如果運(yùn)用工業(yè)工程來改善醫(yī)療服務(wù)-English-94

1、Applying Industrial and Systems Engineering Concepts in Health Care Delivery,Improve Productivity,Improve Customer Satisfaction,Save Money,Improve Quality,Improve Working Conditions,Industrial Engineering,Save Time,Need for IE Now and in the Future,Healthcare Systems,Industrial Engineers,Knowledge o

2、f operations research and systems analysis methods and theories,Health Service Researchers,Knowledge of healthcare delivery,Information and Decision Support Technology Experts,Knowledge of hardware and software capabilities,Role of Industrial Engineers,Industrial Engineers,Bench Marking,Process Simu

3、lation,Comparative Data Analysis,Customer Focus,System Analysis,Quality Management,Industrial Engineering, 1993,Our Research in Health Care Systems,WISE IE Skills in Healthcare Total Quality Management Simulation Supply Chain Management Workflow Analysis and Re-design Additional IE Concepts in Healt

4、hcare Scheduling with average wait of 3 min Examination queue : 1 person; with average wait of 12 min Appointment Scheduling Approach Multiple screening procedures at 15 min intervals Diagnostic procedures at 40 min intervals Bone densitometry and ultrasounds at 30 min intervals Biopsies at 1 and 2

5、hour intervals,Appointment Schedule Optimization,Simulation Results (screening mammography),Appointment Schedule Optimization,Best Scenario: Impact on Technologist Workload,Illustration of system status at 20 minute intervals Key observations: Least number of idle technologists with low WIP,Illustra

6、tion of system status at 20 minute intervals Key observations: High resource utilization (83%) with balanced workload,Time of Day (min),Number of Persons,Best Scenario: Impact on Clerical Workload,Appointment Schedule Optimization,Analysis of Current Workflow,Focus on Ancillary Services,Implementati

7、on of Rapid Care,Post Implementation Analysis,Process Mapping Historical Data Analysis Root Cause Analysis,Laboratory Radiology,Manual Simulation Computer Simulation Alternative Scenarios,Evaluation Recommendations Simulation Study,Emergency Department (ED),Objective: Reduce Patient Turnaround Time

8、at ED at WMRMC,Key Stages of Research,Root Causes of Long PTAT,Focus on Non-Urgent Patients,Rapid Care System,About Rapid Care (or Fast-Track) Separate Treatment Area within the ED Redirection of Patients Focus on Non-Critical Patients Majority Do Not Require Laboratory/Radiology Tests Short Treatme

9、nt Time Ultimate GOALS Reduce Wait Time and Turnaround Time for All Patients Enhance Patient Satisfaction,Garcia, 1995,Data Analysis for Simulation,Data Collection and Analysis (10,091 Sample Patients) (March 04 - June 04),Time Studies,T-System,Statistical Validation,HIS,Probability Distributions (A

10、rrival Candidate,NVA,15.8 days,VA,Total VA Time : 20.3 d Total NVA Time : 22.8 d Cycle Time : 43.1 d,20.3 days,7 days,Kaizen,VIRTUA.ORG,Candidate Interview,Difficult to quantify non-value added time; Although opportunities exist,RECRUITERS,RECRUITERS & HIRING MANAGERS,Hiring Manager,People-soft / Ou

11、tlook,HR SPECIALIST IS TEAM,Job Posting,DEFECT RATE = 33 %,Candidate,* Sample Size: 20 REQUISITIONS,* Requisition transfer time includes weekends,* Based on sample data from positions opened and closed in 2006 - 2007,Example: VSM for HR Recruitment process,Pre-work: Value Stream Map,Achievements 20

12、Minutes = 52 % reduction in patient waiting time 16% reduction in Patient-Turn-Around-Time,Results: Antenatal Testing Unit,Achievements Eliminating excessive downtime in processes resulted in 7 days reduction in processing time Reducing wastes identified by Lean Overall impact of $215,000 annual sav

