Oxford Bibliographies Your Best Research Starts Here ime and Motion Stu Steven Harper, Fariss-Terry Mousa LAST REVIEWED: 18 JUNE 2015 LAST MODIFIED: 28 JANUARY 2013 DOI: 10,1093/080/8780199846740-0027 Introduction ‘Time and motion study (also referred to as motion and time study, the terms are used interchangeably) isthe scientific study of the conservation of human resources in the search for the most eficient method of doing a task. A fascination with the word “eficiency" began in the late 19th and early 20th centuries when itwas considered one of the mostimportant concepts. Time study began in the 1880s as a means of wage-rate setting by Frederick W, Taylor, who is regarded as the “father of scientific management. Itconsists of @ wide variety of procedures for determining the amount of time required, under certain standard conditions of measurement, for tasks Involving some human activily. Motion study was developed by Frank B. Gilbreth and Lillian M. Gilbreth and consists of a wide variely of, procedures for the description, systematic analysis, and means of improving work methods. itis dificult to separate these two aspects, completely. Therefore, the combined term usually refers to all three phases of the activity: method determination, time appraisal, and development of material for tre application of these data. Frank and Lillian also broadened scientific management by including the human element, therefore using psychology to gain the cooperation of employees. Motion and ime analysis could be used to help find a preferential way of doing the work and could assist in effectively managing or controlling the activity. This approach has been successfully applied to factories, hospitals, department stores, housework, banks, cafeteria work, libraries, music, and to many other human activites For instance, factories have used ito reduce wasted time and improve the time to compete a task, while banks use ito help team members reach thelr sales goals. However, the goal of a time and motion study is not simply efficiency. These studies are done to create a baseline that can be used in the future when evaluating procedural, equipment, or personnel changes. The goal can be to understand the skills required to enable individuals to perform the work and, thus, to pravide the correct training. Another may be to reduce the discomfort experienced, especially n the case of surgical procedures—a goal such as this, namely, to create less tissue damage, may run counter to efficiency. In the case of athletes, the goal may be faster speed or more endurance, which may be achieved notnecessarily by the most efficient way. Classic Books Frank and Lillian Gilbreth wrote some ofthe original work that aid the foundation forthe field of motion and time study. They were the pioneers of motion study. Although many believe that Taylor began this area of inquiry due to his book on scientific management (Taylor 2010), however, debate continues on whether Taylor was the actual author (see Wrenge and Stoka 1978 for more details) Frank Gilbreth started out by applying his observations on reducing fatigue and improving processes in his own bricklaying contracting business (Gilbreth 1974), He achieved results that could not be ignored, The three stages used in motion study are detalled in Gilbreth 2008, In this forward-looking book, the author considers the habits, health, nutriton, size, strength, skill, temperament, and training of the worker as variables that can lead to efficiency. Taylor authored another seminal work (Taylor 2070) in which he laid down the principles of scientific management. Gilbreth 1973 consists of a compilation of letters that Lilian Gilbreth organized into a book to answer the publie’s ‘most frequent questions about Taylarism. In Gilbreth and Gilbreth 1973 the authors argue that the main aim of motion study experts is to determine accurately the fatique resulting from any job and then to eliminate that which was unnecessary by designing convenient ‘workbenches, furnishing chaits, providing regular restrecovery periods, and so on. Many of these classical books also had direct, application to certain fields. For instance, Lilian Gilbreth wrote a book to help homemakers apply moton study in order to improve and reduce wasted movements while working “the finest job in the world’ (Gilbreth 1927). She gives practical methods for conducting motionstudies when the normal tools used in industrial settings are not available (e.9., sting being unwound while following someone clearing the table in the place of motion pictures). lbreth, Frank B. Primer of Scientific Management, Easton, PA: Hive, 1973. ‘Tals book contains letters with answers to questions about the elimination of unnecessary human effor! and was writen in response to Taylor 2010) (originally published in 1912). The answers cover definitions, laws or principles, and application of the laws of scientific management. Chapter 4 covers the effect of scientific management on the worker and the last chapter expands scientific managementto other activities such as schools and colleges. Originally published in 1914 Gilbreth, Frank B. Primer of Scientife Management. Easton, PA: Hive, 1973, Gilbreth, Frank B. Bricklaying System, Easton, PA: Hive, 1974, This rst book that Frank Gilbreth authored detals the results of his motion study on bricklayers. The text gives a systematic view of bricklaying covering the materials, personnel, and equipment used in the process. He reports the methods thathe devised forall aspects of brick construction. Results allowed him to reduce wasted motions, resulting in a tripling of productivity while decreasing fatigue, Originally published in 1909. Gilbreth, Frank B. Bricklaying System. Easton, PA: Hive, 1974. Gilbreth, Frank B. Motion Study: A Method for Increasing the Effi icy of the Workman. Whitefish, MT: Kissenger Publ ing, 2008. ‘This work highlights the three stages involved in using motion study: discovering and classifying the best practice, deducing the laws that make itthe best practice, and using these laws to standardize practice to increase efficiency. Variables of the motions needed to perform the work are covered and how to create motion charts that will serve as the basis for making changes that improve eficiency. Originally Published in 1911 Gilbreth, Frank B. Motion Study: A Method for Increasing the Efficiency of the Workman. Whitefish, MT: Kissenger Publishing, 2008, Gilbreth, Frank B., and Lillian M. Gilbreth. Fatigue Study: The Elimination of Humanity's Greatest Waste; A First Step in Motion ‘Study. Easton, PA: Hive, 1973. Fatigue study enhanced efficiency 0 as to reveal its benefits to workers in a tangible way. The authors claim that motion study, unlike other scientific management approaches, actually humanized work conditions and facilitated industrial peace. Many of these principles are in use today in ergonomic design, and they are stipulated in the US Occupational Safety and Health Administration laws, Originally published in 1919, Gilbreth, Frank B., and Lillian M. Gilbreth. Fatigue Study: The Elimination of Humanity’s Greatest Waste; A First Step in Motion Study. Easton, PA: Hive, 1973. Gilbreth, Lilian M. The Home-Maker and Her Job. New York: D. Appleton, 1927. Lillian Gilbreth examines the home and all the requirements of a homemaker using motion study. She opens in stating: "Home-making is the finest job in the world” (p. vil), and she goes on to discuss how to eliminate wasted effort in the home. She affirms that doing so will lead to more satisfaction, less fatigue, more interest in the work, and more free time to do other things Gilbreth, Lillian M. The Home-Maker and Her Job. New York: D. Appleton, 1927. Taylor, Frederick W. The Principles of Scientific Management. New York: Cosimo Classics, 2010. ‘Taylor discusses the concept of ime study and motion study using Gilbreth’s bricklaying system as the prime example of the gains in productivity that can be achieved using more scientific methods. This book has been crecited with the creation of modem organizationaland decision theory, butit has also been criticized for dehumanizing the worker in making them just an extension of the mechanical equipment. Originally published in 1912, ‘Taylor, Frederick W. The Principles of Scientifc Management. New York: Cosimo Classics, 2010. ‘Wrenge, Charles D., and Anne M. Stoka. “Cooke Creates a Classic: The Story behind F.W. Taylor's Principles of Scientific Management.” Academy of Managment Review 3.4 (October 1978): 736-749. The authors analyze the unpublished manuscript for “Industrial Management" writen by Moris L. Cooke and argue that Taylor 2010 is not actually Taylor's work, Instead, Taylor used much of the material in the frst chapters of the Cooke manuscript in his book, Available online for purchase or by subscription, Wrenge, Charles D., and Anne M. Stoka. "Cooke Creates a Classic: The Story behind FW. Taylor's Principles of Scientific Management, Academy of Management Review 3.4 (October 1978): 736-749, Reference Works ‘Time and motion studies constitute part ofa larger agenda of improving human work efficiency and effectiveness. As such, several reference industial engineering handbook chapters are available that include discussion of ime and motion studies. Akiyama and Kamata 2001 introduces time and motion studies as a part of methods engineering. Sellie 2001 adds more detail about conducting a time and motion study, including some social factors. Zandin 2001 gives a detailed discussion on how to use a particular system to break down and record movements during @ motion study. Matias 2001 is another industrial engineering handbook that gives an overview of time and motion studies and that includes tools for collecting data and analysis after these data have been obtained, which thus facilitates proposing actions that will improved ‘Akiyama, Moriyoshi, and Hideaki Kamata, “Methods Engineering and Workplace Design.” In Maynard's Industrial Engineering Handbook. Sth ed. Edited by Kjell B. Zandin, 4.3-4.20. New York: McGraw-Hill, 2001, Discusses methods engineering that includes time and motion studies. Methods engineering looks at each operation that is done to praduce a given piece of work with an analysis that will eliminate each unnecessary element or operation. Time and motion study is seen as one of the tools that can be used in analyzing the processes and thus helping to improve efficiency. ‘Akiyama, Moriyoshi and Hideaki Kamata. “Methods Engineering and Workplace Design." In Maynard's Industrial Engineering Handbook. Sth ed. Edited by Kjell B. Zandin, 4.34.20. New York: McGraw-Hill, 2001 Matias, Aura C. “Work Measurement: Principles and Techniques.” In Handbook of Industrial Engineering: Technology and Operations Management. Edited by Gavriel Salvendy, 1409-1462. New York: Wiley, 2004 ‘Tris isan overview chapter on different types of work measurement, which includes time and motion study. Topics include how to perform the studies, analysis ofthe results, and several data collection methods, including MOST, method-ime measurement, and macromotion analysis. Matias, Aura C. “Work Measurement: Principles and Techniques.” In Handbook of industrial Engineering: Technology and Operations Management. Edited by Gavriel Salvendy, 1409-1462. New York: Wiley, 2001 Selio, Clifford N. “Stopwatch Time Study.” In Maynard's Industrial Engine 17.46. New York: MeGraw-Hill,2001 ring Handbook. Sth ed, Edited by Kjell B. Zandin, 17.21— Details the theory and methods of ime study, including the diferent types of studies, the materials needed for conducting a study, sample {forms used in a study, observation principles and requirements, timing methods and calculations, and some discussion of hostly toward lime study and ways of gaining acceptance by the workers being studied,Sellie, Cliford N. “Stopwatch Time Study." In Maynard's Industral Engineering Handbook. Sth ed. Edited by Kjell B. Zandin, 17.21~17.46. New York: McGraw-Hill, 2001 Zandin, Kjell B. “MOST® Work Measurement Systems.” In Maynard's Industrial Engineering Handbook. Sth ed. E Zandin, 17.65-17.82. New York: McGraw-Hill 2004 In this article, the author describes the MOST system that is used to describe motion sequences. This shorthand for a motion is broken into actons: distance (A), body motion (B), gain control (G), placement (P), move control (M), process time (X), and align (). There are subscripts associated with each that indicate a distance, time, or type of motion class and are then translated to time units. Zandin, Kjall B."MOST® Work Measurement Systems.” In Maynard's Industrial Engineering Handbook. Sth ed. Edited by Kjell B. Zandin, 17.85-17.82. New York: MeGraw-Hill, 2001 Textbooks ‘Time and motion studies are generally covered in industrial engineering or manufacturing textbooks, In general, these texts follow a pattern, in either the entire book orjusta few chapters, of presenting the history of time and motion studies, making a case for the Importance of these studies, tachniques for performing time and motion studies, and how to interpret the data to make improvements. ‘These textbooks are revised avery few years and published as new editions. The books vary on the amount af space devoted to time and ‘motion studies, namely, whether the topic serves as the focus of the entire book or constitutes just a chapter or two ofa mare general industrial or manufacturing engineering text. Two representative texts on time and motion study specifically and as a method of proper manual work design are Barnes 1980, now in its seventh edition, and Niebel and Freivalds 2009, now in its twelfth edition. n both of these texts the overall topic of work design includes detailed chapters on how to use time and motion studies to support the design of ‘work. Meyers and Stewart 2002 applies time and motion study in the context of lean manufacturing, giving an update to the topic applications, Mundel 1978 adds quality control charts in the context of ime and motion studies to expand the usefulness of these studies, Finally, Pigage and Tucker 1954 shows how to set up a working program in industy to improve efficiency. Barnes, Ralph M, Motion and Time Study: Design and Measurement of Work, Hoboken, NJ: Wiley, 1980, A classic textbook frst published in 1937 that covers the history the process of work methods design, and the use of fme motion studies to support this. Tools and equipment with their advantages and disadvantages are covered as well as standardization methods. Several case studies are discussed, including programs at Volvo, General Motors, Kodak, and Motorola. Barnes, Ralph M, Motion and Time Study: Design and Measurement of Work, Hoboken, NJ: Wiley, 1980. Meyers, Fred E,, and James R. Stewart, Motion and Time Study for Lean Manufacturing. 