Re-enginnering the ER
Mohammad Khasawneh, associate professor of systems science and industrial engineering and assistant director for health systems for the Watson Institute for Systems Excellence.

Industrial and systems engineers help cure some of healthcare's ills

 

By Brian Crawford

Suddenly you’re dizzy, unsteady, your eyes aren’t focusing, and you’re having trouble talking.You could be having a migraine or, even worse, a stroke. Your family rushes you to the hospital. Then you wait. And wait. And wait. Watson School Associate Professor Mohammad Khasawneh has had similar emergency room experiences and is now working to make healthcare more efficient and effective. Through the Watson Institute for Systems Excellence (WISE), an institute for advanced studies at Binghamton and part of the Watson School’s Systems Science and Industrial Engineering Department, Khasawneh and his colleagues have been working on a wide spectrum of applied research projects to improve hospital operations and patient experience.

By expediting emergency room visits, streamlining patient flow throughout the hospital and reducing length of stay and turnaround time of lab results and medications, their goal is to enhance productivity and reduce medical errors, ultimately improving patient experience and satisfaction.

Khasawneh and his team are working with healthcare providers across the United States, including United Health Services (UHS) locally, Virtua Health in Marlton, N.J., and the Mayo Clinic in Rochester, Minn. The WISE healthcare program includes 12 graduate research associates and one undergraduate research assistant who conduct onsite research for the partnering hospitals, even as they continue their coursework in the Watson School through EngiNet online courses.

So why do you wait so long in the emergency room? Khasawneh explains that most patients aren’t admitted to the hospital until emergency care — X-rays, blood tests and observation — has been completed and a physician establishes the necessity of admission. Because this can take hours and most processes are sequential in nature — one of the many reasons associated with the dynamic nature of a complex system such as this — patients “stack up,” waiting to be treated

With the help of WISE, UHS, for example, is working to address the problem by applying a systems approach that begins when the patient enters the hospital or emergency room. Using criteria and streamlined processes developed by the WISE researchers, doctors and nurses assess whether a patient will be admitted and can immediately begin the search for a hospital bed. By the time the emergency physicians have completed their initial care, the hospital has prepared a room and informed the nursing staff of the admission. The patient spends less time in the ER, and everyone in the waiting room is treated that much more quickly.

A Different Point of View

Khasawneh says WISE (an effort initially led by Dr. Krishnaswami Srihari, dean and distinguished professor of the Watson School and WISE director) was inspired to begin the healthcare systems engineering initiative after a 1999 report by the Institute of Medicine indicated that as many as 98,000 people die in the United States as a result of medical errors. “This was a problem that had relevance for systems engineering,” Khasawneh says. “The goal was to make healthcare more efficient, more effective, with higher quality and fewer errors — and, in the process, save lives.”

“What WISE does is help providers look at their clinical care practices from a different perspective,” Khasawneh says. “Until recently, hospitals and healthcare providers rarely looked at their operations as ‘systems.’ In fact, hospitals are really ‘systems of systems,’” he says, “and most problems develop at the point where systems interact — the hospital pharmacy, inpatient care, the medical supply chain and, especially, the operating room and emergency departments.” These are the most cost-intensive areas of the hospital and frequently serve as gateways for patients entering the system.

Although most patients won’t recognize the process engineering that goes on behind the scenes, they will appreciate its results. Industrial and systems engineers in WISE are finding ways to reduce waiting time and improve workflow so providers can treat the patient faster and more accurately. “What patients hate most is waiting and wasting time,” says research collaborator and Systems Science and Industrial Engineering Assistant Professor Sang Won Yoon.

The same is true of doctors and nursing staff. “When we are working with physicians and nurses, we often talk about the ‘circle of work’ and about how much energy is spent on a particular task,” Khasawneh says. “We want to make their jobs easier.” Doctors and nurses can commit themselves to patient care instead of inefficient tasks. Instead of having nurses waste time looking for bandages and wraps, for example, it is much better to have supplies available at the patient’s bedside, ready to be used. “As a result, the patient is made more comfortable and has a better healthcare experience.”

