The Future of Health Care Management Engineering: Improving Your Organization's Processes,

Outcomes and Technology Benefits Realization

April 13, 2015

Panelists: Tracey Butler, Larry Dux, Cynthia Hartman, John Hansmann

Moderator: Jean Ann Larson

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest Jean Ann Larson, BSIE, MBA, EdD Tracey Butler, BSIE, MBA Larry Dux, BSIE, MBA John Hansmann, BSIE, MSIE Cynthia Hartmann, MBA, CPHIMS Have no real or apparent conflicts of interest to report.

© HIMSS 2015

Learning Objectives This panel discussion is an interactive overview of what top management engineering thought leaders see for the future of Management Engineering in health care. Learning objectives are: 1. Identify current and future health care challenges that Management

Engineers can immediately address 2. Summarize the top tools and approaches that you and your ME-PI

team can use to improve your organization’s processes and outcomes

3. Evaluate how integrating ME-PI with change management techniques can ME-PI solutions more impactful and longer lasting.

Benefits Realized This presentation provides ideas and approaches to help you enhance your organization’s operational efficiency resulting in reduced costs, higher quality, improved associate engagement and increased customer satisfaction

Introduction of the Panelists

Tracey Butler – Baylor Scott and White Larry Dux – Froedtert Health John Hansmann – Tenet Healthcare Corp Cynthia Hartmann – Wake Forest Baptist Medical Center

Show of Hands

What is your primary role at your organization? 1. PI Professional 2. IT professional 3. Clinical informaticist 4. CIO or Senior Executive

Role and Value of Management Engineering to Health Care The use of systems engineering and organizational behavior approaches to solve complex problems

Systems Engineering

Organizational Behavior

Man

agem

ent E

ngin

eerin

g

Management Engineering

Management engineering utilizes industrial engineering knowledge and skills to provide internal consulting services to health care organizations in order to develop, implement, and monitor more efficient, cost-effective clinical and business processes and strategies

A Recent Presidential Advisory panel of experts note:

• The health-care system is challenged by rising costs, now one-fifth of the United States’ gross domestic product (GDP).

• A significant portion of those costs do not produce better health or quality of care.

• The report provided a comprehensive set of recommendations to address these cost and quality challenges, including through an interdisciplinary approach known as systems engineering.

• Management engineering tools have been widely used in other industries, such as manufacturing and aviation, to improve efficiency, reliability, productivity, quality, and safety of systems.

The United States would benefit from more widespread adoption

of systems engineering (management engineering approaches) in health care.

Panelist Discussion Questions 1. Do you concur with what the experts have noted? At your

organization, what do you believe are some of the biggest current problems in health care that Management Engineer’s and PI Professionals can address?

2. Can you provide examples of how are you addressing those challenges?

3. What future challenges do you see on the horizon that ME-PI professionals could address?

4. What are your top approaches and/or methods that you use in your organization to begin addressing these challenges?

5. How do you integrate change into your ME-PI initiatives to ensure that your recommendations and new approaches are sustainable?

Lean at Baylor Scott and White

https://vimeo.com/user26739935/review/99834074/dc484a9c01

Cost, Quality and Safety Challenges • Electronic Health Records Implementation

• Extensive Engagement of Providers in System Selection, Design/Build, Validation/Testing, and Training

• Current and Future State Workflow and Process Reviews

• Incorporate Evidence Based Best Practices and Relevant Alerts

Cost, Quality and Safety Challenges

• Provider Order Entry (CPOE) • Relevant Drug-Drug/Drug- Allergy Alerts • Fall Risk Assessments • Nutritional Assessments

• Laboratory Testing • High Cost Tests (>$1000) • Duplicate Test Orders • Daily Orders – Stop Dates

Cost, Quality and Safety Challenges

• Change Management is Critical • Individual Change is Incremental and

Iterative - Peer Support and Assistance is Essential

• Organizational Change – Requires Senior Leader Support and Visibility

• Establish Relationships to Build Trust and Credibility

Future Challenges for Health Care

• Volumes continuing to decrease • Preparing for a resurgence of in-home care • Transparency in pricing – so consumers can know in advance their

out of pocket costs

Future Workforce Resources

US Population > 65 Years Old “Baby Boomer Effect”

35 40.2

54.8

72.1 81.2

88.5

0102030405060708090

100

2000 2010 2020 2030 2040 2050

Popu

latio

n (in

mill

ions

)