3d ed, Upper Saddle River, NJ: Pearson Prentice Hall, 2002. This text applies time and motion studies inthe context of lean manufacturing. The authors provide a how-to approach on the techniques and procedures of motion and time study that apply to workstation design, proper wage-payment systems, and time-management techniques. Meyers, Fred E., and James R. Stewart. Motion and Time Study for Lean Manufacturing. 3d ed. Upper Saddle River, NJ: Pearson Prentice Hall, 2002. Munde!, Marvin E. Motion and Time Study: Improving Productivity. 7th ed. Englewood Cliffs, NJ: Prentice-Hall, 1978. First published in 1946 as Systematic Motion and Time Study, this is another classic textbook that covers all the facets of conducing time land motion studies. This text covers the techniques and tools used in time study, many of which are used in quality control charts. The final part of the book provides notes that give further details on ime and motion study techniques. Mundel, Marvin E. Motion and Time Study: Improving Productivily. 7th ed. Englewood Clifs, NU: Prentice-Hall, 1978.Niebel, Benjamin, and Andris Freivaids. Niebel's Methods, Standards, and Work Design. 12th ed. Boston: McGraw Hill, 2009. First published in 1955, this classic textbook examines the engineering methods for quantiying, analyzing, and designing manual work in industrial settings. The text starts with the biomechanics of the human body and incorporates this in the design of manual work design. By incorporating time and motion study into work design, optimization is achieved within ergonomic, cognitive, work environment, and safety constraints Niebel, Benjamin, and Andris Freivalds. Niebel's Methods, Standards, and Work Design. 12th ed. Boston: McGraw Hill, 2009, Pigage, L. C., and J. L. Tucker. “Motion and Time Study.” University of llinois Bulletin 51.73 (1954): 1-48, Although not strictly a textbook, this bulletin explains some of the popular methods used in time and motion study. Rwas designed to provide assistance in developing a working program in industy. It details the methods followed to create process charts, ow charts, operation charts, and time study sheets. Ithas examples of filled-in sheets with pre- and postimprovement methods. Pigage, L.C.,and J.L. Tucker. "Motion and Time Study." University of linois Bulletin 51.73 (1954): 148. Films Many of the time and motion studies done by Frank Gilbreth were done by recording the process under study. Archival flms are available that were presented by James S. Perkins in collaboration with Lillian M. Gilbreth and Ralph M. Bames. A selection of the more than 250,000 feet of fim made by Frank B. Gilbreth in his time and motion studies has been indexed by Perkins, Perkins has selected the sections of greatest interest for these fms that run fifteen to sixteen minutes long. Original Films of Frank B, Gilbreth (Part 1) covers the early studies of @ more industial and office nature. Original Films of Frank B. Gilbreth (Part 2) deals with new areas for ime and motions studies, Including, most notably, medical procedures, sports, and new measuring techniques. Original Films of Frank B, Gilbreth (Part 1), ‘Tis first part discusses the camera used (hand crank) and the requirement to change the cranking speed due to available lighting. To allow for timing when the filming speed varied, Gilbreth placed a microchronometer in view of the operators being filmed. There are also some office and family shots. Brclaying, horseless carriages, stamping dates, and soap bar packaging examples are shown. Original Films of Frank B. Gilbreth (Part). Original Films of Frank B, Gilbreth (Part 2), ‘Tne selection of examples from Gilbreth’s ime and motion study films covers topics thatinclude one-handed versus two-handed laboratory studies, various industrial processes, part packets and carts, work with and without rest periods, typist (one- and two-handed) and keyboard layout, eye motion studies, baseball pitching, rowing crew, medical surgery, cycle graphs (lights attached to the fingers), and military raining, Original Films of Frank B. Gilbreth (Part2). Classic Articles Most ofthe classic articles are authored by Frank Gilbreth and Lillian Gilbreth, as they were the founders and champions ofthis, methodology. These early articles are contained in Gilbreth and Gilbreth 1973. Gilbreth and Gilbreth 1917 argued that this system helps ‘workers become experts in their tasks and serves as a valuable aid to management. In this piece, the goal was fo show that motion studyis a systematic program for the betterment of work and nota sequence of mechanical devices for improving output. In Gilbreth and Gilbreth 1920, the authors had a very diferent focus in mainly intending to show their innate interest with the human elementinvolved ‘and with the scientific analysis of work processes and methodologies. Zerga 1944 provides a complete biography of mation and time studies. The publishing dates of the classic articles reveal that much of the traditional time and motion studies for improving industrial eficiency were undertaken in the fist half of the 20th century when great improvements were underway in the fleld of scientific ‘management. Thus Zerga 1944 serves as a valuable reference resource written in the heyday of ime and mation studies. Gilbreth, Frank B., and Lillian M. Gilbreth. “Motion Study for the Crippled Soldier.” In Applied Motion Study. Edited by Frank Gilbrath and Lillian Gilbreth, 131-157. New York: Sturgis and Walton, 1917. Ths article revealed to the world Frank's innovation, namely, the “therbligs," in which he announced that all work motions could be reduced to sixteen types of movements (e.g, search, find, select, and grasp), Notice that he consciously placed treatment ofthe therbligs Ina paper that focuses on the treatment of a handicapped soldier in order to reduce any possible critique that might arise. Gilbreth, Frank B., and Lillian M. Gilbreth. “Motion Study for the Crippled Soldier” in Appliod Motion Study. Edited by Frank Gilbreth and Lillian Gilbreth, 131-157. New York: Sturgis and Walton, 1917, Gilbreth, Frank B., and Lillian M. Gilbreth. “The Engineer, the Cripple, and the New Education.” In Motion Study for the Handicapped. By Frank B. Gilbreth and Lilian M. Gilbreth, 89-109, London: Routledge, 1920. Here Frank and Lillian wanted to show their deep concer with the human element and process improvement of work. They developed a slogan that became associated with their name later: “The quest ofthe one best way to do work’ (pp. 96-97). Gilbreth, Frank B., and Lillian M. Gilbreth. "The Engineer, the Cripple, and the New Education.” In Motion Study forthe Handicapped. By Frank B. Gilbreth and Lillian M. Gilpreth, 89-109. London: Routledge, 1920 Gilbreth, Frank B., and Lillian M. Gilbreth. Applied Motion Study: A Collection of Papers on the Efficient Method to Industrial Preparedness. Easton, PA: Hive, 1973. Many of the classic articles are in this collection of papers. The authors start with an explication of what the scientific method can do for America’s industrial position, and they go on to discuss the definitions and methods for conducting mation study, including a description of the chronocyclegraph motion devices, how motion study applies to educational methods, and the effect on the workers and thelr promotion. Originally published in 1918. Gilbreth, Frank B., and Lillian M. Gilbreth. Applied Motion Study: Collection of Papers on the Efficient Method to Industrial Preparedness, Easton, PA: Hive, 1973, Zerga, Joseph E. “Motion and Time Study: A Resume and Bibliography.” Journal of Applied Psychology 18.6 (December 1944): 447-500. Using World War Il as motivation for new, more efficient production methods, the author discusses how time and motion study improves job performance and increases productivity as well as how it reduces unnecessary fatigue for the worker. tcontains more than three hundred references touching on results from these shidies and on other literature writen between 1923 and 1943. Available online for purchase or by subscription Zerga, Joseph E. “Motion and Time Study: A Resume and Bibliography.” Journal of Applied Psychology 18.6 (December 1944): 447— 500, Libraries Libraries, ike other organizations, also needed to operate efficiently, Two leaders in the fleld were especially involved in this movement during the formative years: Melvil Dewey (b. 1851=d. 1931) and Charles McCarthy (b. 1873-d. 1921). Long before Frederick Taylorwrote, possibly as early as 1873, when he designed his classification system, Dewey's writings indicate a deep interest in efficiency. The application of ime and motion studies came much later following a concer to promote better building plans to save staff the time and effort involved in receiving, cataloging, and preparing books for the shelves. In one of the frst works with direct application to libraries (Baldwin and Marcus 1941),Lilian Gilbreth was involved as a consultant. inthis study, she developed the process chart. The first formal motion and time study ofa library routine reported inthe literature is found in Bates, etal. 1943. Hardkopf 1949 applies time motion methods and techniques to the processing of books for circulation at the New York Public Library. Logsdon 1954 gives a nice overview of the state of the field up to that point. Baldwin, Emma V, and W. E. Marcus. “Library Costs and Budgets.” In Library Costs and Budgots: A Study of Cost Accounting in Public Libraries, By Emma V. Baldwin and W. E. Marcus, 110-111. New York: R.R. Bowker, 1941 ‘The authors published the frst industial motion study process chart to appear in the library Iterature where the goal ofthat study was to establish measuring reds forthe evaluation of library service using data from thirty-seven public libraries and the experiences of 1,560 people in the dally performance of work for a four-month period Baldwin, Emma V,, and W.E. Marcus. “Library Costs and Budgets." In Library Costs and Budgets: A Study of Cost Accounting in Public Libraries. By Emma V. Baldwin and W. E, Marcus, 110~111. New York: R. R. Bowker, 1941 Battles, Dean D., Howard Davis, and William Harms. “A Motion and Time Study of a Library Routine.” Library Quarterly 13.3 (July 1943): 241-244, Introduced six main recommendations by focusing mainly on ene part ofthe circulation routine of loaning a book to a patron in the Bradley Polytechnic Institute Library that used the one-card elrculation system. Some ofthe techniques used included micromation analysis with motion pictures, a microchronometer, motions broken down into therbligs, and a simo chart. Available online by subscriation Battles, Dean D., Howard Davis, and William Harms, “A Motion and Time Study of a Library Routine." Library Quarterly 13.3 (July 1943) 241-244, Hardkopf, Jewel C. “An Application of Methods and Motion Techniques in Preparing Books in the New York Public Library.” MS thesis, Columbia University School of Library Service, 1949, Interesting piece in which the author reviews the historical development of methods of motion study, analyzes the techniques that were Used, and provides a good review on the motion study as itwas applied to libraries. Hardkopf, Jewel C, "An Application of Methods and Motion Techniques in Preparing Books in the New York Public Library” MS thesis, Columbia University Schoo! of Library Service, 1948. Logsdon, Richard H. “Time and Motion Studies in Libraries.” Library Trends 2 (1954): 401~409, Covers most literature that discusses motion study specifically and work simplification and efficiency in general. The author ends the article with very good suggestions (lessons leamed from studying the literature) drawn from his own experience to help librarians apply the principles of motion study to their libraries, Logsdon, Richard H, “Time and Motion Studies in Libraries." Library Trends 2 (1954): 401—409, Sports ‘The movement