Cutting costs in healthcare

When provincial governments announce they will find ways to cut health care costs, they are usually, and rightly, met with an outcry that they will cut services. Fortunately, with the help of Industrial Engineering professionals and new medical and nursing grads who approach their fields with more open minds than their long-entrenched colleagues, cost savings are a definite possibility. There has long been skepticism from the bureaucracy about fundamentally changing the way programs are delivered, and no politician wants to preside over job cuts. The reality of the situation, however, is that change is necessary.

Last year, Health PEI announced a plan to have paramedics provide some aspects of the homecare program in rural areas. Their logic was sound. The paramedics were under-utilized, and there is a deficit of nursing resources. The paramedics could provide many basic services, such as re-dressing a wound and ensuring patients took their medications, releasing the nurses to do other, more specialized work. Through this change, it would be cheaper to keep an ambulance in West Prince 24/7, something that was promised when emergency room hours were cut. The nurses union took this as an affront, but the government persevered, albeit with a smaller program, which launched this spring. Initial reports make it seem rather successful, and hopefully the nurses union will embrace its expansion.

Other changes have occurred behind the scenes. Two years ago, two graduating Dalhousie students applied queuing theory and simulation to the call centre for women looking for breast cancer screening in Nova Scotia. The problem at the call centre was tri-fold: staffing costs needed to be decreased, the average wait time for a caller needed to be less than one minute (due to fears they’d hang up and not be screened), and the call volume was highly seasonal, with a surge during and shortly after Breast Cancer Awareness Month each year. After applying sound engineering principles to this problem, new staffing levels were devised to meet these three goals, saving the system money, and possibly saving lives.

While large health authorities have been employing industrial engineers for a number of years, the system is still largely inefficient. At a conference I attended in 2010, I learned that some 15,000 Canadians die each and every year through inefficiencies in our health care system. A project featuring a co-op student at Canada’s largest hospital, the Sunnybrook Health Sciences Centre, was presented. The student was tasked with reducing spoilage, errors, and re-sampling for blood tests. With the old system, the nurse would take the sample, the porter would come by and collect that unit’s samples, and when finished the round, would deposit them at the lab. The lab would then analyze the samples, provide reports, and the porter would bring them back to the correct unit. Unfortunately, this process was time consuming, though rush jobs were moved more quickly. In the time between the sampling and the analysis, two things happened with shocking frequency: some samples would spill and others were mixed up, becoming useless. In both of these situations, the already-frail patient would require a second blood sample, taking up time for the nurse and the lab, and delaying the patient’s treatment. The student’s approach was (looking back) quite simple: better labeling and storage of the samples, and a switch to new containers that were less likely to spill. The result was a dramatic reduction in re-sampling of blood, and quicker care for the patients, ultimately getting more patients out of the hospital more quickly, and saving lives.

Another example, which was presented at a conference this past year, involved re-designing a Montreal-area hospital. The hospital’s elevator was running above capacity, with patients being transferred from the ward to the OR with an average transfer time of approximately 25 minutes. The hospital’s target was five minutes. With a mean of 25 minutes porters could move approximately two patients per hour. By reducing it to five minutes, the porters could be re-assigned to more valuable tasks than watching over a stretcher in a hallway. The hospital hired a local company, Trellisys, who used queuing theory and Arena, a simulation software from Rockwell Automation, to examine the layout of the hospital, as well as the arrival, departure, and movement of everyone inside. To an outsider, it would seem that five new elevators would be required to hit the hospital’s target. Five elevators would take up huge amounts of space inside the hospital’s narrow tower. Thankfully, that was not the case, and Trellisys recommended installing just one additional elevator. Their simulation found that the dialysis unit was wasting elevator resources, and recommended moving that to the first floor, and moving the cafeteria upstairs to where the dialysis unit used to be. Not only did this recommendation meet the hospital’s target, but they estimated it would take but two minutes to transfer a patient, on average, saving valuable porter resources, improving the timeliness of patient transfers, reducing patient stress, and saving huge capital and maintenance costs associated with adding four elevators.

A shocking example of industrial engineering came from Health PEI, who recently hired their first industrial engineer. After a few months on the job, she has already paid her way for years to come. A scheduling task which took a team of employees two days to complete has reportedly been modified to take a mere two hours. That’s an 800% improvement! This wasn’t a once-per-year task either. The team was continuously generating this schedule. The human resources are quickly being re-assigned to other tasks, and layoffs were reportedly avoided through attrition. (No public link to this report is available)

In 2010, Ontario ruffled some surgical feathers by insisting surgeons use checklists during procedures, no matter how many years on the job. While no statistically significant change in the complication rate was observed at the western hospitals in a major international study of surgical checklists, the Toronto hospital in the study quickly chose to push for the use of checklists across the board in Ontario. The government complied with their request and mandated it, partly in response to problems occurring at one Windsor-area hospital. Industrial Engineers are frequently called on to thoroughly document processes and create checklists to reduce variability and error.

Further savings in our health care system will be achieved through integrated practice models, where the doctors, nurses, pharmacists, dietitians, physiotherapists, and alternative practitioners such sports coaches, yogi, and others will work together to help patients live healthier lifestyles and concentrate human resources to their particular areas of expertise.

Industrial Engineers work behind the scenes to clean up processes and keep our hospitals humming along nicely. We enhance patient outcomes by applying queuing theory, simulation, statistics, and principles such as Lean and Six Sigma to every environment, reducing the strain on human resources, stresses to the patient, and costs to the public purse. When politicians are ready to get serious about cost savings in health care, they should continue to turn to us, and listen to the sound advice engineers provide across a variety of industries.