1. Update on the UT System Initiative - Systems Engineering in Healthcare Victoria Jordan, PhD Director, Quality Measurement and Engineering – MDACC UT Health Services Fellow for Systems Engineering October 27, 2011

2. Industrial and Systems Engineering Industrial and Systems Engineers deal with systems. They design, implement, or improve integrated systems comprised of people, material, information, and/or energy. Industrial and Systems Engineering focuses on developing a better way of doing just about anything. Industrial and Systems Engineering makes things better, faster, safer, cheaper

3. Components of Systems Engineering Frontline Improvement Methods  Six Sigma  Lean  Standardization Quality Engineering Methods  Statistical Quality Control  Reliability  Engineering Economics Process Optimization Methods  Operations Research  Scheduling  Simulation  Staffing Models Human Factors  Error Proofing  Safety  Ergonomics Logistics  Facility Design Layout  Supply Chain / Inventory Management Data Mining and Analytics  Clinical Informatics  Clinical Decision Making  Reporting

4. Systems Engineering in Healthcare Clinical Operations (Efficiency, Safety, Value of Patient Care Delivery) Business Operations (Efficiency, Value of business systems such as administrative requests, research approvals systems, inventory management) Therapeutic Optimization

5. Systems Engineering in Healthcare Make health care safe, timely, effective, efficient, equitable, and patient centered Design / layout new facilities Reduce patient wait times Increase efficiency so we can deliver the same quality of care without increasing staff Eliminate non-value-added steps to improve efficiency, reduce cost Simulation to try new processes Make care safer for patients Identify when we need to add resources (staff or equipment or rooms)

6. Example: Virginia Mason In two years (2002-2004) Va Mason showed the following improvements: Inventory down 53% ($1.35 million) Productivity up 36% (158 FTE’s deployed to other, value-added, jobs) Floor space required down 41% (22,200 sf) Lead time down 65% (23,082 hours) People – Distance traveled down 44% Product – Distance traveled down 72% Set up time down 82% 6

7. UT Example – Nurse Scheduling Problem in OR Develop two integer programming nurse scheduling models  Nurse Assignment Model (NAM)  Nurse Lunch Model (NLM) Consider nurse scheduling attributes in an operating suite  Case specialties  Procedure complexities  Nurse skill levels Consider different aspects of goals  Minimizing nurse over times and idle times  Maximizing surgery case demand satisfactions Provide efficient schedule for each nurse

8. System Dynamics Human Factors Analysis Systems Thinking Created by: Office of Performance Improvement, UT MDAnderson Cancer Center Human Factors Analysis Classification System Evidenced Based Medicine Ethnography Link Between Systems Engineering and Clinical Safety and Effectiveness Course Quantitative Complexity Optimization Mathematical Programming Forecasting Queuing Discrete Event Simulation Statistical Analysis Operations Research Decision Analysis Network Analysis Inventory Modeling Decision Trees Statistical Process Control Six Sigma Heuristics Usability Lean Root Cause Analysis Fault Tree AnalysisFailure Mode Effect Analysis Project Management Process Mapping Constraint Base Scheduling Quality Function Deployment Time/Motion Study Basic Quality Tools Data Mining QI Leadership Clinical Variation Patient Safety Plan-Do-Study-Act Decision Making Facility Design Layout Current CS&E Content Scheduling Qualitative

9. What Others Are Doing Johns Hopkins ($30 million Systems Institute) Brigham and Women’s ($30 million for Systems View of Primary Care) Mayo Clinic (Systems Engineering Group) Geisinger (Operations Research) VA Engineering Resources Centers Virginia Mason (Lean) Charleston Area Medical Center, WV (Six Sigma) Banner (Relationship with Academia) Academic Centers (CHOT - Center for Healthcare Operations Transformation, others) Institute for Industrial Engineers (IIE) – Society for Healthcare Systems (SHS)

10. UT Systems Engineering Mission Apply industrial and systems engineering tools and methods to further advance clinical effectiveness and safety and improve operations across the health institutions of The University of Texas System. 10

11. UT System - Systems Engineering Steering Committee Steering Committee includes members from across the UT System:  UT Southwestern, UTMB, UT MD Anderson, UT Tyler, UTHSC – San Antonio, UTHSC – Houston  UT Austin – McCombs School of Business, Cockrell School of Engineering; UTSA – Ind Engr, UT-Arlington – Ind Engr; UT-Dallas-Ind Engr; UT Medical School  UT Physicians  UT Health Services – Vice Chancellor’s Office 11

12. Our Expected Deliverables Develop a whitepaper to serve as a recommendation for Dr. Shine to the UT System and Board of Regents (presented Aug, 2011) Provide educational sessions for academic, business, and clinical leaders on the role of Systems Engineering in healthcare (increase awareness) and courses in frontline methodology Coordinate grants for transformational efforts using Systems Engineering Explore the possibility of a Systems Engineering internship program among the UT health institutions Initiate an annual conference to share success stories 12

13. Board of Regents – August 2011 Approved $4 million to fund the initiative for three years  Approx $1 million for infrastructure support  Approx $3 million for grants for transformational change using Systems Engineering tools and techniques 13

14. Next Steps Communication across UT System - Present plan to Presidents, Deans, CMO’s, and CQO’s Develop plan for embedding frontline training and application of Lean tools - Target Feb start for Lean and Systems Engr Overview courses Launch RFP process for grants and initiate projects; Grant solicitation and approval – Mar- May; approvals in June First (to be annual) conference in Galveston, April 13, 2012 Plan for internships and sabbaticals to begin Summer and Fall 2012

15. We need your help … Support the effort – learn more about it Spread the word at your institution Attend the April 13 conference and invite others Look for opportunities to apply for grants – talk with UT Ind Engrs in your area Identify opportunities for system transformation at your institution 15