Opportunities, Challenges, and Locus of Control in Undergraduate Research in Healthcare Settings

A profound shift in the healthcare industry has been sparked in part by legislation and initiatives at the federal level. Among the results of this shift are an emphasis on process improvement and systems thinking, a viewpoint that often conflicts with the traditionally individualistic and compartmentalized culture that has dominated healthcare delivery. As Industrial Engineering faculty members, the authors believe this culture change presents great opportunities and great challenges for undergraduate engineering students. For the past 20 years, we have been involved in a variety of applied research projects involving Industrial Engineering undergraduates and healthcare facilities, primarily hospitals and affiliated clinics. This paper will examine the experiences and observations of the authors as we have watched the healthcare industry evolve over the past 20 years. We will discuss Industrial Engineering methodologies that our students have used to positively influence healthcare outcomes. We will also focus on some of the more concrete challenges involved in facilitating undergraduate research experiences in healthcare settings. These include, among others, changing Human Resource requirements, access to data, and personnel issues such as finding the right sponsor for a project and insuring the students have both administrative and clinical/operational staff support. Introduction and Background Recent initiatives such as the creation of the Joint Commission Center for Transforming Healthcare (2008), legislation establishing a link between Hospital Acquired Conditions and reduction in Medicare payments (2008-2010), and the implementation of the Patient Protection and Affordable Care Act (2010), are causing healthcare facilities to sharpen their focus on efforts to improve the quality of healthcare delivery. The Joint Commission’s adoption of Robust Process Improvement or RPI® (“a systematic, data-driven methodology that incorporates Lean Six Sigma and formal change management” as defined by the Joint Commission) as its primary performance improvement methodology has influenced many hospitals to offer training sessions in the basic principles of Lean Six Sigma, which has its roots in Industrial Engineering. As a result, administrators and key clinical personnel are exposed to the philosophy and key concepts, but not necessarily to the systems thinking that underlies the approach. Industrial Engineers can bring to the table concepts and methods to support and improve efficiency, standardization, human centered design, and systems thinking. However, the dominant culture in healthcare, which tends to be compartmentalized and individualistic, often conflicts with the systems thinking that can facilitate improvement. The new approach to improving the quality of healthcare is gaining momentum and Industrial Engineers have an opportunity to be a guiding force in that change. Public awareness of the need for improvement in the quality, safety and efficiency of healthcare delivery in the United States was strongly influenced by the publication of two reports from The Institute of Medicine (IOM) approximately fifteen years ago. The statistics that were presented with respect to the number of deaths due to medical errors was shocking; the fact that the acknowledgement came from the medical profession itself was even more noteworthy. Certainly, there was still a culture of silence among some in the healthcare profession. However, the respectability of the members of the IOM made it difficult to deny that a problem existed. Although progressive hospitals had employed professionals with the title management engineer to improve financial operations, there became an increasing awareness that industrial engineering methods could also improve the clinical side of healthcare. Industrial engineers were called upon to apply their expertise in areas such as computer simulation and Six Sigma to solve specific problems or improve efficiencies More recently there has been an emphasis on the benefits of interdisciplinary collaboration between healthcare professionals and industrial engineers. Although a publication by the IOM called for an increase in interdisciplinary research, support from the Agency for Healthcare Research and Quality (AHRQ) was most influential. In Industrial and systems engineering and health care: Critical areas of research – final report, Valdez et al document successful approaches and outline specific recommendations for future interdisciplinary research projects. There is evidence that the resistance to change that was once prevalent in the healthcare community is diminishing. As was mentioned earlier, outside forces such as legislation and accreditation agencies are encouraging the implementation of quality improvement techniques. However, articles by healthcare administrators in healthcare journals and engineers in engineering journals indicate that the use of industrial engineering methods by interdisciplinary teams is having a positive effect on the delivery of healthcare. 10,11 This paper documents aspects of our fifteen year history of collaboration between Mercer University Department of Industrial Engineering and healthcare facilities in Georgia. It includes both a summary of the successes and an exploration of the challenges faced as these relationships were built and sustained. The resulting lessons learned will, we believe, give valuable insights and advice to faculty members and programs who are embarking on similar collaborations. Opportunities and Successes Partnerships with healthcare providers for student projects can result in a number of benefits for the healthcare institutions, students, and faculty members. One of the primary gains for institutions is the ability to draw on the skills and knowledge of faculty and students in Industrial Engineering and Industrial Management to solve real problems. The solutions provided by Mercer students have included process maps, time studies, 5S studies, inventory management systems, simulations, survey analyses, standardized process recommendations, training plans, staffing and resource allocation plans, and conceptual design of human-machine interfaces. A partial list of projects and their deliverables can be found in Table 1. Many of these deliverables also serve as evidence of continuous process improvement that the organization needs to demonstrate as part of their accreditation process. In addition to these concrete deliverables the exposure to systems thinking and lean approaches to the solution of problems, as well as the knowledge of methodologies for process improvement and quality, benefit the organization as a whole and individual constituents as they continue to recognize and address opportunities for improvement in the healthcare outcomes of their organization. The best indicator that the value of this new perspective is recognized by the healthcare organizations who have partnered with Mercer may be the number of students who have been offered internships, part time employment, and career opportunities by a number of these organizations. The benefits that students gain from working on projects in these healthcare organizations are both tangible and intangible. In addition to the benefits inherent with many real world projects – the opportunity to put their academic training to work on “messy” problems, the building of teamwork and communication skills, time management, etc. – the students have been afforded some very concrete opportunities that may not otherwise have been available. For example, students working on one project were able to obtain their Lean Six Sigma Certification as part of their project work. Other students have been offered unpaid internships, paid internships, and part time employment while they were still in school. A number of students obtained offers of full time employment with the organization upon graduation as a direct result of the project work. Several of our graduates who participated in senior design projects 10 to 15 years ago are now in senior management positions in healthcare facilities and are actively involved in recruiting our students for full-time employment or paid/unpaid internships at their institutions. The faculty involved in these projects gain many of the benefits that one would expect from collaboration with professionals in the field. By advising and supervising students the faculty themselves are maintaining currency in their field and sharpening existing skills. Because of the complex nature of the problems addressed by student teams, the faculty will often find themselves learning new skills in order to help the students resolve unexpected issues. Furthermore, the relationships faculty advisors develop with healthcare professionals have led to collaboration on research proposals and publications. Finally, it should be noted that both faculty and students have benefited from a decision in one healthcare organization to commit to innovation throughout the organization. This has resulted in the creation of an executive-level position within the organization devoted to the integration of the organization and support of innovation projects. A strong working relationship with this person has already begun to result in improved coordination of projects and implementation of results. Similar initiatives on the part of the leadership of other healthcare organizations have similarly aided in the successful completion of student projects and implementation of the results. Table 1. Partial List of Student Projects Project Level of Effort Deliverable(s) Patient falls prevention/reduction Two-semester senior design project Identification of major contributing factors, recommendations, and training program Prevention of retained objects during surgery Two-semester senior design project Low-tech simulator and training program Redesign of existing performance measuring system Two-semester senior desig