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University Hospital
Capstone 1 Industrial Assessment Final Report

Group Members:

Hadeel Almutairi
Matthew Furrer
Madeline Rygelski
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Table of Contents

Executive Summary
Problem Context
Company Background
Objective of the Assessment
IE Analysis
Material Flow Diagram
Process Map Process Diagram of the Emergency Department
RPA Analysis
MUDA Analysis
Opportunities for Improvement
Charter and Preliminary Project Plan
Initial Project Charter
Preliminary Plan
Data Requirements
Team Roles
Appendix
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Executive Summary

University Hospital is the University of Missouri - Columbia’s flagship center in their

MU Healthcare system. With nearly 250 beds, University Hospital and extended clinics
serve a wide portion of central Missouri, specifically focused on its home in Columbia. Due
to the private nature of healthcare, our initial visit to the hospital was brief and
unfortunately did not provide much insight into what opportunities our project will
address. Because of this, the following is an outline of potential areas of concern the
hospital has - according to the information shared by our main point of contact within
administration, Kelly Butler - and using our knowledge of IE in healthcare. Additionally,
team member Madeline Rygelski has months of experience in the healthcare industry,
working on lean and industrial assessment projects. Much of the following report draws
from these aspects. This report includes a brief company background, the objective of the
assessment and multiple industrial tools that can be used to address the opportunities
presented in the assessment.

Problem Context

Company Background

University Hospital is based in Columbia, Missouri, and is affiliated with the

University of Missouri and the University of Missouri School of Medicine. University
Hospital was founded on September 16, 1956. The hospital holds a capacity of 247 beds
and contains the region’s only cochlear implant center along with a diabetes center, an
ophthalmology institute, a sleep disorders center, and a SameDay surgery center that is
capable of hundreds of procedures in its fully equipped operating rooms. It also has the
only Level 1 trauma center and helicopter service in central Missouri.

Objective of the Assessment

The objective of this assessment done on University Hospital was to identify

problems that can be improved with industrial engineering techniques in the Spring of
2020. The area of the hospital that work will be done is unknown at this time. In this
report, opportunities for improvement throughout the whole hospital will be discussed and
analyzed with an RPA analysis, MUDA analysis, and a material flow analysis and process
map for the emergency department. From this information, an initial project charter has
been developed along with data requirements and assigned roles.
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IE Analysis

Material Flow Diagram

A general material flow diagram of how patients flow in and out of the hospital is
shown above. There are dozens of ways a patient can flow through a hospital based on
their conditions and how long they are admitted in the hospital. It is shown that patients
can enter through the emergency department in red and can be moved to any of the areas
of the hospital or discharged out of the emergency department. Patients can also enter
through the general entrance to be checked in then moved to their desired area and
potentially moved later to a separate area for further treatment. This material flow
diagram also shows that there are minimal ways for patients to travel through the hospital
and the hallways become clustered with patients, doctors, other workers, and visitors all
traveling in the same path.
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Process Diagram

A process map of how a patient travels through the emergency department is shown
above to provide insight to one area of the hospital’s processes regarding patient flow.
When a patient enters the emergency department, a nurse will check vitals and evaluate
the reason the person is at the emergency department. Based on this, the patient is given a
rating from 1-5 to determine the urgency of being cared for, with 1 being traumatic and 5
being minimal. After this evaluation, patients are either sent to the waiting room if there is
not a bed available or taken back to a bed. From there, the physicians provide the care
needed. Once the patient receives the necessary treatment, it is determined if the patient
will be discharged or taken to another area of the hospital for further care. If the patient is
discharged, he or she exits the system. If he or she is in need of more treatment, the patient
will be moved to another area of the hospital, exiting the emergency department system.

RPA Leanness Rating

After the tour of University Hospital, students who attended filled out a Rapid Plant
Assessment (RPA) to provide numerical data. Tables of the results from the students can
be found in the appendix on page . The average percentage of yeses was 48% and the
average rating was 66.54. In the comments provided by classmates, many said that it was
difficult to analyze the hospital properly due to not being able to speak with patients and
see the flow of patients.
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The number of yeses given ranged from 0% to 100%, as shown in table 1. Questions
1 and 3 both received 100% yes. Question 1 was about welcoming visitors and giving
information and question 3 was about the overall cleanliness and safety of the facility. Both
of these are crucial to hospitals to accommodate those who are visiting patients in care and
safety and cleanliness so patients do not become more sick or hurt. Other questions that
scored above the 75th percentile were 5, 14, 15, and 20.
Questions 9, 11, 13, 16, and 18, however, all scored below the 25th percentile. This
raises attention to these areas being problem areas. 16 scored a 0% of yeses asking if there
was a timetable posted for equipment preventative maintenance and continuous
improvement tools and processes. Some of the other questions that scored low also had to
do with charts and postings. This could be because the tour was unable to go into areas
that doctors and nurses do their primary work around the patients, so there is still
potential that they are exercising these techniques. If not, the project will be able to add
these postings for workers to use. The other areas that scored low regarded layout and
inventory which will need to be further assessed once the project starts and the team is
able to go into the depths of the hospital.
Table 2 shows the results from the ratings given by classmates. Scores were given
from 1 to 11 with 1-2 being poor, 3-4 below average, 5-6 average, 7-8 above average, 9-10
excellent, and 11 best in class. The average of 66.54 is out of possible 121 points. This
means that the part of the hospital shown is about average.
The areas that scored highest were customer satisfaction at 7.11, safety,
environment, cleanliness, and order at 8.16, and people teamwork, skill level, and
motivation at 7.63. These scores align with table 1 in that it was apparent that the workers
are helpful, friendly, and knowledgeable and patients feel comfortable being treated at
University Hospital. Areas that scored the lowest were scheduling system at 5.11,
inventory and WIP levels at 4.68, and supply chain integration at 5.00. Because these are
the lowest scores, these areas will be what the team will focus on for the project, along with
those areas that scored low in the number of yeses.

