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Team Dynamics

Hospitalists as industrial engineers

The president of the Society of Hospital Medicine identifies attributes of industrial engineers that make for a better hospitalist and where to acquire tools and skills to succeed in a multifaceted role.

Interventional radiology throughput optimization

This paper is a case study of work done at Parkland Memorial Hospital in Dallas, Texas, to improve interventional radiology throughput with the main objective of reducing patient wait times and avoiding costly capital investment.

Use of lean and Six Sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center

Researchers applied lean and Six Sigma methodologies to improve OR efficiency. Multidisciplinary teams addressed minimizing volume variation; streamlining the preoperative process; reducing non-operative time; eliminating redundant information; and promoting employee engagement.

Engaging frontline employees in problem solving to provide ideal care in the PICU- East Tennessee Children's Hospital

This poster presented at the 2013 Healthcare Systems Process Improvement Conference describes a staff-driven approach for improving patient care in a pediatric intensive care unit (PICU). Thanks to Mark Graban for identifying this poster.

Lean Six Sigma tools improve more than turn-around-time for ED blood draws

This case study from the Healthcare Systems Process Improvement Conference presents the analysis of the ED-LAB blood draw system for a large tertiary teaching hospital.
Paper | Presentation 

Hybrid field: Nursing and industrial engineering

Patti Brennan, the Lillian L. Moehlman Bascom Professor in the School of Nursing and College of Engineering at the University of Wisconsin, discusses the intersecting fields of industrial engineering and clinical care with members of University of Missouri's Industrial and Manufacturing Systems Engineering Department.

The leaving without treatment reduction plan success story: Advocate Trinitiy

An improvement team at Advocate Trinity Hospital in Chicago addressed the issue of a high rate of "left without being seen." This presentation at the 2012 Healthcare Systems Improvement Conference describes how an improvement team used information systems and analytical approaches to gather information on the root causes for problems and potential solutions in the ED. Leadership rounding throughout the ED, establishing effective treatment protocols and finally, front loading medical orders to help expedite patient treatment and prompt patient disposition. After implementation of the above planned measures, the LWOT percentage reduced from the highest rate of 12.4 percent in July 2009 to 1.1 percent in June 2011.

Transforming care at the bedside: increasing patient satisfaction through employee engagement and teamwork at Our Lady of Lourdes Medical Center

Nursing leaders at Our Lady of Lourdes Medical Center in Camden, New Jersey, engaged staff to improve patient and employee satisfaction and reduce staff turnover on a medical-surgical unit using the Transforming Care at the Bedside (TCAB) model developed by Robert Woods Johnson Foundation and the Institute for Healthcare Improvement. The team focused on a set of directed methodologies and conducted a number of experiments that resulted in dramatic improvement.

Cowboys and pit crews: 2011 Harvard Medical School commencement address

Popular author and speaker Atul Gawande challenged the 200 graduates of the 2011 Harvard Medical School to pursue a more systematic approach to delivering healthcare. He used pit crews and cowboys as examples of working as a system.

Purdue industrial engineering researchers investigate using surgeon hand gestures to improve surgery

Vision based recognition of hand gestures is being researched at Purdue University to control a robotic scrub nurse and access images during surgical cases. The research could lead to short case lengths and reduced infections according to the Purdue University News website.

The Importance of Communication for Patient Satisfaction

A discussion of survey results regarding communication between providers and the patient. The visit quality as perceived by the patient increases with fewer communications.

Adding Value to the Surgical PAT Process

Using Lean Six Sigma tools, a hospital redesigns its PAT department process so that all charting is completed 72 hours prior to the day of surgery.

Management Engineers

Management Engineering: What is it?

Improving Medical Equipment Availability at Barnes-Jewish Hospital

One hospital details improvements to their medical equipment retrieval, cleaning, and distribution process.

Sustaining VAP Bundle Compliance in the ICU: A Model of CQI

Using Lean Six Sigma tools, a hospital redesigns and implements new ICU protocols for patients on mechanical ventilation.  The article details how the initial sustainability effort failed, but was brought back into long-run control.

Optimizing Caregiver Workflow in a PICU

Physician and Nursing roles and responsibilities within a PICU are redefined using lean tools to decrease LOS while increasing outcomes.

5 Projects, 5 Hospitals: Using DMAIC for Rapid Quality Improvements

Pressure Ulcer, Falls, Catheter-Associated UTI, Central Line Infection, and Objects Left in Surgery are addressed using process improvement methodologies.

