Budget, Cost, and Performance Improvement Approaches ◾ 51
where
ΣR = sum of R values
n = number of items measured
UCL = D
4
R (6.3b)
LCL = D
3
R
e values for D
3
and D
4
are obtained from most quality control or operations manuals based
on the number of samples.
Cause-Effect Diagram
e cause–eect (“shbone” or Ishikawa) diagram is a basic tool used to evaluate problems inher-
ent in almost any process and is best used as part of a process improvement team comprised of sta
or users with expertise in the particular problem area being addressed. e cause–eect diagram
consists of dening an occurrence (eect) and reducing it to its contributing factors (causes). e
relationships among these factors are illustrated in a shbone pattern stemming from the eect.
e principle factors are broken into four categories: sta, equipment, methods, and materials.
ese primary four categories are then reduced to subcauses until all are listed and then are criti-
cally analyzed (see Figure6.2).
Facility Planning and Design
Table6.7 outlines cost improvement outcomes for facility planning and design. Modern health-
care brings new challenges to the professions of architecture and engineering. Clients themselves
supplies
unavailable
equipment not
always
available
post-surgery
equipment
is expensive
nurse shortages
for after-care
surgeon
availability
shortage
of beds
little scope for
simultaneous
work
‘bed blocking’
by elderly
patients
lack of
coordination and
information
other unforeseen A & E’s
lead to cancellation
of surgery
Problem: Lengthy
waiting times
for surgery
Materials
MachineryMaintenance Manpower
Methods
Mother Nature/
Environment
increased life expectancy led to
increase in numbers waiting
staff don’t know
schedule
budget cuts
budget cuts
not enough
trained
advances in technology mean it’s now
possible to do operations that weren’t done 5/10 years ago
Figure 6.2 Sample Ishikawa diagram.
52 ◾ Rudolph (Rudy) Santacroce
are changing and instead of being one entity, they are often comprised of complex organizations or
committees involving a building’s nancier, developer, owner, and users. ese clients have higher
expectations for architectural services in terms of breadth and quality.
Traditionally, industrial engineers possess skills and analytical tools for determining site selec-
tion, space requirements, ow and activity analysis, and space–function relationship program-
ming. ese skills form the cornerstone of a function known as systematic layout planning (SLP).
By using the SLP process in conjunction with the architectural design process, the engineer brings
overall value by assisting in operations planning, concept design, and layout evaluation. is ulti-
mately leads to a better design by reducing the amount of design rework, enhancing the design
team’s understanding of processes that will operate within the new facility, and evaluating the
initial design from a functional standpoint. e components of SLP are:
◾ Relationship diagram: e relationship diagram or REL chart lists the major departments
the building will have in a table form on a horizontal and vertical axis. Each area is then
compared to the other by moving along an axis to the juncture of another area. At the junc-
ture of two departments, a value of 1–4 along with a reason code is recorded. A value of
“1” species a critical relationship between the two areas while a value of “4” represents an
undesirable relationship.
◾ Space relationship diagram: e space relationship diagram takes the REL diagram
one step further by quantifying the square foot requirements for each department. e
relationships between the departments are represented by the number of lines connecting
them. Four lines is a critical relationship while no lines or a dotted line represents an unde-
sirable relationship.
◾ Block Plan: Final step in the SLP process. e block plan positions all the departments
together considering the adjacency requirements determined by the space relationship dia-
gram. is gives a good indication of the facility’s oor plan. e block plan only considers
the building’s gross area, that is, hallways and doors are not represented. If the architectural
oor plan is developed from the block plan, the facility will be “optimized” with regard to
the locations of key departments and functions.
◾ Other Services: In addition to the SLP process, MEs add value to the design process through
planning and coordinating with clients throughout the design phases. By representing the
client, MEs act as the liaison between the client and the architect, ensuring the needs of the
client are met. MEs may also assist the architect prior to the design process by developing a
Table6.7 Cost Improvement Outcomes for Facility Planning and Design
Improved efciency by:
Increased employee motivation, moral, and
training
Reduced workload due to:
Work simplication: eliminate, combine,
sequence, simplify
Process improvement
Improved workstation/workplace layout
Evaluated materials and supplies for reduction
through:
Reduce obsolescence, breakage, and
pilferage of items
Reduced contract/consultant costs by:
Negotiations
Used in-house consultants vs. outside
contracted services
Used existing resources to perform more
procedures
Budget, Cost, and Performance Improvement Approaches ◾ 53
functional space program and conducting room utilization studies. is may help in reduc-
ing the number of rooms planned in a new facility and therefore a reduction in the required
square footage of a new building.
Conclusion
e goal of providing tangible, value-added recommendations to our respective healthcare organi-
zations is an ongoing challenge for management engineers. In our business, we are often asked to
help maximize resources and optimize outcomes as the cost of healthcare delivery increases along
with the sheer number of patients we serve; much of the “low-hanging fruit” has already been
picked by our predecessors and our goals are becoming increasingly hard to attain. It is the author’s
hope that this chapter serves management engineers at all levels of leadership as a cross-reference
repository for aligning the common tools of the IE/ME trade with value-added project outcomes.
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