More than an Education

Former WISE research associate Srikanth Poranki, PhD ’09, improvement administrator for quality and patient safety services at UHS, puts it this way: “The goal is not to reduce or remove the human aspect of healthcare, but to allow everyone to use their skills to their fullest ability.”

Research associates Fatima Irshaidat, Marybeth Attanasio '10 and Osama Almeanazel at SUNY Upstate Medical University Hospital in Syracuse

For the past two years, Poranki has been working on projects at Wilson and Binghamton General hospitals, two of the four hospitals operated by UHS. He has one full-time employee and five WISE graduate associates. They are looking at a variety of projects, ranging from speeding heart attack victims into surgery to improving purchasing methods for items such as pharmaceuticals, furnishings and supplies. Poranki indicates that as the program becomes more established, it will be expanded to include all of the UHS hospitals.

It may seem unusual for an engineer to work in healthcare, but Poranki finds it intellectually challenging. He is used to hearing complaints that “this isn’t manufacturing.” And he agrees — it isn’t manufacturing. “But that only makes it more interesting,” he says. “The complexity of human behavior and people’s backgrounds and conditions are much more variable than anything I would find in a factory or supply chain.”

Poranki compliments WISE for its academic qualities and its ability to prepare students. “It is more than an education, it treats every student special. Because you work with regular employees and industry, you learn how it is in the real world and what it takes to succeed there.”

Hanh Nguyen '07, MS '09, who worked with WISE as a graduate research associate several years ago, believes the most valuable aspect of WISE’s academic approach is that it can be applied to just about any field. Nguyen, who is currently working with Montefiore Medical Center, a 1,500-bed teaching hospital in New York City, says “the WISE program is unique, it brings a lot of advantages to the table.” It has helped him learn to “take the context out of the problem. You can apply the same math and science to your subject whether you are looking at widgets made in a factory or reducing the number of falls in a hospital ward.”

Nguyen is currently helping redesign Montefiore’s pneumatic tube system, which transports light-weight carriers at high speeds. The technology is old, but it is still the fastest way to transmit physical samples and other information through the hospital. Unfortunately, the system’s design is inadequate for its traffic. Nguyen describes it as being like an old-fashioned highway system, with one-way streets and crowded intersections. His team is now working with the tube manufacturer and hospital administrators to implement a new system that will significantly increase efficiency among hospital employees

Nguyen believes that systems engineering helps improve the quality of healthcare and helps reign in skyrocketing costs. “Better data allows us to be more efficient. It helps reduce the length of stay, which is good for both the patient and the provider.” But he recognizes no system will be perfect: “Another Binghamton and WISE grad, Joshua Bosire ’07, taught me that there are no ‘clean’ data, no normal distribution in healthcare, so your job is to reduce uncertainty.” Nguyen emphasizes, “If you limit uncertainty, you are helping the managers and physicians make better-informed decisions. That’s your job as a systems engineer.”

WISE FACTS

Watson Institute of Systems Excellence has:

  • 74 research associates — including 42 doctoral, 29 master’s and three undergraduate students — placed at industry partner locations, 13 of whom are healthcare related.

  • Seven faculty members, three research scientists/ managers and one staff assistant.

  • Nearly 25 research partners across the United States, including UHS, the Mayo Clinic, GE Research Center, Solaria and IBM.

  • More than 50 projects in industrial, medical and public service research areas including electronics manufacturing and packaging, healthcare systems, manufacturing engineering, systems simulation, productivity enhancement, small-scale systems and decision-support analysis.

  • Several new projects and partners, including SUNY Upstate Medical University in Syracuse.

  • Research funding that topped $2.6 million in fiscal year 2010 and more than $2 million through March 2011, with healthcare awards accounting for 15% to 25%.