical records for patients so that physicians would know what medical tests and treatments
patients had received. Plummer brought systemized approaches
to medicine using engineering principles. A Systems and Procedures group was established
in 1947 at Mayo. Industrial engineers were among those they hired. The people in
this group are the type of people being trained at Lehigh today in the HSE program.
Q: How large a staff has Mayo committed to the implementation of SE practices? How is
this staff deployed?
A: The Systems and Procedures group now has approximately 100 people. Systems engineers
also work in other areas, such as the Department of Laboratory Medicine Pathology.
The sheer volume of samples tested requires tremendous organization: keeping track of
samples, doing and reporting the analyses. We also have one of largest esoteric clinical
testing facilities for rare, complicated diseases. All this work requires SE skills. Mayo has also
initiated a research focus in the science of healthcare delivery, which involves healthcare
systems engineering and operations research in clinical practice to improve outcomes
and efficiencies.
Q: In what areas of operation has Mayo seen the most dramatic benefit from the implementation
of SE practices?
A: Every area really. One example: We have more than 120 surgical starts every morning.
The staff and equipment, induction of anesthesia, and post-op care all have to be organized
and coordinated. We treat more than 600,000 patients per year. We have to keep track of
who they are, what their problems are, who should see them. All this information should
be organized so that patients get as much as possible out of a single visit to the clinic. I call
this one-stop shopping for clinical care. That’s where systems engineers come in.
Q: In general, what areas of healthcare do you think could most benefit from the application
of SE principles?
A: Communication among specialists treating complex diseases is one area that must
be improved and where SE skills are needed. Information should follow patients around so
that every specialist knows the tests and treatments a patient has received.
Q: According to a UCLA study, the U.S. spends about one-third of its healthcare resources for
care given in the last year of patients’ lives. How can SE practices reduce this percentage?
A: SE can play a role in improving health and wellness. Many patients don’t see a physician
until a disease is well progressed. We need increased attention on sustaining wellness and
avoiding disease. Recognizing the growing incidence of obesity, diabetes and heart disease,
we need better management of these chronic diseases. Diabetes, for example, if left untreated,
can lead to complications requiring intensive care, which is where most of the expense
occurs. The earlier a patient is seen, the better the outcome. SE practices can also make a
contribution in health-monitoring systems.
Q: What has attracted the Mayo Clinic to collaborate with Lehigh University on its new
HSE program?
A: We’re not a university. We have no school of engineering. Lehigh has an outstanding
school of engineering but no medical school. We started a partnership five or six years ago.
We saw advantages for both institutions, first in biomedical engineering but also Healthcare
Systems Engineering. Mayo provides outstanding clinical care, but we have to rely on other
institutions to provide necessary academic training. So we decided to collaborate with
Lehigh. But Mayo is only one of many places where Lehigh’s HSE students could get practical
Q: What kind of “niche” can the new program carve out?
A: There’s a great need for engineers trained in healthcare. Look at the national focus on
things like electronic medical records, improving the efficiency of healthcare and the
political discussion on the direction of healthcare. HSEs will be needed no matter which
direction the field takes. Certainly, when the industry moves to electronic medical records
— which only a small fraction of medical practices have — HSEs will play an important role.
Q: What kind of value will the graduates of Lehigh’s new HSE program offer to an institution
like Mayo?
A: Finding people trained for the kind of work done by our Systems and Procedures group
is a challenge. By introducing a systematic approach to healthcare management, Lehigh is
doing a great service. Its HSE grads will bring immediate value to our SE efforts.