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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 n Fe uar br y 2 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0 ua 0 0 M ry 2 2 ar 00 ch 2 Ap 2 0 ril 02 M 20 ay 02 Ju 20 ne 02 J u 200 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 D mb 20 ec e 02 em r 2 Ja be 002 nu r 2 Fe ar 00 br y 2 2 ua 0 0 M ry 2 3 ar 0 c h 03 Ap 2 0 0 ril 3 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 email@example.com Thank you….
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