To Boost Efficiency, Hospitals Borrow Principles from Factory Floor

BUFFALO, N.Y. -- Many health-care industry bottlenecks can be eliminated, resulting in major improvements in efficiency, cost savings and patient care when hospitals borrow principles from production lines on the factory floor, according to researchers in the School of Engineering and Applied Sciences at the University at Buffalo.

At UB's Center of Excellence for Global Enterprise Management, Li Lin, Ph.D., professor of industrial engineering, and his colleagues apply industrial-engineering tools, including Six Sigma and other lean enterprise methodologies originally developed for manufacturing processes, to improve the operations and competitiveness of hospitals.

"In today's competitive environment, especially with the severe shortage of skilled nurses, the pressure on streamlining hospital operations continues to increase," said Lin. "Health-care managers are seeking new perspectives and creative ways to manage their business. We can engineer medical services with improved cost, quality and efficiency."

Lin and his colleagues use animated computer simulations that are based on statistical analyses -- routinely used to model the flow of parts through complex manufacturing processes -- to uncover the bottlenecks or potential problem areas in health-care facilities.

"What do cars on highways, manufactured parts in a factory and patients in a hospital have in common?" he asks. "They all move. We use computer simulations to analyze how patients flow through hospitals, while ensuring that the drive for efficiency doesn't dehumanize patient care. As industrial engineers, we are trained to always consider the human factors in any system."

The simulations also are ideal, Lin says, for demonstrating to hospital boards of directors the necessity for new facilities or staff.

"Modern medical technology needs modern management," says Lin.

His computer simulations have helped Buffalo's Mercy Hospital envision how increased patient volume will cause congestion in its surgical unit, necessitating and justifying the construction of new operating rooms. They also have helped the Erie County Medical Center justify and efficiently design a new ambulatory-surgery recovery center.

Currently, Lin is working with home health-care provider McAuley-Seton Home Care, a division of the Catholic Health System in Buffalo, to streamline the scheduling of nurses' visits to patients' homes.

In one proprietary study, he tracked the number of tests that each physician in a hospital ran to diagnose and treat the same disease.

"Hospital administrators were shocked to see our data," said Lin, "because they revealed the variability among physicians for ordering different tests and the wide range of costs.

"While the search for the ideal way to treat an illness, called the 'clinical pathway,' remains a significant challenge in the medical profession, industrial engineers can assist hospitals in improving their efficiency with detailed statistical analysis that identifies the root cause of many problems," he said.

While Lin characterized the collection and review of such data as "very delicate," he said it serves as an important starting point for hospitals to find ways to cut costs and for physicians to begin sharing information on the optimal tests to run for each disease.

The computer animations Lin and his team develop visually display a hospital's statistical capacity to handle patients in terms of beds, operating rooms, pre- and post-operation facilities and staff.

Lin notes that computer simulations allow hospitals to ask virtual "what if" questions, testing how well their facilities and staff would support expected future changes in their patient populations.

They also can pinpoint easily where bottlenecks occur and how they can be reduced.

In one case, Lin said, a simulation of patient transport within the hospital revealed that the elevators were a bottleneck. The problem was eliminated easily by dedicating one for patient use only.

Lin is beginning discussions on how to tackle what is likely the least efficient part of any hospital -- the emergency room.

"In the ER, the physician sees you for five minutes, and the actual services you receive take 10 minutes, but nobody can get out of there in under four hours," said Lin.

"The system is just not set up right," he said. "No one is actively seeking to get patients through efficiently. It has to be built into the process."

The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the State University of New York.