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Research Improving Healthcare: One Patient at a Time What do a waiting room of patients at a busy Indianapolis healthcare clinic and an assembly line of cars at an automobile manufacturing plant have in common? Both can lead to a host of workflow problems if they aren't handled correctly. That's the assumption of new research by Her- bert Moskowitz and Shuresh Chand at the Krannert School of Manage- ment at Purdue University in West Lafayette, Indiana. They conducted their research through the Regen- streif Center for Healthcare Engi- neering at Purdue. Both professors have specialties in manufacturing management, but they became interested in applying their expertise to the healthcare field after hearing Paul O'Neill, former Secretary of the Treasury, speak at the University of Minnesota. As the CEO of the Pittsburgh Regional Healthcare Initiative, O'Neill empha- sized the problems with the current healthcare system. "He said that there was a need for people with skills in operations to help make healthcare systems more efficient and effective," says Mos- kowitz. "That was a great motivation for me." When the Indiana Univer- sity Medical Group (IUMG) approached Moskowitz for help in improving patient flow at the most problematic of its 18 outpatient clinics, he and Chand had the per- fect opportunity to apply manu- facturing management principles to healthcare. Their work with IUMG is outlined in the paper "Improving Patient Flow at an Indiana University Medical Group Outpatient Clinic: An Application 52 BizEd MAY/JUNE 2006 Krannert School of Management professors Shuresh Chand (left) and Herbert Moskowitz with their computer simulation designed to streamline operations at an Indianapolis health clinic. of Factory Physics and Six Sigma Principles." Moskowitz and Chand pinpoint- ed several problems with the clinic's operations. First, patient wait times at the clinic were long and unreli- able. Second, inefficient patient processing caused backlogs. Because each medical assistant was assigned to a particular doctor and processed only that doctor's patients, one assis- tant might be overwhelmed with patients while another might have none at all. Third, patient arrivals were erratic and unreliable. Even though the clinic made appoint- ments six to eight weeks in advance, it experienced a patient no-show rate of a staggering 40 percent. As a result, doctors often ran late in seeing their patients; or, if a patient failed to show up, they had times when they weren't seeing anyone. "With that kind of no-show rate, doctors are often underuti- lized," says Chand. "Long waiting times and uncertainty about when patients will see a doctor only make no-shows worse." The researchers decided to apply two tools readily available to manu- facturing but rarely used in health- care: factory physics, which targets the behavior of a manufacturing envi- ronment, and Six Sigma, the quality improvement methodology used at companies like Motorola and GE. "Right now, most healthcare opera- tions simply don't have a systematic way of scheduling and processing patients," says Moskowitz. After observing clinic opera- tions, the two researchers created an animated simulation using Extend,