Medication Administration and the Complexity of Nursing Workflow

This article studies the work processes of nurses involved in the administration of medication.  The goal is to reduce errors and improve efficiency.

Hospitals Need IE Data to Drive Staffing Decisions

Examples are used to detail the need for use of IE methods in the setting of departmental staffing levels

Additional Thoughts Regarding our Roundtable with the Experts

Karen Martin describes the steps needed to ensure an improvement effort is successful at a system level, and ways for a performance improvement consultant to continuously improve their professional skills.

Organizational Factors Influencing the Sustainability of Lean Healthcare

5 organizational factors impacting system acceptance of lean tools are studied and discussed.

Value Stream Mapping Got You Down? The Problem May Not Be You.

When applying value stream mapping, don't forget that sometimes patients will need to be grouped just like part families - and each of those may need a unique VSM.

Paging Dr Toyota

Discussion of applications of lean within the OR.

Lollipops for Excellence

System-level quality and effectiveness programs are implemented using Six Sigma at a children's hospital in Washington DC.

Redesigning Emergency Department Care Delivery Focusing on Patient Safety

An ED is redesigned after patient flows were modeled using queuing theory.

Simulation Medication: Studies Show Patient Flow Improvement

The process of creating and achieving approval of an ED simulation is discussed.

A Four-Arm Framework To Implement Rapid Response Teams

One implementation of Rapid Response Teams is discussed.

Attacking Waste and Variation Hospital-Wide: A Comprehensive Lean Sigma Deployment

Improvement projects in surgery, nursing, and the ED are discussed.  The process of moving a hospital towards adoption of Lean Six Sigma is also described.

Creating A Patient Centered Access Management System

Improvements to a provider appointment-making system are motivated, tested, and sustained

Improving Health Care Quality in a Pediatric Ambulatory OR Setting

Improvements to a pediatric OR are proposed and tested with simulation.

Breaking the Supply Chain Barrier: "Can I do this on my own?"

Successful supply chain management is discussed.  Examples show potential savings and describe the buy-in needed to achieve those dollars.

Development and Implementation of a Healthcare-Based Economic Evaluation Methodology

A methodology for standardized evaluation of the financial impact of operational and patient care improvements is discussed.

Utilizing Industrial Engineering Student Teams to Benefit Management Engineering Efforts

An ED lean project is discussed, highlighting some advantages that undergraduates can bring when partnered with professionals in the field.

In by 9 out by 6 - Load Leveling

Detailed description of a lean project to improve TAT in the CT Scan department.

Pursuing Process Excellence - What's Holding You Back?

Why do some improvement projects fail and others succeed? What are some big-picture concepts that could move organizations to success with process improvement projects?  This is a big-picture discussion of several issues.

Building Lean From the Ground Up

The surgical admitting process is targeted with a lean event.  Current and future state is described, the process of improvement is shown, and results are discussed.

Achieving a Shared Baseline: Implementing Evidence Based Clinical Practices

The authors propose a methodology for shortening the time gap between discovery of new evidence-based clinical results and hospital (provider) utilization of the new practice.

Building Bridges to Clinical Improvement

Clinical improvement results are discussed for glucose control, rapid response teams, vent bundles, and bloodstream infection projects.

Reaching New Levels of Patient Safety Through Improved Specimen Labeling

Results of a hospital-wide specimen labeling lean project is discussed.

Productivity and Quality Indicator Monitoring

A productivity monitoring system is installed and used to manage budget

Establishing Nursing Staffing Requirements in an Imaging Environment

A study is done to improve the communication between and expense of the nursing staff associated with all imaging modalities.

Get em In - Get em Out

Multiple projects and results are discussed in the goal to continuously improve patient flow.

Improving Patient Flow from the ED to a Nursing Unit

A lean event focused on patient flow out of the ED was conducted, and results are discussed

Enhancing Performance Excellence: Total Emergency Services Redesign

All processes in an ED are redesigned, with multiple outcomes showing improvement.

The Journey Toward a Lean ED

A 100,000 annual visit hospital ED is redesigned using lean principles. Wait times decrease and pt satisfaction and revenue increases.  Simulation shows further viability of new processes.  This presentation is made by a MD who became a lean coach.

Applying Redesign Principles to Design ED and Hospital Patient Flow Processes

This is an overview of several lean redesign projects in the ED with overall solutions discussed and analyzed.

A Revolution in ED Patient Throughput Management

ED throughput process improvement projects are discussed.  The presenter is a MD.  Several changes are shown with great results.