of athletes, individually or as a team, is a natural subjectfor the application of ime and motion studies. Sports involve Competition to be the best, the fastest, the strongest, or the most accurate, and this is a field that has gained from systematic and scientific study of micro- and macromotions, In some cases, natural athletes afford an opportunity to study their motion and better understand how they accomplish their deeds. These “best practices” can then be taught o ather athletes to improve their performance. In other cases, byConducting time and motions studies, you can use the classic techniques of finding and eliminating wasted motions while enhancing the necessary motion. At the macrolevel, ime and motion study can help in the proper structural placement of members of team to optimize readiness in offensive and defensive actions with opponents. Frank Gilbreth conducted studies in baseball, as seen in Gilbreth 1913 and Inthe Films section Gilbreth, Frank. “Movie Economize Force.” New York Tribune, 15 June 1913. to Help Baseball Player ‘Tne focus is on characterizing the activity pattern ofa sport and estimating the energetic requirements of the performance. After analyzing the pictures, Frank noted thatit took approximately one and half seconds before the catcher could pass the ball on to second base. Therefore, to take second base, with an eight-ootlead, necessitated a speed faster than the world's record for the 100-yard sprint Gilbreth, Frank. “Movies to Help Baseball Players Economize Force." New York Tribune, 15 June 1913. Individual-Based Sporting Activities Focusing on the athlete movement or notational analysis can provide good objective data about certain sports and enhances scientific tunderstanding of athletic performance. Time and motion analysis offers an impartial evaluation of player demands. talso allows researchers to calculate the distance covered by an athlete, the time spent, and the frequency of different match and movement actions in any sport. This usually aids researchers to help determine movement pattems and work-rate profiles and to identify when fatigue begins to take place as well as providing the ability to estimate the fitness levels of these individuals. For instance, White and Olsen 2010 deals with six rock climbers who were filmed during a national competition, The study focuses on quantifying the movement dynamics of lite boulder climbers, where motion studies were found to be a useful tool for the quantification of movement characteristics, Del Vecchio, etal. 2011 focuses on applying time and motion studies to mixed martial ars. del Vecchio, F.B., 8. M. Hirata, and E. Franchi n Analysis and Combat De Arts Matches at Regional Level Tournaments.” Perceptual and Motor Skills 112.2 (2011): 639-648. Tris study applied time and motion study to mixed martial arts. More specifically it quantified the effort pause ratio and categorized effort segments of stand-up or groundwork developments to spot the number of actions performed per round. lopment in Mixed Marshal el Vecchio, F,B,, S, M, Hirata, and E, Franchini,“A Review of Time-Motion Analysis and Combat Developmentin Mixed Marshal Arts Matches at Regional Level Tournaments.” Perceptual and Motor Skills 112.2 (2011): 639-648. White, Dominic J., and Peter D. Olsen. “A Time Motion Analysis of Bouldering Style Competitive Rock Climbing.” Journal of ‘Strength and Conditioning Research 24.5 (2010); 1356-1360. ‘Tne study found many interesting applications that will be useful fr athletes, The authors suggest that much future research is possible. For example, authors could focus on a larger number of athletes and problems. They could also help develop performance tests and training interventions for bouldering. Available online for purchase or by subscription. White, Dominic J, and Peter D. Olsen. “A Time Motion Analysis of Bouldering Style Competitive Rock Climbing” Joumal of Strength and Conditioning Research 24.5 (2010): 1956-1360. Team-Based Sporting Activities ‘Time and motion studies have bean used extensively, especially in team sports such as soccer, rugby, handball, baseball, basketball, and football. Less research exists on individual-based sporting activities. Motion analysis, using video, is especially useful in such sports, because itis generally very dffcultto determine characterstios because movements can be spontaneous and novel during competition For instance, Reilly and Thomas 1976 examines work rates in professional soccer, while Bangsbo, et al. 1991 extends such work by directly applying motion analysis to the sport. Bloomfield, etal. 2007 goes further in using much more advanced technology to secure very useful data, Ohashi, etal, 1988 provides the basic method used in many subsequent studies on movement measurements, Carling,etal. 2008 examines the role of motion analysis in soccer, Studies have not been limited to soccer, For example, Spencer, et al.2005 focuses on hockey; Rudkin and O'Donoghue 2008 focuses on cricket; and Deutsch, etal. 2007 focuses on rugby. Bangsbo, J., J. Norregaard, and F, Thorsoe. “Activity Profile of Competition Soccer.” Canadian Journal of Sports Sciences 16 (1991): 110-116. Directly applied motion analysis to professional soccer by positioning video cameras near the side of the pitch, atthe level of the midfeld to film each player separately. These studies gave coaches much useful data about the duration of each activity, frequency of each activity, and so on. This study was conducted over an extended period of ime. Bangsbo, J. J. Norregaard, and F. Thorsoe. “Activity Profile of Competition Soccer.” Canadian Journal of Sports Sciences 16 (1991): 110-116, Bloomfield, Jonathan, Remco Polman, and Peter O'Donoghue. “Physical Demands of Different Positions in FA Premier League Soccer.” Journal of Sports Science and Medicine 6 (2007): 63-70. Improved on previous methods by applying better quality cameras that provide high-quality close-up footage focusing on a single Player's movements and actions. also applied more advanced computer input coding methods made available by contemporary computer software, Bloomfield, Jonathan, Remco Polman, and Peter O'Donoghue. “Physical Demands of Different Positions in FA Premier League Soccer” Joumal of Sports Scionce and Medicine 6 (2007): 63-70. Carling, Christopher, Jonathan Bloomfield, Lee Nelson, and Thomas Reilly. “The Role of Motion Analysis in Elite Soccer Contemporary Performance Measurement Techniques and Work Rate Data.” Sports Medicine 38.10 (2008): 838-862. Review article that emphasizes the important role of motion analysis as a tool for measuring the physical performance of soccer players. The authors evaluate different motion analysis techniques that are employed in elite soccer and investigate various research performed Using these methods, Available online for purchase or by subscription. Carling, Christopher, Jonathan Bloomfield, Lee Nelson, and Thomas Reilly. ‘The Role of Motion Analysis in Elite Soccer: Contemporary Performance Measurement Techniques and Work Rate Data.” Sports Modicino 38.10 (2008): 838-862. Doutsch, M.U.,G.A. Kearney, and N. J. Rohrer. “Time-Motion Analysis of Professional Rugby Union Playars during Match-Play Journal of Sports Sciences 25.4 (2007): 461-472. This manuscript aimed to quantiy the movement patterns of diferent playing positions during professional rugby union match play, such thatthe relative importance of aerobic and anaerobic energy pathways to performance could be estimated, Available online for purchase or by subscription Deutsch, M. U., G.A. Keamey, and N. J. Rehrer. “Time-Motion Analysis of Professional Rugby Union Players during Match-Play.” Journal of Sports Sciences 25 4 (2007): 461472. Ohashi, J., H. Togari, M. lsokawa, and S, Suzuki. “Measuring Movement Speeds and Distances Covered during Soccer Match- Play.” In Science and Football: Proceedings of the First World Congress of Science and Football, Liverpool, 13-17 April, 1987. Edited by Thomas Reilly, 328-333. London: E & FN Spon, 1988, ‘A classic study in the sports area. Most newer studies build on the original method developed in this study. Previous studies were very labor intensive and time consuming. This study employed the calculation of players’ position and speed through trigonometric techniques. Similar weaknesses remained, however, such as an inability to analyze more than one player at a time. Ohashi, J, . Togari M. Isokawa, and S. Suzuki. “Measuring Movement Speeds and Distances Covered during Soccer Match-Play.” In Science and Football: Proceedings ofthe First World Congress of Science and Football, Liverpool, 13-17 April, 1987. Edited by Thomas Reilly, 329-333, London: E & FN Spon, 1988,Reilly, T, and V. Thomas. “A Motion Analysis of Work-Rate in Different Positional Roles in Professional Football Matchplay Journal of Human Movement Studies 2 (1978): 87-89, A classic study that frst applied motion analysis to study of work rates in professional soccer over an extended period of time, Reilly. T, and V. Thomas. “A Motion Analysis of Work-Rate in Different Positional Roles in Professional Football Matchplay." Joumal of Human Movement Studios 2 (1976): 87-89, Rudkin, Steven T, and Peter G. O'Donoghue. “Time-Motion Analysis of First-Class Cricket Fielding.” Medicine in Sport 11.6 (2008): 604-607. ‘This study aimed to apply the newly developed technique of “repeated-sprint activity" to cricket in order to improve overall performance. Therefore, the goal was to quantify the movement activity of first-class felders using time-motion analysis. Available online for purchase or by subscription Journal of Science and Rudkin, Steven T, and Peter G. O'Donoghue. “Time-Motion Analysis of First-Class Cricket Fielding" Joumal of Science and Medicine in ‘Sport 11 6 (2008): 604-607. Spencer, M,C. Rechichi ‘Several Games in Succession: A Tournament Scenario.” Journal of Science and Medicine in Sport 8.4 (2005): 382-391. . Lawrence, B. Dawson, D. Bishop, and C. Goodman. “Time-Motion Analysis of Elite Field Hockey during ‘The fist study that we know ofthat aimed to document the movement patterns of fourteen male elite hackey players of two or more games within a few consecutive days. This study algo focused on the effects of fatigue on players’ performance. Introduced anew development in ime-motion analysis: *repeated-sprint activity” Available online for purchase or by subscription. Spencer, M.,C. Rechichi, S, Lawrence, B, Dawson, D. Bishop, and C. Goodman. “Time-Motion Analysis of Elite Field Hockey during ‘Several Games in Succession: A Tournament Scenario," Journal of Science and Medicine in Sport 8.4 (2008): 382-381, Equestrian Sports ‘Time and motion study has been used mainly to study dressage competitions, as a resull of which recommendations were made regarding the type and duration of exercise appropriate for preparing dressage horses for different levels of competition. Although this is nota team sport, the time and mation study here involves two athletes working together (the rider and the horse). For instance, Clayton 11989 finds that the majority of time was spentin gaits and movements that involved slow speed of progression while 12 percent of the time was spent at a medium or extended trot or canter, which mainly occurred in short bursts of nine to thirteen seconds duration. Clayton 11993 aims to develop a conditioning program for dressage horses based on time and motion analysis. Clayton 1996 focuses on the time motion characteristics ofthe sport of show jumping Clayton, Hillary M. “Time Motion Analysis in Equestrian Sports: The Grand Prix Dressage Test.” In Proceedings of the 35th Annual American Association of Equine Practitioners Convention, Boston, Massachusetts, 3-6 December 1989. Edited by Mary G. Royer, 367-373. Lexington, KY: American Association of Equine Practitioners, 1989, Anice article that directly applies time and motion study to equestrian sports (possibly the first). This study focused on studying the Grand Prix dressage test. Direction implications came out ofthis study, such as recommending that cardiovascular conditioning for horses be based on eight-minute periods of continuous exercise, with frequent transitions and brief (twelve second) accelerations in the extended gaits. Clayton, Hillary M. “Time Motion Analysis in Equestrian Sports: The Grand Prix Dressage Test.” In Proceedings of the 36th Annual American Association of Equine Practitioners Convention, Boston, Massachusetts, 3-6 December 1989. Edited by Mary G. Royer, 367 373, Lexington, KY: American Association of Equine Practitioners, 1989,Clayton, Hillary M. “Development of Conditioning Programs for Dressage Horses Based on Time-Motion Analysis of Competitions.” Journal of Applied Physiology 74.5 (1 May 1993): 2328-2329, Here the author wanted to provide information regarding the temporal characteristics of the sport of dressage at the basic and medium levels. The results were applied in developing sport specific conditioning programs. The study finds that, at the basic and medium levels, the sport of dressage depends on aerobic metabolism to meet energy needs. Available online for purchase or by subscription Clayton, Hillary M, “Development of Conditioning Programs for Dressage Horses Based on Time-Motion Analysis of Competitions.” Joumal of Applied Physiology 74.5 (1 May 1993): 