33
Chapter 5
A Case Study of a High
Functioning Management
Engineering Department
Rudolph (Rudy) Santacroce
Do more with less. As industrial and management engineers, we are professionals who hear this
phrase often and constantly strive to improve processes, streamline operations, demonstrate the
value-added impact of change, and ultimately increase our hospital’s quality of patient care. With
the pace of modern healthcare changing at a remarkable rate, healthcare institutions are allo-
cated fewer resources to provide more service with greater expectations for an increasing patient
population. is is the challenge for management engineers as the value of the internal healthcare
engineering consultant grows as hospital administrators face the challenges of modern healthcare
including resource allocation, productivity, operational performance, and clinical quality. is
chapter is written from the perspective of an internal management engineer whose department
serves a large academic and Trauma-1 health system. e author’s department is one of the oldest
in the nation, having been founded in 1968. ere have been many changes in department struc-
ture, leadership, and operation to support the challenges faced over the decades, but key elements
that provided positive results for clients and patients throughout the years remain constant; these
elements will be detailed in this chapter.
Contents
Department Structure ............................................................................................................... 34
Types of Services Oered ........................................................................................................... 34
IME Department Management Tools and Techniques ................................................................35
e Road Ahead ........................................................................................................................ 39
34 ◾ Rudolph (Rudy) Santacroce
Department Structure
Internal management engineering (IME) teams add signicant value to the organization(s) they
serve as they provide an ongoing cycle of strategic vision, operational and technical knowledge,
project management techniques, and follow-up project evaluation services. e IME profes-
sional knows the administration and key leaders and is able to align project initiatives with
the goals of the organization. As opposed to an external consulting group, the IME enjoys a
long-standing relationship with the organization. Since it is also outside of line operations, and
typically outside of line leadership, IME departments should been seen as a completely unbiased
resource. Typical IME departments are structured as a traditional team (pure industrial engi-
neering—IEs) or a hybrid team (IEs mixed with process improvement—PI experts and/or qual-
ity experts). e classication of each professional is based on their educational background;
IEs are trained through a nationally accredited ve-year engineering program, PI experts receive
training and certication as a green or black belt through various Lean or Six Sigma training
programs, and quality experts have a strong nursing/medical provider background. Each profes-
sional brings signicant value and a dierent perspective to the organization and the decision
to keep IME departments siloed or partnered with quality generally depends on the reporting
structure and the department’s focus. From the author’s experiences, IME departments report-
ing to the chief quality ocer (CQO) or vice president (VP) responsible for quality will be
imbedded within the quality department while IME departments with a strong operational or
nancial focus reporting to the chief operating ocer (COO) or chief nancial ocer (CFO)
will stand on its own. As an IME, it is important to recognize that any project dealing with
extensive medical processes or patient outcomes and metrics should be performed in close part-
nership with quality team members, since nancial, service, and quality outcomes are interde-
pendent. An example structure of a typical mid-sized traditional IME department is shown in
Figure5.1.
Note that this structure also details typical time-in-grade requirements and a recommended
sta advancement and replacement process.
Types of Services Offered
Management engineers bring many versatile tools in their tool kit that can be applied to solve
complex problems based on time and data available. Many of these tools stem from traditional
industrial engineering methodologies applied to the stochastic environment of healthcare, rather
than low-variability manufacturing processes from which the industrial engineering profession
originated. A list of these services typically includes, but is not limited to, the following:
◾ Process ow mapping (Lean and Six Sigma)
◾ Strategic and operational planning
◾ Functional facility planning and design
◾ Schedule modeling and development
◾ Computer simulation and queuing analysis
◾ Stang and productivity
◾ Developing management reports and databases
◾ Project management and implementation
◾ Financial and value-added analysis
A Case Study of a High Functioning Management Engineering Department ◾ 35
◾ Statistical and engineering analytics
◾ Benchmarking
IME departments are sometimes also asked to perform sentinel event root cause analysis,
although this is typically performed as part of a clinical team where the IME brings the systematic
investigation process along with data analytics as part of the desired skill set for the team.
