Introduction to Healthcare Introduction to Healthcare for Industrial Engineers for Industrial Engineers This presentation incorporates the work of many active IIE This presentation incorporates the work of many active IIE and SHS members and to whom the society expresses its and SHS members and to whom the society expresses its appreciation for their efforts and continuing the growth in appreciation for their efforts and continuing the growth in our field. our field.
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Introduction to Healthcare for Industrial Engineers
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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.
SOCIETY FOR HEALTH SYSTEMS
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 and audience.
SOCIETY FOR HEALTH SYSTEMS
Healthcare Overview− Quality− Cost
Overview of Hospitals
IE’s in Healthcare− Background− Organizational Structure− Key Roles− Examples
Future of Healthcare
Resources
Overview Of ContentOverview Of Content
SOCIETY FOR HEALTH SYSTEMS
Healthcare OverviewHealthcare Overview
Quality, Cost, Access
SOCIETY FOR HEALTH SYSTEMS
The U.S. Health Care IndustryThe U.S. Health Care Industry
Source: Institute for Industrial Engineers
• Insurance companies work with both employers and MCO’s to provide coverage;
• The government provides a form of insurance for qualifying patients through Medicare/Medicaid
SOCIETY FOR HEALTH SYSTEMS
U.S. Health Challenges: QualityU.S. Health Challenges: Quality
Most American hospitals provide safe and effective care for the vast majority of patients, the vast majority of the time
The vast majority of caregivers are well trained and conscientious
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
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− 20% received contraindicated treatments
Schuster MA, McGlynn EA, Brook RH. How good is the quality of healthcare in the United States? Millbank Quarterly, 1998; 76(4):517-63 (Dec).
SOCIETY FOR HEALTH SYSTEMS
American health care
"gets it right”
54.9%of the time.
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
SOCIETY FOR HEALTH SYSTEMS
So why is this so hard?
Inadequate levels of safety and inconsistent quality result from clinical uncertainty which in turn results from:
− An increasingly complex healthcare environment
− Rapidly exploding medical knowledge
− Lack of valid clinical knowledge (poor evidence)
− Over reliance on subjective judgment
U.S. Health Challenges: QualityU.S. Health Challenges: Quality
SOCIETY FOR HEALTH SYSTEMS
U.S. Health Challenges: QualityU.S. Health Challenges: Quality
Rapidly Exploding Medical KnowledgeIn 2004, the U.S. National Library of Medicine
added
almost 11,000 new articles per week
to its on-line archives
That represented about 40% of all articles published, world-wide, in biomedical and clinical journals.
(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
This is an impossible task…
SOCIETY FOR HEALTH SYSTEMS
U.S. Health Challenges: QualityU.S. Health Challenges: Quality
Medical errors and iatrogenic injury:• 98,000 deaths / year• 770,000 - 2 million patient injuries• $17 - $29 billion dollars
More US deaths/yr than for traffic accidents, breast cancer, & AIDS
Hospital-acquired infections:• 1.7 million NSI/year - $3,000/case• 8.7 million additional hospitals days/year• 98,987 deaths/year• $4.2 - $11 billion annually
Adverse drug reactions:• 770,000 to 2 million per year• $4.2 billion annually• 6-10% of hospital patients suffer 1 or more serious adverse events
Institute of Medicine 2000
Centers for Disease Control and Prevention
SOCIETY FOR HEALTH SYSTEMS
How Would You Measure Success?How Would You Measure Success?
• Patient Safety
• Patient Centeredness
• Timeliness
• Efficiency
• Effectiveness
• Equity
Voice of the Customer!
SOCIETY FOR HEALTH SYSTEMS
We’re We’re NNotot The Best: IE’s Needed! The Best: IE’s Needed!
