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How Industrial Engineers Will Save Health Care
Abstract
Industrial engineers possess the knowledge, training, and experience to widely distribute
solutions to address system inefficiencies, one such system being American health care.
Breakdown in efficiency, including factors related to ambiguous communication and use of
ineffective timelines, contributes to patient frustration and dissatisfaction. Industrial engineers
are rightly sought out to identify flaws in the healthcare system and to develop effective
solutions, ultimately improving patient satisfaction and the standard of care for all American
citizens.
Key Words
Industrial Engineers
Six Sigma
Health care
Prepared by Shayna N. Pepin
Author Biography
Shayna is a Junior in USC’s Viterbi School of Engineering set to graduate with a degree in
Industrial and Systems Engineering in May of 2014. She is interested in management, lean
processes, and aspires to combine aspects of psychology and engineering in her career.
Contact Information
spepin@usc.edu
(253) 273-2559
Paper Submitted October 10, 2012
Prepared for
Marc Aubertin, Writing 340 Professor
USC Viterbi School of Engineering
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Introduction:
Health care is the largest and among the most important systems in the United States of
America. It seems counterintuitive, then, that so many flaws exist in the current system. When
comparing the health care system in the United States against other countries in terms of factors
such as safety, efficiency, and patient centeredness, the United States ranks among the worst
according to the Institute of Medicine, (IOM). [1]
IOM
Australia
Canada
Dimension
New
United
United
Zealand
Kingdom
States
Safety
2.5
4
2.5
1
5
Patient
2
3
1
5
4
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
Centered
Access and
Timeliness
Davis, et al., The Commonwealth Fund, 2004-2009
(1=best, 5=worst)
Figure 1: A table indicating the United States rank against other countries in specific aspects of
health care.
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This data clearly illustrated that the current system is flawed, as evidenced in the state of
frustration and dissatisfaction on the part of recipients of services provided through this flawed
system. Several factors contribute to ultimate patient dissatisfaction, including the absence of
effective communication, lack of trust in the provider, ambiguity in regard to timelines and
continuity of care and the elongated time between the steps in the process.
These alarming figures and ultimate patient dissatisfaction undoubtedly illustrate that
reform is imperative. The initial step in this reformation process is to identify the factors that
contribute to these disturbing trends. The challenge lies in the identification and appointment of
individuals best suited for this task. Industrial and Systems Engineering, a relatively new field of
study, captures the theoretical knowledge, training, and experience which are prerequisites to the
successful identification of systemic weaknesses and the articulation of subsequent solutions,
ultimately improving the standard of care for all American citizens.
What is an industrial engineer, and why does health care need them?
Industrial engineers apply not only the principles of engineering, but the principles of
fields of study such as statistics, economics, and management to improve efficiency and optimize
systems. With their training and experience in improving factors such as productivity, safety and
effectiveness, industrial engineers are in a position to play an essential role in the goal of
improving the efficiency of the health care system in the United States. Reflection on the history
of industrial engineering and analysis of how related contributions impacted another important
American industry help illustrate how this skill set has in the past been successfully applied to
system efficiency. These successes in hospitals include improved communication between
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patients, nurses and doctors, more information given to the patients, and a shorter transfer time
between appointments for patients.
Industrial engineering was developed and defined in the car industry with the Ford Motor
Company leading the way. This engineering specialty subsequently spread to other car
companies, and eventually to a variety of industries. In each of these industries, specific
methodologies were applied with the goal of increasing efficacy and productivity for that
specific company or sector of industry.
One of those approaches, the Six Sigma methodology, involves improving the quality of
production by identifying the defects in the manufacturing process and removing them. This in
turn minimizes variability in both the business and manufacturing processes, minimizing costs
and improving profit. “Six Sigma” is a statistical term and results in a rating which reflects the
percentage of products created that are free of defects. In this process 99.99966% of the
products manufactured are expected to be free of defects. This means that given one million
opportunities for something to meet required specifications in a process, 3.4 or less of them will
be defected. [2] The Six Sigma method is an example of a tool that the industrial engineer is able
to use to analyze a dysfunctional system, and one that other professions and scholars would not
be as adept at using.
Poor communication between patients, doctors, and nurses.
Nothing triggers frustration and exacerbates dysfunction more than a breakdown in
communication. This is especially true in regard to an issue as critical and sensitive as
healthcare. Relinquishing control over one’s health or the health of a loved one necessitates trust
in the care provider; trust that they are equipped with the tools for concise communication and
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the ability to meet health care needs efficiently and effectively. In the absence of effective
communication, trust is in peril.
