Opportunities, Challenges, and Locus of Control in Undergraduate Research in Healthcare Settings Dr. Laura Moody Dr. Joan Burtner Mercer University, Department of Industrial Engineering and Industrial Management ASEE Annual Conference June 2016

Today we’ll be talking about … What we have seen over the past 20 years Where Industrial Engineering has had an impact What our students have done What we have learned from the experience For the past 20 years, we have been involved in a variety of applied research projects involving Industrial Engineering undergraduates and healthcare facilities, primarily hospitals and affiliated clinics. This presentation will examine the experiences and observations of the authors as we have watched the healthcare industry evolve over the years. We will discuss Industrial Engineering methodologies that our students have used to positively influence healthcare outcomes. We will also focus on some of the more concrete challenges involved in facilitating undergraduate research experiences in healthcare settings. These include, among others, changing Human Resource requirements, access to data, and personnel issues such as finding the right sponsor for a project and insuring the students have both administrative and clinical/operational staff support. ASEE June 2016 Dr. Laura Moody and Dr. Joan Burtner

Dr. Laura Moody and Dr. Joan Burtner Change is happening … New approach to improving the quality of healthcare is gaining momentum Industrial Engineers have an opportunity to be a guiding force in that change Hospitals offering training sessions in the basic principles of Lean Six Sigma Key personnel are exposed to the philosophy and key concepts, but not necessarily to the systems thinking that underlies the approach Industrial Engineering concepts and methods support and improve efficiency, standardization, human centered design, and systems thinking Conversely, the dominant culture in healthcare tends to be compartmentalized and individualistic The new approach to improving the quality of healthcare is gaining momentum and Industrial Engineers have an opportunity to be a guiding force in that change. Increasingly, hospitals are offering training sessions in the basic principles of Lean Six Sigma, which has its roots in Industrial Engineering. As a result, administrators and key clinical personnel are exposed to the philosophy and key concepts, but not necessarily to the systems thinking that underlies the approach. Industrial Engineers are subject-matter experts in concepts and methods to support and improve efficiency, standardization, human centered design, and systems thinking. However, the dominant culture in healthcare, which tends to be compartmentalized and individualistic, often conflicts with the systems thinking that can facilitate improvement. ASEE June 2016 Dr. Laura Moody and Dr. Joan Burtner

20 years of student-led projects Two-semester Senior Design Projects Student Teams Real-world Clients Course Related Projects Quality Engineering Ergonomics Healthcare Process Improvement Independent Study and Honors Projects Full semester Simulation in Healthcare MeSEE Research Transportation Algorithms ASEE June 2016 Dr. Laura Moody and Dr. Joan Burtner

Redesign of performance measuring system Senior Design project (1999/2000) Redesign of an existing system Customized software package Consolidated information from different platforms Project Level of Effort Deliverable(s) Patient falls prevention/reduction Two-semester senior design project Identification of major contributing factors, recommendations, and training program Prevention of retained objects during surgery Low-tech simulator and training program Redesign of existing performance measuring system Customized software package that consolidates information from different software platforms Emergency Department registration process One-semester course-related project Process analysis and redesign of workflow Transport efficiency Honors project Multi-year project that included data analysis, model development and simulation using ARENA Benefit cost analysis Employee survey data analysis Data analysis, Pareto charts, written report, oral presentation to upper management ASEE June 2016 Dr. Laura Moody and Dr. Joan Burtner

Patient falls prevention/reduction project Senior Design project (2004/2005) Statistical analysis of data on patient falls Identified major contributors Made specific recommendations Developed training program Project Level of Effort Deliverable(s) Patient falls prevention/reduction Two-semester senior design project Identification of major contributing factors, recommendations, and training program Prevention of retained objects during surgery Low-tech simulator and training program Redesign of existing performance measuring system Customized software package that consolidates information from different software platforms Emergency Department registration process One-semester course-related project Process analysis and redesign of workflow Transport efficiency Honors project Multi-year project that included data analysis, model development and simulation using ARENA Benefit cost analysis Employee survey data analysis Data analysis, Pareto charts, written report, oral presentation to upper management ASEE June 2016 Dr. Laura Moody and Dr. Joan Burtner

Prevention of retained objects during surgery Senior Design project (2005/2006) Observed counting and control processes in the operating room Developed a low-tech patient simulator Extremely portable Allowed for localized training on counting procedures Developed a training program for staff Project Level of Effort Deliverable(s) Consolidation of three practitioners into a single practice One-semester course-related project Collected data and analyzed patient flow for the three different physicians Supply cart restocking Observation, application of 5 S Simulation in healthcare Honors project Independent study Training materials, delivery to students and hospital personnel, annotated bibliography Allocation of technicians in a multi-location clinic Two-semester senior design project Data collection, data analysis, and simulation using ARENA Emergency Department door-to-disposition time improvement Data collection, data analysis, value stream mapping and simulation using ARENA ASEE June 2016 Dr. Laura Moody and Dr. Joan Burtner

