Risk & Resilience Management of Complex Socio-Technical Systems
HEALTHCARE
Health Care services are undergoing a rapid and radical transformation under the pressure of new population needs, disruptive health technologies, and economic constraints. Healthcare Risk Management and Resilience is a key element for re-designing and managing current and future health services.
The r2macs research group is engaged in a series of research and consulting projects ranging from risk-based recommendations for patient safety and quality in different settings (e.g. chemotherapy, surgery, drug, blood services) to Human Reliability in robotic surgery, from the design of eHealth-for-safety solutions to the resilience assessment of mission-critical health services (e.g. Emergency Medical Services, Blood supply chain).
Institutional and Private Research Partners
Associazione Chirurghi Ospedalieri Italiani
Società Italiana di Urologia
Centre for Healthcare Improvement
Regione Lombardia
Società Italiana di Chirurgia
Ospedale Niguarda
Technical University of Denmark
Astir
Fondazione Don Gnocchi
NOEMALIFE
Abmedica
Telbios
Selected Publications
-
Trucco P., Onofrio R. and Galfano A., “Human Reliability Analysis (HRA) for Surgery: A Modified HEART Application to Robotic Surgery”, in Advances in Human Factors and Ergonomics in Healthcare, Advances in Intelligent Systems and Computing 482, V.G. Duffy and N. Lightner (eds.), pp. 27-37, 2017. Springer International Publishing Switzerland, DOI 10.1007/978-3-319-41652-6_2.
-
Onofrio R. and Trucco P., “Assessing the Influence of Personal and Organizational Factors on Surgeon’s Performance: A Study on Surgeons’ Perceptions”, in Advances in Human Factors and Ergonomics in Healthcare, Advances in Intelligent Systems and Computing 482, V.G. Duffy and N. Lightner (eds.), pp. 17-26, 2017. Springer International Publishing Switzerland, DOI 10.1007/978-3-319-41652-6_2.
-
Onofrio R., Trucco P., Torchio A., “Towards a taxonomy of influencing factors for human reliability analysis (HRA) applications in surgery”, Procedia Manufacturing, Vol. 3, 2015, pp. 144-151.
-
Ciofi Degli Atti M., Paolini V., Cavallin M., Corsetti T., Locatelli F., Trucco P., Raponi M. "Proactive evaluation of clinical risk: a FMECA analysis in pediatric chemotherapy", Ann Ig. 2013 Jan-Feb; 25(1):15-21. doi: 10.7416/ai.2013.1902. (PMID: 23435776).
-
Scorsetti M., Signori C., Lattuada P., Urso G., Bignardi M., Navarria P., Castiglioni S., Mancosu P., Trucco P., “Applying Failure Mode Effects and Criticality Analysis in Radiotherapy: Lessons learned and perspectives of enhancement”, Radiotherapy and Oncology, Vol. 94 (3), 2010, pp. 367-374.
-
Amato S, Basilico O, Bevilacqua L, Burato E, Levati A, Molinelli V, Picchetti C, Suardi R, Trucco P, Lucchina C, "Observational Team work Assessment for Surgery as Quality and Safety improvement tool". Ig Sanita Pubbl, Vol. 66 (3), 2010, pp. 357-374. PMID: 20859309.
-
Trucco P., Cavallin M., “A Quantitative Approach to Clinical Risk Assessment: the CREA Method”, Safety Science, Vol. 44, pp. 491-513, 2006.
-
Trucco P., Cavallin M., Lorenzi F., "A Standardised FMECA and Risk Factors Monitoring Method for Clinical Risk Assessment: Results from a Multi Centric Application", Proceedings of the PSAM 11 - ESREL 2012 Conference, pp. 1-10, Helsinki (Finland), 25th-29th June, 2012.
-
Cavallin M., Amato S., Ciofi degli Atti M., Ramponi M. and Trucco P., "Standardised-FMECA (S-FMECA) method to support multi centric risk assessment: Application in chemotherapy", Proceedings of Healthcare Systems Ergonomics and Patient Safety 2011 – Albolino et al. (eds), 2011 Taylor & Francis Group, London, ISBN 978-0-415-68413-2.
-
Trucco P., Arici S., Bertelè P., “Clinical “Risk Control Rules": a new approach for predicting and preventing risk against patient safety in clinical settings”, Proceedings of ESREL 2010 - Reliability, Risk and Safety, Ale, Papazoglou & Zio (eds), pp. 2064-2071, Taylor & Francis Group, London, ISBN 978-0-415-60427-7, Rhodes (GR), 7th-11th September, 2010.
Dynamic Human Reliability Analysis in robotic surgery
The research fosters the diffusion of HRA applications in healthcare, in particular in Mini Invasive Surgery (MIS), where the diffusion of advanced technological solutions adds further complexity and, consequently, possible new error paths. In terms of managerial implications, it addresses the concerns of many practitioners (surgeons, risk managers and technology providers) regarding the nature and role of influencing factors on surgeon’s performance. In this direction, possible future applications of the taxonomy are in the areas of training, ergonomic design of medical devices, and surgical safety checklists.
The research is carried out by continuously facing and collaborating with both the healthcare practitioner and the scientific communities.
The primary objective of this research is the identification and assessment of factors that can influence surgeon’s performance, and the integration of this knowledge into a Dynamic Human Reliability Analysis tool suitable for healthcare applications.
The research proposes an ad-hoc taxonomy of IFs as a contribution to overcome a limitation in current literature, where HRA studies in healthcare implementing Influencing Factors is still scanty; although this is a peculiar component in several HRA techniques and largely adopted in HRA studies in industrial contexts.
