3
Chapter 1
Management Engineering:
A Best Practices Guide
to Industrial Engineering
in Healthcare
Jean Ann Larson
Introduction
e use of industrial engineering (IE) in healthcare by Frank Gilbreth and others can be traced
back as early as 1908; yet opportunities for IEs in healthcare or management engineers have never
been greater. Cost and payment challenges have always been with us, but unique to our times is
the impending impact of signicant stang shortages just when the baby boomers will need more
care than ever. us, more than ever before, it is important to utilize resources, specically highly
paid, highly skilled sta, eciently and eectively.
Certainly there are also societal and political reasons that contribute to our healthcare cost
increases and those reasons are beyond the scope of this book. However, there are also many pro-
cess reasons. Improving operational eciency, helping make key decisions that impact healthcare
processes, and taking a systems view of an organization are the specialties and purview of the
industrial engineer, often called a management engineer (ME) or operations analyst in healthcare.
And despite the challenges mentioned earlier and those we read about in our daily newspapers and
journals, both as a young engineer starting out and now after twenty-ve years in the industry, I
Contents
Introduction ................................................................................................................................ 3
Why Do We Need is Book and Why Now? ............................................................................. 4
Overview of the Chapters ............................................................................................................ 4
4 ◾ Jean Ann Larson
cannot think of another industry that is as rewarding to engineers or as appreciative of the skill
sets we bring to the table.
Why Do We Need This Book and Why Now?
e industrial engineer or management engineer has always possessed a wealth of tools and
approaches that can be employed in addressing the challenges of the healthcare industry. In recent
years, Lean and Six Sigma methodologies have been embraced within the healthcare industry.
ese attractively packaged and promoted methods include only some of the tools and approaches
that have historically been used by IEs to improve healthcare processes, better utilize resources,
and help improve operational eciencies. (Some engineers would argue that we have always prac-
ticed these methods, we just weren’t good enough marketers to sell the ideas as well as has been
done by others.) us, the intent of this book is both to provide an overview of the practice of
industrial engineering or management engineering in the healthcare industry and oer guides to
some of its techniques. It is specically focused on helping practitioners explore and get a good
understanding of the dierent roles an IE might take on, as well as the tools and how they might
be applied in the healthcare industry. Also, it is our intent that industrial engineering students,
as well as those already practicing industrial engineers considering a move into healthcare, would
nd the book to be of benet.
e book may also be used as a reference to explore individual topics, as each of the chap-
ters stands on its own. However, to get a good overview of how organizations can best benet
from the eorts of industrial engineers, it is recommended that readers at least scan all the
chapters. Please note that many of the authors use the terms management engineer and indus-
trial engineer interchangeably since management engineer is the term often used for industrial
engineers in healthcare.
ough the reader may not recognize many of the authors by name, they are all longtime
practitioners. Not only have they witnessed the evolution of this eld up close and in person,
many of them were trained by those who impacted its course and in turn have been inuential
themselves. My approach to inviting contributors to this book was to reach out to subject matter
experts to whom I would want to go to learn more about the topic. eir generosity in sharing
their knowledge and experience was inspirational. us, you the reader will be invited to share a
unique viewpoint and a candid assessment of each topic.
Overview of the Chapters
Section I includes this introductory chapter to give the reader an over of the book. Section II of the
book includes six chapters that talk about how management engineers function. e rst chapter
in this section (Chapter 2), by Steve Escamilla, talks about how management engineering is not
just about application of IE tools. As internal consultants, management engineers serve as change
agents and facilitators of change. And as healthcare’s challenges grow, this trait becomes even
more important every day. Chapter 3 further elaborates on the role of the engineer as a change
management specialist and is written by one of today’s most experienced experts on this topic,
Dutch Holland. His practical how-to steps on what to do and what not to do to be an eective
inuencer of organization change oers wisdom that can be valuable regardless of the number of
years we have been in the industry.
Management Engineering ◾ 5
e next three chapters are very valuable for those individuals charged with setting up a new
management engineering (ME) department, or for someone that uses IE tools in their organiza-
tion. Chapter 4 is an overview of the management engineering function written by two Mayo
Clinic management systems analysts, Tarun Mohan Lal and omas Roh. It talks about the
history of management engineering departments and how they provide value to organizations.
