Introduction to Healthcare for Introduction to Healthcare for Industrial Engineers Industrial Engineers This presentation incorporates the work of many active IIE and This presentation incorporates the work of many active IIE and SHS members and to whom the society expresses its appreciation SHS members and to whom the society expresses its appreciation for their efforts and continuing the growth in our field. for their efforts and continuing the growth in our field.
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Introduction to Healthcare for Introduction to Healthcare for Industrial EngineersIndustrial Engineers
This presentation incorporates the work of many active IIE and This presentation incorporates the work of many active IIE and SHS members and to whom the society expresses its appreciation SHS members and to whom the society expresses its appreciation
for their efforts and continuing the growth in our field.for their efforts and continuing the growth in our field.
Note: this presentation is intended to be a generic set of introductory slides to the profession. Presenters should feel free to adjust the content and emphasis to suit their own experiences andand emphasis to suit their own experiences and audience.
SOCIETY FOR HEALTH SYSTEMS
Overview Of ContentOverview Of Content
Healthcare OverviewQuality− Quality
− Cost
Overview of HospitalsOverview of Hospitals
IE’s in Healthcare− Backgroundg− Organizational Structure− Key Roles
The U.S. Health Care IndustryThe U.S. Health Care Industry
• Insurance companies work with both employers and MCO’s to provide coverage;
• The government provides a form of insurance for qualifying patients
SOCIETY FOR HEALTH SYSTEMSSource: Institute for Industrial Engineers
insurance for qualifying patients through Medicare/Medicaid
U.S. Health Challenges: QualityU.S. Health Challenges: Quality
Most American hospitals provide safe and effectivef th t j it f ti t th tcare for the vast majority of patients, the vast
majority of the time
The vast majority of caregivers are well trained and conscientiousconscientious
Western medicine’s ability to save and extend life, and to improve the quality of life for the ill and injured is nothing short of miraculous
SOCIETY FOR HEALTH SYSTEMS
is nothing short of miraculous
U.S. Health Challenges: QualityU.S. Health Challenges: Quality
…but that does not change a harsh reality…
…care is far too unsafe…
…and quality is too inconsistent…
SOCIETY FOR HEALTH SYSTEMS
U.S. Health Challenges: QualityU.S. Health Challenges: Quality
Extensive literature review performed at RAND in 1998:
Only 50% of Americans receive recommended preventive care
Patients with acute illness:− 70% received recommended treatments− 30% received contraindicated treatments
Patients with chronic illness:− 60% received recommended treatments
SOCIETY FOR HEALTH SYSTEMS
− 20% received contraindicated treatmentsSchuster MA, McGlynn EA, Brook RH. How good is the quality of healthcare in the United States? Millbank Quarterly, 1998; 76(4):517-63 (Dec).
U.S. Health Challenges: QualityU.S. Health Challenges: Quality
American health care" t it i ht”"gets it right”
54.9%5 9%of the time.
SOCIETY FOR HEALTH SYSTEMS
McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003; 348(26):2635-45 (June 26).
U.S. Health Challenges: QualityU.S. Health Challenges: Quality
So why is this so hard?
Inadequate levels of safety and inconsistent quality result from clinical uncertainty which in turn results from:
A i i l l h lth i t− An increasingly complex healthcare environment− Rapidly exploding medical knowledge − Lack of valid clinical knowledge (poor evidence)g (p )− Over reliance on subjective judgment
SOCIETY FOR HEALTH SYSTEMS
U.S. Health Challenges: QualityU.S. Health Challenges: Quality
Rapidly Exploding Medical KnowledgeI 2004 th U S N ti l Lib f M di iIn 2004, the U.S. National Library of Medicine
added
almost 11,000 new articles per weekto its on-line archives
That represented about 40% of all articles published, world-wide, in biomedical and clinical journals.
