summer internship program project types criteria mechanisms ... •summer internship program ... •...

James C. Benneyan, PhD, DirectorHealthcare Systems Engineering Institute

CMS Innovation Healthcare Systems Engineering Center NSF Center for Health Organization TransformationAHRQ Patient Safety Learning Laboratory Center

Northeastern University, Boston MAwww.HSyE.org

Summer Internship Program Day 1 Orientation

Northeastern University © 2012www.HSyE.orgHealthcare Systems Engineering Institute

Welcome!(we’re glad you’re here)

2


Today

1. About us• Me, you, internship

2. About healthcare• Problems (Wed: Healthcare industry, Dr H)

3. About ISyE in healthcare• Overview

4. Logistics, trouble shooting3


Morning

1. Welcome!

2. Who we are and why

3. Summer internship program

4. Logistics

5. Next steps, Calendar

6. Q & A4

Northeastern University © 2012www.coe.neu.edu/healthcareHealthcare Systems Engineering Institute

About us

HSyE, you, internship program


About me / Healthcare Systems Engineering Institute

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Partnerships Project Types Criteria Mechanisms

NSF Research CenterAHRQ Safety CenterR01/other grants

CMS Regional ExtensionVA Application Centers

Research

Discover

Applied

Impact

Experiential

Education

1 ‐ 2years

3 ‐ 9 months

“Developing what we

don’t know”

“Doing what we know”

2 ‐ 6 months

“Teaching others by doing”

Mission: Broad measureable impact on health care, nationally, thru integration of research, education, and application of industrial and systems engineering

1

2

3

Coops, Summer internsPostdoc training programClinicians‐in‐residence


NSF Industry-University Collaborative Center

7

National Science Foundation IUCRC Industry‐University Center Model

• Members = Advisory board, Project selection

• Active members = Vibrant center, Useful research

One or more university research groups

Multiple companies(healthcare systems)

Member steering committee

Response proposals Project selection

Researchresults

Test beds

Common problems

NEU’s Center for Health Organization Transformation (CHOT) IUCRC


Skilled Nursing Facility Centers

HSERC regional center (CMS/CMMI)Ac

adem

ic Com

mun

ityHealth

care Com

mun

ity

Healthcare Informatics

Bouvé College of Health Sciences

College of Engineering

Other

HSERC

Healthcare Systems Engineering Regional Center

Palliative + Hospice Centers

Payers

Home Health

Long Term Acute Care

Hospitals

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Recruiting &Application

CohortResearchExperience

Post REU Year

Time

Winter-Spring Summer Fall-Spring

Education platform

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For Engineers• Formal coursework

– Curricula, classes

• Experiential education– Coop, intern programs

For Healthcare• Seminars, workshops

– Build awareness, skill

• Clinicians‐in‐residence– Medical, MHA students


Us - snapshot

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• Core staffo Dr. Benneyan, Director, NU‐IE faculty; IHI fellow/facultyo 5 Faculty, 5 staff/engineers/advisors, 2 MDs, 2 office staff, 2 technical writers,

o 5 post‐docs, 24 graduate students, 10 undergrads

• 2,600 square foot institute space

• Summer internship programo Intern coordinators (Elizabeth, Cory, Corey)o Jamie Hackney; office admin (hiring, paperwork, etc)o Graduate student and 2015 intern mentors


HSyE values

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• Measurable improvement on healthcare systems, at scale and at pace

• Processes

• Continuous and co‐learning

• Abhorrence of MUDA, waste, mediocre

• Joy and satisfaction in work

• Personal and professional growth


“It’s time for the science of health care to embrace systems engineering” (JAMA, 2012)

My hopes for you – summer interns

• Contribute to our healthcare IE projects & our overall mission, team, internal operations.