Chapter 5, written by Rudolph Santacroce, is a case study that describes the highly eective ME
department at the University of Florida and Shands Health System. is chapter provides sample
forms, organization charts, and tips on how to interact with customers and how to manage the
management engineering function. Chapter 6 talks about how ME departments impact budgets,
costs, and operational performance throughout health systems. Section II concludes with a primer
on how to start your own external ME consulting business written by longtime successful health-
care IE consultant, John L., Templin. He provides dos and don’ts, as well as a checklist of things
you may want to consider if you are thinking of going out on your own.
Section III chapters discuss what management engineers do. Chapter 8, by Amanda Mewborn
and Jean Ann Larson, serves a transition chapter between Sections II and III and discusses how
MEs instigate change and engage teams on all projects and engagements. It bridges the roles of the
ME as change agent, facilitator, and project manager. In Chapter 9, Bennetta R. Raby discusses
how to employ project and program management skills to get everyone on board and to help you
achieve your projects’ goals and objectives. Given that much of our work as engineers is project
based and our work is done through other people through our ability to inuence versus formal
authority, being a strong project manager is essential.
As mentioned earlier, the shortage of nurses, technicians, and other caregivers is a perennial
problem. In Chapter 10, David Z. Cowan and Joyce T. Siegele discuss how engineers help organi-
zations manage sta productivity through labor analysis and stang studies. To provide further
information on this key area of what IEs in healthcare do, Chapter 11 by Kelly Arnold discusses
the issues and challenges unique to scheduling and stang in healthcare. In addition to healthcare
being a 7/24, 365-day-per-year operation, patient conditions vary widely, individually, and over
time. Also, technology and scientic advances in medicine impact stang in ways that are often
dicult to predict. In Chapter 12, “Understanding Nursing Care Models,” Marvina Williams, a
trained and practicing nurse who works closely with IEs, brings her nonengineering view of the
impact of nursing care models on scheduling and stang and how they may aect nursing pro-
ductivity and labor costs.
Chapter 13 on facilitation changes gears as Duke Rohe describes and discusses best practices
in facilitating teams, whether for process improvement, process redesign, or innovation. A critical
skill, regardless of the methods or problems being solved, is that of the objective and observant
facilitator. It is from this role that the wisdom of the team can emerge and organizational learn-
ing can occur. Chapter 14, by Alexander Bohn and Sue Ann Te, discusses the how-to of pro-
cess redesign and oers a case study to illustrate how it is used. Lawrence (Larry) Dux (Chapter
15) discusses Total Quality Management and the Malcolm Baldrige Award in healthcare in the
next chapter. Chapters 16 and 17 by Cristina Daccarett and Karl Kraebber discuss manufactur-
ing industry concepts that became very hot topics in healthcare management engineering—Six
Sigma and Lean. Both of these generated a lot of interest in healthcare, and there are countless
books and conferences that cover these topics. Many organizations have used one or both of these
approaches to entice their stas to push forward process improvements and organizational and
cultural change.
Chapter 18, by Roger Grunieson, discusses the bread and butter of any industrial engineer’s
work—operations analysis, or the ability to observe, document, and then use tools or teams to
6 ◾ Jean Ann Larson
improve the current state. Chapter 19, by Deborah D. Flint and Phil Troy, describes approaches
to analyzing and presenting data and ways that good data, well displayed, can be used to evalu-
ate operations, processes, and make decisions. In Chapter 20, John Hansmann discusses how
benchmarking can be used to help challenge sta and help them glean ideas for improving their
functions. e last chapter in Section III, written by Amanda Mewborn and Richard Herring,
discusses how industrial engineering tools can be applied to facility design, making sure that new
facilities are built to include streamlined processes versus being built around less than ideal pro-
cesses. At a time when organizations are becoming strapped for capital, it is even more desirable
to improve and streamline a process versus building a bigger facility to accommodate inecient
processes and larger waiting areas.