IME Department Management Tools and Techniques
Management of an IME department’s project request list is a delicate balance between the project’s
reection of the organization’s strategic and operational priorities, nancial value-added impact,
and available project resources. It is critical for the IME to constantly engage hospital adminis-
trators and market their services as a means of accomplishing key initiatives or meeting annual
organizational goals, much as the leader of an external consulting practice might. Maintaining
ongoing advisory relationships with past customers is another key technique that enables the IME
to have a direct and ongoing pipeline for new projects from trusting customers. As projects and
initiatives arise within the organization, many departments nd it very helpful to post an online
project request form that lists important criteria and aids the IME manager in making the right
decisions regarding the timing of taking on new projects. An example Project Request Form is
shown in Figure5.2.
Once deemed appropriate and prioritized, the project must be assigned to a sta member
or team. In most cases, this project allocation can be attributed to three main factors: sta
Engineer development cycle:
• 3-5yr staff to senior
progression
• Performance based
All replacement
positions will be
staff engineers
Promote from
within - develops
organizational
leaders
IME Department Director
8+ years experience
1.0 FTE
Senior Engineer
5+ years experience
1.0 FTE
Staff Engineer
New grad 1+ years
experience
1.0 FTE
Student Engineer Intern
or Co-Op
0.5 FTE
Student Engineer Intern
or Co-Op
0.5 FTE
Student Engineer Intern
or Co-Op
0.5 FTE
Staff Engineer
New grad or 1+ years
experience
1.0 FTE
Senior Engineer
5+ years experience
1.0 FTE
VP/Director
Clinical Quality
Improvement
Figure 5.1 IME department structure model.
36 ◾ Rudolph (Rudy) Santacroce
Figure 5.2 Project Request Form.
A Case Study of a High Functioning Management Engineering Department ◾ 37
availability, sta specialization or interest, and the relationship the IME sta has with the
requesting customer. e graph in Figure5.3 displays the author’s average allocation of projects
to department sta over the past ve scal years.
In order to clearly dene project scope, resources, expectations, and timeframe, a Charter,
Project Primer, or Project Initiation Form is typically developed at the start of a project. After
the initial meeting with the client, the IME develops the Project Initiation Form and shares
the draft with the customer to gain consensus. e Project Initiation Form should accomplish
the following:
◾ Specify project goals and objectives
◾ List the project charter and problem statement
◾ Specify the project team and other resource requirements
◾ State initial expected project outcomes
◾ Detail project timeframe/phases
◾ Provide an initial look at value-added nancial impact
◾ Raise initial outstanding issues
It is important to consider the Project Initiation Form as a conduit to communicate the key
aspects of the project to stakeholders outside the project team. An example of a Project Initiation
Form used in a recent Lean initiative for the author’s organization is shown in Figure5.4.
From this author’s experience, as the project turnaround time requirement is reduced and the
number of project requests increase, a department project repository and tracking mechanism
becomes critical. A project database can be developed in Microsoft Access or similar software to
keep track of the project status and serve as a project library once the project is complete. Features
may be added that enable the IME to upload project les and key deliverables so sta and custom-
ers alike have a one-stop-resource for all projects completed in the IME’s department. Detailed in
a project database is information on current project status, project team composition, next steps,
project background information, project type, and nancial value-added information. Reporting
is extremely easy and may be used by IMEs to search for similar projects performed in the past and
a management tool for project status updates during sta meetings. Key reporting items include
the number of projects that each IME is currently working on, the duration of each project, the
next project step, any obstacles the IME may have encountered, and value-added nancial infor-
mation. An example of a project database input screen is shown in Figure5.5.
Available Time and
Existing Workload
Average Project Allocation
FY 2007 - 2012
Sub-specialty or Project
Interest
Relationship/Trust
Built with Customer
48%
22%
30%
Figure 5.3 Average project allocation chart.
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