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Management Engineering Consulting Services for Shands Healthcare

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					Management Engineering
 Consulting Services for
   Shands Healthcare

Introduction to ISE Presentation
       October 13, 2003
Presentation Outline

•   MECS Department Mission and
    Overview
•   Review of Current Projects
•   Internship Program
•   Questions
MECS

Originated in 1968
Staffing = 7.5 FTEs, Industrial Engineers
  Manager
  2 Senior Management Engineers
  3 Management Engineers
  2 ME Interns (0.5 FTE Paid)
  2 ME Interns (0.25 FTE Volunteer)
MECS Mission
MECS mission is to function as in-house
management consultants who assist Shands
HealthCare management in identifying ways to
improve processes and enhance the effective
deployment of resources (people, equipment,
facilities, supplies, and systems) in order to:

             Improve financial performance
             Improve quality
             Reduce service turnaround time
             Improve customer satisfaction
    MECS Services

•   Process improvement       •   Management reports
•   Staffing & productivity       & databases
•   Benchmarking              •   Project management
•   Functional facility       •   Financial analysis
    design                    •   Statistical &
•   Education & training          mathematical analysis
•   Scheduling                •   Quality Control
Roque Perez-
Velez, PE
 Degree: BS in Industrial Engineering, University of Puerto Rico
    (Mayagüez Campus)
 Enrolled: MS in Engineering Management, University Of Florida
 Specialties: Structured Estimating Techniques, Work distribution,
    Staffing, Databases, Sensitivity Analysis.
 Years at Shands Healthcare: 4 years (started in 1999)
 Prior Experience:
     • Avon-Mirabella
     • Warner-Lambert Pharmaceutics
    • Hanes Menswear
 Professional Affiliations:
    • Institute of Industrial Engineers (IIE) - SHS
    • Association of Professional Engineers and Surveyors of PR,
    • Company Commander, 153rd Engineer Company, Florida Army
      National Guard
  CT Scan Process Improvement
at Shands Alachua General Hospital (AGH)




      Roque Perez-Velez, PE
Problem Statement
•   Majority of cases are performed from 10:00 AM
    to 6:00 PM.

•   Physician coverage reduces to one staff
    member after 5:00 PM.

•   Procedures are impeded when patients are not
    fully prepped for procedures.

•   Technologist screening processes, patient’s
    history research and, performing clerical duties
    slows workflow.
Methodology
Techniques Used:

•   Analyze data from electronic sources.

•   20-80 Rule (22 procedures accounted for 95% of
    workload).

•   Analyzed patient distributions by type (hour of
    day, weekly and monthly)

•   Processing times (before, in room and outside)
    for both procedure and reading.

•   Forecasting.

•   Tasks shifting.
Recommendations
 •   Implement database to track progress.

 •   Shifting of clerical tasks.

 •   Scheduling of outpatients during non-peak
     times.

 •   Capacity analysis (additional machine
     needed when workload approaches 1190
     patients per month).

 •   Add 1 technologist and 1 assistant.
Financial Impact


 •   Recommendations will provide an increase
     of 10% in throughput (5 patients per day).

 •   After salary, benefits and other expenses,
     revenue enhancement of $ 204,927.
Shands Infusion Center

      Robin Main
Robin Main
Degree: BS in Industrial Engineering, University of Florida

Specialties: Work distribution, Staffing Analysis, Facility Redesign.

Years at Shands Healthcare: 1.8 year

Prior Experience:
    • Emergency One - Ocala

Professional Affiliations:
    • Institute of Industrial Engineers (IIE) - SHS
    • State of Florida Engineer In Training (EIT).
Infusion Center
 Breakdownof patients: 72% cancer,
 7% Anemia, 6% solid organ transplant,
 5% Crohn’s, 4% Sickle Cell, 1% Lupus.

 Total   area is approximately 2090 sq.ft.

 15   infusion chairs

 Currentstaff consists of 5 nurses with
 1:3 nurse to patient ratio.
Project Objectives
 To evaluate whether the Infusion Center
  requires more infusion chairs to properly
  accommodate current and future patient
  volumes.

         improvements to the current
 Identify
  scheduling process.

 Identify    improvements to physical layout of
  facility.
Methodology
 Data   Collection
  • Time Studies
  • Historical Data from schedules
  • Interviews


 Determine       current capacity and utilization.

 Determine   recommendations to optimize
 utilization of resources and determine
 impacts of those recommendations.
Problems
   Management concerned with decreasing patient
    referrals due to:
    • previous patient refusal
    • increasing competition with better facility.
   Management wants to be the leading Infusion Center.
   Management wants more comfortable, “homey”,
    atmosphere.
   Facility not large enough to provide:
    • enough space between chairs
    • enough space for nurse’s documentation and drug preparation.
    • patient privacy.