+14.6M

+17.3M

Source: U.S. Census Bureau, http://www.census.gov/prod/2011pubs/12statab/pop.pdf

US Aging Workforce 2000-2020 Percent of Workforce by Age Groups

15.8

71.1

13.1 13.6

66.9

19.5

11.2

63.7

25.2

0

10

20

30

40

50

60

70

80

16 to 24 Yrs 25 to 54 Yrs 55 Yrs and Older

Perc

ent o

f Wor

kfor

ce

Age Group

2000

2010

2020

Source: US Department of Labor, Bureau of Labor Statistics, Occupational Employment Projections, http://www.bls.gov/emp/ep_table_304.htm

Source: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition

ProfessionJob Growth

Outlook

Employment Change -

GROWTH (in 1000's)

Employment Change -

REPLACEMENT (in 1000's)

Openings Due to Growth & Replacement

(in 1000's)RNs 19.4% 526.8 525.8 1,052.6Rad Techs 20.8% 41.5 28.1 69.6RT 19.1% 22.7 17.4 40.1PT 36.0% 73.5 50.2 123.7RPh 14.5% 41.4 68.4 109.8MD's & Surgeons 18.7% 65.3 87.3 152.6Nurse Aides/Orderlies 21.1% 312.1 281.5 593.6Nursing Instructors 35.4% 24.0 10.2 34.2Elementry School Teacher 12.3% 167.9 299.5 467.4Retail Salesperson 9.8% 434.7 1,521.0 1,955.7Computer System Analyst 24.5% 127.8 81.8 209.6Industrial Engineer 4.5% 10.1 65.3 75.4National Average 10.8% - - -

Bureau of Labor Statistics Job Outlook 2012-2022

Bureau of Labor Statistics Job Outlook 2012-2022: RNs

• Growth - the need for nurses is expected to grow from 2.71 million in 2012 to 3.24 million in 2022, an increase of 526,800 or 19.4%.

• Replacement - an additional 525,800 replacement RNs are needed, bringing the total number of RN needs due to growth and replacements to 1.05 million by 2022.1

• Expected shortage of 260,000 nurses by 2025.2

1 Source: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2014-15 Edition 2 Source: Buerhaus PI, Auerbach DI, Staiger DO. The Recent Surge In Nurse Employment: Causes and Implications. Health Affairs, 2009; 28(4):w657-68. The published article is archived and available online at www.healthaffairs.org.

Questions to Answer

What will your staffing models need to look like in 5, 10,

15 years?

What percent of your workforce will be

retiring per year over the next 10 years?

What are your recruitment and

retention strategies?

• How will you identify and

develop future staffing models?

• What skill mix do you need?

• How many staff by skill set will you need?

• How will you estimate the number of staff needed?

• Where will you get the potential employees?

• How will you retain existing employees?

Future Staffing

Requirements & Strategies

Human Resources

Operations (Nursing, et.

al.)

Schools & Professional

Organizations

ME/PI

Others

Strategic Planning

Partnership to Resolve Future Staffing Crisis

Key Take Aways

•Right at the time the industry needs more people to take care of the new influx of patients, work force shortages will occur.

• Inherent in this reality is the need to change staffing models, redesign the work, and develop new staffing plans [that optimize labor resources and the cost of care.]

Revenue Cycle Remediation

• How do we improve the way the revenue cycle functions?

• What are key areas that management engineers can assist with?

• How are the results seen?

How can we improve revenue cycle? • By what we do best – look at process

– What tools are being used – Are there duplicative tools

• Evaluate training – How many workarounds are in place – Is there continual training to reinforce best practice

• eLearning • Tip sheets • Pod casts • Rounding

• Ensure that teams have a good understanding of how work comes to them, and what happens to it in the next step

– Train on what the revenue cycle really is

Areas that ME can assist with • Focusing on workflow and work queue

redesign – Are staff finding ways around the

system? – Are they operating as they always

have? – Were workflows optimized when

implementing a new system • Can achieve quick wins

– Where are denials coming from? – Do all work queues have owners

and are they being reviewed regularly?

– Provide understanding to employees of impact of what they do

How are results seen?

• Use of best practice • Increased knowledge of

business – Understanding of key

areas, such as Medicaid issues

• Ownership and accountability for work that is done by each individual

– No “passing the buck”

Tracey Butler, FHIMSS, MBA Tracey Butler has 24 years of experience in Healthcare Process

Improvement. Currently she serves as the System Director of

Operations and Integration Support at Baylor Scott and White

Health, Dallas, Texas. She has been with Baylor since 1990 holding

several positions leading internal consulting services in labor

management, cost containment, mathematical simulation, lean

implementations and merger integration to Baylor's nineteen acute

care and specialty hospitals, ranging in size from less than 50 to

over 1,000 licensed beds located throughout North and Central

Texas.