Partners:
Blood Supply Chain resilience: systematic comparison of agile and lean operations models
Taking inspiration from the most recent literature demonstrating the existence of synergies between lean practices and resilience capabilities, this research aims at systematically assessing the resilience characteristics of agile and lean configurations of the BSC. Discrete-event simulation is used to compare the performance of the two SC strategies, under normal and crisis conditions.
The study is based on real data of the Blood Supply Chain and system in Lombardy Region (10M citizens, Italy)
The BSC is a key asset for the quality and continuity of healthcare service delivery, and thus on citizens’ safety and wellbeing. The major complexity factors affecting the BSC’s performance are the high variability and uncertainties on both patient and donor sides. Moreover, the BSC is asked to cope with emergencies that suddenly may occur in case of unexpected events, further increasing operational complexity.
Definizione e sperimentazione di un modello di analisi dei flussi degli accessi a pronto soccorso, dei ricoveri ospedalieri, e costruzione di un sistema di georeferenziazione
(Patient choice and resilient planning of Health Services in Lombardy Region)
Il progetto nasce dall’esigenza espressa dalla Direzione Generale Welfare di Regione Lombardia di proseguire l’esperienza realizzata attraverso il programma di attività Supporto tecnico scientifico al percorso di riordino del sistema sanitario lombardo (GEN13017).
In continuità con le attività dell’anno precedente, il progetto è finalizzato alla realizzazione di studi e ricerche sui modelli di riorganizzazione di segmenti del sistema sanitario lombardo e allo stesso tempo ha lo scopo di prestare un’attività di supporto tecnico scientifico alla Direzione Generale Welfare, in modo puntuale e continuativo, a supporto dell’attuazione della legge di riforma del sistema sanitario lombardo approvata nell scorso mese di agosto (L.R. 23/2015).
La prima fase di progetto ha l’obiettivo di dotare la Direzione Generale Welfare di uno strumento capace di:
-
analizzare i dati derivanti dalla rendicontazione delle prestazioni sanitarie (in particolare le SDO)
-
mostrare i flussi di domanda ed offerta secondo diverse dimensioni
-
DRG / ACC Dia / ACC Int
-
Comuni di Origine della Domanda
-
Strutture Sanitarie (Offerta Sanitaria)
-
Specialità
-
-
rappresentare su mappa geografica tali flussi di domanda ed offerta
-
evidenziare i trend rispetto alle dimensioni sopra elencate
-
simulare l’effetto di possibili scelte organizzative (accorpamenti, aperture nuove UU.OO, …)
Il progetto è realizzato da un raggruppamento temporaneo di imprese formato da Politecnico di Milano – School of Management e Astir srl (www.astir.com)
Safe Surgery On-line
Safe surgery on-line è una piattaforma web che ha lo scopo di diffondere la conoscenza e l’adozione di best practice di qualità e sicurezza nell’arco di tutto il percorso chirurgico dall’accettazione alla dimissione, di permettere l’autovalutazione e il monitoraggio della diffusione delle best practice presso la propria struttura ospedaliera e di condurre analisi di benchmark anche per confronto con i dati provenienti da altre strutture ospedaliere (resi anonimi).
Safe surgery on-line nasce a seguito del progetto “Qualità e sicurezza in chirurgia” (realizzato da ACOI e MIP-Politecnico di Milano), allo scopo di fornire uno strumento che supporti, semplificandola, la diffusione della knowledge base di buone pratiche e abiliti un’ampia fruibilità del percorso di verifica e controllo sviluppati e sperimentati nel corso del progetto, garantendo una restituzione immediata dei risultati.
Safe surgery on-line è stato realizzato per iniziativa di ACOI, con il contributo scientifico del Politecnico di Milano – School of Management e il supporto tecnico di Astir srl (www.astir.com)
ReMINE - High performances prediction, detection and monitoring platform for patient safety risk management
REMINE project idea originates from the common difficulty in conducting a detailed analysis, an early identification and an effective prevention of Risks Against Patient Safety (RAPS) when there are several sources of inhomogeneous data - stored in multimedia databases - and a distributed environment with different health care professionals contemporary involved in the clinical pathway of a patient.
REMINE contributes to the RAPS management process in a local health care system through the definition of a framework architecture, instantiated and validated in a proof-of-concept, enabling a collection and analysis of RAPS-related data, through a semantic approach that allows a fast and secure extraction of data and correlation of the information across several domains.
The project was partially funded by the European Commission
Integrated RFID solution for safer blood services
An undetected error in the transfusion process can lead to severe adverse effects to patients. Moreover, even a slight service incident can lead to a reduction in donor’s willingness to donate blood, with negative effects on the long-term sustainability of the blood system. RFId (Radio Frequency Identification) technology has specific capabilities for guaranteeing high levels of service quality and patient safety. Nevertheless, it must be acceptable from the organizational and economical standpoints and it must be adaptable to different settings.
For answering the need for full traceability of blood components, as well as higher levels of patient safety and donor care in the entire transfusion process, three Hospitals in Lombardy (Italy) have been involved in a pilot project for the reengineering of the blood supply chain, by exploiting the capabilities offered by the RFId technology.
A multidimensional FMECA has been developed and adopted to assess the expected benefits of RFId over the entire blood supply chain. The proposed method has been applied to compare the risk of the “as is” process (supported by barcode technology) and a planned “to be” process (supported by a prototypal application based on RFId technology).