Australia CanadaNew
ZealandUK US
Patient Safety 2.5 4 2.5 1 5
Patient-Centeredness
2 3 1 5 4
Timeliness 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
Source: Davis, et al., The Commonwealth Fund, 2004
(1 = best, 5 = worst)
SOCIETY FOR HEALTH SYSTEMS
Healthcare System TodayHealthcare System Today
Descriptive Statistics
• Largest single industry in the world• Approximately 17% of the USA’s
GDP• Expenses increasing at 4 - 10%
annually• Major pressure to become more
efficient and provide higher quality care
• Shortage of skilled workers
Costs of Poor Quality
• Estimated 35% of all healthcare costs = waste
• Duplication, non-value add, redundancies
• Medical errors, adverse events, preventable deaths, process defects
Sound familiar?
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.
(2) Expressed in 1980 dollars; adjusted using the overall Consumer Price Index for Urban Consumers.
U.S. Health Challenges: CostU.S. Health Challenges: Cost
SOCIETY FOR HEALTH SYSTEMS
U.S. Health Challenges: CostU.S. Health Challenges: Cost
Source: www.oecd.org/health/healthdata
SOCIETY FOR HEALTH SYSTEMS
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.
Other Medical Durables and Non-durables, 5.88% Other Medical Durables and
Non-durables, 3.35%
Nursing Home Care, 6.48%Nursing Home Care, 5.88%
Other,(3) 11.4% Other,(3) 15.5%
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.(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.
$235.6B $2,330.1B
U.S. Health Challenges: CostU.S. Health Challenges: Cost
SOCIETY FOR HEALTH SYSTEMS
Distribution of National Health Expenditures by Source of Payment, 1980, 2000, and 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.
$255.7B $2,486.3B$1,378.0B
U.S. Health Challenges: CostU.S. Health Challenges: Cost
SOCIETY FOR HEALTH SYSTEMS
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
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.
Private Health Insurance
Medicare
U.S. Health Challenges: AccessU.S. Health Challenges: Access
SOCIETY FOR HEALTH SYSTEMS
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
Fragmentation of care− Repeated medical histories and duplicative diagnostic tests
Services that yield savings are not used effectively− Preventive care
− Care for chronic conditions, such as hypertension, high cholesterol, diabetes
Source : IIE & Ronald M. Davis, MD, Addressing the Rising Cost of Health Care, AMA eVoice, Feb 2008,
SOCIETY FOR HEALTH SYSTEMS
More Contributions To Rising CostsMore Contributions To Rising Costs
Intensity of Services− Longer life spans and increase in chronic disease
− Increased need for on-going treatment, long-term care
Inflation in high cost / high technology products− Pharmaceuticals
− Surgical supplies
Non-Clinical Spending- especially “transactional” costs
Duplicative services− Facilities & technology
− Staffing
SOCIETY FOR HEALTH SYSTEMS
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 disease
Health care delivery must be more efficient
Must reduce nonclinical health system costs (administration, overhead, etc.)
Source: IIE & Ronald M. Davis, MD, Addressing the Rising Cost of Health Care, AMA eVoice, Feb 2008
SOCIETY FOR HEALTH SYSTEMS
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 care
Decreasing cost through increasing efficiency
This creates a high demand for Process Optimization and Project Management
SOCIETY FOR HEALTH SYSTEMS
Overview 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
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 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, consultations with subspecialists and when sophisticated intensive care facilities are required
SOCIETY FOR HEALTH SYSTEMS
Community Hospitals By OwnershipCommunity Hospitals By Ownership
Source: Kaiser Family Foundation 2009, www.statehealthfacts.org
SOCIETY FOR HEALTH SYSTEMS
Number of Community Hospitals,(1) 1989 – 2009
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2009, for community hospitals.
(1) All nonfederal, short-term general, and specialty hospitals whose facilities and services are availableto the public.
(2) Data on the number of urban and rural hospitals in 2004 and beyond were collected using coding different from previous years to reflect new Centers for Medicare & Medicaid Services wage area designations.
Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2009, for community hospitals.
