Welcome back to the Johns Hopkins University, Whiting School of Engineering, Foundations of Healthcare Systems Engineering. This is module 4 of 4, where will talk about healthcare systems engineering approaches and applications. We will be bringing all the items that we learned in the previous three modules into this application module. What we talked about, in the first module were healthcare drivers, we talked about: the healthcare, the healthcare systems, and healthcare services, that provided the foundation for healthcare context. Next, we talked about the system types, we talked about three different systems types: complex systems, systems of systems, and enterprise systems. We then spoke about the systems engineering approach, we talked through a 13-stage approach for systems engineering. What we're now going to do in module 4, is bring these all together and show applications of healthcare in the systems engineering approach. What we discussed in the last module was a 13 stage systems engineering approach. What you saw is that there were several different types of systems engineering approaches, but this is the one we'll be using in the short course. What we talked about first was the idea that you needed to understand the objectives and the context of your problem, because they are several types of problems within healthcare. Next, we talked about there are several different systems types, and understanding what type of system type you have is important because you will be applying systems engineering differently depending on the different type of system. We talked about first, the baseline of the needs. What is the existing system that you have? That sets the stage for what gaps you have, so you can explore concepts, come up with ideas, functionally allocate what needs to be done that allows you to develop requirements, design a system, understand how the system is put together through interfaces, how it's put back together through integration and verified and validated through test and evaluation, and eventually, produced and deployed and put into in-service. This is the cycle that begins to set the stage for what is the new baseline, and we will start this all over again, we will look at this in the context of healthcare and health care problems. One of the first things you need to know when you talk about systems engineering is understand the problems scope. Let's look at the problem scope in the context of the different types of systems first. Number 1, we talked about a complex system, we talked about that in terms of a ventilator. We also talked about a systems of system, like in an ICU, with multiple pieces of complex systems in one area. We also talked about enterprise systems, maybe an ICU within the hospital, where you now have people processes in addition to the technology. If you were picking out a problem scope, you'd want to understand, ''Is my responsibility just for the ventilator, or is my problem scope the whole ICU and I need to take into account all the different technologies in complex systems, or is my scope and responsibility for the hospital within the ICU that has the people in the processes?'' Understanding that scope is very important, but also, look at it from this point of view as well. Are you at a suite level, for your problem? Are you at a station level? Maybe you're at a floor level, maybe you're at an entire hospital level. So understanding what scope you're involved with first, allowed you to better focus your resources and plans in the systems engineering approach. One of the first things we talked about in stage 3 of the systems engineering process is understanding, what is our baseline? What do we have currently? Let's just say you're in charge of the ICU in a hospital, multiple ICUs within a hospital. First of all, let's say you're interested specifically in the ventilator systems or those areas. First of all, you may have an inventory, your baseline asks, ''How many do I have?'' Then you may want to say, ''Okay, I have ventilator systems, but under what conditions do they operate? How do they perform in those conditions?'' That'll give you a sense of your baseline. Also, hopefully you have a set of goals and objectives you're trying to pursue, but you have an idea of what your end state is, so you now know where you need to go from with your baseline or what you need to do. We'll talk about ways that you can measure and improve to address the gap. One of the best ways and systems engineering tools that you can use to help establish your baseline and needs is the idea of using scenarios and use-cases. Scenarios and use-cases are simply operational contexts and operational stories that describe what goes on in a certain event that you're interested in. On the right-hand side here, you can see there are different types of healthcare areas that you may want to pursue. These are just some examples: cardiac, trauma, medical, surgical, neurological, pediatric, neonatal, so many different areas within healthcare, so many stories that you can tell. When you tell that story, you get a sense of the scope of the problem, the problem timeline, how quickly do things need to be done. Is it a longer-term care or is it an emergency care? Also, where are you in the process? Also, who needs to be involved? Because you will tell the story and you will talk about the stakeholders involved. Here's just a very simple narrative, but once you describe this narrative, you get a sense, and zero in and focus on what the scope of the problem is. First of all, a 92-year-old female, you understand it's a female, it's an elderly person. Pacemaker-lead surgery, so you understand where the area is and also, they need to be in the ICU for a certain amount of time. In this really simple short narrative, you get a sense of the scope of the problem, the timeline, the context, as well as the stakeholders. When you put together scenario and use-case, you want a lot more information than this, but at least this gets you on the start to describing the problem baseline and needs through scenarios and use-cases.