(1 500 3 500 l t d f d 5 d k)(1,500 – 3,500 completed references per day, 5 days a week)
To maintain current knowledge, a general internist would need to read:– 20 articles per day, 365 days of the year
SOCIETY FOR HEALTH SYSTEMS
20 articles per day, 365 days of the year
This is an impossible task…
U.S. Health Challenges: QualityU.S. Health Challenges: Quality
Medical errors and iatrogenic injury:• 98,000 deaths / year
770 000 2 illi ti t i j i• 770,000 - 2 million patient injuries• $17 - $29 billion dollars
More US deaths/yr than for traffic yaccidents, breast cancer, & AIDS
Hospital-acquired infections:1 7 illi NSI/ $3 000/
Institute of Medicine 2000
• 1.7 million NSI/year - $3,000/case• 8.7 million additional hospitals days/year• 98,987 deaths/year• $4.2 - $11 billion annually
Centers for Disease Control
Adverse drug reactions:• 770,000 to 2 million per year• $4.2 billion annually
Centers for Disease Control and Prevention
SOCIETY FOR HEALTH SYSTEMS
y• 6-10% of hospital patients suffer 1 or more
serious adverse events
How Would You How Would You Measure SuccessMeasure Success??
• Patient Safety
• Patient Centeredness
Ti li• Timeliness
• Efficiencyy
• Effectiveness
• Equity
Voice of the Customer!SOCIETY FOR HEALTH SYSTEMS
Voice of the Customer!
We’re We’re NNotot The Best: IE’s Needed!The Best: IE’s Needed!
Australia Canada New UK US
(1 = best, 5 = worst)
Australia Canada Zealand UK US
Patient Safety 2.5 4 2.5 1 5
Patient-Centeredness 2 3 1 5 4
Timeliness 2 5 1 4 3Timeliness 2 5 1 4 3
Efficiency 1 4 2 3 5
Effectiveness 4.5 2.5 2.5 1 4.5
Equity 2 4 3 1 5
SOCIETY FOR HEALTH SYSTEMS
Source: Davis, et al., The Commonwealth Fund, 2004
Healthcare System TodayHealthcare System Today
Descriptive Statistics Costs of Poor Quality
• Largest single industry in the world• Approximately 17% of the USA’s
GDP
• Estimated 35% of all healthcare costs = waste
• Duplication non value addGDP• Expenses increasing at 4 - 10%
annuallyM j t b
• Duplication, non-value add, redundancies
• Medical errors, adverse events, preventable deaths process• Major pressure to become more
efficient and provide higher quality careSh t f kill d k
preventable deaths, process defects
• Shortage of skilled workers
Sound familiar?
SOCIETY FOR HEALTH SYSTEMS
Sound familiar?
U.S. Health Challenges: CostU.S. Health Challenges: Cost
SOCIETY FOR HEALTH SYSTEMS
U.S. Health Challenges: CostU.S. Health Challenges: Cost
Total National Health Expenditures, 1980 – 2009(1)
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 6, 2011.(1) CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source
data that are applied to the entire time series (back to 1960). For more information on this revision, see http://www cms gov/nationalhealthexpenddata/downloads/benchmark2009 pdf
SOCIETY FOR HEALTH SYSTEMS
http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.(2) Expressed in 1980 dollars; adjusted using the overall Consumer Price Index for Urban Consumers.
U.S. Health Challenges: CostU.S. Health Challenges: Costge
of G
DP
Per
cent
a
SOCIETY FOR HEALTH SYSTEMS
Source: www.oecd.org/health/healthdata
U.S. Health Challenges: CostU.S. Health Challenges: Cost
National Health Expenditures as a Percentage of Gross Domestic Product, 1989 – 2009(1)
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 6, 2011.(1) CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source
data that are applied to the entire time series (back to 1960). For more information on this revision, see http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
U.S. Health Challenges: CostU.S. Health Challenges: Cost
National Health Expenditures as a Percentage of Gross Domestic Product and Breakdown of National Health
Expenditures 2009
$2.49 TrillionU.S. GDP 2009
Expenditures, 2009
Other, 33.6%
Nursing Home Care, 5.5%
Prescription Drugs, 10.1%
Nursing Home Care, 5.5%
Physician Services, 20.3%Other
Sectors, 82.4%
Health Care Expenditures,
17.6%
Hospital Care, 30.5%
SOCIETY FOR HEALTH SYSTEMS
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 6, 2011.