Allocation of technicians in a multi-location clinic Senior Design Project (2012) Collected and analyzed staffing and patient demand data from a number of consolidated clinics Arena simulation Project Level of Effort Deliverable(s) Consolidation of three practitioners into a single practice One-semester course-related project Collected data and analyzed patient flow for the three different physicians Supply cart restocking Observation, application of 5 S Simulation in healthcare Honors project Independent study Training materials, delivery to students and hospital personnel, annotated bibliography Allocation of technicians in a multi-location clinic Two-semester senior design project Data collection, data analysis, and simulation using ARENA Emergency Department door-to-disposition time improvement Data collection, data analysis, value stream mapping and simulation using ARENA ASEE June 2016 Dr. Laura Moody and Dr. Joan Burtner

Individual and smaller projects … Honors projects Transportation efficiency (2014-2016) Simulation in healthcare (2015) Course projects Process analysis of emergency department registration Employee survey data analysis Application of 5S to supply cart restocking Observational study of nurse interruptions Conceptual design of patient registration interface Call light data analysis Project Level of Effort Deliverable(s) Laboratory Services turnaround time reduction Two-semester senior design project Data collection, data analysis, and process redesign Hospital door-to-balloon time reduction Value stream mapping, process redesign Nurse interruption observational study One-semester course-related project Documented source, time and frequency of interruptions experienced as nursing staff administered medications Inventory tracking and management system 5S, layout changes, development of Access database, employee training for implementation of new system Conceptual design of a patient registration interface Paper and pencil prototype of a kiosk interface for patient registration. ASEE June 2016 Dr. Laura Moody and Dr. Joan Burtner

Using formal Affiliation Agreements Affiliation Agreement procedure Legal document describing detailed agreement between university and outside agency Reviewed/approved by Mercer University legal counsel and hospital legal counsel Authorization for students enrolled in Dr. Joan Burtner’s industrial engineering courses to “conduct research” at a specific facility Agreement expires after a certain time period Course-related project examples Observational study of nurse interruptions (Industrial Management Case Studies course) Call light data collection and analysis (Healthcare Process Improvement course) Affiliation Agreements Process Legal document describing detailed agreement between university and outside agency Reviewed/Approved by Mercer University legal counsel and hospital legal counsel Requires one-month to one-year lead time Nurse interruption observational study One-semester course-related project Documented source, time and frequency of interruptions experienced as nursing staff administered medications Students allowed on-site at prescribed hours Students designed data collection forms Students conducted statistical analysis Call light data analysis Data provided by hospital Data collected by nurses over three month time period Student project began after data was collected No need for students to visit hospital Messy data/interpretation after the fact ASEE June 2016 Dr. Laura Moody and Dr. Joan Burtner

Dr. Laura Moody and Dr. Joan Burtner Lessons Learned Buy-in and support from upper administration is critical to the success of any project. Navigating complex organizations with competing cultures. Buy-in of constituencies. Improve the chances recommendations will be implemented and sustained. Students will usually need specific guidance and training on how to work with healthcare organizations to Understand the terminology and regulations Recognize the culture(s) and constraints of the organization. Buy-in and support from upper administration is critical to the success of any project. While this is the case for most industrial projects, in an organization as complex as these and in which there may be multiple competing cultures that must be navigated, the strong support of leadership is essential to gain the buy-in of the various constituencies impacted by the project. The support of upper management will also improve the chances that whatever recommendations are implemented as a result of the project will be sustained after the student team leaves. Students will usually need specific guidance and training on how to work with healthcare organizations. From understanding the terminology and regulations to recognizing the culture(s) and constraints of the organization in which they will be working, students must be prepared to work in this new environment. ASEE June 2016 Dr. Laura Moody and Dr. Joan Burtner

Dr. Laura Moody and Dr. Joan Burtner Lessons Learned Leadership and individual units within healthcare organizations must be sufficiently prepared to work with the student teams. How process improvement and quality approaches apply to healthcare. How to develop an appropriate scope for the project. The participation and support required on the part of healthcare personnel. The time constraints imposed by the academic calendar and the schedules of individual students. Faculty must be aware of and plan for all regulatory and organizational requirements that must be followed in order for student teams to work in the hospital. Similarly, the leadership and individual units within healthcare organizations must be sufficiently prepared to work with the student teams. This includes education regarding the application of process improvement and quality approaches to healthcare, developing an appropriate scope for the project, the requirements for participation and support on the part of healthcare personnel for the individual project, and the time constraints imposed by the academic calendar and the schedules of individual students. Faculty must be aware of and plan for all regulatory and organizational requirements that must be followed in order for student teams to work in the hospital. In some cases meeting these requirements will impact the starting date of the project, but if it is well understood that time can be used by the faculty to prepare students to work in the hospital environment. ASEE June 2016 Dr. Laura Moody and Dr. Joan Burtner