Number of Beds
Number of Beds per 1,000
Hospital Bed ChangesHospital Bed Changes
SOCIETY FOR HEALTH SYSTEMS
Number of Hospitals in Health Systems,(1) 2000 – 2009
2,400
2,500
2,600
2,700
2,800
2,900
3,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Hos
pita
ls
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
health-related subsidiaries as well as non-health-related facilities including freestanding and/or subsidiary corporations.
Hospitals & Health SystemsHospitals & Health Systems
SOCIETY FOR HEALTH SYSTEMS
Hospital CostsHospital Costs
SOCIETY FOR HEALTH SYSTEMS
Hospital CostsHospital Costs
SOCIETY FOR HEALTH SYSTEMS
Hospital Labor CostsHospital Labor Costs
SOCIETY FOR HEALTH SYSTEMS
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
SOCIETY FOR HEALTH SYSTEMS
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
SOCIETY FOR HEALTH SYSTEMS
Percent of Hospitals Reporting Emergency Dept. Capacity Issues by Type of Hospital, March 2010
21%
22%
19%
20%
23%
17%
14%
32%
11%
27%
38%
36%
51%
31%
50%
0% 10% 20% 30% 40% 50% 60%
All Hospitals
Non-teaching Hospitals
Teaching Hospitals
Rural Hospitals
Urban Hospitals
ED is "At" Capacity ED is "Over" Capacity
Source: American Hospital Association 2010 Rapid Response Survey: Telling the Hospital Story.
ED TrendsED Trends
SOCIETY FOR HEALTH SYSTEMSSource: IIE & Vital and Health Statistics, National Hospital Discharge Survey, 1995; 2000 AHA Statistics; 2005 AHA Statistics
Total Hospital Days and Outpatient Visits, 1970-2003
Multi-Hospital System StructureMulti-Hospital System Structure
Organizational Structures− Traditional Functional
− Matrix Organizations
System vs Facility Structure− System functions vary by organization
− IE’s may be at system level or facility level (or both)
SOCIETY FOR HEALTH SYSTEMS
Integrated Health Care SystemsIntegrated Health Care Systems
“ a network of organizations that provides, or arranges to provide a coordinated continuum of services to a defined population and is willing to be held fiscally and clinically accountable for the health status of the population served.”
Source: IIE & http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=459233From parallel practice to integrative health care: a conceptual framework
SOCIETY FOR HEALTH SYSTEMS
IE’s in HealthcareIE’s in Healthcare
BACKGROUND
ORGANIZATIONAL STRUCTURE
KEY ROLES
SOCIETY FOR HEALTH SYSTEMS
Healthcare Systems EngineeringHealthcare Systems Engineering
IE/OR in Healthcare Rich and diverse history
As old as the field of industrial engineering itself
Gilbreth’s 1911 surgical studies
Application Areas
Hospital operations– Patient and information flow– Appointment access– Scheduling– Facility layout and location
Public health– Vaccination optimization– Outbreak surveillance– Emergency response
Public policy– Disease screening– Regional planning– Organ sharing
SOCIETY FOR HEALTH SYSTEMS
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
1945‘Management engineering’ invented and applied to nursing (L. Gilbreth)
1957 Deming advocates use of SPC in healthcare
1959First queuing and scheduling studies (Smalley, others)
1965Clinical information systems
(Kennedy et al)
1960sFlagle’s Nursing Acuity Studies at Johns Hopkins
1972Nurse scheduling (branch and bound) algorithms (Warner, Wolfe)
1970-72Perishable inventory theory applied to blood banks (Pierskalla)
1972-73 Simulation planning models (Rising)
1974 Regional planning OR models (Wolfe)
1967-82 Diagnostic-related groups (DRG’s)
1979 Forecasting bed needs (Griffith)
1980 Cancer screening optimization (Eddy)
1980’s MDM utility theory (Weinstein)
1988 Total quality management (Berwick)
1990’s Patient safety movement (Leape)
2000’s Lean & Six Sigma
SOCIETY FOR HEALTH SYSTEMS
IEs Needed!IEs Needed!