U.S. Health Challenges: CostU.S. Health Challenges: Cost
National Expenditures for Health Services and Supplies(1) by Category, 1980 and 2009(2)
Other Medical Durables and N d bl 5 88% Other Medical Durables and
Nursing Home Care, 6.48%Nursing Home Care, 5.88%
Other,(3) 11.4% Other,(3) 15.5%$235.6B $2,330.1B
Physician Services, 20.25%
Other Professional,(4) 7.1%Other Professional,(4) 7.3%
Non-durables, 5.88% Other Medical Durables and Non-durables, 3.35%
Hospital Care, 42.67% Hospital Care, 32.58%
Physician Services, 21.71%
1980 2009
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 6, 2011.(1) Excludes medical research and medical facilities construction
SOCIETY FOR HEALTH SYSTEMS
(1) Excludes medical research and medical facilities construction.(2) CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data that are applied to the
entire time series (back to 1960). For more information on this revision, see http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
(3) “Other” includes net cost of insurance and administration, government public health activities, and other personal health care.(4) “Other professional” includes dental and other non-physician professional services.
U.S. Health Challenges: CostU.S. Health Challenges: Cost
Distribution of National Health Expenditures by Source of Payment, 1980, 2000, and 2009(1)
Oth P i t 7 9%
Other Private, 6.5% Other Private, 6.3%Out-of-pocket, 22.8% Out-of-pocket, 14.7% Out-of-pocket, 12.0%
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 6, 2011.(1) CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source
data that are applied to the entire time series (back to 1960). For more information on this revision, see http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
U.S. Health Challenges: AccessU.S. Health Challenges: Access
Percent Growth in Medicare Spending per Beneficiary vs. Private Health Insurance Spending per Enrollee, 1989 –
Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released January 6, 2011.(1) CMS completed a benchmark revision in 2009, introducing changes in methods, definitions and source data
SOCIETY FOR HEALTH SYSTEMS
that are applied to the entire time series (back to 1960). For more information on this revision, see http://www.cms.gov/nationalhealthexpenddata/downloads/benchmark2009.pdf.
(2) Data reflects spending on benefits commonly covered by Medicare and Private Health Insurance.
Inefficiencies Drive Up CostInefficiencies Drive Up Cost
Unnecessary & Overuse of Medical Services− Practice variation among providers− Defensive Medicine – Risk of liability suits− $70 – 126 billion annually
End of Life Care− Seen to have significant overuse− ¼ cost of Medicare services is for patients in last year of life
F t ti fFragmentation of care− Repeated medical histories and duplicative diagnostic tests
Services that yield savings are not used effectivelyServices that yield savings are not used effectively− Preventive care− Care for chronic conditions, such as hypertension, high cholesterol,
diabetes
SOCIETY FOR HEALTH SYSTEMS
diabetesSource : IIE & Ronald M. Davis, MD, Addressing the Rising Cost of Health Care, AMA eVoice, Feb 2008,
More Contributions To Rising CostsMore Contributions To Rising Costs
Intensity of ServicesLonger life spans and increase in chronic disease− Longer life spans and increase in chronic disease
− Increased need for on-going treatment, long-term care
Inflation in high cost / high technology productsInflation in high cost / high technology products− Pharmaceuticals− Surgical supplies
Non-Clinical Spending- especially “transactional” costs
Duplicative services− Facilities & technology
SOCIETY FOR HEALTH SYSTEMS
− Staffing
What Are The Solutions To The What Are The Solutions To The Rising Costs Of Healthcare?Rising Costs Of Healthcare?
Reduce the burden of preventable didisease
Health care delivery must be more efficient
Must reduce nonclinical health system costs (administration, overhead, etc.)