   Long wait time for Lab results and Pharmacy’s medicine
    preparation and delivery.
Current Capacity - Patient Mix
Summary of Daily Block Scheduling
                   Duration per No. Sched.     Total
  Visit Type       Visit (hours)    Per Day Hrs Per Day
       2                 2             8        16
       3                 3             8        24
       4                 4             5        20
       6                 6             4        24
  Flex Hours             1            24        24
   Injection           0.33           24         8
                Infusion Total Hours Per Day    108
Current Capacity
• Hours of Operation: 7:30 AM - 5:30 PM

• Hours for Patient Visits: 8:00 AM - 5 PM

• 12 Infusion Chairs and 3 Infusion Beds = 15 Spaces

• Nurse to Patient Ratio is 1:3

                                 Injection   Infusion   Total
      Daily Total Capacity (hrs)     9          135      144
 Daily Schedule Capacity (hrs)       8          108      116
 % Schedule of Total Capacity       89%        80%      81%
                                     Utilization
  Ja
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                               0.2
                                     0.3
                                            0.4
                                                   0.5
                                                         0.6
                                                               0.7




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               0
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    A ly 2
Se ug 20
  pt us 02
    em t 2
  O be 002
    c r
N tob 20
  ov e 0
    e r 2
                                                                                            Hours Per Day




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 ec e 02
    em r 2
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     nu r 2
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    br y 2 2
       ua 0
               0
    M ry 2 3
       ar 0
         c h 03
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       M 20
                                                                     Mean Infusion and Injection Utilization of Available Scheduled




         ay 03
             20
                03
Facility Issues
   PROBLEM: Backroom chairs are not viewable from
    Nursing Station.

   SHORT-TERM RECOMMENDATIONS: Place a
    window in the wall
    behind the Nursing
    Station.

   IMPACT: Easier
    communication with
    patients while staff is
    working at Nursing
    Station will increase
    patient safety.
                         Another patient
                            behind wall
Facility Issues
   PROBLEM: Patient treatment bays are located too
    close to each other.

   LONG-TERM RECOMMENDATIONS: Allocated
    more space for each bay allowing at least 2 feet
    circulation space around each chair.

   IMPACT: Increase patient safety when nurses are
    setting up treatment or providing care. Increase patient
    privacy during consultations.
Facility Issues
   PROBLEM: Delays occur while paging PA and
    waiting for PA to arrive so that orders can be
    processes.

   SHORT-TERM RECOMMENDATIONS: Use
    Nextel phones for faster contact.

   LONG-TERM RECOMMENDATIONS: Locate
    PA’s office and exam room in Infusion Room.

   IMPACT: Delays reduced or eliminated from time
    spent searching or waiting for PA. Patient care is
    increased by providing better access to PA care and
    additional patient confidentiality.
Facility Issues
   PROBLEM: The atmosphere of the Infusion Room is
    clinical looking and drab.

   SHORT-TERM RECOMMENDATIONS: Repaint
    walls to warmer shades. Provide reading material and
    mind games (crosswords, word searches). Place ledges
    with greenery around the Infusion Room.

   LONG-TERM RECOMMENDATIONS: In expanded
    redesign incorporate elements to make atmosphere of
    infusion room to increase patient sense of well being.

   IMPACT: Increase patient satisfaction through
    considerations for how their surroundings contribute to
    their comfort level.
Scheduling Issues
   Problem: Add-on patients cause the daily utilization of
    resources to be unpredictable.

   Recommendation: Decrease the hours blocked from 14 hours
    to 12 hours. Twelve hours are blocked until the day before
    treatment, then six hours are released. The other six hours are
    released the day of treatment.
   Impact: Reduces the number of blocked hours that could be
    made available to schedule patients. An additional visit a day
    can be scheduled in advance resulting in 3.5% increase in
    available capacity. The total value added impact is estimated to
    be $72,801 from cost reductions for the Infusion Center and
    additional revenue for the Pharmacy.
    Scheduling Issues
   Problem: Physicians expect their add-on patients to be
    seen in the Infusion Center for treatment on same day as
    clinic visit. This results in congestion in the Infusion
    Center. Nurses and other resources are strained due to
    additional workload from add-on patients.
   Recommendation: Encourage physicians to schedule
    non-emergent add-on patients for treatment in the next
    available time slot. Since Friday’s schedule utilization is
    the lowest, physicians should be educated to schedule
    patients on this day.
   Impact: The daily and weekly workload for the
    resources will be more balanced, which will reduce the
    stress for the staff.
Operational Issues
   PROBLEM: Longer turnaround time on lab results
    (chemistry results) cause delays in Pharmacy regimen
    preparation causing delays in treatment start time.