2325-2328. Clayton, Hillary M. “Time-Motion Analysis of Show Jumping Competitions.” Journal of Equine Veterinary Science 16.6 (1996): 262- 266. Ths study aimed to describe the time-motion characteristics ofthe sport of show jumping atthe preliminary intermediate, and open levels of competition at the Spruce Meadows National tournament in 1990. Used video recording graphics to measure the time spent galloping between fences and the alrbome time over the fences and the different levels of competition. Available online for purchase or by subscription Clayton, Hillary M. "Time-Motion Analysis of Show Jumping Competitions.” Journal of Equine Veterinary Science 16.6 (1986): 262-266. Management Managementis another field in which time and motion study has obviously left an impact. The Gilbreths, along with Frederick Taylor, are considered leaders in the field of scientific management. Their teachings laid the foundations for many of the madern process Improvement systems that are widely popular today (e.g, Six Sigma). This section includes some of the main manuscripts that look at time and mation study from a management perspective and that aim to compare such a methad with other process improvement methods (e.g., Jean manufacturing—see Dankbaar 1997). Mousa and Lemak 2008 even argues that the Gilbreth’s system was superior to some of the newer, more famous systems with which most practitioners are familiar. Also listed below are some sources that aim to apply time and motion study to certain organizations (e.g., Adler 1993, Graham 2000). Chatzis 1999 gives a good historical look at ime ‘and motion study during a specific ime period in France. Price 1989 looks atthe efforts pu forth by the Gilbreths to sell their ideas in a very dificult environment, The Gilbreths needed to show that their system is different and better than other systems available al the time, Adler, Paul S. “Tim nd-Motion Regained.” Harvard Business Review71.1 (1993): 97-108, Excellent study that looks into how GM-Tayota’s joint venture (NUMMI) succeeded in employing an innovative form oftime and motion study on the factory oor not only to create world-class productivity and quallly, but also to Increase worker motivation and satisfaction, This article tries to debunk the modern trend that argues for less standardization, less study of ime and motion, and less hierarchy in order to increase innovation and creativity. Available online for purchase or by subscription ‘Adler, Paul S. “Time-and-Motion Regained.” Harvard Business Review 71.1 (1993): 97-108. Chatzis, Konstantinos. “Searching for Standards: French Engine 1950s.” History and Technology 18.3 (1999): 233-261, Gives a historical overview of ime and motion study in French companies between 1945 and 1975 while focusing specifically on the creation of the engineering department. Available online for purchase or by subscription Chatzis, Konstantinos, “Searching for Standards: French Engineers and Time and Motion Studies of Industial Operations in the 1950s.” History and Technology 15.3 (1999): 233-261 1's and Time and Motion Studies of Industrial Oper:Dankbaar, Ben. (1997): 567-583, A.useful study in that it compares motion and time study to the Japanese system of lean production. The authors argue that lean was not the end of motion and time study but, on the contrary, an extension of t especially in more turbulent markets with more diverse products, Available online for purchase or by subscription 1ean Production: Denial, Confirmation of Extension of Sociotechnical Systems Design?" Human Relations 50.5 Dankbaar, Ben. “Lean Production: Denial, Confirmation of Extension of Saciotechnical Systems Design?" Human Relations 50 5 (1997): 567-583. Graham, Laurel. “Lilian Gilbreth and the Mental Revolution at Macy's, 1925-1921 305. Journal of Management History 6 (2000): 285— Interesting study that shows how Lillian applied motion study to Macy's department store after Frank’s death and struggled to keep these ideas alive, Therefore, she had to focus on “the human element,’ and she worked hard to convince Macy's executives thal, to achieve a ‘mental revolution, they must stop blaming the lower-level employees. Available online for purchase or by subscription. Graham, Laure. ‘Lilian Gilbreth and the Mental Revolution at Macy's, 1925-1928." Journal of Management History 6 (2000): 285-30. Mousa, Fariss T, and David J. Lemak. “The Gilbroths’ Quality System Stands the Test of Time.” Journal of Management History 15.2 (2009): 198-215. This manuscript gives an overview of the life and work of Frank and Lillian Gilbreth, The authors seek to compare time and motion study to'a number of mare current process improvement methods (2. lean manufacturing) while suggesting that motion and time study could be added as a supplement, or even considered as a replacement to certain madern process management systems. Available online for purchase or by subscription Mousa, Fariss T. and David J. Lemak. “The Gilbreths’ Quality System Stands the Test of Time.” Journal of Management History 15.2 (200): 198-215. Price, Brian, “Frank and Lillian Gilbreth and the Manufacture and Marketing of Motion Study, 1908-1924.” Business and Economic History 18 (1989): 1~12. ‘The author argues that Frank and Llian’s fame and reputation mainly is due to their abundant efforts to advertise themselves and their work (e.g.,as humane scientist), rather than to the intrinsic quality oftheir motion study techniques they developed. The article further presents how Frank worked hard on separating his work from Taylor's and how he and Lillian had to realign the positioning of their work ina constantly changing environment, Price, Brian. “Frank and Lillian Gilbreth and the Manufacture and Marketing of Motion Study, 1908-1924." Business and Economic History 18 (1989): 1-12. Applied Exercises In-class, or hands-on, activites are also extremely important to anyone learning about he principles of classical management. Such exercises help reinforce the students understanding and appreciation of the topic at hand, namely, time and motion study. Peterson 2007 develops a simple but effective exercise to do just that Peterson, Dan W. “The Bread and Butter of Classical Organizational Approaches: The Time-and-Motion Study.” Communication Teacher 24.1 (2007): 21-26. ‘Auuseful in-class exercise to help students find the one best way of spreading butter on bread to demonstrate organizational issues related to the mechanistic metaphor of organizing (e.g., specialization, standardization, and predictability), Available online for purchaseor by subscription, Peterson, Dan W. "The Bread and Butter of Classical Organizational Approaches: The Time-and-Mation Study.” Communication Teacher 21.4 (2007): 21-26. Motion and ‘ime Study in Medical Practice Medical practice has become a significant area for carrying out time and motion studies. Frank Gilbreth was extremely interested in this field, in which he filmed and studied surgical operations. For instance, one af his observations led to a technique thathe developed while ‘working with doctors, and itis stl in use today. When a surgeon is performing surgery, and is ready for a new instrument, he or she simply extends his or her hand, palm up, and calls to the nurse forthe instrument needed, Such a technique allows surgeons to keep their eye focused on the open incision, instead of having to scramble and search for the tools themselves. These techniques helped to reduce operating time, which is important for doctors and patients, and lead possibly to better results. Studies have been undertaken that characterize the movement of physicians, nurses, and other clinicians, These have been done to create a baseline for further changes in procedure, equipment, medical personnel, or customers (e.g, the change in patients for pediatricians during the baby boom). Many comparison studies have also been done on pre-and postaddition of technology, new procedures, or added personal. The aim has been to try to find the benefis from these changes or to document the new activites that result. In some cases, recommendations based fon the observations from time and motion studies either have remained as suggestions only or have been implemented and evaluated, Medical time and motion studies often use activites inthe place of motion to study the time spentin actives, while others actually tack the motion in search ofimprovements. In some cases itis difficult to separate the type of study from the subject of te study and, thus, studies have been grouped under the medical procedure, as in the case of medical delivery systems (contains some comparative improvement and some activity ime characterization). Medical Process Record Keeping ‘The increased prevalence of electronic records and prescription systems has led to a desire to understand the effect ofthis new technology on the work patterns, work flows, and work time of various medical personnel. These studies invalve, in part, categorizing the activities as a percentage ofthe work day; they are purely prescriptive in nature. Other studies seek to offer suggestions to make the processes more efficient and thus are more prescriptive in nature. Sill others actually look at the results ofa change in the system, such as a change that was put n place to achieve more efficiency and effectiveness. Yen, et al. 2009 looks at using computers for physician orders in an emergency department and how doing so can help or hurt patient care. Quach, et al, 2011 looks at pandemic immunizations ‘and how to increase throughput. Pizziferr, et al. 2005 takes the approach of a betore-and-aftr study dealing with the implantation of electronic health records (EHRs) to address the concems of adopters involving a slowdown in record keeping. Hollingworth, et al. 2007 ‘also looks at his concern with e-prescriptions and finds no time increase with the electronic system. This finding stands in contrast to that of Devine, etal, 2010 on electronic prescriptions, which shows thatit took longer than previous paper methods, However, quality control Increased, thus increasing safety. Dwibedi, et al. 2011 employs a pre-post ime and motion study on nurses’ activities with medication administration in finding that administrative time decreased in using bar code-assisted medication administration. In looking at record- keeping time differences in optometry, the difference between electronic and paper base was not statistically diferent (Abdul, eta 2010), Finally Lo, etal. 2007 looks at specialist ime and EHRs and finds that he differences were not significant. Abdul, Shabbir S., Luai A. Ahmod, Rachapalle R. Sudhir, Jeremiah Scholl, and Der-Ming M. Liou. “Comparison of Documentation ‘Time botwoon an Electronic and a Paper-Based Record System by Optometrists at an Eye Hospital in South India: A Time-Motion Study.” Computer Methods and Programs in Biomodicino 100.3 (2010): 283-288. In this study the authors wanted to compare the time efficiency of documentation between electronic and paper records in a hospital in a developing country, The results find that the time differences were insignificant, Available online for purchase or by subscription. Abdul, Shabbir S,, Luai A. Ahmed, Racnapalle R. Sudhir, Jeremiah Scholl, and Der-Ming M. Liou. “Comparison of Documentation Time between an Electronic and a Paper-Based Record System by Optometrists at an Eye Hospital in South India: A Time-Motion Study. ‘Computer Methods and Programs in Biomedicine 100.3 (2010): 283-288,Devine, Emily B., William Hollingworth, Ryan N. Hansen, et al. “Electronic Prescribing at the Point of Care: A Time-Motion Study in the Primary Care Setting." Health Services Research 45.1 (2010): 152-171 ‘The purpose of this study was to evaluate prescribing time between handwritten and electronic e-prescriptions, and e-prescriptions Ltlizing several hardware configurations, Results were very interesting. For example, e-prescribing takes longer than handwriting; also, e-prescribing at the point of care takes longer than e-prescribing in offices and workstations. However, the improvements in safety and quality might be worth it Avallable online by subscription. Devine, Emily B., William Hollingworth, Ryan N. Hansen, etal. Electronic Prascribing at the Point of Care: A Time-Motion Study in the Primary Care Setting.” Health Services Research 45.1 (2010): 152-171 Dwibedi, Nilanjana, Sujit S. Sansgiry, Craig P. Frost, et al. “Effect of Bar-Code-Assisted Medication Administration on Nurses’ Activities in an intensive Care Unit: A Time-Motion Study.” American Journal of Health-System Pharmacy 68.11 (2011): 1026- 1031. Appre-posttime and motion study was conducted on nurses’ activities with paper-based medication administration (pre) and with bar code-assisted medication administration (post). Five categories were used for the activtios observed: administration, direct patient care, indirect patient care, miscellaneous, and other, Administrative time decreased in the postobservation and direct patient care time increased. Available online for purchase or by subscription. Dwidedi, Nilanjana, Sujit S. Sansgiry, Craig P, Frost, etal. “Effect of Bar-Code-Assisted Medication Administration on Nurses’ Activities in an Intensive Care Unit A Time-Motion Study." American Journal of Health-System Pharmacy 68,11 (2011): 1026-1031, Hollingworth, William, Emily B, Devine, Ryan N. Hansen, et al. “The Impact of e-Prescribing on Prescriber and Staff Time Ambulatory Care Clinics: A Time-Motion Study.” Journal of the American Medical Informatics Association 146 (2007): 722-730, ‘Tne goal ofthis study was to compare praseribing times at throe ambulatory care sites in the Seattle area that used paper-based Prescribing, desktop, or laptop e-prescribing. E-prescribing was not found to increase the combined computer and writing time for prescribers. Hollingworth, William, Emily B. Devine, Ryan N. Hansen, etal. "The Impact of e-Preseribing on Preseriber and Staff Time in Ambulatory Care Clinics: A Time-Motion Study” Journal of the American Medical Informatics Association 14.6 (2007): 722-730. Lo, Helen G, Lisa P. Newmark, Catherine Yoon, etal. “Electronic Health Records in Specialty Care: A Time-Motion Study.” Journal of the American Medical Informatics Association 14.5 (2007): 609-615. Tris study applies time and motion study to assess the effect of using an EHR on special'sts' time, which is timely given that many specialists feel that EHRs could slow down their work substantially. Interesting findings, such that using EHR in specialty clinics did not, result in significant differences in clinic visit time. Lo, Helen G, Lisa P, Newmark, Catherine Yoon, etal. "Electronic Health Records in Specially Care: A Time-Motion Study.” Journal ofthe American Medical Informatics Association 14.5 (2007). 