Promote value-based decision makingPromote value based decision making− Understanding cost, benefit, clinical outcomes− Selecting drug therapies, insurers, legislators
SOCIETY FOR HEALTH SYSTEMS
Source: IIE & Ronald M. Davis, MD, Addressing the Rising Cost of Health Care, AMA eVoice, Feb 2008
What Does It All Mean For IE’sWhat Does It All Mean For IE’s
IE’s are in a unique position to greatly improve the healthcare system
• Improving quality of careg y• Decreasing cost through increasing
efficiencyy
This creates a high demand for Process Optimization and Project Management
SOCIETY FOR HEALTH SYSTEMS
Overview of HospitalsOverview of HospitalsOverview of HospitalsOverview of Hospitals
SOCIETY FOR HEALTH SYSTEMS
Types Of HospitalsTypes Of Hospitals
Community − Profit – Investor owned − Non-Profit – Supported by local funding
Teaching- Associated with a Medical College & provide clinical training to medical g p g
students and other health professionals
Public - Owned and operated by federal, state or city governments
Tertiary – Could be any one of the above- A major hospital that usually has a full complement of services including
pediatrics general medicine various branches of surgery and psychiatry orpediatrics, general medicine, various branches of surgery and psychiatry or - A specialty hospital dedicated to specific subspecialty care (pediatric
centers, oncology centers, psychiatric hospitals). Patients will often be referred from smaller hospitals to a tertiary hospital for major operations,
lt ti ith b i li t d h hi ti t d i t i
SOCIETY FOR HEALTH SYSTEMS
consultations with subspecialists and when sophisticated intensive care facilities are required
Community Hospitals By OwnershipCommunity Hospitals By Ownership
SOCIETY FOR HEALTH SYSTEMS
Source: Kaiser Family Foundation 2009, www.statehealthfacts.org
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2009, for community hospitals. (1) Hospitals that are part of a corporate body that may own and/or manage health provider facilities or
SOCIETY FOR HEALTH SYSTEMS
(1) Hospitals that are part of a corporate body that may own and/or manage health provider facilities orhealth-related subsidiaries as well as non-health-related facilities including freestanding and/or subsidiary corporations.
Hospital CostsHospital Costs
SOCIETY FOR HEALTH SYSTEMS
Hospital CostsHospital Costs
SOCIETY FOR HEALTH SYSTEMS
Hospital Labor CostsHospital Labor Costs
SOCIETY FOR HEALTH SYSTEMS
Patient Volume Is IncreasingPatient Volume Is Increasing
Inpatient Admissions in Community Hospitals, 1989–2009
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2009, for community hospitals. (1) Defined as hospitals reporting ED visits in the AHA Annual Survey.
ED TrendsED Trends
Hospital Emergency Department Visits per 1,000 Persons, 1991 – 2009
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2009, for community hospitals. US Census Bureau: National and State Population Estimates, July 1, 2009. Link: http://www.census.gov/popest/states/tables/NST-EST2009-01.xls.
ED TrendsED Trends
Percent of Hospitals Reporting Emergency Dept. Capacity Issues by Type of Hospital, March 2010
23% 27% 50%Urban Hospitals
ED is "At" Capacity ED is "Over" Capacity
19%
20%
32%
11%
1%
31%
T hi H it l
Rural Hospitals
22%
19%
14%
32%
36%
51%
Non-teaching Hospitals
Teaching Hospitals
21% 17% 38%
0% 10% 20% 30% 40% 50% 60%
All Hospitals
SOCIETY FOR HEALTH SYSTEMS
Source: American Hospital Association 2010 Rapid Response Survey: Telling the Hospital Story.
Inpatient Use Has Plummeted While Outpatient Use Has Soared
Total Hospital Days and Outpatient Visits, 1970-2003
550 000600,000
ays
Total
350 000400,000450,000500,000550,000
er o
f Hos
pita
l Din
000
s)l N
umber of O
ut(in 000s
200,000250,000300,000350,000
Tota
l Num
be ( tpatient Visits
s)
150,000,
1970
1975
1980
1985
1990
1997
1998
2000
2002
2003
SOCIETY FOR HEALTH SYSTEMSSource: IIE & Vital and Health Statistics, National Hospital Discharge Survey, 1995; 2000 AHA Statistics; 2005 AHA Statistics
Hospital Outpatient
Healthcare Is Highly RegulatedHealthcare Is Highly Regulated
SOCIETY FOR HEALTH SYSTEMS
The Changing FocusThe Changing Focus
Old New
Coordination Fragmented Continuity
Strategy “Every institution for itself” Strategic AlliancesStrategy Every institution for itself Strategic Alliances
A b l t Feeder for Hospital Core Business withAmbulatory Care
Feeder for Hospital Core Business with Independent Sites
MultiMulti--Hospital System StructureHospital System Structure
Organizational Structures− Traditional Functional − Matrix Organizations
System vs Facility Structure− System functions vary by organizationy y y g− IE’s may be at system level or facility level (or both)
SOCIETY FOR HEALTH SYSTEMS
Integrated Health Care SystemsIntegrated Health Care Systems
“ t k f i ti th t id“ a network of organizations that provides, or arranges to provide a coordinated
ti f i t d fi dcontinuum of services to a defined population and is willing to be held fi ll d li i ll t bl f thfiscally and clinically accountable for the health status of the population served.”