Solution:
Industrial engineers are trained to consider human factors when determining solutions to
problems. In addressing poor communication, engineers start with surveying those most
impacted—the end-user who is, in this case, the patient. The first step in this survey process is to
identify where precisely in the system’s progress the communication happens. In the case of a
hospital visit, communication, both verbal and written, is an integral component throughout the
entire stay. The initial step in a hospital visit involves paperwork a patient must complete upon
arrival, typically including both verbal and written feedback to an intake person regarding the
presenting concern. This is typically followed by written and verbal instructions regarding where
to go and what to do. Once past this intake point, patients are expected to explain the reason for
their visit to what are often multiple individuals, typically including at a minimum a nurse and
ultimately a physician. By the time the patient actually comes face to face with a physician they
have been expected to communicate via a variety of mediums with a number of people.
Next the industrial engineer determines the best methods to apply in order to analyze and
interpret the effectiveness of communication. The most efficient way to determine this is by
surveying the patient to determine their perception of the experience and the quality of care
received.
An illustrative example of this method is found in a study conducted by industrial
engineers in Jackson Mississippi involving 44 patients who were surveyed in order to determine
patient satisfaction following a hospital visit. The survey results reflected that the number of
nurses patients were required to communicate with was inversely correlated with satisfaction and
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perceived quality of care. [3] After the survey results were analyzed, changes were put into place
and it was found that minimizing the number of staff the patient is asked to communicate with
led to less frustration and greater satisfaction, having a positive impact on communication and
overall quality of care.
Industrial engineers possess the knowledge and skills to effectively design sound and
reliable survey instruments and the ability to analyze the resulting data in a technically sound and
efficient manner.
Patients being kept in the dark about timeline of treatment
Another problem identified in the healthcare system in the US is that patients are often
unaware as to the timeline of their treatment, this is especially significant among patients
needing more serious medical care. In general, this ambiguity about the timeline and continuity
of care leads to greater patient dissatisfaction. It is most certainly unnerving for a patient whose
health is in jeopardy to perceive they are being put on hold, left confused and uninformed about
how the steps in their care plan will unveil. Often multiple specialists who may provide
conflicting feedback are assigned to a patient, contributing to the lack of clarity in terms of
continuity of care or even knowing what the next step is in their journey.
Industrial engineer Sherry Weaver first took note of this problem while at the hospital
with her father, when she was inspired to use her background in engineering to improve the
efficacy of communication in the health care setting. Weaver identifies this problem as the lack
of a “quarterback” on the team of specialists working with a patient. She contends that the deficit
in the system is that one single individual is not assigned to coordinate scheduling and be in
direct and consistent communication with the patient-there is no “quarterback”. [4]
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Solution:
In order to address this problem, Weaver created a computer-mapping program to help
predict appointment timing in hospitals. The program takes into account various factors about
each patient in order to determine an approximate time frame which will be optimal for
scheduling of that patient’s procedure. These factors include the urgency of each patient’s
appointment, operating room times, patient lengths of stay, and care pathway. [5] Analyzing
these dynamics with statistical principals such as Six Sigma leads to determining a possible
schedule for the patient. This leads to improved quality of care and increased patient satisfaction
as it increases the likelihood of patience compliance and preparation for appointments and
treatments. It was further noted by Weaver that there was a need for someone to take charge in
terms of arranging and communicating these logistics to the patient, the aforementioned
“quarterback”. Weaver calls her “quarterback” a “case manager,” a registered nurse who is
assigned to a specific patient for the purpose of keeping that patient apprised of the scheduling of
appointments, timeline of care, and providing accurate and thorough explanations and feedback,
leading to greater patient satisfaction in hospitals.
Weaver is an example of an industrial engineer encountering an ineffective system, and
applying her background to identify the contributing problems and initiate change, leading to a
more effective operational system and ultimately greater satisfaction among the end-users.
Delay in transferring patients between ER and other services
Another contributing factor to hospital patient frustration and perceived quality of care in
regard to hospital stays is the elongated time between the steps in the process. Many go to the ER
and have to wait for an extended period of time in a waiting area before they are admitted, often
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returning to the waiting area for another long wait before they see a doctor. This is followed by
further waiting periods if testing, intervention or treatment is initiated.
Solution:
As with the previously highlighted problems, the most important thing for the industrial
engineer to do in seeking a solution is to first is take all factors into account. Engineers start by
determining all of the possible locations that each patient is expected and required to cycle
through. Possible time frames are estimated for each of these steps. Through analysis of the
system it becomes clear that each step in the cycle of the patient through this process is
connected—if one stop is delayed, so are the rest.