609-615. Pizziferri, Lisa, Anne F.Kittler, Lynn A. Volk, et al. “Primary Care Physician Time Utilization before and after Implementation of an Electronic Health Record: A Time-Motion Study.” Journal of Biomedical Informatics 38.3 (2005): 176-188. Even though the benefits of using EHRs include improved qualily, safety, and efficiency, combined with an increased ability to conduct, education and research, most primary care physicians in the United States (83 fo 95 percent) stl use traditional paper records to document and process clinical data, This study aims to address the main concem of physicians that EHRs may take longer to use than the taditional-based systems. Pizziferi Lisa, Anne F-Kittler, Lynn A. Volk, etal. “Primary Care Physician Time Uiilization before and after Implementation of an Electronic Health Record: A Time-Motion Study.” Journal of Biomedical Informatics 38 3 (2005): 176-188‘Quach, Susan, Jemila S. Hamid, Jennifer A. Pereira, et al “Time and Motion Study to Compare Electronic and Hybrid Data Collection Systems during the Pandemic (H1N1) 2009 Influenza Vaccination Campaign.” Vaccine 29.10 (2011): 1997-2003. ‘A very well done study that looks atthe first large-scale national study that included nine Canadian provinces and thiry-eight organizations that applied time and motion analysis o assess the amount of tme spent by immunization staffon the collection of H1N1 pandemic immunization data in 2009 to compare efficiencies between data collection systems. Available online for purchase or by subscription, Quach, Susan, Jemila S. Hamid, Jennifer A. Pereira, etal. Time and Motion Study to Compare Electronic and Hybrid Data Collection ‘Systems during the Pandemic (H1N1) 2008 Influenza Vaccination Campaign.” Vaccine 29.10 (2011): 1997-2003, ‘Yon, Kennith, Elizabeth L, Shane, Sachin S, Pawar, Nichole D. Schwendel, Robert J. Zimmanck, and Mare H. Gorelick.“ Study in a Pediatric Emergency Department before and after Computer Physician Order Entry.” Annals of Emergency Medicine 53.4 (2009): 462468. ‘This study aimed to clarify the impact of computer physician order entry on time allocation by pediatric emergency department care providers, Possibly the first study performed in a pediatric emergency department, this study also adds to the small amount ofliterature ‘on emergency medicine and the application of ime and motion studies. Available online for purchase or by subscription. ime Motion Yen, Kennith, Elizabeth L. Shane, Sachin 8. Pawar, Nichole D. Schwendel, Robert J. Zimmanck, and MarcH. Gorelick. “Time Motion Study in a Pediatric Emergency Department before and after Computer Physician Order Enty." Annals of Emergency Medicine 53.4 (2009): 462-488, Medicine Delivery Studies ‘Time and motion analysis has been applied to in the process of giving medication in the form of shots or through nasal inhalation. These studies compare variables such as the delivery equipment, the preparation need for the medication, or the characteristics of the patient group. The studies break the process into a learning phase (either the health care provider or the patients receiving the treatment), a dolivery phase, and a disposal phase. Some add a documentation phase to the overall procedure. Not surprisingly, the products that are designed for speed (e.g., auto injectors or premixed medication) are faster. These reduced times are translated to cost savings or increasing throughput of the process. Many of these studies constitute more time of activity than time and motion studies as the ‘observation ofthe micromotions is not present. Rebmann, etal. 2009 confirms the common belief that injections given with an auto- Injector proved faster than traditional and dual auto-injectors. Nickman, et al. 2010 finds similar results with different auto-injectors; however the mixing requirement for the injection pens can increase the overall ime, Further confirmation on reconstitution time driving the overall time of injection is found in Wiedenmayer, et al, 2008. Washington, etal, 2005 looks at the context of giving injections and, interestingly the family size being vaccinated did not influence total time. Finally, Pellisier, tal. 2000 documents the time savings per shot using time and motion techniques (about two minutes of clinic time saved for each shot eliminated). Nickman, Nancy A., Sandra W. Haak, and Jaewhan Kim. “Cost Minimization Analysis of Different Growth Hormone Pen Devices Based on Time-and-Motion Simulations.” BMC Nursing 9.6 (April 2010). ‘The authors ofthis paper studied the time ittakes to perform injections with four different products that delivered human growth hormone (GH), The process was divided into leaming how to use the devices, preparing the injection pens, administering the injection, ang storing the pen for nextuse, The rhGH formulations were in a premixed form and in a reconstitution required form, Nickman, Nancy A, Sandra W. Haak, and Jaewhan kim. "Cost Minimization Analysis of Different Growth Hormone Pen Devices Based ‘on Time-and-Motion Simulations.” BMC Nursing 9.6 (April 2010). ; James M, Paul M. Coplan, Lis Administration Process: Results of a Tim ‘A. Jackson, and Joseph E. May. “The Effect of Additional Shots on the Vacci -Motion Study in 2 Settings.” American Journal of Managed Care 6 (2000): 1038-1044. ‘This study used time and motion techniques to characterize and time the effect of shifting from individual to combination vaccines in a pediatric regime, Results were that in the two clinics 2.4 and 1,7 minutes were eliminated during the visit for each shot eliminated, Theauthors also found that preparation time was reduced and infant crying ime per injection eliminated. Available online by subscription, Pollissier, James M,, Paul M, Coplan, Lisa A. Jackson, and Joseph E. May. "The Effect of Additional Shats on the Vaccine Administration Process: Results of a Time-Motion Study in 2 Settings.” American Journal of Managed Care 6 (2000): 1038-1044, Rebmann, Terri, Bruce W. Clements, Jeffrey A. Balley, and R. Gregory Evans. “Organophosphate Antidote Auto-Injectors vs. ‘Traditional Administration: A Time Motion Study.” Journal of Emergency Medicine 37.2 (2008): 139-143. The paper reports on a time motion study for administering injections using an auto-injector with single injection, an auto-injector with two simultaneous injections, or traditional needle and syringe injection, The time was determined between the removal ofthe safety cap and the removal ofthe needle from the patient's body. Results indicate that itis statistically faster to use the single injection auto-injector. Available online for purchase or by subscription. Rebmann, Terri, Bruce W. Clements, Jeffrey A. Bailey, and R. Gregory Evans. “Organophosphate Antidote Auto-Injectors vs. Traditional ‘Administration: A Time Motion Study.” Journal of Emergency Medicine 37.2 (2009): 139-143. Washington, Michae! L,, Sharon G. Humiston, Peter B. Fauerbach, et al Vaccination in Healthy Children.” Vaccine 23.40 (2005): 4879-4885, A study comparing the six variables of giving an influenza vaccination to children from age one to eighteen using a nasal spray. The six steps measured were explaining the product and process to the patiants/guardians, obtaining the vaccine, preparing the vaccine, administering the vaccine through spraying into both nostrils, veiying the completion of the process, and disposing ofthe vaccine container. Available online for purchase or by subscription. ‘A Personnel Time-Motion Study of intranasal influenza Washington, Michael L., Sharon G. Humiston, Peter B. Fauerbach, etal. “A Personnel Time-Motion Study of Intranasal Influenza Vaccination in Healthy Children.” Vaccine 23.40 (2005): 4879-4885, Wiedenmayer, Karin A., Svenja Weiss, Chandon Chattopadhyay, et al. HepB-Hib Combination Vaccine: Evidence from a Comparative Time-Motion Study in India.” Vacci Simplifying Paediatric Immunization with a Fully Liquid DTP- 27 (2008): 655-659. ‘A study comparing five steps in vaccinating children: obtain from storage, prepare vaccine, administer the vaccine, dispose of he needle, and document the vaccination. The time recorded was thirty-six seconds less for the vaccination that did not require reconstitution. Available online for purchase or by subscription. Wiedenmayer, Karin A. Svenja Weiss, Chandon Chattopadhyay, etal. “Simplifying Paediatric Immunization with a Fully Liquid OTP- HepB-Hib Combination Vaccine: Evidence from a Comparative Time-Motion Study in India.” Vaccine 27 (2008): 655-859. New Technology Introduction in Medical Practice Introduction of new technology into the workplace will often necessitate changes in work habits and procedures. This holds true for medical practice as well. One of the common questions asked in these studies is: will the new technology introduction result in a benefit to the patient? This can prove to be directly beneficial, as in the reduction of recovery time after surgery or itcan be more indirect, asin the ability to increase the number of patients who can be seen by a physician or serviced by a clinic. Sadowski and Broenink 2008 finds that new technology in esophageal manometry does reduce time. Kreulen, etal. 2000 looks at the industial process involved in manufacturing dental ceramic inlays, but time efficiencies were due mostly tothe skill ofthe individual and not from use of the new machine, Helyer and Helsig 1995 finds better times and, more importantly, fewer errors during radiotherapy with use of new techniques of creating shielding blocks, Helyer, S. J.,and S, Heisig, “Muttieaf Collimation versus Conventional Shielding Blocks: A Time and Motion Study of Beam ‘Shaping in Radiotherapy.” Radiotherapy and Oncology 37 (1995): 61-64.‘The difference between the work process times of different beam shaping during two types of radiotherapy was examined on fity radiation treatments. Using time and motion techniques, the authors determined that there was a time saving seen using the multleat collimation over the conventional shielding, thus allowing more time for seeing other patients and reducing errors due to patient ‘movement during the overall procedure. Available online for purchase or by subscription, Heyer S. J., and S. Heisig. ‘Multleaf Collimation versus Conventional Shielding Blocks: A Time and Motion Study of Beam Shaping in Radiotherapy." Radiotherapy and Oncology 37 (1995): 61-64. Kreulen, C.M., H. Moscovich, K.A. Dansen, and N. H. Creugers. “Time-and-Motion Study on Class Il Copy-Milled Ceramic Inlays.” Journal of Dentistry 28.6 (2000): 429-436. In this article, seven dentists and a dental technician were treated as factory workers ina time and motion study on the use of a class I! copy-mill in creating dental ceramic inlays for patients. The overall procedure was broken into measured steps of cavity preparations, taking an impression, laboratory stage (production of the ceramic inlay using the milling machine), fing and adjustment, and placement, Available online for purchase or by subscription, Kreulen, C. M., H. Moscovich, K.A. Dansen, and N. H. Creugers. “Time-and-Motion Study on Class II Copy-Mliled Ceramic inlays.” Journal of Dentistry 28.6 (2000): 429-436. ‘Sadowski, David C., and Linda Brosnink, “High-Resolution Esophageal Manometry: A Time Motion Study.” Canadian Journal of Gastroenterology 22.4 (2008): 365-368. ‘A study that examines the difference between two processes for conducing esophageal manomety by looking at four variables: setup, procedure, cleaning, and analysis. Results indicate that there is @ 25 percent decrease in using the newer high-resolution manometry over the water perfusion method. Each step, as well as the time for the whole procedure, was statistically significantly shorter for the newer method. ‘Sadowski, David C., and Linda Broenink. “High-Resolution Esophageal Manometry: A Time Motion Study Canadian Journal of Gastroenterology 22.4 (2008): 