Aligns health care facilities to deliver integrated healthcare services by improving quality and reducing costs to aservices by improving quality and reducing costs to a defined geographic area
Hospital and physician components and at least one otherHospital and physician components and at least one other component of care are required for a system to be considered highly integrated
In 2007, there were an estimated 450 health care systems that were vertically integrated
Ownership or formal agreementsOwnership or formal agreements
Source: IIE & http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=459233From parallel practice to integrative health care: a conceptual framework
IE’s in HealthcareIE’s in HealthcareIE’s in HealthcareIE’s in Healthcare
BACKGROUND
ORGANIZATIONAL STRUCTURE
KEY ROLES
SOCIETY FOR HEALTH SYSTEMS
Healthcare Systems EngineeringHealthcare Systems Engineering
IE/OR in HealthcareRi h d di hi t
Application Areas• Rich and diverse history
As old as the field of industrial engineering itself
• Hospital operations– Patient and information flow– Appointment access– Scheduling
Gilbreth’s 1911 surgical studiesScheduling
– Facility layout and location
• Public health– Vaccination optimization– Outbreak surveillance– Emergency response
• Public policy– Disease screening– Regional planning
O h i
SOCIETY FOR HEALTH SYSTEMS
– Organ sharing
History Of Healthcare IE/ORHistory Of Healthcare IE/OR
1911-18Time studies of surgery and delays (F. Gilbreth)
1920-40 Basic process and capacity analysis
1972 Nurse scheduling (branch and bound) algorithms (Warner, Wolfe)
Perishable inventory theory applied to bloodp p y y
1945 ‘Management engineering’ invented and applied to nursing (L. Gilbreth)
1957 Deming advocates use of SPC in healthcare
1970-72 Perishable inventory theory applied to blood banks (Pierskalla)
1972-73 Simulation planning models (Rising)
1957 Deming advocates use of SPC in healthcare
1959 First queuing and scheduling studies (Smalley, others)
1974 Regional planning OR models (Wolfe)
1967-82 Diagnostic-related groups (DRG’s)
1965Clinical information systems (Kennedy et al)
1960s Flagle’s Nursing Acuity Studies at Johns Hopkins
1965-66 First simulation queuing studies of patient waits (Nuffield Report, Fetter, Thompson) 1990’s Patient safety movement (Leape)
2000’s Lean & Six Sigma
IEs Needed!IEs Needed!
Systems Engineering/Engineering/ Healthcare PartnershipPartnership
National Academy of Engineering
SOCIETY FOR HEALTH SYSTEMS
National Academy of Engineering and Institute of Medicine, 2005
WhereWhere Do IE’s Work In Healthcare?Do IE’s Work In Healthcare?
OrganizationsHospitals
Departments
S i iHospitals
HMO’s
Physician offices
• System engineering
• Management engineering
• Quality managementLong-term care facilities
Outpatient clinics
• Quality management
• Process improvement
• Performance improvementPublic health (CDC, etc)
Insurance organizations
Government agencies
• Clinical safety
• Information systemsGovernment agencies
Healthcare Consulting Firms
Healthcare Information Systems
• Facilities management
• Others
SOCIETY FOR HEALTH SYSTEMS
Healthcare Information Systems Companies
IE’s In Healthcare: Job TitlesIE’s In Healthcare: Job Titles
Management Engineer
D i i S t A l tDecision Support Analyst
Performance Improvement Consultant
Financial Analyst
Productivity Manager
Project Manager
Just to name a few….