   SHORT-TERM RECOMMENDATIONS:
    Implement in-lab or point of care analyzer for BUN and
    creatinine tests currently being delivered to Rocky
    Point.

   IMPACT: Improve turnaround time for test results
    from 1.5 - 6 hours currently to 5 minutes. Ultimately
    reduces patient wait time and chairs can be better
    utilized.
Thoracic and Cardiovascular
Surgery and Vascular Surgery
       Consolidation


       Ashley Benedict
Ashley Benedict
Degree: BS in Industrial Engineering, University of Florida

Specialties: Work distribution, Value Stream Management, Facility
  Redesign.

Years at Shands Healthcare: 4 months

Prior Experience:
    • BellSouth Telecommunications Co-op

Professional Affiliations:
   • Institute of Industrial Engineers (IIE) - SHS
Objectives
 Recommend best configuration for new layout.
 Improve workflow.
 Reduce work, staff and/or process redundancies.
 Enhance staff cross-cover.
 Improve room/equipment utilization.
 Determine the optimal administrative layout.
 Provide general layout designs.
 Provide relationship and proximity diagrams.
Desired State
 Professional and safe environment.
 More privacy and less noise for office staff.
 Study room for fellows and residents.
 Separate chart room and individual chart space
  at desks.
 Patient support staff (Patient Secretaries, nurses)
  in adjacent offices.
 Program Assistants seated next to their attending
  faculty members.
Conference Room Schedules
            Monday Tuesday Wednesday Thursday             Friday
7    - 8 15-20 10 15-20 15 15-20     15-20               30
8    - 9    6       6   15   6         6                  6
9    - 10           6                                          5
10   - 11
11   - 12
12   - 1
1    - 2
2    - 3
3    - 4
4    - 5                         5-7
          15-20
5    - 6
                                  Thoracic and Cardiovascular Surgery
                                                   Vascular Surgery
Thoracic and Cardiovascular
Staff Interviews
                                                        Main Object
  Job Title              Main People Interactions
                                                        Interactions
                               Office Manager,
  Division Chief             Clinical Coordinator,    printer (has own)
                              Attending Faculty
                              Attending Faculty,
  Office Manager                                      printer, fax, copier
                             Program Assistants
                            Program Assistants,
  Attending Faculty
                                Chief, Fellows
                            Physician Assistants,
  Fellows/ Residents                                       VCR/TV
                         ARNPs, Attending Faculty
  ARNPs                       Attending Faculty
  Clinical Trial Nurse        Attending Faculty       copier, fax, printer
                         Attending Faculty, Program
  Physician Assistants
                             Assistants, ARNPs
                         Attending Faculty, ARNPs,
  Program Assistants                                  fax, printer, copier
                            Physician Assistants
  Database Coordinator        Attending Faculty
  Lab and Pacer
                             Attending Faculty
  Technician
Thoracic and Cardiovascular
Relationship Diagram
      A   Chief                           A

      B   Office Manager                  1        B
      C   Program Assistants              3         3                C
      D   Attending Faculty               2         3                 1                   D
      E   Clinical Trial Nurse            4         4                 4                    4                  E
      F   Fellows                         4         4                 4                    4                   4                   F
      G   Database Coordinator            4         4                 4                    4                   4                   4          G
      H   Lab and Pacer Technician        4         4                 4                    4                   4                   4            4                      H
      I   PA / ARNP                       4         4                 4                    4                   4                   4            4                       4                        I
      J   Copier area                     4         1                 1                    4                   1                   3            4                       4                       4           J
      K   Access Doors                    1         4                 4                    2                   4                   1            4                       4                       1           4             K
      L   Conference Room                 1         2                 4                    2                   2                   4            4                       4                       4           4             4               L
      M   Fax Machines                    4         1                 1                    4                   1                   3            4                       4                       4           1             4               4               M




                                                                                                                                                                   Lab and Pacer Technician
          Value     Rel. Closeness
           1       Must be adjacent


                                                                                                                                            Database Coordinator
                                                                  Program Assistants



           2           Important
                                                                                                           Clinical Trial Nurse




                                                                                                                                                                                                                                       Conference Room
                                                                                       Attending Faculty



           3            Ordinary
                                                 Office Manager




                                                                                                                                                                                                                                                         Fax Machines
                                                                                                                                                                                                                        Access Doors
           4      Unimportant/not near



                                                                                                                                                                                                          Copier area
                                                                                                                                                                                              PA / ARNP
                                                                                                                                  Fellows
                                         Chief




                                                                                                                                                                                                                                                          M
                                                                                                                                               G
                                         A