• Learn about healthcaresystems engineering

• Develop useful career experience and insight

• Grow personally and professionally

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National Academy of EngineeringInstitute of Medicine


Your turn : )

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• Name, year, major (minor if any)

• Something interesting about yourself

• Something fun about yourself

• Favorite (and least favorite) subject so far

• Past work, coop, or healthcare experience, if any

•


Summer internship


Summer internship program

• 12 week internship• Students from across U.S.• Applied, research projects• Reflection activities, presentation skills

• Weekly in‐services• Mentoring• Post‐summer activities

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Summer Internship ProgramHealthcare Systems Engineering Institute – Northeastern University

Recruiting &Application

CohortResearchExperience

Post REU Year

Time

Winter-Spring Summer Fall-Spring


Calendar

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Spring• March 28 – Orientation call 1• April (date) – Orient. call 2• Background reading assign• Pre‐onboarding, paperwork• “Pre‐flection” exercise (what you want to gain from this)

Fall• Quarterly conference call• Post‐reflection• Short writing assignment

Summer Week 1: May 27 2014

• General orientation, onboarding• Project finalization

June – Aug 14• Team projects, HSyE activities• Learn, grow, teach, contribute

Weekly• Team meetings• Guest lectures, IHI Open school• Weekly meetings: mentor, me

Aug 10 week• Reflection, report, presentation


Typical summer responsibilities

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1. Two (ish) applied IE projects• Team structure (following slide)• Fluid over time, load balancing, help others as needed

2. One (ish) research IE projects

3. One internal project team• Fill in ebb + flow of other projects. Ad hoc help as needed

4. Learning and growth• Guest lectures, summer course sit‐ins, IHI Open School• Weekly mentor meeting. Reflection exercises (August)• Self‐motivated


Expectations

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• Contribute to projects and unanticipated needs

• Conduct oneself and represent Center professionally

• Attend all team and staff meetings and project reviews (schedule to follow)

• Self‐manage team projects on daily/weekly basis

• Keep senior manager and me updated on progress, results, and barriers

• Co‐learn

• Ask for help, information, and direction when needed or uncertain


Typical projects

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Delivery System Logistics• Inventory• Supply chain and reusable

equipment optimization• Regional network design• Real time location systems and

RFIDWorkforce Planning

• Capacity planning• Staff scheduling• Demand management• Operating room scheduling and

turn‐around• Academic workforce logistics

Quality & Patient Safety• Reliable and consistent care• Harm and error reduction• Readmission reduction• Nurse knowledge exchange &

hand‐off practices• Treatment optimization

Patient Flow• Workflow smoothing • Patient flow simulation models• Operating room logistics• Emergency department flow• Diagnostic test scheduling


Typical number ongoing projects

28

System Project Year

Impact

Education

Course‐based

Yes/No

Embedd

ed

Phase In

Senior

Lead

Proposal

Scoping

Measures

Test Plan

Approved

ISyE Com

pleted

Evaluatio

n

Dissem

ination

Completed

Cancelled

NeedsI II III 5% 50% 100% $ Other/Category

BWH Non‐OR anesthesia util ization '13 ● ● TA ● ● ● 44k +10% utilizationCHA Primary care continuity '13 ● ● SF/ JB ● ● ● ● o +20% continuityHVMA Obstetrics admissions optimization '13 ● ● SG ● ● ● ● ● ● ○ Implementation + measurement 3mHVMA OB/GYN ultrasound capacity optimization '13 o ● ● JB ● ● ● ● ● ● ○ Implementation + measurement 340kLahey CHF post‐discharge scheduling '13 ● ● SG ● ● ● ● ● ○ Measurement 360k ‐3% readmissions

Atrius Homecare population optimization ● ● JB ● ● healthAtrius Homecare networks/resource design ● ● JB ● ● cost

BIDMC Surgery call center ● ● JB ● ○BMC Specialty appointment access ● ● VS ● accessBWH System‐wide appointment access ● ● TA ● accessCCA SNF care incentive design ● ● JB ● ● health, costCHA Peri‐op supplies ‐ inventory science ● ● VS ● ● costCHA Peri‐op supplies ‐ process flow ● ● VS ● ● costCHA Peri‐op supplies ‐ master l ist standardization ● ● VS ● ● costDFCI Project 1 access, delaysDFCI Project 2 access, delaysDFCI Project 3 access, delaysHallmark Breast clinic access + delays ● ● JB ● ○ Aim, measurement access, delaysHCH Project 1 TBD SF