Systems Engineering/ Healthcare Partnership
National Academy of Engineering and Institute of Medicine, 2005
SOCIETY FOR HEALTH SYSTEMS
WhereWhere Do IE’s Work In Healthcare? Do IE’s Work In Healthcare?
Organizations
Hospitals
HMO’s
Physician offices
Long-term care facilities
Outpatient clinics
Public health (CDC, etc)
Insurance organizations
Government agencies
Healthcare Consulting Firms
Healthcare Information Systems Companies
Departments
System engineering
Management engineering
Quality management
Process improvement
Performance improvement
Clinical safety
Information systems
Facilities management
Others
SOCIETY FOR HEALTH SYSTEMS
IE’s In Healthcare: Job TitlesIE’s In Healthcare: Job Titles
Management Engineer
Decision 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, report to many departments and have various titlesreport to many departments and have various titles
SOCIETY FOR HEALTH SYSTEMS
Management Engineering Management Engineering Department: ExampleDepartment: Example
Chief Operating Officer
Director of Management
Systems
ManagementEngineer
ManagementEngineer
(Decision Support)
DataAnalyst
• Process Improvement• Productivity Management• Position Control• Labor Standards Development
• Cost Accounting• Benchmarking• Labor Standards Development
FinanceQualityImprovement
• Productivity Monitoring• Benchmarking• Marketing Data Analysis
• Clinical Pathway Development• Quality Improvement Training
• Financial Decision Support
SOCIETY FOR HEALTH SYSTEMS
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
WhatWhat Do IE’s Do In Healthcare? Do IE’s Do In Healthcare?
Maximize Quality and Safety, Minimize CostMaximize Quality and Safety, Minimize Cost
SOCIETY FOR HEALTH SYSTEMS
WhatWhat Do IE’s Do In Healthcare? Do IE’s Do In Healthcare?
Practitioners Data analysis
Benchmarking
Cost analysis and reduction
Economic analysis
Feasibility studies
Process/quality improvement
Simulation flow analysis
Queuing analysis
Space planning and layout
Appointment scheduling optimization
Researchers
Statistical quality control
Disease screening optimization
Scheduling algorithms
Regional capacity planning
Organ transplant optimization
Statistical surveillance
Cognitive and human factors research
Public policy
SOCIETY FOR HEALTH SYSTEMS
WhatWhat Do IE’s Do IE’s NOTNOT Do In Healthcare? Do In Healthcare?
Practice medicine
Make medical decisions
Infringe on clinical prerogatives
Pretend to know medicine/clinical content
SOCIETY FOR HEALTH SYSTEMS
Typical IE Projects In HealthcareTypical IE Projects In Healthcare
Productivity Management
Staffing and Scheduling
Process Improvement
Inventory Management
Simulation
Benchmarking
Facility Design and Capacity Analysis
Operations and System Analysis
Quality Improvement
All require excellent All require excellent change management change management
skills!!skills!!
SOCIETY FOR HEALTH SYSTEMS
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 - 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
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 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
“You can design and create and build the most wonderful place in the world, but it takes people to make the dream a reality.”
Walt Disney
SOCIETY FOR HEALTH SYSTEMS
IE’s in HealthcareIE’s in Healthcare
EXAMPLES
SOCIETY FOR HEALTH SYSTEMS
Key Operational & Strategic Key Operational & Strategic Challenges For Hospitals Challenges For Hospitals
ManagementEfficient OR Allocations High OR UtilizationEfficient SchedulingHigh Value Proc SpaceContracting / UsageComm / Docmt TimeManage Profitability
Accurate Case InfoSmooth Urgent / Add-ons Patient InformationReduced DelaysClinical StandardsReal-time Mgmt InfoReal-time Patient Info
Accurate Case TimesReduced DelaysLimit Delay / ChangeNo Space DelaysJust-in-Time InventoryImprove CoordinationTimely Info Access
Start Times & Follow onPhysician Wait TimesReduced overtimeSmooth Flow & AccessRight Supplies, Place & Time High Info AvailabilityEase of Info Access
SchedulingCase ManagementStaffing FacilitiesLogisticsCommunicationInformation Systems
IncreaseProfit perProcedure
Right Patient,Procedure,& Care
Reduce TotalOR Time
Financial Quality Service Satisfaction
ImproveConvenience& Access
Source: Institute for Industrial Engineers
SOCIETY FOR HEALTH SYSTEMS
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 transmission.
