Our expert answers 3 Questions
As a gastroenterologist and health services researcher, I am interested in using principles of system engineering, implementation science and predictive modelling to improve access, timeliness, and efficiency for endoscopic procedures. Among VA patients, the big focus for me is trying to better understand the process that leads up to a successful procedure and thinking about ways that our health system can reduce these barriers, through strategies like improved bowel preparation education, innovative scheduling techniques, and coordination of care.
I first became interested in the issue of health care quality as a Fellow at the Institute for Ethics at the American Medical Association. With the help of colleagues, I wrote a chapter titled "Physician Ethics and Participation in Quality Improvement: Renewing a Professional Obligation" highlighting the history of our ethical obligation to provide the highest quality of care to our patients and families. As a gastroenterologist, it’s clear that we could do more to make the process of endoscopy more seamless and efficient, and as a health services researcher, I’ve been exposed to a range of methodologies for tackling this problem. When patients fail to show up for a colonoscopy, or show up with an inadequate bowel preparation, it results in unnecessary costs, depletion of limited endoscopic resources, and potential harm to patients.
The work I’m doing now focuses on how to use systems engineering in endoscopy units, which has direct implications for the quality of care for patients undergoing procedures. But really, endoscopy units are just a laboratory in which to study the implementation of these novel strategies. In the long term, the same strategies of systems engineering and predictive modelling could be used to improve scheduling, access and timeliness for a host of other types of medical encounters, from clinic visits to MRIs.