HCH Project 2 TBD SF/ JB

Lahey OU appropriate patient ID + standardization ● ● JB $$ costLahey OU capacity + staffing optimization ● ● JB costMGH CLABSI reliabil ity engineering science ● VS ● ● $ AEs, LOS, $MGH Interventional radiology o ● ● JB ● ○ accessMGH Neurosurgery (access/flow?) ● ● TA ● ○

Scop

ing

Type

Activ

e

Implement Status

Project

Conductin

g

Estimated Annual Impact

Project Status, June 2013


Methods we use

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We do a LOT of this…

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6, Lean, CQI, PDSA, …

More this afternoon


…and we do a lot of this

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Max Z=

, s

Max Z=

, sPatients

Check In

Receptionist

Prep for Provider

Medical Assistants

Provider

Provider.2

Provider.3

Provider.4

Exam 1A & 1B

Exam 2A & 2B

Exam 3A & 3B

Exam 4A & 4B

Provider?

Check Out (Exit)

25

25

25

25

Patients

Check In

Receptionist

Prep for Provider

Medical Assistants

Provider

Provider.2

Provider.3

Provider.4

Exam 1A & 1B

Exam 2A & 2B

Exam 3A & 3B

Exam 4A & 4B

Provider?

Check Out (Exit)

25

25

25

25

More this afternoon and later


Project team structure

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Example – old (revise!)

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How we do the work

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Project Evaluation Matrix

Date: 1/1/1

Instructions: Score each category on a scale of 1‐5 (1 = low, 5 = high)

(only fill in the non‐shaded cells)

# Proposal University

1 Inverse propogation solution to ED no‐showsState College University

2 1 1 1 2 3 2 N 12 5

2 Reversing the aging processYouth Fountain

College4 2 4 0 5 4 1 Y 20 4

3 Optimal patient centered medical apartmentsEastnorthern University

4 4 4 3 2 3 4.5 Y 24.5 2

4A multi‐site test of post‐disease screening protocol accuracy

Implausible Research Institute

1 5 2 5 2 5 2 N 22 3

5Effect of optimal lighting in discharge instructions on non‐preventable readmission

Hooneeds School 2 1 1 3 2 2 1 N 12 5

6 CHOT‐wide collaboration project all 4 schools 5 5 5 5 5 5 5 Y 35 1

7 0 7

8 0 7

9 0 7

10 0 7

Pote

ntial for

spre

ad; g

ener

alizab

ili

Reco

mmed

n (yes

, no)

‐ no

t sur

e of

Total

Rank

ord

er

Ove

rall scor

e

Impo

rtan

ce of p

roblem

Appr

opria

tene

ss of a

ppro

ach

Pote

ntial impa

ct

Like

lihoo

d of

succes

s

Inte

rest in

pro

posa

l

2. Project vetting and selection process

1. Project lifecycle mgmt 4. Implementation & impact measurement

3. Project management and formal design reviews

More later this week


Writing assignment (1)

• “Pre‐flection” exercise (what you want to gain from this)

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Why healthcare


1 = best, 7 = worst

Why healthcare?

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• National crisis

• CWF and WHO studies

• $3 trillion/year (18%)

• 1/3 = pure waste

• Unsafe, unreliable

• Poor health, outcomes

• High variability

• Poor access, equity

Commonwealth Fund Study (2010)


Why systems engineering

Significant interest (IOM, NAE, AHRQ, NSF, NIH, PCAST, etc)

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‘Time for science of health care to embrace science of systems engineering... but examples of… impact… are rare’ (JAMA, 2012)

‘Greater use of (IE) principles… widely used in manufacturing and aviation… small number health care organizations… not widespread in U.S. health care’

Institute of Medicine / NAE reports

Advisory report to Obama (5‐29‐14)


Why us?