MUDA Analysis

Transportation: How a patient is transported throughout a hospital, for instance from the
emergency department to a room upstairs, may be inefficient based on the layout of the
hospital and the route taken.

Inventory: There could be excess inventory of medicines that can expire and excess
equipment in a patient’s room.
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Motion: The layout of the hospital may cause inefficient flow if equipment and supplies are
not stored in areas of the hospital that are easily accessible, or if equipment and supplies
are not stored in the correct area.

Waiting: Hospitals are notorious for having long wait times. There is excess waiting time in
waiting rooms, the emergency department when patients are waiting for a hospital room,
when a physician or nurse has to wait for test results, and when a patient is ready to be
discharged.

Over-Processing: Doctors may order more or higher tests necessary for a patient, for
instance an MRI as opposed to an X-ray. Follow up appointments long after a patient is
helped does not always provide any benefit to the patient. Specialists may be called in to
help a patient when a normal physician could provide the treatment.

Defects: Doctors could misdiagnose a patient, give an incorrect or ineffective prescription,

or incorrect communication between doctors and nurses causing the wrong treatment to
be given.

Overproduction: Overproduction could be running unnecessary tests, having too much staff
on hand at a given time, and prescribing medicines that are not necessary.

Opportunities for Improvement

The RPA results gave indication which areas are in need of the most improvement.
One opportunity would be regarding the scheduling system of staff. Patient flow is
essentially unpredictable making it difficult to staff accordingly. If hospital beds in the
main areas of the hospital, it can cause backups throughout the entire hospital. For
example, if patients in the emergency department are waiting to be transferred to the main
area of the hospital and there are open beds but they are not staffed, there causes a backup
in the emergency department. A project that could be done with this could be predicting
how much staff is necessary by using forecasting. Data based on time of year, day of the
week, and hour of the day can be used to predict what the flow of patients should be at that
particular time. Current data from different areas of the hospital can also be used to
predict how many patients will be transported to other areas of the hospital along with
how many will be discharged. By being able to predict patient flow, the hospital can staff
accordingly without overworking doctors and nurses and also appropriately staffing
cleaning crews and transport workers to minimize backlogs.
Another opportunity in healthcare is the layout of an area of a hospital. Industrial
engineers can use optimization and ergonomics to place materials, medicines, and other
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equipment in a way that saves time for doctors and nurses to have these things easily
accessible. For example, storage areas can be redesigned so that equipment that is used
often and for many patients is placed in multiple areas around the hospital that is easily
accessible. The reorganization of specific areas, such as the lab, can also be redesigned
based on the processes followed to minimize transportation and eliminate wasteful time.
A third opportunity at the hospital would be to add continuous improvement charts
and postings and improve communication between doctors and nurses. One of the biggest
flaws in healthcare is the miscommunication between doctors, nurses, and management.
Part of the project could be adding daily communication tasks so everyone is on the same
page. For example, having charts or boards with each patient’s status and condition allows
other workers to be aware of what is going on with other patients. Daily meetings should
also take place so nurses briefly update each other on patients. At these meetings, a
continuous improvement board could also be used so workers can talk about what has
been good that day and what has been bad. By doing this, everyone can learn from each
other’s mistakes or successes and work as a whole to help each other help each patient.

Charter and Preliminary Project Plan

Preliminary Plan

The main objective of the intended project done in the Spring of 2020 will be to
improve scheduling throughout the hospital. Although patient flow is unpredictable, there
is still opportunity to predict demand for staffing with transport, doctors, nurses, and
cleaning crew. The first step to doing this will be to identify where the bottlenecks of the
hospital are and where there is the most non-valued time. This could be from transport,
staffing, full capacity, unused rooms, or a number of other factors. It will also need to be
determined which specific process to focus on, particularly which types of patient flow
whether that be an area of the hospital or multiple. To do this, shadowing of multiple
workers in different departments, such as transport, nurses, and cleaning crew will take
place to fully understand the process. Once understood, a process map will be created to
understand the flow along with analyzing the overall efficiency. An RPA will be done on the
process along with possible shadowing of the departments to fully understand the patient
flow. After analyzing the process, past data will be used for forecasting to determine trends
for each department to produce a predicted schedule. Lastly, continuous improvement
techniques will be provided to the workers.

Data Requirements
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Past data will be necessary to determine trends based on particular times. This will
consist of how many patients were in the particular areas of the hospital and how much
time each patient spent in that area along with information such as if he or she was moved
to a different area of the hospital or discharged. The time between each move of the
patient will also be necessary, for example how long it took transport to get to the patient
and how long a room took to be ready. Along with this, past data of staffing will be
necessary such as how many patients each nurse or doctor was taking care of. With this
data, trends will be able to be seen and if staff were properly scheduled.

Team Roles

For the project, all team members will take time to shadow the workers so all have
the same understanding of the processes. Maddie will be in charge of gathering the
previous data that will be used for forecasting and working to determine the trends based
on each specified time measure. Matt will be in charge of the time studies we will perform
on our own and logging the data found. Hadeel will be in charge of helping teach the
workers continuous improvement through these processes as the bottlenecks are
determined. All team members will work together on the forecasting done to determine a
finalized schedule based on past data and current status of the hospital at a given time.

Appendix
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Table 1

Table 2
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