2009 Service Science Innovation
Partnership Award
Finalist Presentation
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Service Science in Hospitals:
A Research-Based Partnership for
Innovating and Transforming Patients Care
IBM Research, Haifa
Rambam Hospital
Technion, IE&M
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Partners
Rambam Hospital (1000 beds): Government
• Teaching hospital (research): clinical, managerial
• “We shall be your lab” for innovative research
IBM Research Lab, Haifa (500 researchers): Industry
• IS/IT/Healthcare, SSME; products
• OCR: “Spur innovation through university collaboration”
Technion IE&M (1500 students, 100+ faculty): Academic
• From OR & Stat, through IS & HFE, to Psychology
• SEE Lab: data repositories, analysis tools (online)
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Project Goals
Innovate and transform patients care
• Clinical
• Operational
• Financial
Archive and disseminate research-based knowledge
R&D of new products and services
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Service Science (in Hospitals)
1. Measurements / Data
7. Feedback
8. Novel needs,
necessitating Science
4. Maturity enables
Deployment
6. Improvement
5. Implementation
3. Validation
2. Modeling,
Analysis
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Methodology
Focus on central representative hospital units:
• Emergency Department (ED): gate, window
• Operating Rooms (OR): frontier, capital intensive
• Neonatal: longest costly “projects”
• Trauma: team to “save a life in 40 minutes”
• Internal Ward: the hospital’s heart
Patient-centric processes: full scientific-cycle to some (ED,
Trauma, Neonatal), in the midst of others (OR, Internal).
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Project Outputs – Tangibles
Hospital: examples of tools and measurable improvements
• ED: simulator (soon online), location-tracking in real-time
• IW: least waits (quality) plus: shorter LOS have higher
throughput (efficiency) yet lower occupancy (fairness)
• Trauma: human-factor engineering of the new unit
• Neonatal: team-shared models to improve info. transfer
Industry: research designed into products & services
University: teaching material (ServEng website)
• PhD, MSc (locals, IBM, Rambam); students’ projects
• Data-bases / repositories (future universal accessibility)
Innovation & transformation of patients care processes
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Project Outputs – Knowledge
Research
• Models: beds, staff, workload (operational, cognitive), ED-design
• Education, training: Service Engineering course, ED experts
New technologies, beyond hospitals
• e.g. telephone call centers: Workload forecasting;
LWBS vs. Abandonment
Teaching: academia (students, colleagues), practitioners (hospital,
industry), other hospitals (Hadassah, Jerusalem)
Potential
for revolutionizing patient care processes
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Real Time ED Monitoring and Control (Work in Progress)
Data Collection
RFID/US-based Location Tracking
• Low level location tracking for patients
and care personnel
• Technology dependent capabilities
Hospital IT Systems
• Admit, Discharge, Transfer
• Electronic Health Records
• Lab request/results
• Picture Archive and
Communication System
(PACS)
Analysis
Data Visualization
Real Time
Event Processing
Network
Rule-Based Analysis
Statistical Inference
Forecasting/Machine
Learning Algorithms
Analysis of Historical
and Real-time Data
Models: Math.
Simulation
Queueing (Flow)
Theory, ED Simulator
Optimization / Control
WFM, Priorities, Realtime Control, etc.