13、ings to the organization,Results: HR Recruitment,Bed Capacity Planning,Objective: Greenfield site: bed capacity of 365 beds Determine allocation of beds to inpatient units for optimal utilization levels Analysis of bed mix to enhance revenues for forecasted volumes (year 2012) Minimize distances tra

14、veled throughout patient stay (evaluation of existing designs),Critical Pathway Analysis,Cardiology,ED,Direct,OP,ICU 22%,M/S 11%,Diagnostic Ancillaries - Diag Rad 22% - CT Scan 11% - Ultrasound 17% - Nuc. Med 8% - EEG/EKG 14% - MRI/MRA - Special Procures - Mammography - Labs,Therapeutic Ancillaries

15、- Endo/Cysto 8% - Resp. Therapy 15% - Phys. Therapy 5% - Rad. Therapy 1% - Pharmacy 40%,Surgical Services - OR - PACI - CSR,PCU 44%,41%,59%,43%,12%,Critical Pathway Analysis,VB Template,Distance-editing features allow the user to compare distance scores for different master plan layouts,Cost factor

16、for patient (based on Service Line) Throughput per Service Line,Use of Simulation Modeling,Inputs: Outputs: LOS statistics per Service Line Utilization of IP unit beds Total traveling distances per Service Line,Patient Arrival,-Rates determined per Service Line & mode of admission (direct/ED),Bed Av

17、ailable?,IP Units,Holds Area,Y,N,Discharge?,N,Patient Discharge,-Admission location percentages,-LOS per unit per service line -Distance between units -Capacity per unit,-Transfer location percentages,Y,Completed Projects,Just-In-Time Medication Administration Use of MRP in the OR Equipment Depot In

18、ventory Management Pre-Admissions Testing Study Lean Implementation through Kaizen Simulation Modeling at the ED,Publications,Selected Conference Proceedings,Bosire, J., Wang, S., Srihari, K., and Gandhi, T., Comparing Simulation Alternatives Based on Quality Expectations, Proceedings 2007 Winter Si

19、mulation Conference, Washington DC, December 2007. Bosire, J., Kost, S., Srihari, K., and Rivero, R., Application of Discrete Event Simulation to Facilitate the Transition to Filmless Mammography, Proceedings Industrial Engineering Research Conference, Nashville, Tennessee, May 2007. Nagula, P., Lan

20、der, R., Ramakrishnan, S., DeGennaro, M., & Srihari, K., Simulation as a Solution Methodology to Improve the Efficiency of Health Care Delivery Systems, FAIM 2006, Limerick, Ireland, June 2006. Nagula, P., Lander, R., Rivero, R., Gomez, S., Srihari, K., Use of Continuous Quality Improvement Tools to

21、 Streamline the Workflow of Ancillary Departments, Proceedings - Industrial Engineering Research Conference, Orlando, Florida, May 2006. Lander, R., Courtney, A.K., Emick, F., Srihari, K. & Rivero, R., Analyzing the Transition to Filmless Radiology Using Discrete Event Simulation, Proceedings - Indu

22、strial Engineering Research Conference, Orlando, Florida, May 2006. Ramakrishnan, S., Courtney, A., Srihari, K. and Emick, F., Streamlining the Workflow at the CT Scan Area of a Healthcare Provider, Industrial Engineering Research Conference, Atlanta, Georgia, May 2005. Ramakrishnan, S., Nagarkar, S

23、., DeGennaro, M., Srihari, K., Courtney, A., & Emick, F., A Study of the CT Scan Area of a Healthcare Provider, Proceedings 2004 Winter Simulation Conference, Washington, DC, December 2004. Nivarthi, S., Nagarkar, K., DeGennaro, M., & Srihari, K., Enhancement of the Utilization of a Suite of Operating Rooms, Proceedings - Industrial Engineering Research Conference, Houston, Texas, May 2004. Nivarthi, S., Nagarkar, K., DeGennaro, M., & Srihari, K., Effective Utilization of Ancillary Services to Reduce Patient