Systems engineering analysis of diagnostic referral closed-loop processes.

Area of Science:

• Healthcare Systems Engineering
• Patient Safety Science
• Process Improvement Methodologies

Background:

• Diagnostic referral completion failure rates range from 65%-73%, posing a significant patient safety risk.
• Existing improvement efforts have not resolved persistent delays and failures in closing referral loops.
• Systems engineering (SE) methods are increasingly recognized for their potential in analyzing and redesigning complex healthcare processes.

Purpose of the Study:

• To conduct a formative SE analysis of diagnostic referral processes.
• To examine process logic, variation, reliability, and failure modes in two distinct primary care settings.
• To utilize dermatology referrals as a case study for analysis.

Main Methods:

• An interdisciplinary team collaborated to map referral processes using iterative interviews.
• Cross-functional process maps were developed for an urban community health center and an academic medical center practice.
• Engineering process analysis was performed to assess variation and identify failure modes.

Main Results:

• Referral processes exhibit significant workflow variation and statistical instability in completion rates.
• Only 21% of process activities were estimated as value-add, with common failures linked to low-reliability concepts.
• Opportunities for higher reliability constructs like simplification, automation, and forcing functions were identified.

Conclusions:

• Poor performance in diagnostic referrals stems from fundamentally flawed, low-reliability designs rather than incremental issues.
• Existing processes often include workarounds and rework, indicating a need for redesign.
• SE perspectives provide novel approaches to address patient safety problems and referral failures.