f1 rapid fire: making sense of health care dollars - a. muniak and s. raschka
TRANSCRIPT
A Cost-Benefit Analysis of Human Factors in Healthcare Procurement
Quality Forum 2012
Breakout Session F1
March, 9th 2012
Stefanie Raschka,Graduate Student, University of Cologne
Allison Muniak, M.A.ScHuman Factors Specialist, Vancouver Coastal Health
Agenda
1. Background
2. Objective
3. Methods
4. Results
5. Discussion
2
Agenda
1. Background
2. Objective
3. Methods
4. Results
5. Discussion
3
• Designing for human use• A body of information about human abilities,
human limitations, and other human characteristics that are relevant to design
4
1. Background1.1 Human Factors
1. Background1.1 Human Factors
5
Sys
tem
Human
Human characteristics:Physical, cognitive and psychosocial
Design:Human-machine, human-environment, human-job
and human-organization
Identification of Problems
Implementation of Solutions
1. Background1.2 Health Economics
Consideration of medical, social and economical factors by comparing possible alternatives in term of their costs and consequences
Outcome indicators: productivity, performance, occupancy, lengths of stay
Technical efficiency: maximizing output with given quantities of inputs
Evaluation based on a cost-benefit analysis by adapting Human Factors Evaluation outcome into monetary units
Opportunity costs: Benefits forgone by particular use of resources
6
Agenda
1. Background
2. Objective
3. Methods
4. Results
5. Discussion
7
2. Objective2.1 Human Factors and Health Economics
Are Human Factors evaluations worth it?
Human Factors Engineering Health Economics
► Enhancing performance, safety, and satisfaction
► Maximizing social benefits under consideration of maximal efficiency and equity
1. Heuristic Evaluation
2. Usability Testing
3. Clinical Evaluation
► Cost-Benefit Analysis
► Cost-Effectiveness Analysis
► Cost-Utility Analysis
8
• Request for Proposal prepared and published December 2008
• Four vendors replied at closing during March 2009
• Multidisciplinary team conducted evaluations
• Evaluations commenced April 2009
• Implementation occurred in November 2009
2. Objective2.2 Case Introduction – Epidural Pumps
9
• Cost• Estimated life cycle of product
• Vendor support• Convenience of maintenance• Having the latest & greatest
• Clinical opinion
2. Objective2.2 Case Introduction – Procurement Drivers
2. Objective2.3 Human Factors in Healthcare Procurement
11
Agenda
1. Background
2. Objective
3. Methods
4. Results
5. Discussion
12
13
3. Methods3.1 Assumptions for Analysis
The performance of HFE methodologies leads to:
•Error prevention and reduction of adverse drug events•Increasing productivity•Reduction of skill requirements•Increasing employee satisfaction
Evaluation based on a hospital-centered approach
Selected Heuristic Evaluation, Usability Evaluation, and Clinical Evaluation
The developed cost analysis was adapted from other industries
Benefits based on cost avoidance and opportunity costs
1
2
3
4
14
3. Methods3.2 Health Economics of Human Factors Methods
Usability EvaluationVideo analysis (time differences, ease-of-use)Failure ratesLevel of frustration/satisfaction leads to increased productivity
Identification of yearly costs and
benefits in monetary units
Heuristic EvaluationPrevention of adverse drug eventsComparison based on MAUDE database research
Clinical EvaluationUser-interface surveyUser/Employee satisfaction as a part of TQM approachTurnover reduction
Cost EvaluationCapital costs5-year life cycle costsPersonnel costs (HF group)Reduced productivity
3. Methods3.3 Initial Benefit of Heuristic Evaluation
Usability outcomeClinical Risk Management
Clinical Impact and Outcome measurement
Economic outcome measurement
Severity Rating Risk Consequence Score (Non-monetary) Costing (monetary)
2 = minor usability problem
1Delay, interruption of workflow
Costs for error correction (ineffective time)
3 = major usability problem
2 or 3Delay, interruption of workflow, potential Adverse Event