There is no clear path: IE’s work in many areas, There is no clear path: IE’s work in many areas, t t d t t d h i titlt t d t t d h i titl
There is no clear path: IE’s work in many areas, There is no clear path: IE’s work in many areas, t t d t t d h i titlt t d t t d h i titl
SOCIETY FOR HEALTH SYSTEMS
report to many departments and have various titlesreport to many departments and have various titlesreport to many departments and have various titlesreport to many departments and have various titles
Management Engineering Management Engineering Department: ExampleDepartment: Example
Chi f O tiChief OperatingOfficer
FinanceQualityImprovement
Director of Management
Systems
• Clinical Pathway Development• Quality Improvement Training • Financial Decision Support
ManagementEngineer
ManagementEngineer
(Decision Support)
DataAnalyst
• Process Improvement• Productivity Management• Position Control• Labor Standards Development
• Cost Accounting• Benchmarking• Labor Standards Development
• Productivity Monitoring• Benchmarking• Marketing Data Analysis
SOCIETY FOR HEALTH SYSTEMS
WhatWhat Do IE’s Do In Healthcare?Do IE’s Do In Healthcare?
Integrate people, equipment, facilities and other resources to improve work results
Use skills learned in IE (process redesign, flowcharting, layout optimization, Lean, forecasting methodologies, simulation, etc.)
Performs cost-saving & quality improvement projects− Finance / Decision Support− All Patient Care Areas (Nursing, ER, Imaging, Surgery, Laboratory, etc.)− Support Services (Laundry, Food Service, Housekeeping, etc.)− Materials Management− Scheduling / Registration / Discharge− Administration− Medical Records− Quality and Patient Safety
SOCIETY FOR HEALTH SYSTEMS
Maximize Quality and Safety, Minimize CostMaximize Quality and Safety, Minimize CostMaximize Quality and Safety, Minimize CostMaximize Quality and Safety, Minimize Cost
WhatWhat Do IE’s Do In Healthcare?Do IE’s Do In Healthcare?
Facility Design and Capacity AnalysisFacility Design and Capacity Analysis
Operations and System Analysis
SOCIETY FOR HEALTH SYSTEMS
Quality Improvement
The Importance Of The Importance Of Change ManagementChange Management
•What is Change Management?– Structured process and set of tools for managing the people side of change
so that business results are achieved, on time, and within budget
– Organizational change management
– Individual change management
•What is a Change Agent?– Individual/group responsible for actually making the change happen -– Individual/group responsible for actually making the change happen -
diagnose, plan, execute
• Why is it important to develop these skills?– All change must be planned in order to be sustained
– The “human side” of change is often forgotten
– You will add value to the project if you are skilled at managing change
SOCIETY FOR HEALTH SYSTEMS
p j y g g g
IE’s In Healthcare:IE’s In Healthcare:The Importance Of Interpersonal SkillsThe Importance Of Interpersonal Skills
Negotiating with Decision Makers
Selling data and building accountability
Facilitation in difficult situationsFacilitation in difficult situations
Balancing quality of Patient Care and Efficiency
Communicating priorities / opportunities to leadership through data
The most successful IE will have a strong communication skills and will have ability to work with all levels within the healthcare setting
SOCIETY FOR HEALTH SYSTEMS
healthcare setting
“You can design and create and build theYou can design and create and build the most wonderful place in the world, but it takes people to make the dream a reality ”takes people to make the dream a reality.
