As healthcare moves from volume to value with greater emphasis on both efficiency and quality, the need to adopt the lean practices used in other industries has become apparent.
Conversations about big data, analytics and process engineering are becoming increasingly commonplace. Best practices are no longer limited to the clinical arena but are also a key part of the business plan. In today’s evolving delivery system, positive patient outcomes are often attributable not only to providers but also to the processes that have been put in place.
During the recent INFORMS Healthcare conference in Nashville (see sidebar), Mike Fabel, a senior health systems engineer with the Mayo Clinic, and Victoria Jordan, PhD, executive director of Strategic Management and Systems Engineering with the University of Texas MD Anderson Cancer Center, sat down to discuss their role in the healthcare delivery system.
“I have a manufacturing background,” said Fabel. “We just have a different way of viewing things as far as looking for waste in the process. I think we bring a simplified, team-based effort to looking for waste.”
Fabel added that in his experience, physicians, nurses and other team members have the necessary skills to rethink the status quo but need the guidance, facilitation and tools the engineering department brings to the table to help them map out new solutions.
Jordan added, “There are complex tools like operations research, simulation, mathematical modeling and statistical analysis that engineers can bring to help optimize processes that people in healthcare typically have not traditionally used.”
Since arriving at MD Anderson Cancer Center eight years ago, Jordan and colleagues have built a quality engineering group to support efforts to maximize efficiency and quality, while minimizing waste. Although some of that work was already underway, Jordan said it wasn’t nearly at the level of expertise, focus or acceptance that is found today.
“We’ve raised awareness from the clinical staff how these tools and techniques can help.” She added, “When they ask what industrial engineers do, I always tell people we make things better, safer, faster, cheaper … that’s the mantra for the industrial engineering profession. In healthcare, that translates to safe, timely, effective, efficient, equitable and patient centered.”
Value Stream Mapping
One of those tools, value stream mapping, helps a team break down a process step-by-step. “It’s more valuable if you have everybody that’s involved in the process sit around the table and discuss it because what you find often is that people are doing it differently,” Jordan noted.
After searching for consensus on the general process, she said you begin to look at each step along the way to see if it added value to the finished product or deliverable service. “If it didn’t add value, why are we doing it?” she questioned, adding the answer could be because there is a regulatory requirement in play. “But either there’s a reason we’re doing it or not … if not, it’s waste. So we start to identify how we can streamline the process and make it more efficient.”
Fabel added there is also a quality element to value stream mapping. Is there is a safety concern or lapse in quality? In what part of the process does it typically occur? After identifying the issue and adding a corrective step, the hope is to eliminate the concern.
Fabel and Jordan said these types of exercises are particularly eye opening in hospital settings that are often siloed. When bringing together various groups that touch a process at different points along the way, duplication and extraneous steps can come to light.
Fabel said groups are often surprised to find out how their process impacts another department downstream. The key to changing behaviors, he added, is to let the group collaboratively come up with solutions. “When people come together and actually talk and generate ideas together, they can understand how their actions affect others later, and they’re much more willing to buy in (to the change).”
Jordan agreed cross-functional teams are critical to reengineering the process but added leadership and communication are equally important when rolling a program out. “Every project, to work, has to have an implementation plan,” she said.
Access to Engineering Tools
While Fabel and Jordan are part of large, prestigious institutions, they said the types of tools they bring to the table aren’t out of reach for community hospitals or physician practices. Fabel noted the Mayo Clinic, like many other large health systems, makes their resources available to affiliates in their network.
“We try to create almost a grassroots effort as far as quality improvement using some of these industrial engineering tools. We have at Mayo what’s called the Quality Academy, which is really our own educational institute,” Fabel explained, adding many of the engineers use the platform to teach the basics – such as value stream mapping and PDSA (plan, do, study, act) – so that individuals can take these tools back to their facilities and begin to put them in play with quality efforts.
Even without access to an educational offering like the Quality Academy, Jordan said almost every community has resources to assist with quality and efficiency. In addition to private consultants, she said there are opportunities to partner with the local community college or closest university. Additionally, she continued, “There are professional organizations like American Society for Quality and the Institute for Industrial Engineers that have courses online so there are places where they can find affordable training and education in some of the basic tools.”
For more advanced tools or projects, Jordan suggested partnering with a college or university on a capstone project, which is a graduation requirement for industrial engineering students. “Schools are always looking for people who are willing to sponsor those projects.”
Some are free; others require a minimal cash outlay, but the return on investment can be significant. “You get the benefit of four or five students who have been through four years of industrial engineering and their faculty advisor all working on your project,” she concluded
RELATED LINKS:
INFORMS: www.informs.org
Healthcare in the Age of Analytics: http://pubsonline.informs.org/editorscut/healthcareanalytics