Cost for AE due to increased length of stay, increased treatment effort, increased medication costs, physical, psychological impact on patients, family members and staff
4 = usability catastrophe
4 or 5Delay, interruption of workflow, potential Adverse Event
15
Agenda
1. Background
2. Objective
3. Methods
4. Results
5. Discussion
16
4. Methods4.1 Cost evaluation
1. Equipment and Material
Capital Costs $ 452,717
5-year life cycle costing $ 511,320
2. Personnel Costs
HFE evaluation group $ 7,896
3. Reduced productivity
Down time $ 504
Education/Training $ 3,600
Overall Costs $ 976,037
Acquisition costs
• Lifecycle costs for capital$ 3,470 per year
• The 5-year lifecycle costs for capital are summed up to $ 14,475
• The total 5-year lifecycle costs were $ 578,255
5-year lifecycle costs
17
4. Results4.1 Evaluation of Benefits
1. Benefits associated with materials and equipment
Identified violations $ 70,611
Reduced maintenance costs $ 65,700
Total benefits materials and equipment $ 136,311
2. Personnel-related Benefits
Prevented ADES $ 232,078
Reduction in turnover $ 4,032
Total personnel-related benefits $ 236,110
Overall Benefits $ 372,420
18
4. Results4.2 Cost-benefit comparison in Year 1
19
Benefits Costs
4. Results4.3 Cost-benefit analysis on a 5-year life cycle
20
The benefits outweigh the costs in the second year after purchase
5-year “savings”: $ 2.34 M 5-year costs: $ 0.58 M
5-year Profit (costs-benefits): $ 1.76 M
5. Discussion
21
Limitations: -Adaptation of methods due to availability of data-Other correlations that may be impacting quality outcomes
Demonstrates the potential of cost savings/benefits
Human Factors Engineering is an investment on a long-term evaluation and can provide an considerable benefit for the organization
Provides opportunity for further cost-benefit evaluations
22
It shouldn‘t be the question if Human Factors Engineering is a good investment, it should be the question If it is a good investment
not to include Human Factors Engineering within the organization
Thank you!Stefanie [email protected]
Allison [email protected]
Backup
23
3. Methods3.1 Health Economics for Heuristic Evaluation
Yearly/Singe
valuesYear 1 Year 2
Education Time $ 3,060.00
Increased likelihood of adverse events 15
Adverse Drug Events 5
Costs for adverse drug events $ 5,857.00
Total Earnings $ 442,335.00 $ 442,335.00
Additional costs of capital $ 210,257.15
Aditional life-cycle costs $ 49,919.70
Total Costs $ 210,257.15 $ 49,919.70
Profit $ 232,077.85 $392,415.30
• Based on the MAUDE database 826 adverse events has been reported to the FDA for pump A,C,D
• 60-70% of usability problems can be detected by Heuristic Evaluation
• The likelihood of a reported adverse drug events was 15-times higher for pump D (financial rated 1st) compared to pump A (heuristic rated 1st)
• Opportunity costs by performing a Heuristic Evaluation before purchasing
Adverse Drug Events Prevented
24
3. Methods3.2 Health Economics for Usability Evaluation
Time on average [hh:mm:ss] Pump A Pump C
Training 0:13:50 0:14:02
Range [0:10:13-0:16:06) [0:08:06-0:22:09]
Case 1 0:03:06 0:02:25
Range [0:01:57-0:04:10] [0:01:39-0:04:50]
Case 2 0:03:22 0:03:40
Range [0:01:20-0:05:44) [0:02:00-0:06:18]
Case 3 0:01:47 0:02:20
Range [0:00:55-0:02:58] [0:01:39-0:04:37)
Changing Batteries 0:00:54 0:02:30
Range [0:00:13-0:02:10] [0:01:15-0:03:37]
• A reduction of 5 minutes maintenance time per pump
• Increasing productivity could lead to savings of $ 65,700 per year
• For example reduction of one full time position in nursing
Reduction of maintenance time
25
3. Methods3.3 Health Economics for Clinical Evaluation
CategoryAverage Score
Pump A Pump C
Display and Keypad 5.89 4.59
Lockbox 5.70 4.93
Alarms 5.52 4.67
Setup 5.65 4.58
Operation 5.66 4.48
General 5.63 3.63
Overall Score 5.68 4.48
• Assumption: Correlation between employee satisfaction and a reduction in turnover• Part of a Total Quality Management Process• Based on this assumptions and published study results a reduction of turnover by 36 %
and an overall operating budget of $ 800,000 leads to savings between $ 4,032 and $ 10,944 per year
Reduction in turnover
26