Section IV is the decision-support section. And though much of our work as IEs in healthcare
falls into this realm, for example, data analysis and presentation, this section gives an overview of
direct activities in which IEs in healthcare may be involved, or even serve as project leads in some
cases. Chapter 22, “Assessing the ROI and Benets of New Technology” by Dean Athanassiades,
discusses how in addition to helping to select new technology, we are often called upon to identify
and document return on investment (ROI), whether for new information technology or clinical
technology. IEs are well suited to understanding the impact of technology upon processes and
other systems. Chapter 23 by Mary Ellen Skeens discusses how IEs can help organizations review
information and technology system solutions, evaluate them, and then assist the organization with
selection. In Chapter 24, Adrienne Dickerson shows us how an IE’s facilitation, problem-solving,
and analytical skills can help leaders develop a request for information (RFI) for consulting and
other professional services to ensure that the engagement is a good investment and meets the needs
of the organization.
Section V covers several fundamental tools that are used across the board within many meth-
odologies and in a variety of projects. Flowcharting, the topic of Chapter 25 by Ryan Wood,
discusses how this venerable tool is often the rst step in analyzing a process in order to improve
it. She provides examples of dierent types of owcharts and how they are used. “Value Stream
Mapping,” Chapter 26 by Bart Sellers, gives examples of a very specic way of describing and
analyzing a process. In Chapter 27, Roque Perez-Velez discusses the use of statistical analysis in
healthcare industrial engineering projects and some of the unique challenges faced by the health-
care IE.
In Chapter 28, Cristina Daccarett discusses human factors as applied to healthcare. And
though it may seem a very specialized topic, it is included in the fundamentals section in order to
highlight one of the major benets that IEs can bring to healthcare. ey help bring the perspec-
tive of people, processes, and technology to bear in projects and improvement eorts. eir train-
ing and experience makes them uniquely qualied to assess the impact of the work environment
and technology on the humans within the system. Similarly, Chapter 29 by Bridget O’Hare deals
with root cause analysis. ough often considered a very specialized topic that helps ensure patient
safety, getting to the root of the issue is important in all projects. As Bridget’s chapter illustrates,
IEs have the tools and skill set to use a systematic approach to determine root causes. “roughput
and Cycle Time Reduction” by Alyn Ford and Ben Sawyer (Chapter 30) explores how this key
analytical tool used can be used for healthcare improvement eorts as resources become more
expensive and as providing healthcare quickly and eciently is a key to improving healthcare
quality. Finally, given that changes that produce unintended consequences can be particularly
expensive in the healthcare setting, simulation, discussed in Chapter 31 by Tarun Mohan Lal
and omas Roh, is a key modeling tool that is used for both analysis and facility design. As a
modeling method demonstrating how a proposed process solution will work, or not, it provides a
Management Engineering ◾ 7
picture of the dierent versions of a process so that the entire healthcare team can visualize it and
understand it.
is book has a heavy emphasis on the use of IE tools in healthcare organizations such as
hospitals, clinics, and medical oces. However, Chapter 32 by Michael Washington discusses
opportunities for the use of IE tools in the public health sector, allowing IEs to have inuence on a
much broader international scale. is chapter should be of great interest to both new and veteran
MEs given that this will be an area requiring more and more analysts and engineers in the future.
In Section VI, Chapter 33, my colleague Duke Rohe and I discuss the issue of leaving a profes-
sional legacy. Regardless of where or how an IE practices within healthcare, the rewards are great.
However, as was often quoted to me by my father, the more you put into something, the more
benets you will reap. Both of us having been in this eld for several decades can certainly attest
to this.
Hopefully, those of you considering an IE career in healthcare will nd that this book gives you
the impetus and encouragement to make you pursue this career in earnest. For those of you already
in the eld, we hope that you will gain insight or be reminded of the other ways you may bring your
skills to help your organizations and clients. Also, for those healthcare leaders looking for long-term
solutions to our healthcare challenges, it is my hope that having read this, you’ll consider hiring IEs
on your team to help you create a better future for your patients and your community.
e bad news is that this book is not a quick x. e good news is that if these IE tools and
methods are applied to healthcare, the improvements can be both exible and remain sustained
over time. It is wise to remember that our healthcare challenges did not appear overnight, so we
are not going to be able to nd quick and easy solutions. ough healthcare is a very complex, and
currently highly regulated industry, we are going to have to use tried-and-true methods in new
ways and give them time to produce their inevitable benets. As both consumers of healthcare and
members of society, we all will be the beneciaries of these improvements.
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