Tracey holds a Bachelors degree in Industrial Engineering from

Texas A&M University and a Masters of Business Administration

from University of Texas at Dallas. She is a past Board member for

Health Care Information Management System Society.

Tracey Butler Baylor Scott and White Health 4005 Crutcher Street, Suite 220 Dallas, Texas 75246 Phone: 214 820 4871 Tracey@BHCS.com BaylorScottandWhite.com

Larry Dux, CPHIMS, FHIMSS, DSHS

Larry Dux is the Director of Patient Care Informatics

& Process Improvement at Froedtert & the Medical

College of Wisconsin Community Hospital Division

He holds a Bachelor of Science Degree in Industrial

Engineering and a Masters in Business

Administration from the University of Wisconsin-

Madison. He is a Senior Member of the Institute of

Industrial Engineers and a Diplomate of the Society

for Health Systems, a Senior Member of the

American Society for Quality, and a Fellow/CPHIMS

member of the Healthcare Information and

Management Systems Society.

Lawrence (Larry) E. Dux

Froedtert & the Medical College of Wisconsin Community Hospital Division

W180 N8085 Town Hall Road

Menomonee Falls, WI 53051

Phone 262-257-3808 Email: larry.dux@froedtert.com www.linkedin.com/in/larrydux/

With more than thirty years in Healthcare Information Technology, Cindy has worked with several software vendors to manage support, services and development for laboratory, radiology, document management and EMR systems. In addition, she has consulted with healthcare organizations on the implementation and optimization of their EMR systems. Currently, she is with Wake Forest University Baptist Medical Center as the Director of Access and Revenue Systems Management in Information Technology Services.

Cynthia Hartmann, MBA, CPHIMS, Six Sigma Lean Black Belt

Office – 336.716.6652 | Mobile – 601.715.4961 | chartman@wakehealth.edu www.wakehealth.edu

John Hansmann, FHIMSS, DSHS

John Hansmann, MSIE, FHIMSS, DSHS is the Senior Director of Labor Management & Productivity for Tenet Healthcare Corporation, a 77 hospital investor-owned health care system based in Dallas, TX. He has over 29 years of healthcare experience in operations, productivity management, strategic and IT analyses. He has expertise in the development of standardized nursing care models and staffing practices, optimizing patient throughput, and leading workflow analysis.

Mr. Hansmann is a Fellow of the Healthcare Information and Management Systems Society (HIMSS), a senior member of the Institute of Industrial Engineers (IIE) and Diplomate within the Society for Health Systems (SHS.) He is a past Board member for HIMSS and past President for SHS. Mr. Hansmann currently serves on the Advisory Board for the school of Industrial and Manufacturing Engineering (IME) at North Dakota State University (NDSU.) He received his BSIE and MSIE from NDSU.

John Hansmann Sr. Director Labor Management and Productivity Performance Management & Innovation Tenet Healthcare Corporation 1445 Ross Avenue, Suite 1400 Dallas, Texas 75202 Office: 469-893-2287 Cell: 214-364-7745 Email: john.hansmann@tenethealth.com

Dr. Jean Ann Larson, FHIMSS, FACHE, DSHS Jean Ann has over 25 years of experience as a healthcare executive.

She has led organizational, professional and business transformations serving as an internal process engineer and consultant, a change agent, Vice President of Clinical Quality and Safety and Chief Learning Officer founding an award winning and respected Corporate university. She also served as a Senior Executive of two large healthcare organizations where she has led the functions of organizational effectiveness, process improvement, executive development, talent management, team building, employee engagement, accreditation, care management, quality and patient safety, as well as several clinical areas.

She currently heads up her own consulting firm where she partners with health care organizations, executive teams, business owners, leaders and individuals to help them become more productive while bringing results-oriented strategic change into their organizations. She has a BS in Industrial Engineering, an MBA and a doctorate in organization change from Pepperdine University. She is a Fellow with the American College of Healthcare Executives and a senior member of the Institute of Industrial Engineers. She is a Past-President and Diplomate of the Society for Health Systems of the Institute for Industrial Engineering and a past Vice-Chair of HIMSS. She is editor of Management Engineering: A Guide to Best Practices for Industrial Engineers in Health Care and her most recent book out this summer is Organizational and Process Reengineering: Approaches for Health Care Transformation.

Cultural Transformation Through Strategic Process Change

jeanann@jalarson.net

800-823-4330

www.jalarson.net Twitter: @jeanannlarson

www.linkedin.com/in/jeanannlarson/

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