Turning the ED into Your Hospital's New Front Door

Multiple projects are performed to improve an ED.  Problems are stated and results are given.

Creating a Flexible Position Control Process--Linking Management Engineering and Human Resources

Process improvement within the HR department is shown through this project dealing with RN flex staffing.

Changing Organization Culture through Performance Management

A systemwide linking of departmental performance to manager and employee annual pay is discussed.

Using Six Sigma Principles to Reduce Billing Errors

Billing error reduction as a Lean Six Sigma project

Using Six Sigma to Improve ICU Patient Flow

A Lean Six Sigma project focusing on ICU throughput times is completed.  Lessons learned and successes are shared.

Key Performance Indicators: Relevant Metrics that Sell Results and Drive Ongoing Improvement

A discussion of the importance of metric and measurement accuracy during execution of improvement projects.

Improve Outpatient Clinic Access and Service with Lean Six Sigma

A lean project is done at a cardiac clinic.  Problem is to reduce wait time for an appt and cycle time of the appointment.  Results are discussed.

Creating a WOW! Experience At the First Point of Contact

A performance improvement team tackles a call center.  Issues and lessons learned are discussed.

Gain Competitive Advantage by Aligning Process Improvement with Hospital Strategy

Changing managerial thought is a process; this presentation demonstrates one way that managers are forced to confront the reality of differing goals/expectations of other managers they must work with.

How to Build a Lean Sensei Army for Continuous Improvement!

What's the benefit of developing a team of lean experts? This presentation proposes an answer.

Putting Data Into Action in the Operating Room Setting

New ways to display OR data are proposed in this presentation.

Optimization of Surgical Scheduling

An OR's case scheduling process is studied; improvement projects are proposed.

Improving Patient Care - Case Carts and the Operating Room

Reasons for delay in creation of case carts are addressed.  SPD often has inefficient workarounds as part of their daily routine.

Continued Barriers to Operational and Financial Performance in Surgical Services

Surgical services projects often have many barriers to success; this presentation helps illuminate and identify where they may be for your hospital.

Streamlining Your OR

A hospital undertakes a systemic improvement of their OR suite.  The process and final results are detailed.

Moving Up the Curve: From Individual to Team to Organizational Effectiveness

Management team-building requires careful thought and planning. The presentation goes over several common pitfalls and proposes solutions.

How Change Management Transformed a Multi-site GI Practice

Replacing manual processes and disparate systems with a multi-site Gastroenterology electronic medical record system in a large multispecialty practice had many challenges.

Change Management-The Key to Successfully Re-engineering Health Care Solutions

The presentation is a discussion of change management proposals and policies.. Some are successful yet some fail miserably.

Ways and Wonders of Change?

Key success factors for change as well as the keys to team dynamics are considered and explained within this paper.

Applying SHS Conference Learnings Back at the Ranch

Emergent Care was redesigned to decrease wait time significantly.

Managing Variability in Patient Flow - Data, Process, Sustainability

Methods of confronting and smoothing the variability of patient flow are discussed.

Weekend Services: The Patient is Here, So Why Aren't We?

A 848-bed hospital is experiencing long LOS and targets ancillary service availability as one potential source of improvement. The project discussed tracks the data, demonstrates immediate results, and suggests future improvements.

Optimizing Cargiver Workflow in a New Pediatric Intensive Care Unit

A lean project generated proposals for rescheduling the providers' workload. During testing of the proposals, daily departmental volume was completed significantly earlier in the day.

Engaging Staff in Lean Improvements for Patient Care Settings

4 lean projects were performed - pharmacy, lab, outpatient clinic, and telemetry unit. Each project was meticulously documented in the presentation. Pre- and post- metrics are included, as well as a discussion of sustainability.

Recruiting Change: Process and Productivity Improvement in Human Resources

Improvements within an HR department are proposed and implemented. Results are examined, as well as a simulation of the process.

Henry Ford West Bloomfield Hospital Recruitment Redesign

HR process redesign cuts down the time spent at each process step. Lessons learned, sustainability, and metrics are discussed with the group during this presentation.

Transforming Organizational Culture

A senior member of the Johnson&Johnson consulting group discusses his approach to organizational culture change and the importance of sustained leadership commitment.

Pursuing Process Excellence in Health Care

This presentation motivates the approach to management of a hospital as continuous improvement of many systems.

The Cult of Healthcare - A Warning to New Arrivals

Although healthcare is unlike any other service industry, improvement concepts are immediately applicable. This presentation teases out some specifics and attempts to answer student questions regarding the complexities of health care.



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