I love working in healthcare. It is a privilege to serve others and it is highly rewarding. As an IET chartered engineer, it helps me to build and act on my values ‘to engineer a better world’.
Engineers have a largely unseen role in healthcare working in areas such as nuclear medicine and medical physics, in bio-mechanics, equipment maintenance and device design, estates and facilities, IT and informatics. They also play key roles in improvement, strategy and operations, where I have typically worked, using engineering techniques such as systems thinking, supply chain management, human factors, design for safety, quality improvement, control and assurance, as well as project and change management. These are all elements of a larger interdisciplinary concept that the healthcare sector increasingly calls 'improvement science'.
When I joined the NHS ten years ago, skills like mine were sought after, though not necessarily recognised as ‘engineering’ skills. The national NHS Modernisation Agency had just disbanded and local NHS Trusts were seeking people who could help them to improve safety, flow and quality. Now there is a growing call for engineering science knowledge in healthcare and the NHS coming from respected commentators such as the Kings Fund, the Health Foundation and the Nuffield Trust, prominent clinicians such as Professor Don Berwick[1][2] and Governmental reports written by engineers themselves; including this new campaign from the Institution.
I feel there is now growing evidence and discourse for the potential of healthcare engineering to help both redesign and improve healthcare. Healthcare engineers working in partnership with patients, clinicians and managers are tackling the triple pressures of increasing demand, rising expectations of quality and reduced funding. That is not to say it is easy. Approaches used in industry inevitably need careful adaptation within the complexity of healthcare and learning, and outcomes from existing clinical improvement work needs greater recognition. Flexibility is also required as local and national improvement priorities change regularly.
Communication too is often a barrier to success. I am regularly the only engineer in a team and sometimes terminology, mindsets and values can clash, preventing improvement success. In some cases, governmental and political changes can end improvement projects before they have even begun; or significantly influence their outcomes[3].
Despite this, it is hugely rewarding. I have had the privilege of working with staff and patient groups in hospitals, communities and nationally. I have applied my engineering skills to collaborate with and support teams to reduce mortality rates and the length of hospital stays and patient waiting times, and in doing so, improve care quality, patient experiences and clinical outcomes[4][5][6][7][8].
I have also developed educational programmes, building capacity and capability for NHS staff to use systems engineering and operations management approaches; including lean thinking, constraints, flow and queuing theories, to help scale up improvement activity all to the benefit of patients.
I am just one of many healthcare engineers working with patients, clinical, managerial and other professions to improve patient care and build on best practice. The potential gain from engineers in healthcare is huge and our contribution to the NHS could be profound, especially at scale. However, there are not enough of us. We need to raise the profile of engineers in healthcare to attract new blood to the profession and ensure that they receive the right professional development support from both healthcare employers and the professional institutions. This new campaign from the Institution is a welcome start.
The Healthcare sector is beginning to recognise what we can offer, and we engineers need to be ready to respond to the huge challenge of improving healthcare, for our communities, our families and ourselves. Our mission is to ‘improve the world through engineering’; where better to do this than in healthcare?
Joy Furnival CEng MIET is a healthcare engineer. She has a degree in engineering science and management from the University of Durham, and for the last ten years she has worked in healthcare following a successful career in the chemical industry. She is currently reading for a PhD in Business and Management (Healthcare Policy and Improvement Science) at Manchester Business School, funded by the Health Foundation.
The views of the writer do not necessarily represent the views of the Institution.
References
[1] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/226703/Berwick_Report.pdf
[2] http://www.pnhp.org/news/2006/may/how-to-fix-the-system
[3] Hunter, D. J., Erskine, J., Small, A., McGovern, T., Hicks, C., Whitty, P. & Lugsden, E. (2015) Doing transformational change in the English NHS in the context of “big bang” redisorganisation. Journal of Health Organization and Management, 29(1), 10-24.
[4] Bradley, B., Bowden, M., Furnival, J. & Walton, C. (2011) A change is in the air. Health Service Journal.
[5] Burgess, N., Radnor, Z. & Furnival, J. (2016) A case study of a whole organisation approach to lean implementation across an English hospital. In: Radnor, Z., Bateman, N., Esain, A., Kumar, M., Williams, S. & Uption, D. (eds.) Public Service Operations Management - A research handbook. Abingdon, UK: Routledge.
[6] Furnival, J. & Richards, D. (2013) Lean at NHS Blood and Transplant. Lean Management Journal, (June).
[7] Martin, A. J., Hogg, P. & Mackay, S. (2013) A mixed model study evaluating lean in the transformation of an Orthopaedic Radiology service. Radiography, 19(1), 2-6.
[8] Singh, S., Lipscomb, G., Padmakumar, K., Ramamoorthy, R., Ryan, S., Bates, V., Crompton, S., Dermody, E. & Moriarty, K. (2012) Republished: Daily consultant gastroenterologist ward rounds: reduced length of stay and improved inpatient mortality. Postgraduate Medical Journal, 88(1044), 583-587.