365-368, Where and on What Is Time Being Spent ‘To better understand the percentages of ime spent in activities by medical personnel, many studies have been done that have characterized the activities being performed and the extent of those activities. The broad classes of activities are generally direct patient care, indirect patient care, administration, personal time, and other tasks. By understanding what the percentages are for these activities and by using some heuristics or policy requirements, we can benchmark how well medical personnel are performing. mismatches ‘occur between whats expected and what is observed, observers can carry out follow-up work to tr to find the activites that are taking too long and apply effort to try to make these activities more efficient. Many of these papers give recommendations, but the majority record data collections of the status quo. Hollingworth, et al. 1998 documents how physicians and nurses spend their time in creating a benchmark for further study. Bergman, et al. 1966 looks at use of ime by pediatricians and finds that the staff atthe pediatriclan’s office had a major influence in the effcientuse of the doctor's time. Melgar, et al. 2000 baselines the activities for attending physicians to help determine policies to increase efficiency. This is also done in Were, etal, 2008 for how health care providers spend thelr time in an ‘African HIV clinic. The movements and tasks of dietitians are studied and categorized in Milosavijevc, etal. 2011, which may be used as a baseline for further changes and evaluation. Wirth, et al. 2009 looks at pharmacists to categorize thelr activites and finds that they spend the majority oftheir time in clinical activities. Hendrich, etal. 2008 uses the authors’ nursing database to understand the activities in hospital and to made recommendations on how to improve nursing practices. Finally, Tang, et al. 2007 studies the actives of both physicians and nurses in remotely monitoring ICU patients and finds that workflow interruption reduces the quality and efficiency of the clinicians’ work. Bergman, Abraham B., Steven W. Dassel, and Ralph J. Wedgwood. “Time-Motion Study of Practicing Pediatricians.” Pediatrics 38.2 (1966): 254-263.Early time and motion study of four practicing pediatricians with a goal of characterizing the percentage of each day spent with patients, fn the telephone, in consulting, doing paperwork, doing personal actions, ravel, and miscellaneous. Results indicated that the greatest amount of ime is spent seeing patients (48 percent), followed by time on the telephone (often talking with the family of patients). Available online by subscription. Bergman, Abraham B., Steven W. Dassel, and Ralph J. Wedgwood. “Time-Motion Study of Practicing Pediatricians.” Pediatrics 38.2 (1966): 254-263. Hendrich, Ann, Marilyn P. Chow, Bogusiaw A. Skiereztnski, and Zhengiange Lu. “A 36-Hospital Time and Motion Study: How Do Medical-Surgical Nurses Spend Their Time?.” Permanente Journal 12.3 (2008): 25-34. Avery comprehensive study group with thirty-six hospital medical-surgical units. Studies of a fotal of 767 nurses’ movements using four protocols (document each activity, document when requested, location tracked by radio-frequency identification, and automatic recording of parameters with an armband). Categories of activites used were nursing practice, unit-related functions, nonclinical activities, and waste. Locations were patient room, nurse station, on-unit, and off-unit, Hendrich, Ann, Marlyn P. Chow, Boguslaw A. Skierczinski, and Zhengiange Lu. “A 36-Hospital Time and Motion Study: How Do Medical- ‘Surgical Nurses Spend Their Time?.” Permanente Journal 12.3 (2008): 25-34 Holingworth, J. C., C.D, Chisholm, B. K, Giles, W. H, Cordell, and D, R, Nelson, “How Do Physicians and Nurses Spend Their Time in the Emergency Department?" Annals of Emergency Medicine 31.1 (1998): 87-91, ‘Tne authors apply time and motion analysis ata thirly-six-bed emergency depariment with an annual census of eighty-four thousand in a central city teaching hospital to investigate how physicians and nurses spend their ime. The study found that emergency physicians and ‘nurses spent almost half their time on indirect patient care activities. Available online for purchase or by subscription. Hollingworth, J.C., C. D. Chisholm, B. K. Giles, W. H. Cordell, and D. R. Nelson. “How Do Physicians and Nurses Spend Their Time in the Emergency Department?" Annals of Emergency Medicine 31.1 (1998): 87-91 Melgar, Thomas, Howard Schubiner, Robert Burack, Anil Aranha, and Joseph Musial. “A Time-Motion Study of the Activities of Attending Physicians in an Internal Medicine and Internal Medicine-Pediatrics Resident Continuity Clinic.” Academle Medicine 75.14 (2000): 1138-1143. ‘Attending physicians’ activities were studied using time and motion techniques to determine how they spent their work activities, The activities were categorized as clinic operations, residency, personal andior professional, and miscellaneous. The authors indicate that these descriptive results can help in determining policy designed to increase efficiency in dealing with increasing numbers of patients to be seen, Melgar, Thomas, Howard Schubiner, Robert Burack, Anil Aranha, and Joseph Musial. "A Time-Motion Study of the Activities of Attending Physicians in an internal Medicine and intemal Medicine-Pediatrics Resident Continuity Clinic." Academic Medicine 75.11 (2000): 1138— 1143. Milosavijevic, Marianna, Peter Willams, Geraldine Perez, and Tegan Dalla. “The Results of a Pilot Time-and-Motion Study in Three ‘Australian Hospitals: Where Do We Spend Our Time?” Nutrition & Dietetics 68.3 (2011): 185-188. ‘Atime and motion study was done to characterize where nine dietitans spent thelr ime during a typical working shif. The categories. ‘wore in patient contact, patient suppor activities, administrative tasks, research and education, and travel and miscellaneous tasks. The authors provide descriptive information that may be used in further research (e.g., on improving the efficiency of the dietitians). Available online far purchase or by subscription, Milosavijevic, Marianna, Peter Willams, Geraldine Perez, and Tegan Dalla, “The Results ofa Pilot Time-and-Motion Study in Three Australian Hospitals: Where Do We Spend Our Time?" Nutrition & Dietetics 68.3 (2011): 185-188,‘Tang, Zhihua, Liza Weavind, Janine Mazabob, Eric J. Thomas, Ming Ying L. Chu-Weininger, and Todd R. Johnson. “Workflow in Intensive Care Unit Remote Monitoring: A Time-and-Motion Study.” Critical Care Medicine 35.9 (2007): 2057-2063. Physicians’ and nurses’ tasks and activities were studied in a remote monitoring unit at an ICU remote monitoring facility. The activites were categorized as patient monitoring, collaboration, system maintenance, maintaining health records, and administrative/socialipersonal tasks. The major issues in the quality and efficiency ofthe clinicians’ work were found to be due to ‘workflow interruption, clinical information system usability, and collaboration with the bedside caregivers, Tang, Zhinua, Liza Weavind, Janine Mazabob, Eric J. Thomas, Ming Ying L. Chu-Weininger, and Todd R.. Johnson. “Workflow in intensive Care Unit Remote Monitoring: A Time-and-Motion Study Critical Care Medicine 35.9 (2007): 2087-2063, Wore, M.C., J.M. Sutherland, M. Bwana, J. Ssall, N.Emenyonu, and W. M. Tlornoy. Uganda, Africa: A Time-Motion Study.” AIDS Care 20.6 (2008): 677-682. attorns of Care in Two HIV Continuity Clinics in Using personal digital assistants, the authors recorded activity times for two HIV continuity clinics to find where the health care providers spent their time. Results indicated that there were differences between the two clinics, indicating that efficiency gains could be made at each. Even with minimal equipment, studies are possible in the field that may lead to Improvements that can inerease the throughput of these clinics. Available online for purchase or by subscription. Were, M.C.,J.M. Sutherland, M. Bwana, J. Ssali, N. Emenyonu, and W. M. Tiemey. ‘Patterns of Care in Two HIV Continuity Clinics in Uganda, Attica: A Time-Motion Study” AIDS Care 20.6 (2008): 677-682 Wirth, Francesca, Lilian M. Azzopardi, Marise Gaucl, Maurice Zarb Adami, and Anthony Serracino-Inglott. “Time and Motion Study for Pharmacists’ Activities in a Geriatric Hospital.” International Journal of Pharmacy Practice 17.6 (2009): 373-376, ‘Time and motions techniques were used to determine the categorization and percentages of time spentby the pharmacists. The categories used were clinical activities (60.6 percent), administration activities (27.4 percent), and other activities (12.0 percent). Results indicated that the pharmacists spent the majority of their time in clinical activities. There is a large burden of administrative actions that should be examined for efficiencies or elimination, Available online for purchase or by subscription, Wirth, Francesca, Lilian M, Azzopardi, Marise Gauci, Maurice Zarb Adami, and Anthony Serracino-Inglott, “Time and Motion Study for Pharmacists’ Activities in a Geriatric Hospital.” International Joumal of Pharmacy Practice 17 6 (2009): 373-376. Gaining Efficiency to Serve More Patients ‘These studies either call for creating these efficiencies or actually complete the loop and make solid recommendations that will advance efficiency with the goal of increasing the number of patients who can be served. n this way, fewer delays in conducting procedures will occur, and this may lead to fewer complications due to delays. Another reason to raise the number of patients seen is to meet the possibilty that the number of medical personnel in that specialty wil decrease while the number of potential clients increases. In both cases, efficiencies will improve the situation. Ross 1966 makes the case that to ensure that pediatricians can serve a growing number of patients, they should use time and motion studies to discover and create efficiencies, Harewood, etal. 2008 uses the concept of efficiency quotient to characterize endoscopic practices with improving efficiency as the goal, Hendrich, et al. 2009 uses architectural special analysis to find the design characteristics that wil help in more efficiently designing and arranging patient rooms and nursing stations. Joch 2008 constitutes an interview with Marilyn Chow, which adds insight to conducting time and motion studies in the hospital environment. Harewood, Gavin C., Kristia Chrysostomou, Naila Himy, and Wai Ling Leong. “A ‘Time-and-Motion’ Study of Endoscopic Practice: Strategies to Enhance Efficiency.” Gastrointestinal Endoscopy 68.6 (2008); 1043-1050. ‘A study of the endoscopy suite at a teaching hospital was performed to determine the efficiency quotient. The durations of he following parts of the procedure were measured: patient time in the suite, preprocedure, procedure, postprocedure, and interval between patients.Several recommendations for improving efficiency were presented, A good example of time and motion studies leading to overall ficiency and recommendations for procedural changes. Available online for purchase or by subscription. Harewood, Gavin C., Kristia Chrysostomou, Naila Himy, and Wai Ling Leong. “A Time-and-Motion’ Study of Endoscopic Practice: Strategies to Enhance Efficiency.” Gastrointestinal Endoscopy 68.6 (2008): 10431050. Hondrich, Ann, Marilyn P. Chow, Sonit Bafna, Ruchi Choudhary, Yeonsook Hoo, and Boguslaw A. Skiorczynski. “Unit-Related Factors That Affect Nursing Time with Patients: Spatial Analysis of the Time and Motion Study.” Health Environments Research & Design Journal2.2 (2009): 5-20. ‘This study looks at the special aspect ofthe medical-surgical nurses’ movement to make recommendations on medical unit layout. The collected data determined that a more centralized geometry of assigned patients’ rooms and the nursing station correlated with more {otal ime spent in patients’ roams. The findings call for recommendations for planning medical units or optimizing nursing assignments in current units, Hendrich, Ann, Marilyn P. Chow, Sonit Bafna, Ruchi Choudhary, Yeonsook Heo, and Boguslaw A. Skierczynski “Unit Related Factors ‘That Affect Nursing Time with Patients: Spatial Analysis of the Time and Motion Study” Health Environments Research & Design Journal 2.2 (2008): 5-20. Joch, Alan, “It's About Time and Motion: Study Reveals How to Improve Nurses" Productivity and Efficiency.” Materials ‘Management in Health Care 17 (September 2008): 15-17. Joch interviews Marilyn Chow about conducting the study used in the two previous papers. Its of interest here because Chow talks about the social and cultural aspects of planning and conducting a time and motion study. Recommendations for how to look at the results of the above study are given as well as how the subjects reacted to doing the study. Joch, Alan. Its About Time and Motion: Study Reveals How to Improve Nurses’ Productivity and Efficiency” Materials Management in Health Caro 17 (September 2008): 15-17. Ross, Ralph A. “Time, Motion, and Pe: atric Practice.” Pediatrics 38.2 (1966): 165-166. Ross makes a call for more scientific management, in particular time and motion studies to be done in the area of pediatric practice. The growing number of patients is reducing face-to-face contacts between the patients and the pediatricians. The