Tuesday, 24 September 2013

US Health Care Spending

Two interesting links, explaining why US Health Care costs are so high (also in comparison to other developed countries). In a nutshell: lack of transparency about costs + inherent power imbalances = a flawed market.

Time Magazine - "Bitter Pill: Why Why Medical Bills Are Killing Us"

8-minute video. "Why Are American Health Care Costs So High?"

Tuesday, 17 September 2013

Applicability of Engineering Design Processes in the Design of Integrated Intellectual Disabilities Services in England

I have been quiet for an aweful long time - and a lot has happened since. Most importantly: my thesis is all done, approved and on the shelves of the Cambridge libary, so I am now a doctor (yeah). I since moved back to Germany and for the last 14 month I have been working as a consultant in Munich, with a focus on health care projects.

In case you are interested, I pasted the abstract of my thesis below. If you want to read the full thing, drop me a message (ideally with a bit of beackground on what you do and why you are interested in my work) and I can send you the pdf.

Applicability of Engineering Design Processes in the Design of Integrated Intellectual Disabilities Services in England

This dissertation investigates the applicability of engineering design processes for the design of integrated intellectual disabilities (ID) services in England. It aspires to contribute to the development of an engineering-design-style (ED) design process for a particular integrated health and social care organisation. Healthcare services in the developed world are faced with challenges arising from a growing burden of chronic disease and aging populations. In order to address these challenges, a more holistic understanding of health that also considers social factors is needed. A local integrated care service for people with intellectual disabilities constitutes an interesting case study as these intellectual disabilities services have several decades of experience in integrating health- and social care.

This study contributes to knowledge by elicitating the need to combine the engineering tradition of design as problem-solving with the tradition of design as enquiry. The applicability of engineering design processes in an indisputably complex domain, such as integrated ID services, also helps clarify of the concept of complexity within engineering design. Methodological contributions are made by developing and applying a research framework for exploratory design research and by demonstrating the utility of engineering design tools outside engineering. Furthermore, this study also provides important insights for the healthcare management literature by suggesting an approach to distinguishing complicateness from complexity, demonstrating the value of contributions of currently marginalised stakeholders and showing the applicability of a mathematical technique for pre-structuring service user involvement.

The research is guided by a framework developed specifically for exploratory design research into the care service domain. An initial exploratory study investigates design-related issues faced by the local service and to which degree engineering design is applicable. The predominantly qualitative data is analysed in diagrammatic form. It emerges that the formal, structural aspects of the organisation are complicated and suited to an engineering design approach. However, complex informal aspects, such as customs or personal relationships, surround the formal structure and are beyond the current scope of ED design processes but can be addressed by approaches in the design as enquiry tradition. Four issues are identified which will require amendments to the ED design process: organisational settings, knowledge management, the lack of a clear role, and neglected stakeholders.
The exploratory study is followed up by a detailed study which uses a Delphi approach to investigate whether the confusion about the role of specialist services is a general problem in the ID field. It further characterises key stakeholder groups in ID services in terms of their expertise and level of agreement or disagreement. The findings outline requirements for new design approaches that bridge the traditions of design as enquiry and design as problem-solving.