A partnership between the Industrial and Systems Engineering department and the Keck
School of Medicine at the University of Southern California is focused on reducing the time it
takes for patients to transition through each step in the hospital stay. Their research has
demonstrated that the most effective way to organize this information is through the use of a
flow chart. In addition to the aforementioned factors, engineers account for each patient’s level
of medical need, how that relates to available resources in the hospital, and how that affects the
time and space for each patient.
To understand how industrial engineers outline and apply Six Sigma processes using flow
charts, reference the diagram, which displays a sample flow chart. This is the type of flow chart
that would be implemented in the reference research currently being conducted at USC.
“The engineering approach makes this study unique,” said David Altman, Assistant Dean
of the Keck School of Medicine. “We’re looking at process issues that we don’t normally look
at. There’s a lot that the industrial world has been figuring out that we don’t know much about in
health care, but it could be applied to us and be tremendously beneficial.” [4]
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DEFINE
MEASURE
ANALYZE
Project
Charter
Allotted
Appointment
Times
Core Analysis
Tools
IMPROVE
CONTROL
Waste
Reduction
Tools
Update
Relevant
Documents
-Problem
-Goal
Number of
Appts per
hour
Team
Composition
Length of
appts
Value Stream
Mapping
-Description of
Process
-Non-valueadded activities
and time:
identify what
elements are
without value
Project Plan
-Begin to
create Six
Sigma project
notebook
Who, what
when, where,
why, how for
each of these
Measurement
system
assessment
Assess
behavior over
time
Measure shape
of process
distributions
Determine
relationships
between
variables
Variation
Reduction
Process
Optimization
Train Relevant
Personnel
Utilize control
charts
Verify
Effectiveness of
Improvements
Design
Experiments
Value-Added
Analysis
-Identify and
Organize all
tasks
Figure 2: General outline of a flow chart used in Six Sigma methodology
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Conclusion:
Health care is the largest and among the most important systems in the United States of
America--yet current data reflects that, when compared to the health care systems in other
countries, the United States ranks among the worst given issues such as safety, efficiency, and
patient centeredness. The daunting task of health care reform in the United States will require an
approach which is not only innovative and creative, but capitalizes upon the application of
proven analytical processes to improve systems. Surprisingly, the notion of focusing on a
systems analysis approach to improve the efficiency of the health care system in the US is quite
new. Improving the overall efficiency of the health care system has proven to be one of the best
arenas for industrial engineers to apply their work. It is an exciting time in the field of
engineering and more exciting yet for the patients who will be the recipients of the improved
quality of care that will come about as a result of applying the principles of engineering to
improve the functionality of the health care system.
Topics of interest and relevance to the engineer have been addressed in this article;
include surveying human factors, analyzing statistics, and the creation of flow charts to optimize
systems. It is easy to identify professionals who possess training and expertise in one of the
aforementioned disciplines.
It is important to recognize that there is only one professional
trained in all of the above—the industrial engineer. The unique profession of industrial
engineering incorporates human factors with design, and capitalizes upon the effective use of the
latest technology. This unique set of skills is crucial to the analysis of countless systems in
today’s technology-based world. The health care system in particular has much to gain through
the through the application of the principles of industrial engineering.
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[1] “Why Healthcare Systems Engineering?” Northeastern University College of Engineering.
Internet: http://www.coe.neu.edu/healthcare/about/why.html. [6 October 2012]
[2] “What is Six Sigma?” General Electric. Internet:
http://www.ge.com/en/company/companyinfo/quality/whatis.htm. [7 October 2012]
[3] Arash Salehi, Lesley Strawderman, Laura Ruff. “The Importance of Communication for
Patient Satisfaction.” Society for Health Systems: Leading Healthcare Improvement. Internet:
2http://www.iienet2.org/SHS/Details.aspx?id=15572. [7 October 2012]
[4] David Brandt. “Engineers Who Make a difference: Closing the Waiting Gap.” Industrial
Engineer: Engineering and Management Solutions at Work. Internet:
http://www.iienet2.org/IEMagazine/Details.aspx?id=29262. [8 October 2012]
[5] Diane Ainsworth. “Patient Flow.” USC Viterbi School of Engineering. Journal 2005, [OnLine] Available: http://viterbi.usc.edu/news/news/2005/2005_01_31_patients.htm. [8 October
2012]