Walt DisneyWalt Disney
SOCIETY FOR HEALTH SYSTEMS
IE’s in HealthcareIE’s in HealthcareIE’s in HealthcareIE’s in Healthcare
EXAMPLES
SOCIETY FOR HEALTH SYSTEMS
Key Operational & Strategic Key Operational & Strategic Challenges For Hospitals Challenges For Hospitals
Patient / Site VerificationCorrect Procedure / DrugsTimely Intervention
Reduced Case DelaysReduce Procedure DelaysDischarge Delays
Patient Wait TimesEffective Staff / SuppliesReduced Wait time
Pre surgeryProcedurePACU
ManagementEfficient OR Allocations Accurate Case Info Accurate Case Times Start Times & Follow onSchedulingHigh OR UtilizationEfficient SchedulingHigh Value Proc SpaceContracting / UsageComm / Docmt TimeManage Profitability
Reduced DelaysLimit Delay / ChangeNo Space DelaysJust-in-Time InventoryImprove CoordinationTimely Info Access
Physician Wait TimesReduced overtimeSmooth Flow & AccessRight Supplies, Place & Time High Info AvailabilityEase of Info Access
gCase ManagementStaffing FacilitiesLogisticsCommunicationInformation Systems
IncreaseProfit per
Right Patient,Procedure
Reduce TotalOR Time
ImproveConvenience
SOCIETY FOR HEALTH SYSTEMS
Profit perProcedure
Procedure,& Care
OR Time Convenience& Access
Source: Institute for Industrial Engineers
Simulation And Risk AnalysisSimulation And Risk Analysis
Risk analysis is a useful tool to capture the uncertainty and to account for multiple factors affecting infection p gtransmission.
Components affecting the risk of infection transmission i l d h i l i l i k i t ti i k d itiincludes physiological risk, intervention risk and cognitive risk. Combine these components into a composite score for the current system.
Utilizing known process and infection control rates, we can create a simulation and generate the risk score.
A i l l iAssessing alternate solutions
− Identify and assess the factors that may reduce the risk of infection transmission
SOCIETY FOR HEALTH SYSTEMS
of infection transmission
− Change medical practices
Public Health ExamplePublic Health Example
Response Planning for Avian FluNo Intervention Interventions
SOCIETY FOR HEALTH SYSTEMS
Process Analysis ExampleProcess Analysis Example
Billing Error Process Basic Data Analysis
Correlation to Paperwork Volume?New Member Application,
Statistical surveillance of infectious diseasesStatistical surveillance of infectious diseases
Regional capacity planning models
D l b li d ti (h f t )Drug labeling and error prevention (human factors)
SOCIETY FOR HEALTH SYSTEMS
Possible Career PathsPossible Career Paths
Hospitals and Health Systems− Management engineering (IE) departmentManagement engineering (IE) department− Quality, process improvement department
Non-hospitalsHMO’ di l ti i th− HMO’s, medical practices, senior care, others
− Government, regulatory agencies, other
Industry− Biomedical− Pharmaceutical
Graduate school
It starts with your It starts with your initial project initial project
opportunities and opportunities and
It starts with your It starts with your initial project initial project
opportunities and opportunities and Graduate school− IE/OR with healthcare emphasis − Healthcare degrees (MPH, MHA, etc)
ppppchoiceschoices
ppppchoiceschoices
SOCIETY FOR HEALTH SYSTEMS
Future of HealthcareFuture of HealthcareFuture of HealthcareFuture of Healthcare
SOCIETY FOR HEALTH SYSTEMS
FutureFuture
The future will be led by the needs and wants of the patient – trends include:
Changing health of the community
the patient trends include:
The exchange of information − Patient information
H it l f− Hospital performance− Physician performance
P t f f f / tPayment reform - pay for performance/outcomes as opposed to pay for service
Healthcare reform and regulations
SOCIETY FOR HEALTH SYSTEMS
Healthcare reform and regulations
ResourcesResourcesResourcesResources
SOCIETY FOR HEALTH SYSTEMS
Society For Health Systems (SHS)Society For Health Systems (SHS)
The leading professional organization for analysis and improvement of healthcare processes.and improvement of healthcare processes.