Components affecting the risk of infection transmission includes 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.
Assessing alternate solutions
− Identify and assess the factors that may reduce the risk of infection transmission
− Change medical practices
SOCIETY FOR HEALTH SYSTEMS
Public Health ExamplePublic Health Example
Response Planning for Avian Flu
No Intervention Interventions
SOCIETY FOR HEALTH SYSTEMS
Process Analysis ExampleProcess Analysis Example
New Member Application, Termination, or Re-Enrollment
It starts with your It starts with your initial project initial project
opportunities and opportunities and choiceschoices
SOCIETY FOR HEALTH SYSTEMS
Future of HealthcareFuture of Healthcare
SOCIETY FOR HEALTH SYSTEMS
Changing health of the community
The exchange of information − Patient information
− Hospital performance
− Physician performance
Payment reform - pay for performance/outcomes as opposed to pay for service
Healthcare reform and regulations
FutureFuture
The future will be led by the needs and wants of the patient – trends include:
SOCIETY FOR HEALTH SYSTEMS
ResourcesResources
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.
Largest and most active society within IIE Education Resources National initiatives 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
www.shsweb.org
SOCIETY FOR HEALTH SYSTEMS
Further Information / Next StepsFurther Information / Next Steps
Society for Health Systems, SHS (www.shsweb.org)- Co-op jobs, Internships, Job bank- Student webpage, Mentoring- Annual conference- Paper competitions, Senior projects
Local hospitalsOther organizations
- Institute for Healthcare Improvement , IHI (www.IHI.org) - HIMSS (www.himss.org)- ASQ Healthcare (www.asq.org)- INFORMS (www.trinity.edu/aholder/HealthApp)
“Insert your contact info here”
SOCIETY FOR HEALTH SYSTEMS
Society for Health Systems
Healthcare Management Engineers
Healthcare Professionals Improving Healthcare
Hospital Patient Flow
Lean & Toyota Production System Healthcare Professionals
LinkedIn has developed a strong professional network and can be leveraged to expand your knowledge and network; suggested groups include:
SOCIETY FOR HEALTH SYSTEMS
Professional SocietiesProfessional Societies
Institute of Industrial Engineers, Society for Health Systems
Healthcare Management and Information Systems Society
- ME/PI Community
Healthcare Financial Management Association
American Society for Quality, Healthcare Division
Others
WHY??? Networking with peers
Professional growth and mentoring
Do not recreate the wheel
Membership and Membership and networking is vital networking is vital
part of your part of your professional growth professional growth
and successand success
SOCIETY FOR HEALTH SYSTEMS
Some ReferencesSome References
Sahney VK. Evolution of hospital industrial engineering: from scientific management 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 Engineering, 1959; 10:171-175.
Flagle CD, Young JP. Applications of operations research and industrial engineering to problems of hospitals. Journal of Industrial Engineering, 1966; 17:609-614.
Fries BE. Bibliography of operations research in health-care systems. Operations Research, 1976; 24:801-814.
Larson, J. Management Engineering, Healthcare Information and Management Systems Society, 2001.
SOCIETY FOR HEALTH SYSTEMS
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.
Admissions - The # of inpatients who are admitted to the hospital.
Discharges - The # of inpatients that are released from the hospital.
Average 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.
Patient Days - The # of days total patients stay in the hospital for a defined period.
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 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
“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.
− Indemnity - Providers are paid on a fee-for-service basis.
− Self-Pay - Patient pays all out-of-pocket expenses.