author believes that, by Using time and motion studies, pediatricians will be able to use their time more efficiently and thus will have more time for patients Available online for purchase or by subscription Ross, Ralph A. “Time, Motion, and Pediatric Practice.” Pediatrics 98.2 (1966): 165-166. Before-and-After-Comparison Medical Studies ‘Tne addition of medical personne! who bridge the traditional space between physicians and nurses can theoretically have benefits for the patients serviced. These benefis can include more time with patients or the ability to serve more patients. These studies look at the addition of nurse practiioners and physician assistants and at the use of tachnology to allow more patients to be virtually seen. All give before-and-after results in activites of the original personnel. Kahn and Wirth 1975 finds that even with savings of ime from having more advance medical personnel in the office, the extra time was not consistently used to increase the number of patients being served. Sells, and Herdener 1975 also looks at more advanced medical personnel assigned to a physician's office, The authors find that although this helped in number of patients being served, the quality of service in dealing with emotionally based problems did not increase, Finally, Cady, etal. 2010 looks al more advanced decision systems to assist home monitoring of transplant patients, which did reduce the time required to effectively monitor patients but required new skils for the monitoring personnel.Cady, Rhonda, Stanley Finkelstein, Bruce Lindgren, et al. “Exploring the Translational Impact of a Home Intervention Using Time-Motion Study.” Telemedicine and e-Health 16.5 (2010): 576-584. ‘Atime and motion study was used to determine the effect of introducing new technology in the home monitoring of lung transplant patients, The new technology employed a clinical decision support that uses a Bayesian predictive model to generate an alertin the home monitoring data, which will rigger further analysis and potentally additional follow-up. Available online for purchase or by subscristion, Cady, Rhonda, Stanley Finkelstein, Brice Lindgren, etal. “Exploring the Translational Impact of a Home Talemonitoring Intervention Using Time-Motion Study.” Telemedicine and e-Health 16.5 (2010): 576-584. Kahn, Lawrence, and Patrica Wirth, “The Modification of Pediatrician Activity Following the Addition of the Pediatric Nurse Practitioner.” Pediatrics 55.5 (1975): 700-708. ‘Time and motion study was done to characterize the pre- and postintroduction of @ pediatric nurse practitioner (PNP) at three pediatricians’ offces and in an emergency room. In all cases, the doctors gained time in the working day due to the presence of the PNP. However, diferences were found in how this ofloaded time was spent that were highly dependent on the physician present. Available online for purchase or by subscription, Kahn, Lawrence, and Patrica Wirth. “The Modification of Pediatrician Activity Following the Addition of the Pediatric Nurse Practitioner: Pediatrics 85.5 (1975): 700-708. Solls, Clifford J., and Richard 8, Herdener. “Medex: A Time-Motion Study.” Pediatrics 56.2 (1975): 255-261. ‘Time and motions study was done to characterize the impact of adding a Medex ([ormer military corpsmen, nurses, and other qualified Individuals to work with family practitioners when tained as physician's assistants), Activities were classified into the areas of personal and miscellaneous (38 percent), with patients (30 percent), doing paperwork (15 percent), in consultations (3 percent), on the telephone (G percent), in ab or X-ray (2 percent), and traveling (2 percent). Available online for purchase or by subscription. Sells, Clifford J,, and Richard S, Herdener. “Medex: A Time-Motion Study." Pediatrics 56.2 (1975): 255-261 Gathering Information for Improving Cost Accounting ‘As the health insurance industry has evolved, so has the art of medical procedures, The billing procedures that once may have served as fan accurate measure oftime and materials in medical practice no longer accurately reflect the actual cost. The following papers look at establishing baselines for the cost and seek to more accurately portray the cost to the individual, the institution, and society. Henry, etal 2007 uses time and motion study to determine total colonoscopy costs. Van de Werf, et al. 2008 studies the different conditions that take place during radiotherapy. Henry, Stephen G., Reid M. Ness, Renee A. Stiles, Ayumi K. Shintani, and Robert S. Dittus. “A Cost Analysis of Colonoscopy Using Microcosting and Time-and-Motion Techniques.” Journal of General Internal Medicine 22.10 (2007): 1415-1421 ‘The authors use time and motion study to find the microcosting of a colonoscopy procedure at two medical facilities, Using the results from this study the authors were able to determine the total colonoscopy cost to the individual, the instituton, and society, These more accurate cost results can help inform health policy decisions, Henry, Stephen G., Reid M. Ness, Renee A. Stiles, Ayumi K. Shintani, and Rober S. Dittus."A Cost Analysis of Colonoscopy Using Microcosting and Time-and-Motion Techniques.” Journal of General Internal Medicine 22.10 (2007): 1415-1421, van de Werf, Evelyn, Yolande Lievens, Jan Verstraete, Kris Pauwels, and Walter van den Bogaert. “Time and Motion Study of Radiotherapy Delivery: Economic Burden of Increased Quality Assurance and IMRT.” Radiotherapy and Oncology 93.1 (2009):137-140, ‘Tne timing was taken from the entry ofthe patient into the treatment room until the individual lef. lems recorded include the type of quality assurance and whether an electronic portal imaging device or intensity modulated radiation therapy was used. This was done with the end goal to improve the model of treatment time and thus improve the activity-vased costing for the procedure. Available online {for purchase or by subscription. van de Werf, Evelyn, Yolande Lievens, Jan Verstraete, Kris Pauwels, and Walter van den Bogaert. “Time and Motion Study of Radiotherapy Delivery: Economic Burden of Increased Quality Assurance and IMRT” Radiotherapy and Oncology 93.1 (2008): 137—140. Emergency Medical Transportation and Initial Patient Contact A close relationship exists between the time of a medical emergency event, the recognition of that event, the initiation of medical care, and the survival chances of a patient. These next studies look atthe speed at which patients are seen by the physician, the information that s received in transit that can help the preparations for a patient, and the turnaround time so as to enable the ambulance to serve other patients. Penner, etal. 2003 sets a baseline for further comparison in the ambulance and triage staff communication with the resulting initial patient care. Cone, etal. 1997 furthers this work in looking at the tumaround intervals for ambulances and setting baseline data to use in comparison with future process improvement. Finally, Or, etal. 2007 examines the relationship between a pregnant woman's being first seen and fetal and maternal death, with an eye toward making Improvements that can save lives. Cone, Davic C., Steven J. Davidson, and Que Nguyen. “A Time-Motion Study of the Emergency Medical Services Turnaround Interval." Annals of Emergency Medicine 31 2 (1997): 241-248, Ambulance tumaround intervals were determined by observing events at the emergency entrance and in the emergency rooms of the hospitals as well as the postdelivery actions in the emergency vehicle. Using ime and motion techniques, the authors broke down into smaller movements the turnaround interval and, thus, made possible identification of where improvements could be made. Available online for purchase or by subscription, Cone, Davie C., Steven J. Davidson, and Que Nguyen. "A Time-Motion Study of the Emergency Medical Services Tumaround Interval.” Annals of Emergency Medicine 31.2 (1997): 241-246. Or, Ernest ©., Ebenezer O. Ojofeitimi, Adebanjo B. Adeyemi, Adepeju O. Esimai, Ebun Adejuyigbe, and Olbimpe 0. Owolabi.“Time- Motion Study of Obstetric Emergencies in a Teaching Hospital.” Journal of the Turkish-German Gynecology Association 8 (2007): 172-476. ‘Tris study looks at the time intervals between when a pregnant woman entered the obstetrics unit ata teaching hospital when she was first interviewed by a doctor and the results ofthe delivery for the mother and fetus, Longer times between arrival and being interviewed, and between the decision and commencement of a caesarean section, was correlated to fetal death and matemal death. Oi, Emest O., Ebenezer O. Ojoteitmi, Adebanjo B. Adeyemi, Adepoju O. Esimai, Ebun Adejuyigbe, and Olbimpe O. Owolabi. “Time- Motion Study of Obstetric Emergencies in a Teaching Hospital” Journal of the Turkish-Gorman Gynecology Association 8 (2007): 172— 176. Penner, Mark S., David C. Cone, and Don MacMillan, “A Time-Motion Study of Ambulance-to-Emergency Department Radio Communications.” Prehospital Emergency Care 7 (2003): 204-208, ‘This is a study in which time and motion recording techniques were used to characterize what is happening in a procedure but thats aimed at not necessarly tying to improve the procedure. The authors employed these data in a social scientific manner in using oscriptive statistics to verify that radio messages were not acted upon by emergency depariment personnel on nonpriorty, single patient deliveries. Available online by subscription. Penner, Mark S., David C. Gone, and Don MacNillan. “A Time-Motion Study of Ambulance-to-Emergency Department Radio Communications.” Prehospital Emergency Care 7 (2003): 204-208.Newborn Intensive Care Similar to other health-related areas, financial constraints on care systems have forced clinicians and managers to pay greater attention to the economic evaluation to be able to successfully redirect resources into the highest yield therapies. Newborn intensive care is no diferent, but only a few of ts therapies have been subjected to careful analysis. Therefore, much more research is needed. The following studies shed light on some of the research inthis feld. Tyson, etal, 1981 and Williams, et al. 1993 focus on the activites of nurses using different observation methods. The Northem Neonatal Network 1993 gives guidance on care requirements based on five test criteria, thus allowing for better nurse scheduling Northern Neonatal Network. “Measuring Neonatal Nursing Workload.” Archives of Disease in Childhood 68.5 (1993): 539-543. Direct observation of nursing time in several care levels of premature newboms took place in 1983 and 1989, This study identified five simple criteria that would indicate more time being required by attending nurses, Criteria are respiratory suppor, oxygen requirements, Intravenous fluid intake, weight, and needs for stoma or drains. Staffing requirements are determined using a simple test of the babies in the neonatal unit. Nortnem Neonatal Network. “Measuring Neonatal Nursing Workload.” Archives of Disease in Childhood 68.5 (1993): 539-543. ‘Tyson, Jon E,, John E. Clarkson, John C. Sinclair, and Rosemary Leitch, “Analysis of Newborn Intensive Care by Time-Lapse Photography.” Critical Care Medicine 9.11 (1981): 780-784, One of the original studies on the topic that focused on recording the activiies of nurses and physicians using time-lapse photography, ‘This study was conducted during a period before the introduction of neonatal intensive care. Available online for purchase or by subscription ‘Tyson, Jon E., John E. Clarkson, John C. Sinclair, and Rosemary Leitch. “Analysis of Newborn Intensive Care by Time-Lapse Photography.” Critical Care Medicine 9.11 (1981): 780-784, Wiliams, S.,A. Whelan, A. M. Weindling, and R, W. Cook Disease in Childhood 68.5 (1993): 534-538, lursing Staff Requirements for Neonatal intensive Care.” Archives of British nurses recorded their own time in this study while caring for forty-five infants, This study was also conducted before the widespread use of exogenous surfactant and newer modes of ventilation, Williams, S., A. Whelan, A. M. Weindling, and R. W. Cooke. “Nursing Staff Requirements for Neonatal intensive Care.” Archives of Disease in Childhood 68.5 (1993): 534-538, Time and Motion Study with Unique Outcomes ‘Some time and motion studies do not readily it standard categorization, but they are valuable in that they show some unique ways of applying this methodology or learning from its findings, A good example of a study that used archived footage ofa procedure and applied time and motion study techniques to improve the procedure or results is Tebbetts 2002. The analysis resulted in procedures that enabled 96 percant of patients who undertook breast augmentation surgery in the final part ofthe study in 1998 to 2000 to resume normal activities twenty-four hours after the operations. Attimes efficiency is not the goal; rather, patient comfort is sought, as evidenced iin reducing recovery time after surgery. At other times itis a real-time display thats employed in analyzing motion much like that in athletes, but with the aim to prevent motions that may harm patents after surgery. Otake, etal, 2005 focuses on injury prevention. The results of time and motion study can also inform observers of the skils needed in personnel when new technology is