• Largest and most active society within IIE• Education• Resources• National initiatives• Partnerships with other organizations• Partnerships with other organizations• Job bank, co-op jobs, and student mentoring• Recommended reading list• Part of the Institute of Industrial Engineers (IIE)• Industrial engineers and process improvement professionals• Excellent annual conference
SOCIETY FOR HEALTH SYSTEMS
www.shsweb.org
Further Information / Next StepsFurther Information / Next Steps
Society for Health Systems, SHS (www.shsweb.org)Co op jobs Internships Job bank- Co-op jobs, Internships, Job bank
- Student webpage, Mentoring- Annual conference- Paper competitions, Senior projects
Local hospitalsOther organizationsOther organizations
- Institute for Healthcare Improvement , IHI (www.IHI.org) - HIMSS (www.himss.org)- ASQ Healthcare (www.asq.org)- INFORMS (www.trinity.edu/aholder/HealthApp)
SOCIETY FOR HEALTH SYSTEMS
• “Insert your contact info here”
LinkedIn GroupsLinkedIn Groups
LinkedIn has developed a strong professional network and can be leveraged to expand your knowledge and network;
Society for Health Systems
g p y g ;suggested groups include:
Healthcare Management Engineers
Healthcare Professionals Improving Healthcare
Hospital Patient Flow
Lean & Toyota Production System Healthcare Professionals
• Institute of Industrial Engineers, Society for Health Systems
H lth M t d I f ti S t S i t• Healthcare Management and Information Systems Society
- ME/PI Community
• Healthcare Financial Management AssociationHealthcare Financial Management Association
• American Society for Quality, Healthcare Division
• Others
WHY???• Networking with peers
Membership and Membership and networking is vital networking is vital Membership and Membership and
networking is vital networking is vital • Networking with peers
• Professional growth and mentoring
• Do not recreate the wheel
part of your part of your professional growth professional growth
and successand success
part of your part of your professional growth professional growth
and successand success
SOCIETY FOR HEALTH SYSTEMS
and successand successand successand success
Some ReferencesSome References
Sahney VK. Evolution of hospital industrial engineering: from scientific management to total quality management Journal of the Society of Healthmanagement to total quality management. Journal of the Society of Health Systems, 1992; 3(4):3-17.
Smalley HE. Industrial engineering in hospitals. Journal of Industrial y g g pEngineering, 1959; 10:171-175.
Flagle CD, Young JP. Applications of operations research and industrial i i t bl f h it l J l f I d t i l E i iengineering to problems of hospitals. Journal of Industrial Engineering,
1966; 17:609-614.
Fries BE Bibliography of operations research in health-care systemsFries BE. Bibliography of operations research in health care systems. Operations Research, 1976; 24:801-814.
Larson, J. Management Engineering, Healthcare Information and
SOCIETY FOR HEALTH SYSTEMS
Management Systems Society, 2001.
Hospital DefinitionsHospital Definitions
Inpatients - The # of patients who stayed for 1 or more nights in the hospital.
Outpatients - Ambulatory patients who receive service but do not stay overnight in the hospital.
Ad i i Th # f i ti t h d itt d t th h it lAdmissions - The # of inpatients who are admitted to the hospital.
Discharges - The # of inpatients that are released from the hospital.
A D il C (ADC) Th b f i ti t i thAverage Daily Census (ADC) - The average number of inpatients in the hospital for a defined time period.
Length-of-stay - The # of days an inpatient stays in the hospital.g y y p y p
Patient Days - The # of days total patients stay in the hospital for a defined period.
SOCIETY FOR HEALTH SYSTEMS
Average Length-of-Stay (ALOS) - Total # of patient days / Total discharges for period
Medicare - Health insurance for people age 65 or older people under age 65 with certain disabilities, and people of all ages with End-Stage Renal Disease. Providers are paid on a fixed basis for inpatient services and discounted fee-for-service for most ambulatory services.
Medicaid - Health insurance for low-income individuals and families whoMedicaid Health insurance for low income individuals and families who fit into an eligibility group that is recognized by federal and state law. Providers are paid on a fixed cost per case or discounted fee-for-service for most services.
Commercial Insurance− HMO - Health Maintenance Organization – Providers are paid on a fixed
“ it t d” “ b th”“capitated” or “per-member-per-month” .− PPO - Preferred Provider Organization- Providers are paid on a
negotiated percentage of fees or fixed cost per case basis.I d it P id id f f i b i
SOCIETY FOR HEALTH SYSTEMS
− Indemnity - Providers are paid on a fee-for-service basis.− Self-Pay - Patient pays all out-of-pocket expenses.