                                                   B

                                                                    C

                                                                                         D




                                                                                                                                                                      H




                                                                                                                                                                                                                         K
                                                                                                              E

                                                                                                                                   F




                                                                                                                                                                                                                                         L
                                                                                                                                                                                                           J
                                                                                                                                                                                               I
Proposed Layout1
Thoracic and Cardiovascular Spatial
Requirements (Layout 1)
                                                   Current Area                             Proposed       Additional Space
                                                     per Unit                              Area per Unit   Needed per Unit
Unit                                                  (sq ft)                                 (sq ft)            (sq ft)
Chief                                      (1)             160                       (1)       160                0

Office Manager                             (1)             105                       (1)       105                0

Student Assistants                         (2)                                       (2)
Program Assistants                         (4)            645**                      (5)       433               -212

Attending Faculty                          (6)             655                       (7)       762               107

Clinical Trial Nurses                      (2)             130                       (2)       123                -7

Database Coordinator                       (1)              65                       (1)        65                0

Lab and Pacer Technician                   (1)             130                       (1)        65               -65

PA / ARNPs                                 (5)              65                       (5)       125               60

TOTAL                                                      1955                                1838              -117
** This square footage includes records area and hallways in the current location.
Vascular Spatial Requirements
(Layout 1)
                              Current Area          Proposed       Additional Space
                                per Unit           Area per Unit   Needed per Unit
                                 (sq ft)              (sq ft)            (sq ft)
Unit
Chief                   (1)       156        (1)       160                4

Office Manager          (1)        68        (1)       102                34

Attending Faculty       (2)       265        (4)       445               180

Clinical Practitioner   (1)                  (1)
Research Nurse          (1)                  (2)
Clinical Coordinator    (1)       156        (1)       226                70

Patient Secretaries     (3)                  (4)                         166
OPS Office Assistant    (1)       109        (1)       275

TOTAL                             754                  1208              454
  Shared Spatial Requirements
  (Layout 1)
                                    Current Area                             Proposed       Additional Space
                                      per Unit                              Area per Unit   Needed per Unit
Unit                                   (sq ft)                                 (sq ft)            (sq ft)

Coders                                                                (2)        80                80

Fellows                      (5)                                      (5)
Residents                    (3)            200                       (3)       180               -20

Records Room                                77**                                325               248

Copy Room                                                                       190               190

Break Room                                                                       75                75

TOTAL                                       277                                 850               573
** This square footage includes only Vascular Surgery's Record Room
 Combined Spatial Requirements
 (Layout 1)

                                 Current Area   Proposed Area per   Additional Space
                                   per Unit            Unit         Needed per Unit
                                    (sq ft)           (sq ft)             (sq ft)
Unit
Thoracic and
Cardiovascular Surgery               1955             1838                -117
Vascular Surgery                     754              1208                454
Shared Space                         277               850                573


                   GRAND TOTAL       2986             3896                910
Recommendations
   Relocate to basement to accommodate the future forecast
    of additional faculty and staff.
   Provide overhead cabinets in each workspace.
   Add at least two more file cabinet to allow for adequate
    space for storage of the patient files.
   Setup conference room to allow for use of audio/visual
    equipment and a view box.
   Place a view box in the copy room so both departments
    have access to it. This will allow for increased utilization.
   Place small conference tables in each of the Division
    Chiefs’ offices to allow for small meetings.
Internship Program


    Lisa Barber
        and
  Fred Thompson
Lisa Barber                 Fred Thompson
   Graduating May 2004        Graduating May 2004
   IPPD Project Member        IPPD Project Leader
   IIE member                 IIE member
    • Social Chair Office      Other Internships:
       – Fall 2002              • Civil Engineering firm
    • Fundraising Chair         • Environmental Eng.
      Office                      Company
       – Spring 2003
                                • Pharmaceutical
   Treasurer of SAE              Manufacturing
                                  Company
General Information
•   What training did I receive?
•   When can I apply?
    - Hiring for Spring semester.
    - Must have 3 semesters available.
    - Volunteer the first semester (10hrs/wk).
    - Paid last two semesters if hired (20hrs/wk).
•   What was expected of me prior to being
    hired?
    - Completion of Facilities Planning or Work
      Design, and Technical Writing.
    - Healthcare interest.
Project Involvement

   • Infusion Center
     • simulation
   • Medical Plaza Labs
     • process improvement
     • facility redesign
   • Transplant Admissions
     • database development
     • forecasting
Project Involvement
    • Food Services Trayline Process
      Improvement
      • timestudies
      • work design
    • Pharmacy Inventory
      Replenishment Improvement
      • process analysis/improvement
    • Ingredient Control Process
      Improvement
      • work balancing
Benefits of Interning for MECS
 •   Real-world experience
 •   Opportunity to apply IE coursework
     •   time studies
     •   work sampling
     •   work design
     •   facility layout
     •   cost / benefit analysis
Contact



               Robin Main
            Email resume to
          mainre@shands.ufl.edu
Thank you….