Faculty Spotlight: E. David Zepeda.

Collaborative work is key to developing sustainable public health solutions and improving population health outcomes. This weekly series spotlights one SPH faculty member who advances public health through collaborations within the field and across sectors.

Can you provide an overview of your research in healthcare operations, costs, and analysis?

I should first mention that my academic and professional training has largely been in engineering and management with specific emphasis on operations and supply chain management (OM/SCM).

Consequently, the central motivation that guides my research program is the gap between the supply and demand for high-quality, cost-effective, and timely healthcare. The domains of my research span primary care, specialty care, hospital care, and community health. With healthcare costs continuing to outpace economic growth with decreasing returns on the improvement of health for certain segments of the population, I draw from operations and supply chain management knowledge to identify ways to make healthcare more effective and also more equitable.

My research also places significant emphasis on social characteristics of patients and the environment. Study results suggest that horizontal and vertical organizational arrangements in healthcare such as multi-hospital systems and hospital employment of physicians may be positive developments for improving hospital operating performance. Yet, many general hospitals may be stretched too thin across service areas for which they lack necessary patient volumes for clinical proficiency.

A viable alternative is to select a limited set of service areas on which to focus. In addition, study results provide further evidence that location does influence how healthcare is delivered and resulting health outcomes. Hospitals respond to environmental characteristics related to supply and demand uncertainty by accumulating costly inventory to meet anticipated requirements. Further, integration of primary care with specialty care can be a viable strategy in delivering a more holistic bundle of healthcare services that spans both behavioral and physical ailments consequently improving effectiveness of healthcare.

Lastly, various policy initiatives are expected to have significant implications for hospitals’ provision of community benefits.  While we do not find strong evidence of community benefits related to a specific form of how health care is organized (Accountable Care Organizations) and highly debated health policies (Medicaid expansion and Affordable Care Act), results do point to modest improvements.

With more than a decade of experience in engineering, management, and consulting at industrial automation and newspaper companies, how has your work in these areas helped inform your current research and work in health policy and management?

Regardless of the industry context, all organizations wrestle with creating plans to meet anticipated requirements (demand) with the resources that they expect to be available (supply).  For health systems, excess demand can result in long wait times (access), suboptimal quality of care (process), and higher mortality and readmission rates (outcomes).

On the flip side, excess supply translates to wasted resources that contribute to the rising costs of healthcare. Healthcare is by no means immune to this phenomenon. The COVID-19 pandemic has provided us with a tragic picture of what can happen when there is not adequate supply to meet the demand (the gap). Further, more rural geographic regions, at risk population groups, and under-resourced healthcare settings are more vulnerable to the impact of this gap.

My experience has provided me with an understanding that effectively matching supply with demand is extremely difficult, but that we have a supply chain and operations management toolbox at our disposal to assist us. For example, we can rely on well-established tools to assist us with managing capacity and inventory as well as technology and human capital all in an effort to reduce the gap.

My research suggests that smaller and more localized hospital systems can experience the benefit of risk pooling (a well-established OM/SCM concept) by having the ability to share supplies amongst system members and therefore can carry less inventory to meet anticipated requirements. In fact, some hospitals proceeded in an ad-hoc fashion to ask neighboring hospitals to share supplies as they each faced supply shortages in their response to the COVID-19 pandemic.

How are collaborative partnerships integral to your work, and can you describe one or two collaborations that have been most meaningful to you?

Improving the production of health inevitably requires an interdisciplinary lens. My conceptualization of healthcare operations and supply chain at multiple levels deliberately adopts an interdisciplinary lens to address consequential issues that span across levels of analysis. Consequently, I have proactively built collaborations with faculty across colleges and universities, developed partnerships with experts from different disciplines and fields of study, targeted projects that include at risk population groups, and published scholarly research that is interdisciplinary.

For example, my ongoing work with Professor Gary Young, director of Northeastern University’s Center for Health Policy and Healthcare Research and professor of strategic management and healthcare systems, has produced a meaningful and significant stream of interdisciplinary research spanning operations and supply chain management, healthcare management, medicine, and health policy. This work was also a result of an enriching and rewarding collaboration with PhD students of health sciences and engineering. I should mention that Gary was on the faculty and a former chair in SPH and was instrumental in my decision to join SPH.

Further, my ongoing collaboration with Community Psychiatry PRIDE and the Center for Anxiety and Traumatic Stress Disorders (CATSD) and Complicated Grief at Massachusetts General Hospital (MGH) has provided me with the opportunity to work on projects specifically aimed at addressing the growing mental health needs for some of the most vulnerable populations including those at higher risk of recidivism and struggling in the educational system.

I am also in the process of forming a collaboration with the VA Center for Healthcare Organization & Implementation Research (CHOIR) which will provide me with the rewarding opportunity to work with the largest integrated healthcare system in an effort to enhance the physical and mental recovery of behaviorally vulnerable veterans.

“David’s smooth entry in 2019 into the SPH community, has made it feel like he’s been a department fixture for years. With his recent special attention on the Leadership & Management core course syllabus, I’m betting this year’s version will be truly exciting for incoming students. In addition, David’s important research couldn’t be more timely: now all Americans understand all too well what supply chain problems look like when they interrupt healthcare delivery.”

Michael Stein, chair and professor in the Department of Health Law, Policy & Management