PAUL M. GRIFFIN, PHD, is the Joseph C. Mello Chair and Professor of Industrial Engineering at Georgia Tech.

HARRIET B. NEMBHARD, PHD, Is a Professor of Industrial Engineering at Pennsylvania State University. She is Director of the Center for Integrated Healthcare Delivery Systems.

CHRISTOPHER J. DEFLITCH, MD, is the Chief Medical Information Officer and an Associate Professor of Emergency Medicine at the Pennsylvania State University Hershey Medical Center.

NATHANIEL D. BASTIAN, PHD, is a Healthcare Operations Research Analyst in the United States Army Medical Department.

HYOJUNG KANG, PHD, is a Research Assistant Professor of Systems and Information Engineering at the University of Virginia.

DAVID A. MUÑOZ, PHD, is a consultant at McKinsey & Company.

Acknowledgments xi

Chapter 1 The Healthcare Delivery System 1

Overview 1

1.1 Healthcare Delivery Components 2

1.2 Major Stakeholders 6

1.3 Global Issues in Health 6

1.4 Drivers for Healthcare Systems 13

Questions and Learning Activities 22

References 23

Chapter 2 Complexity and Systems in Healthcare 25

Overview 25

2.1 Taking a Systems Approach to Healthcare 25

2.2 Complex Adaptive Systems 28

Case Study 2A: Complexity in Chronic Kidney Disease 31

2.3 Systems Thinking and System Dynamics 34

Case Study 2B: Systems Thinking and Causal Loop Diagrams in CKD 40

Case Study 2C: System Dynamics and Stock Flow Diagrams in CKD 45

Questions and Learning Activities 48

References 49

Chapter 3 Patient Flow 53

Overview 53

3.1 Healthcare Settings and Clinical Workflows 53

3.2 Patient Flow through a Hospital 64

3.3 Care Transitions 71

3.4 Process Mapping 75

3.5 Queuing 78

Case Study 3: ED Crowding – A Patient Flow Solution 80

Questions and Learning Activities 83

References 83

Chapter 4 Healthcare Financing 91

Overview 91

4.1 Financing Models for Health Services 91

4.2 Compensation Models for Providers 95

4.3 Cost Allocation and Charges 97

4.4 Capital Budgeting 103

Questions and Learning Activities 107

References 108

Chapter 5 Health Data and Informatics 111

Overview 111

5.1 Healthcare Data 116

5.2 Electronic Health Records 121

5.3 Health Information Exchange 130

5.4 Publicly Reported Healthcare Data 132

Case Study 5: Health Informatics at a Hospital—A 10-Year Journey 136

Questions and Learning Activities 139

References 140

Chapter 6 Lean 141

Overview 141

6.1 Lean Philosophy and Methods 141

6.2 Drivers for Lean Healthcare Systems 143

6.3 A Toolset for Eliminating Wastes 146

6.4 Value Stream Mapping 148

6.5 A3 150

6.6 5S 157

6.7 Kanban 160

6.8 Lean Implementations 164

6.9 Lean Thinking 165

Questions and Learning Activities 166

References 166

Chapter 7 Six Sigma 169

Overview 169

7.1 Six Sigma Philosophy 169

7.2 Six Sigma Quality 170

Case Study 7A: Quantifying Complexity in Translational Research 201

Case Study 7B: Evaluating Collaboration in Translational Research 205

Case Study 7C: Resource Allocation in Translational Research 208

Questions and Learning Activities 210

References 212

Chapter 8 Reliability and Patient Safety 217

Overview 217

8.1 Human Reliability 217

8.2 Errors in Healthcare 218

8.3 Medication Errors 220

8.4 Patient Falls 222

8.5 Human Factors and Ergonomics for Patient Safety 227

Questions and Learning Activities 236

References 237

Chapter 9 Health Analytics 245

Overview 245

9.1 Data Mining 245

Case Study 9A: Predicting Parkinson’s Disease Using Data Mining 251

9.2 Data Visualization 255

Case Study 9B: Data Visualization in Obesity Counseling 269

9.3 Social Network Analysis 271

Case Study 9C: SNA in a Pediatric Intensive Care Unit (PICU) 277

9.4 Data Envelopment Analysis 280

Case Study 9D: Using DEA for Finding Best-in-Class Hospitals in a Network 285

9.5 Multicriteria Decision Making 287

Case Study 9E: Use of GP to Optimize Helicopter Emplacement at Medical Treatment Facilities 291

Questions and Learning Activities 292

References 293

Chapter 10 Capacity Management 297

Overview 297

10.1 Capacity Management Challenges 297

10.2 Managing Nursing Units 299

10.3 Managing Operating Rooms 310

10.4 Managing Diagnostic Units 316

10.5 Nurse Staffing and Scheduling 317

Questions and Learning Activities 320

References 321

Chapter 11 Healthcare Logistics 323

Overview 323

11.1 Facility Location 323

Case Study 11: Location of Federally Qualified Healthcare Centers 337

11.2 Home Healthcare Routing and Scheduling 341

Questions and Learning Activities 347

References 349

Chapter 12 Health Supply Chains 351

Overview 351

12.1 Forecasting Demand 351

12.2 Inventory Control 357

12.3 Healthcare Distribution 363

12.4 Coordinating Activities in the Supply Chain 369

Questions and Learning Activities 375

References 377

Chapter 13 Infection Control 379

Overview 379

13.1 Historical Perspective 379

13.2 Infection Control Classification 381

13.3 Checklists for Infection Control 383

13.4 The Case of Sepsis 385

13.5 Mathematical Modeling of Hospital Infection Control 388

Case Study 13: Impact of Interventions on TB Infection in a Clinic 398

Questions and Learning Activities 402

References 403

Index 405

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