In U.S. military lingo, a “force multiplier” is any capability or advantage that, when added to and employed by an enterprise, significantly increases the potential of an individual or organization, and thus enhances the probability of successful mission accomplishment”[1].  American military strategy calls for achieving battlefield dominance over any regional power with which U.S. forces might be engaged in conflict and accomplishing this through leadership in systems technology.

In this blog, “system” is defined as an “organized collection of diverse elements (people, equipment, software, facilities, policies, etc.) required to produce results not obtainable by the individual elements alone.  The ‘value added’ by the system as a whole, beyond that contributed independently by the parts, is primarily created by the relationship among the parts”[2].   Military systems typically include both physical hardware/software systems technologies (e.g. weapons, sensors, communications/networks, information technology systems) as well as human user/warfighter dimensions (e.g. maintaining situational awareness, training, education, experience, teamwork, ingenuity, organizational/leadership culture).

The scale and scope of military operations has led the military community to formalize the concepts of organized “system of systems” (SoS) and the processes of “system of systems engineering” (SoSE) as an extrapolation of traditional systems engineering thinking.  This extrapolation considers the organization and evolution of networks of systems as a system with components that are operationally and managerially independent systems, and, that over time, exhibit emergent behavior based on component interactions. High levels of performance induced by force multipliers can be thought of as “emerging” through SoS component system-system interactions.

A widely recognized military systems force multiplier is enhanced situational awareness (SA)[3] that describes a person’s or organization’s knowledge and understanding of the circumstances, surroundings, and influences with regard to an unfolding situation, thereby enabling effective timely decisions. SA typically requires information technology/network connectivity to the “right”, potentially diverse, real-time data sources reflecting the situation, and analytics that can “fuse” disparate evidentiary clues to create a coherent “picture” enabling recognition of the contextual meaning of dynamically changing raw data[4].  Moreover SA is only useful if it can be effectively delivered in a timely manner as “actionable information” to decision makers for immediate exploitation when engaged in high stress workflows[5]. Enhanced SA is an emergent property[6] of SoS comprised of sensor platforms, fusion centers, command and control, communications and battlefield operations.

Unlike the global success of U.S. military actionable intelligence systems, enabling effective preemptive, highly precise/coordinated/timely warfighting operations worldwide, we have not leveraged information technologies for a comparable dominance in healthcare[7]. I will continue my thoughts on applying best practices to the healthcare industry in Part 2 of “Systems Engineering and Healthcare”.

[1] https://en.wikipedia.org/wiki/Force_multiplication

[2] http://www.incose.org/

[3] https://en.wikipedia.org/wiki/Situation_awareness

[4] http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.563.206&rep=rep1&type=pdf

[5] http://www.dtic.mil/doctrine/new_pubs/jp1_02.pdf

[6] http://www.dtic.mil/ndia/2012system/track1014745.pdf

[7] In this paper we use “healthcare” or “healthcare system” to mean the organization of people, institutions, and resources (e.g. facilities, equipment, information systems) used to deliver healthcare services that meet health needs of the target population