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“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it is the only thing that ever does.”

Margaret Mead

• Significant experience with healthcare IE (application, education, research)

• Unique team, strong healthcare collaborators, 3 past centers, >75 years combined experience

• Will, vision, passion


What matters What IEs do

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Safe

Effective

Patient centered

Timely

Efficient

Equitable

• Flow, waits, delays

• Logistics, capacity

• Quality, lean, six sigma

• Safety, reliability

• Treatment, medical decision making

• Policy

Common Applications of Systems Engineering


“Triple Aim”

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• Better care• Better health• Lower costs

• Pervasive• CMS, AHRQ, IHI


Reading assignment (2)

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Paper: Overview of IE in healthcare

1 2


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Where is the Waste?Redundancy, rework, non‐value‐add, unnecessary work

1. Poulin et al; 2. Boutwell AE 2009; 3. Blackford Middleton, Ctr. for Information Technology Leadership, 2005

1. Misuse, overuse, re‐use, underuse – critical/costly resources

2. Unnecessary readmissions ≈ $19 ‐ 25 billion/yr2

3. Noncompliant medication use ($290B)

4. Inventory ≈ 15‐30% hospital costs. Estimated ½ waste1

5. Routine NVA ≈ 80 ‐ 95% lean studies

6. 20% lab/x‐ray tests and 14% admissions because original tests or medical records from previous visits unavailable (VA)

7. 81% cases have missing data (Palo Alto Medical Foundation)

8. Average 6.4 providers/year seen by Medicare patients

9. 75% cost is for chronic illness (significant % readmitted)

Price Waterhouse 2011 study: $1.1 Trillion in waste

CMS / Berwick (2011): $11 Trillion over 9 years

Healthcare Systems Engineering | www.coe.neu.edu/healthcare | Northeastern University © 2010

Process inefficiencies

• Documentation: 35%• Non‐nursing practice: 25%• Foraging, Travel time, Patient escorting

IHI TCAB Study

~50% NVA!


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Berwick D, Hackbarth A, JAMA 2012;307(14):1513‐1516


Over / under use

• Massive over use, over treat

• Some under use

• Example 1: Imaging in ED

• Example 2: 60‐80% of all specialty referrals

• Unnecessary, wrong sub‐specialty, or could have been via phone consult

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Safety report cardEstimates (IOM 1999, etc)

Medical errors & iatrogenic injury:• 98,000 deaths/year• 770,000 ‐ 2 million patient injuries• $17 ‐ $29 billion dollars

Adverse drug events (ADE):• 770,000 to 2 million per year• $4.2 billion annually

Hospital‐acquired infections:• 2 ‐ 5 million NSI/year, $3,000/case• 8.7 million hospital days• 20,000 deaths/year

More US deaths/year than for traffic accidents, breast cancer, & AIDS.

Endemic AE’s

6 ‐10% hospital patients suffer ≥ 1 serious adverse events• Adverse drug events (ADE)• Surgical site infections (SSI)• Needle sticks• Wrong side/site surgery• Device‐associated infections

‐ Ventilator‐associated pneumonia‐ Catheter & central line infections

Per episode average costs:• ADE: $4,000 ‐ $5,000• NSI: $2,000 ‐ $3,000• VAP: 13 additional days & 30 ‐

50% attributable mortality• SSI: Can exceed $14,000

2006 study: 195,000 deaths, $6 billion/year


Human Process errors

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Rare events not so rare….


Variation & one-sigma quality

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30

35

40

45

50

55

60

65

70

75

time

11/08 12/08 01/09 02/09 03/09 04/09 05/09 06/09 07/09 08/09 09/09 10/09 11/09 12/09

Recommended Care Received ≈ ½ 1

64.7% Hypertension63.9% Congestive Heart Failure53.9% Colorectal cancer53.5% Asthma45.4% Diabetes 39.0% Pneumonia22.8% Hip Fracture

50%

30%

70%

Hand washing compliance rate

Number of Hours Before 1st C-6 -5 -4 -3 -2 -1 1 2 3 4 5 6 7 8 9 10 11 12

(Too Late) (Too Early)

Average - 61 Mins. Before St. Dev. - 90 Minutes (!)