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Summary
A lot has been achieved but no less yet to be done
Foundational scientific impact
Significant, innovative and potentially revolutionary
improvements to patient care processes
Enabled via true collaboration and lasting partnership:
Industry, Government, Academia
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
2009 Service Science Innovation
Partnership Award
Support Material
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Dashboard (in Process) – Room Occupancy Level
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Efficiency vs. Fairness at the Internal Wards
Ward A
Ward B Ward C Ward D
ALOS (days)
6.368
4.474
5.358
5.562
Mean Occupancy Rate
97.8%
94.4%
86.8%
91.1%
Mean # Patients per Month
205.5
187.6
210.0
209.6
45
30
44
42
4.57
6.25
4.77
4.77
16.4%
17.4%
19.2%
17.6%
Standard capacity
Mean # Patients per Bed per Month
Return Rate (within 3 months)
• Data refer to period: 1/05/06-30/10/08 (excluding 1-3/07)
Smallest + “fastest” ward is subject to highest loads
Patients allocation unfair, as far as wards are concerned
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Delays and Fairness in ED-to-IW Transfers
Data-driven Theory
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Data-Driven Research is a Must + Fun
Length of Stay (LOS), Internal Ward A (2004-8/2008), by Day
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Data-Driven Research is a Must + Fun
Length of Stay (LOS), Internal Ward A (2004-8/2008), by 2 Hours
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Data-Driven Research is a Must + Fun
Length of Stay (LOS), Internal Ward A (2004-8/2008), by 30 minutes
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Workload at the Internal Ward (In Progress):
Arrivals, Departures, # Patients in Ward A, by Hour
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
The Business-case for RFID/US–based Tracking:
Value Assessment at the Hospital ED (In Progress)
Define Required
Process
Change(s)
Define
Additional
Data
Define Sensor
Related Data
Model-based
Metric-Evaluation
Witout RFID Orth
1.2
Ideal RFID Orth
Workload
1
WiFi RFID Orth
Passive RFID Orth
0.8
0.6
0.4
0.2
0
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Hour
Orthopedic (Orth for short) physician workload
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Work in Progress
Systems: RFID / US tracking systems
Smart Equipment: Dashboard for monitoring & control
Education: ED Education via simulation (+ Hadasa)
Research: Theses and projects: PhD, MSc
Teaching: Service Engineering – existing, planned
SEE Center: data repositories, accessible server
• Online ED simulator
• Online accessible data interface
• Platform for teaching and research
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Project Output & Future Work
Working Papers (Conferences)
• Toward Simulation-Based Real-Time Decision Support Systems For Emergency
Departments (WSC09)
• RFID-Based Business Process Transformation: Value Assessment in Hospital
Emergency Department (BPM09)
• InEDvance: Advanced IT in Support of Emergency Department Management
(NGITS09)
Teaching
• Service Engineering http://ie.technion.ac.il/serveng
• Healthcare seminars material
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Project Output & Future Work (continued)
Graduate theses (PhD, MSc)
• Task Mental Models and Neonate Medical Status Maps of Doctors and Nurses in
Neonatal Units
• Queues in Hospitals: Semi-Open Queueing Networks in the QED Regime
• The Workload Process: Modeling, Inference and Applications
• Uncertainty in the Demand for Service: The Case of Call Centers and
Emergency Departments
• Queueing Systems with Heterogeneous Servers: Improving Patients' Flow in
Hospitals
• Improving quality of treatment in the Emergency Department
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Project Output & Future Work (continued)
Students Project
•
•
•
•
Improving the Pre-surgical Process in the Hospital
Operational Aspects of Transfer the Rambam's ED to a Temporary Location
Choosing the Most Effective Operational Model for the new Rambam's ED
Patient Flow from ED to Internal Wards: Solving Bottlenecks and Operational
Problems
• Feasibility Test for Implementation of RFID system in Hospital
• Comparison of Four possible operational models for ED
• Simulation of Patients Routing from an Emergency Department to Internal Wards
in Rambam Hospital
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Project Output & Future Work (continued)
OCR projects in progress
• Patient Quality of Care – Longitudinal observations and Analysis of Medical
Records
• Human Factors in the design of a New Trauma Room
• Development of an advanced BI system for an ED, which involves a dashboard
and forecasting capabilities
• Development of a Virtual World Simulation for ED: Training Individuals and
Teams in clinical and managerial issues
• Empirical Analysis of an Emergency Department
• Emergency Department, Hospitalization, and everything in between: using
Simulation, Empirical and Theoretical Models for the Operational Analysis of
Hospitals
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Empirical Analysis
(Work in Progress) - ED:
Activity (Flow) Chart
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Empirical Analysis
(Work in Process) - ED:
Resources (Flow) Chart
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Empirical Analysis
(Work in Process) - ED:
Activity – Resources
(Flow) Chart
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Empirical Analysis
(Work in Process) - ED:
Information (Flow) Chart
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Empirical Analysis
(Work in Process)
– From ED to IW:
Activity (Flow) Chart
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Empirical Analysis
(Work in Process)
– from ED to IW:
Resources (Flow) Chart
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Empirical Analysis (Work in Process) – from ED to IW:
Activity – Resources (Flow) Chart
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Empirical Analysis
(Work in Process)
– From ED to IW:
Information (Flow)
Chart
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Human Factors in the
Design of a New Trauma Room
The aim of the research:
Designing the layout of the new trauma room bays
•The Trauma unit is currently under the process of doubling
its capacity with new admitting room that would contain 6
bays.
•Each bay is equipped for both surgical and internal trauma
patients at all ages including children
•Each bay is designed for the two side operation of a double
trauma team with two surgeons and two nurses.
