Engineering efficiency in medicine

Apr 3, 2009

Senior students at Kettering University applied Industrial Engineering methods and processes to the flow of patients through a medical office and found it is more interesting to study people than machines.

A Senior Design Project turned into just what the doctor ordered for four Industrial Engineering (IE) majors in Dr. Matthew Sanders’ fall capstone class at Kettering University.

The four were asked to study and improve the efficiency of services to Rheumatic disease patients at the office of Dr. John Tower and Dr. Mahpara Syed, in Rochester Hills, Mich., associated with Beaumont Hospital.

Dr. Tower said he became aware of the capstone class through the IT Department at Beaumont Hospital. “Through my administrative position at William Beaumont Hospital-Troy as the Medical Director of Quality and Patient Safety, I have had significant exposure to the engineering profession working in the medical field in a number of areas,” said Tower.  “I was quite confident at the onset of the project that we would learn valuable information.”

“Our assignment was to look at streamlining processes and improve operations without sacrificing quality of patient care,” said John LaRose, an IE major from Birch Run,Mich.

Their goals were to increase patient value added time with the doctors; increase patient throughput by reducing delays and waiting time for patients; improve access and efficiency of clinical office operations.

To address the issue of increasing patient value added time, the group followed patient flow through the office, with times associated with every movement of the patient recorded, creating a time study. This gave the group a visual representation of when the physician was and was not adding value to the patient visit. The students considered waiting to be non-value added time, whether in the waiting room or in the examination room.

To increase patient throughput by reducing delays and waiting time for patients LaRose and his team, including Nick Latiano, of Niles, Ohio, Nick Maschino, of Davison, Mich., and Cidney McGee, of Detroit, utilized time study data to analyze how long the individual medical assistants and doctors spent with each patient in the exam room.

Tower said that the standard research methodology employed by the students was good.  “It was rather transparent to the office and non-interrupting,” he added. 

Through their research, the students found there was a scheduling bottleneck in the process caused by usage of four examination rooms. They recommended that instead of scheduling patients at certain times, the office should schedule patients to a specific exam room.

Their theory is that scheduling by exam room allows the exam room bottleneck to be optimized to see the most patients in a reduced amount of time. Moreover, it decreases the opportunity for a patient to be waiting in an exam room for the physician to finish with another patient.

“When we performed our time study analysis there were only two physicians in the department,” said LaRose, “now there are three. Our plan was designed to help ease the congestion when scheduling exam rooms, now I don’t know if there will be enough rooms to accommodate three doctors,” he said.

Analyzing the access and efficiency of clinical office operations, the students also determined the space allocated for office operations was not efficient. Recommendations were made to eliminate paper files in favor of electronic files opening up additional physical space, and categorically grouping operations such as phone calls, patient greeting and sign-in, scheduling, billing, and patient check-out for better division of labor.

The students also recommended rearranging the front desk area and a sign in the waiting room alerting patients to check-in procedures.

“The recommendations served to validate our hypothesis, or presumptions about office flow and opportunities for efficiency,” said Tower. “We have implemented some of the recommendations but not 100 percent.”

Tower said his office continues to work on ongoing adjustments in their schedule and office flow, calling it a “work in progress. Overall the experience was very positive, and I would recommend it to my colleagues,” he added.  

Comparing their experience to more traditional Industrial Engineering enterprises, the students found the medical industry could have higher rate of variability than manufacturing and that industrial methods and processes can be used to improve the medical industry. And finally, that it is much more interesting to time study a human being than a machine.

“We all came from an automotive background,” said LaRose, “yet we were able to use everything we learned to help a hospital achieve greater efficiencies. Who would have thought it possible?”

Written by Dawn Hibbard