Optimal

Optimal Window - 0-2 Hrs Before

SSI Antibiotic Timing Example

‘Not’‘Not’

‐6 ‐5 ‐4 ‐3 ‐2 ‐1 0 1 2 3 4 5 6 7 8 9 10 11

1. McGlynn et al; 2. Chan DC et al ; 3. World Health Organization; 4. National Council on Patient Information and Education

Practice variation


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• National campaigns

• P4P, demonstration projects

• Numerous such workshops

• Search for penicillin (EMRs, bundles, new QI/PI models, latest HBR idea, …)

• ‘Innovation’ centers

Institute of Medicine (IOM) reports

Lots of Activity (10‐20 years)


And now the bad news…!


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Not much is improvingPer capita cost (US) = trend unaffected

• Largest study since IOM

• “No significant change in overall rate of harm”


Higher costs ≠ Better outcomes

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U.S. System versus BenchmarksCommonwealth Fund (2006)

Measure (U.S.) Score

Mortality 70%

Infant mortality 39%

Healthy life expectancy at 60 87%

Overuse / waste 46%

Unnecessary ER visits 23%

Same/next day access 58%

After hours access 53%

Adult preventative care 61%

Childhood absenteeism 74%

Chronic disease under control 61%

Administration cost 28%

Use of electronic records 21%

Benchmarks typically top 3‐6 countries


Economic train wreck

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BCBSMA’s medical cost trend is growing four times faster thanworkers' earnings, and nearly five times the rate of inflation.

Source: Vin Sahney, BCBSMA, Bureau of Labor Statistics

BCBSMA Medical Trend Workers’ Earnings Overall Inflation

0.0%2.0%4.0%

6.0%8.0%

10.0%12.0%

14.0%16.0%

18.0%

2000 2001 2002 2003 2004 2005 2006 2007

8.2%

15.9%13.8%

13.1%

12.1%

13.3%

12.8%

12.5%

Percen

t Increase

?!


More than healthcare crisis

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• U.S. manufacturing firms $2.38 per hour

• Foreign average $0.96 per hour. (2005, 2.4 times)

Example

• Chrysler: $1,000 per vehicle more Japanese‐based manufacturers

• GM: $1,525 per vehicle (2005)


Employment logistics(Suzy, Jillian)

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Orientation packet

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• New employee check list…

• Complete all items

• (check each when completed)

• Sign and return to Jamie Hackney

• Due within first week of start


NU – New employee hires

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All□ NU personal information form□ I‐9 employment eligibility form□ W‐4 federal tax withholding form□ Direct deposit form

Full Time Hires□ Confidential race and gender declaration (optional)□ Benefits enrollment

Coop students□ Coop hire sheet

International students□ Read international student FAQ


COE and HSyE

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COE□ Sponsored computer account□ 253 RI and 254 RI key access request form□□

HSyE□ Contact information sheet□ Interest areas form (internal/external projects)□ HSyE (“QPL”) listserve□ Sharepoint access□ Space, desk, and computer assignment□


General orientation

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HSyE website□ Mission statement□ CHOT center□ Tools and resources□ Project scoping document templates

Sharepoint website□ Regular meeting schedule□ Time reporting□ Expense reimbursement□ Templates and forms□

Reading, browsing□ Triple aim paper□ PDSA paper□ Healthcare IE chapter□ others as distributed □

Sharepoint website□ Escape fire video or paper□ Measuring triple aim□ IHI open school modules□ others as distributed□


HSyE organization chart

63


Wrap up


Questionswww.hsye.org

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Contact information:James Benneyan, PhD, DirectorHealthcare Systems Engineering Institute334 Snell Engineering CenterNortheastern UniversityBoston MA [email protected]

summer internship program project types criteria mechanisms ... •summer internship program ... •...

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