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Human Factors in the
Design of a New Trauma Room
Method:
construction of 1:1 carton-board Mockup of new
cabinet
• The mockup allowed representation and
rearrangement of all drawers, shelves, medical
equipment and communication devices, which are
planned for the new workstations.
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Human Factors in the
Design of a New Trauma Room
Method:
construction of 1:1 carton-board Mockup of new
cabinet
• The mockup allowed representation and
rearrangement of all drawers, shelves, medical
equipment and communication devices, which are
planned for the new workstations.
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Human Factors in the
Design of a New Trauma Room
Work procedures :
1. Preparation of a detailed list, with all the required
instrumentation and inventory content of a bay.
2. Specification for general layout requirement of a bay.
3. Mockup development and testing with the active participation
and iterative inputs of the trauma medical team, and
architects, as well as the emergency department and hospital
management.
May 4-6, 2009 Technology
Work was carried out in a participatory
process
that included
all relevant people
Services World
Conference,
Silicon
Valley, CA
A 1:1 carton-board mockup
The work was summarized in design sketches and
a list of recommendations for building cabinets and
specification of their measures and inventory.
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Task models and neonate medical status maps of
doctors and nurses in neonatal units
•Patient care in Intensive Care Units (ICU) requires
continuous and ongoing information transfer, collaboration
and coordination between team members, at different times
and locations.
•There are unexpected events and gaps due to the dynamic
nature of the process and the medical status of the patient,
or at times works procedures and hand over that are not
properly defined
•These failures, and in particular those associated to
impaired information transfer, are a serious cause of
adverse events in the medical work environment
(Xiao, et al. 2003; Cook, et al. 2000; Bates & Gawande, 2003).
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Task models and neonate medical status maps of
doctors and nurses in neonatal units
•When working in a team, it is not enough that each medical
team member will develop a good representation of the situation
from his own perspective.
•To be efficient and work in coordination, teams should have an
appropriate team-shared model (STM) of the patient and his
medical status should be developed.
•STM is the shared understanding and mental representation of
team's task, knowledge and situation
•When having a good STM, the team's performance will
improve, the overall load will be better divided between team
members and effective working strategies will be adopted
(Klimoski and Mohammed, 1994; Mohamammed & Dumville, 2001; Cooke,
et al., 2000).
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Task models and neonate medical status maps of
doctors and nurses in neonatal units
The aim of the research:
To examine the differences and gaps between physicians and
nurses models of their task, its influence on creating a medical
status map of the neonates they treat and the resulting gaps in
these maps.
The study of this problem may enhance our understanding of
the ways to improve information transfer and create better
shared maps among medical teams in health care procedures.
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Task models and neonate medical status maps of
doctors and nurses in neonatal units
The study has been conducted on the medical staff members of
3 neonatal units in Israel.
To derive their status map of a treated neonate, a simulation
of information transfer was conducted during hand over (shift
change). Simulation data has been collected on 13 doctors
and 30 nurses and has been submitted to statistical analysis.
In the post simulation stage nurses and physician are given a
detailed questionnaire that will help extrapolating their STM by
allowing each member to describe his own tasks as well as
those of the other member. Questionnaires are being
administered these days.
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Patient Quality of CareLongitudinal observations and analysis of
medical records
The aim of the research:
• to specify and document the process that an arriving and
treated patient undergoes
• an attempt to uncover possible gaps in the treatment process.
Method:
• 147 longitudinal, patient-centered observations, were
conducted, on all shifts and all types of patient.
• Observations covered all stages, stations and staff interactions
that a patient goes through during his treatment.
Initial results show differences between patients' type and
shifts on factors such as treatment time and waiting time.
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Specification and Human Factors
in Designing an Intelligent ED Dashboard
Research goal:
Development of a computer driven dashboard which will be
• Real-time tool: providing each specific user type the specific
information required for carrying out daily routines, treat
patients, assure efficiency and reduce errors.
• Forecasting tool: plan ahead and thus avoid congestion (e.g.
via forecasting peaks of arrivals). This will be supported by
mathematical models that forecast, based on historical data,
future loads on bottlenecks of the ED.
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA
Specification and Human Factors
in Designing an Intelligent ED Dashboard
Work method in three stages:
1. Analysis of the existing state: learn the current way in which
the ED team gathers information and makes decisions on care
processes, by conducting interviews and observations.
2. User-centered task analysis of objectives: expectations
desired content and required information for each type of user.
3. User-centered design and beta testing of the dashboard via
usability testing methods and prototyping techniques.
May 4-6, 2009 Technology Services World Conference, Silicon Valley, CA