Reducing Health Care Costs, Improving Care

Would doctors’ offices and hospitals work better if they functioned like the airline industry?

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By Marlene Cimons, National Science Foundation

Airlines protect themselves from passenger “no-shows” by overbooking. Could the same approach—overbooking patients—work in a doctor’s office or hospital?

This is, in fact, an example of the kinds of questions under study by the Center for Health Organization Transformation, a multi-university National Science Foundation center involving Northeastern University, Texas A & M Health Science Center and Georgia Institute of Technology, in partnership with a growing number of prominent health care systems and hospitals across the nation.

As one of several projects, the consortium is looking at whether “systems engineering’’ approaches, that is, methods used by other industries, can help reduce the nation’s health care costs while improving patient care.

“Health care is the biggest sector of our economy and is riddled with problems,’’ said James Benneyan, professor of industrial engineering and operations research in Northeastern’s College of Engineering. “We are trying to do in health care what others have done in aviation, manufacturing other industries. The challenge, however, is that it’s a different industry with different issues and nuances.

“So, while similar concepts may apply, they need to be modified, researched and adapted,’’ he added. “For example, unlike manufacturing widgets, all patients are different and often defects in the process, such as harm to a patient, cannot be reworked, and overbooked patients can’t be offered a free flight.’’

The center, in part, is being funded with a $290,000 National Science Foundation grant as part of the American Recovery and Reinvestment Act of 2009.

Health care is a $2.3 trillion industry in the United States, “and dozens of peer reviewed studies estimate that at least one-third of it is waste,’’ Benneyan said. “Lost records, waits, delays, inefficiency, poorly designed processes, about $780 billion a year.’’

Moreover, an estimated 98,000 hospitalized patients die every year from adverse events. “We give them the wrong drug or the wrong dose,’’ he said. “We spread an infection into their room or perform wrong-side surgery.’’

In recent years, the growing use of a “checklist’’ in hospital facilities, modeled after those routinely used by airline pilots before takeoff, has resulted in a significant reduction in patient harm. The British Medical Journal, for example, recently reported that patient deaths in three London hospitals dropped by 15 percent after introducing the practice.

“That’s one very good example of applying reliability concepts from aviation and manufacturing to health care,’’ Benneyan said. “A checklist forces you to do everything that is supposed to get done, and it’s important because a failure could be catastrophic. That’s exactly the approach the patient safety movement now is taking.’’

Systems engineers use a variety of mathematical, statistical and computer processes to analyze and improve the performance of complex systems, an approach that cuts billions in costs annually within other industries.

“Another common problem in much of the health care industry is scheduling: who works and when?’’ Benneyan said. “How do we schedule operating room suites? This is one of the most expensive parts of a hospital. If you have a lot of idle time, it’s very expensive. How do we schedule so that things are very efficient, so there aren’t a lot of waits, delays, underutilization and wasted resources?’’

The center is using mathematical algorithms and other models to simulate patient flow, in order to replicate real life situations, and experiment with different ways of doing things, including “strategic’’ overbooking. “Like with an airline, patients don’t always show up,’’ he said. “That’s a waste of the doctors’ and nurses’ time. No-shows back up the queue, and it’s very costly. So some amount of ‘optimal’ overbooking might be part of a solution.’’

For example, the Harvard Vanguard Medical Associates obstetrics and gynecology clinic in Quincy, Mass., is trying Northeastern’s approach on a trial basis. Last year, its no-show rate topped 18 percent, and the clinic lost an estimated $446,000 in wasted clinical time and appointment delays. “When you ask health care professionals what is causing them misery, almost every one of them will talk about no-shows,’’ Benneyan said.