implemented, thus facilitating provision of the right training with the changes in workflow (Lindquist, et al. 2011). Finally, Spielholz, et al.2008 shows how time-motion video analysis can be used in the design process and, thus, produce designs that reduce operator fatigue and the probability ofrepetitve-type movement injuries.Lindquist, Ruth, Arin van Wormer, Bruce Lindgren, Kathleen MacMahon, Willam Robiner, and Stanley Finkelstein. “Time-Motion Analysis of Research Nurse Activities in a Lung Transplant Home Monitoring Study.” Progress in Transplantation 21 3 (2011) 190-199. Indoing a time and motion study of research nurses to evaluate the home-monitored data on lung transplant patients the authors identifed a skil set that will improve the monitoring and evaluation process. These skills consist of data management, computer use, and interprofessional communication, Activites fall nto the following categories: data review, computer, e-mail, clinic, mailletters, phone calls, verbal face-to-face meetings, organizational, and other. Available online for purchase or by subscription Lindquist, Ruth, Arin van Wormer, Bruce Lindgren, Kathleen MacMahon, William Robiner, and Stanley Finkelstein. “Time-Motion Analysis, of Research Nurse Actvities in a Lung Transplant Home Monitoring Study” Progress in Transplantation 21.3 (2011): 190-199, Otake, ¥., N. Suzuki, A. Hattori et al, “Real-Time Motion Analysis for Patients after Total Hip Arthroplasty by Using 4-Dimensional Patient-Specific Model.” International Congress Series 1281 (2005): 696-701. real-time motion analysis system that allows for time and motion study of patients after total hip arthroplasty is shown to help patients lear to avoid motion that could lead to hip dislocation. This use oftime and motion study does not have the traditional goal of allowing {or greater efficiency. Here the goal is to prevent injury, and less eficient actions are allowed ifthey support this goal. Available online for purchase or by subscription, Otake, ¥,N. Suzuki, A. Hattori, etal. “Real-Time Motion Analysis for Patients after Total Hip Arthroplasty by Using 4-Dimensional Patient- Specific Model.” International Congress Series 1281 (2008): 696-701, Spietholz, Peregrin, Ninica Howard, Ernesto Carcamo, and Bruce Coulter. “Field Evaluation of a New Grocery Checkstand Design.” Applied Ergonomics 39.1 (2008): 87-91. ‘Time and motion study was conducted on a simulated grocery checkout workstation (both old and new design) to determine the usability and efficiency gain in the new arrangement. Results found that wrist flexion duration and repetition were reduced, thus lessoning the fatigue of the operator. This demonstrates the utility ofthe new design. Available online for purchase or by subscription. Spletholz, Peregrin, Ninica Howard, Emesto Carcamo, and Bruce Coulter, “Field Evaluation of a New Grocery Checkstand Design” Applied Ergonomics 39.1 (2008): 87-91, \chieving a Predictable 24-Hour Return to Normal Activities after Breast Augmentation: Part |, Refining Practices by Using Motion and Time Study Principles.” Plastic Reconstruction Surgery 109.1 (2002): 273-290. Movies of cosmetic surgical procedures from the 1980s and 1990s were used to determine where reduction of ime could be achieved and thus optimize movements to reduce time under anesthesia, reduce surgical trauma, and thus reduce perioperative morbidity. Available online by subscription ‘Tebbetts, John B. “Achieving a Predictable 24-Hour Return to Normal Activities after Breast Augmentation: Part |. Refining Practices by Using Motion and Time Study Principles.” Plastic Reconstruction Surgery 109.1 (2002): 273-290. Process Operation Agriculture ‘Time and motion study has been applied to various areas in agriculture, An unlimited number of applications can be imagined after reading the two studies below. Therefore, time and motion management would seem to be extremely beneficial not only, for example, to Improve the quality and quantity of milking performance as the authors of Armstrong and Quick 1986 accomplish in their study, but also to enhance any work routine or system used currently in agriculture. Sweeten and Reddell 1978 focuses on feedlot manure collection systems and the application of motion study to improving such a system. This is especially critical given the challenges agriculture will face in the next decades from feeding a growing population to encouraging sustainable agricultural practices.‘Armstrong, Dennis V, and A.J. Quick. “Time and Motion to Measure Milking Parlor Performane (1986): 1169-1177. Journal of Dairy Science 69 ‘The purpose of this study was to apply time and motion studies to help institute time for work routine in milking pariors. All data were recorded using a stopwatch, Data established from work routine studies can ultimately help to determine the number of cows that can be milked per hour by each operator, Available online for purchase or by subscription, Armstrong, Dennis V., and A. J. Quick. "Time and Motion to Measure Milking Parlor Performance.” Joumal of Dairy Science 69 (1986) 1169-1177. ‘Sweeten, John M. and Donald L. Reddell, “Time-Mation Analysis of ASAF22 (1973): 138-143. Jedlot Manure Collection Systems.” Transactions of the The objective of the authors was to apply time and motion analysis at four Texas cattle feedlots in order to compare different manure collection systems on the basis of machine productivity, energy, consumption, and cost, and to evaluate the productivity, cost, and operator performance for loading manure trucks and determine the time required to haul and spread manure. ‘Sweeten, John M,, and Donald L. Reddell."Time-Motion Analysis of Feedlot Manure Collection Systems.” Transactions of the ASAF 22 (1979): 138-143. Process Operation ‘Tne articles here focus on improving certain processes in diferent organizations. The authors of these studies did not stop at simply identifying problems and botlenecks; rather, they went one step further in developing anew system (e.g, collection) that could be putin, place that corrects eater weaknesses. Al-Saleh 2011 focuses on motor vehicle inspection systems while Aremu, et al. 2010 deals with solid waste collection systems. The results make for good applied studies that may be used for instuuction At-Saleh, Khalid S, “Productivity Improvement of a Motor Vehicle Inspection Station Using Motion and Time Study Techniques.” Journal of King Saud University—Engineering Sciences 23 (2011): 33-41. ‘This study aimed to evaluate the workllow and increase the productivity in a molor vehicles periodic inspection station in Riyadh, Saudi Azabia, specifically in the hopes of enhancing the bottleneck inspection point by utizing diverse applications to reduce inspection time. Av-Saleh, Khalid S. “Productivity Improvement of a Motor Vehicle Inspection Station Using Motion and Time Study Techniques.” Journal of King Saud University—Engineering Sciences 23 (2011): 33-41 ‘Aremu, AdeniyiS,, James R. Mihelcic, and B. F, Sule, “Time and Motion Analysis of Hauled Container System for Municipal Solid Waste Collection in Ilorin, Kwara State, Nigeria.” In Proceedings of the 25th international Conference on Solid Waste Technology and Management, Philadelphia, 14-17 March 2010. Edited by Ronald L. Mersky, 1144~1151. Philadelphia: Journal of Solid Waste ‘Technology and Management, Widener University, 2010, ‘The purpose of this study was to divide collection operation into units, estimate the time spent on the activity associated with each unit operation, and account or other idling times during solid waste collection. itwas performed using the ive collection operation units that collect municipal solid waste within the city of llrin, Nigeria. Aremu, Adeniyi S,, James R, Miheleic, and B, F Sule, “Time and Motion Analysis of Hauled Container System for Municipal Solid Waste Collection in arin, Kwara State, Nigeria.” In Proceedings of the 25th Infemational Conference on Solid Waste Technology and Management, Philadelphia, 1417 March 2010. Edited by Ronald L. Mersky, 11441151. Philadelphia: Journal of Solid Waste ‘Technology and Management, Widener University, 2010.Methods Even though it might appear that some ofthe following studies should fit under one of the standard categorizations employed earlier, these studies were lumped together for their specific focus on methods. Some of these studies focus on improving the design and Conduct ofime and motion studies, while other studies focus on improving specific methods that were used in previous studies in a specific field to show that researchers must consider better and more accurate ways, Zupancic and Richardson 2002 examines the characterization and prediction of personnel time inpuls to neonatal intensive care using infant characteristics from chart reviews. The researchers almed also to provide a too! to predict daly time inputs from information in the hospital chart. This study improved on previous methods in providing more than 1,200 hours of direct observation of nursing, physician, nurse practitioner, and respiratory therapist workloads in 154 neonates. Zheng, etal. 2011 is a roview of the best practices of conducting time and motion studies in an effortto improve study quality, while, in a comparative study, Finkler, etal. 1993 finds that time and motion methodology is better than ju: ‘work sampling. Other studies, such as Wirth, etal. 1977, compare methods of time and motion study. Meyer, et al. 2008 proposes an indoor positioning system to use in automating data collection during time and motion studies. » James R. Knickman, Gerry Hendrickson, Mack Lipkin Jr, and Warren G. Thompson. “A Comparison of Work ‘Sampling and Time-and-Motion Techniques for Studies in Health Services Research.” Health Services Research 28.5 (1993): 577— 597, ‘This study compared work sampling and time and mation methodologies using a sample of medical residents in two large hospitals. The rosults here clearly show that ime and motion analysis is more precise. Finkler, Steven A. James R. Knickman, Gerry Hendrickson, Mack Lipkin Jr, and Warren G, Thompson. "A Comparison of Work-Sampling and Time-and-Motion Techniques for Studies in Health Services Research,” Health Services Research 28.5 (1993): 577-597, Meyer, Mark A., Andreas R. Seim, Pamela Fairbrother, Marie T. Egan, and Warren S. Sandberg. “Automatic Time-Motion Study of a Muttstep Preoperative Process.” Anesthesiology 108.6 (2008): 1109-1116, ‘Tne authors created and used the system to track 226 pationts through the steps of check-in, changing, preparation, radiology, waiting, and operating room. The system had a success rate of 78 percent (177 patients) in providing valid tracking paterns over a one-month Period of use. This system has implication for simplifying the collection of data in time and motion studies. Meyer, Mark A,, Andreas R, Seim, Pamela Fairbrother, Marie T, Egan, and Warren S, Sandberg, “Automatic Time-Motion Study of a Multistep Preoperative Process.” Anesthesiology 108.6 (2008): 1109-1116. With, Patricia, Lawrence Kahn, and Gerald T. Perkoff. “Comparability of Two Methods of Time and Motion Study Used in a Clinical Setting: Work Sampling and Continuous Observation.” Medical Care 15.11 (1977): 953-960. Compared continuous observation method and work sampling that were used to measure physician behavior in a prepared group practice, No significant diferences were found. Available online by subscription Wirth, Patricia, Lawrence Kahn, and Gerald T. Perkoff. "Comparability of Two Methods of Time and Motion Study Used in a Clinical Setting: Work Sampling and Continuous Observation.” Medical Care 18.11 (1977): 953-960. Zheng, Kai, Michael H, Guo, and David A, Hanauer, “Using the Time and Motion Method to Study Clinical Work Processes and Workflow: Methodological Inconsistencies and a Call for Standardized Research.” Journal of the American Medical Informatics Association 18.5 (2011): 704-710. ‘An excollent study that focuses on identifying ways to enhance the steadiness of design and conduct, and improve results reporting of time and motion research in health informatics by analyzing empirical studies published behveen 1990 and 2010 that applied time and motion analysis to the application of health IT implementation on clinical work processes and worktlow. Zneng, Kai, Michael H. Guo, and David A. Hanauer. “Using the Time and Motion Method to Study Clinical Work Processes and Workflow: Methodological inconsistencies and a Call for Standardized Research." Joumal ofthe American Medical Informatics Association 18.5(2011):704~710, Zupancie, John A., and Douglas K. Richardson, “Characterization of Neonatal Personnel Time Inputs and Prediction from Clinical Variables: A Time and Motion Study.” Journal of Perinatology 22.8 (2002): 658-663. ‘This study improves on many limitations in the three studies in he section above (newbom intensive care). Many critical issues are tackled after delving into this field (e.g., nursing costs account for about one-half to two-thirds of the cost of labor when they spend much ‘more time in direct patient care). Zupancic, John A., and Douglas K. Richardson. “Characterization of Neonatal Personnel Time Inputs and Prediction from Clinical Variables: A Time and Motion Study.” Journal of Perinatology 22.8 (2002): 658-663, back op OXFORD Copyright © 2017. All rghts reserved.