UNIVERSITY OF TORONTO

FACULTY OF APPLIED SCIENCE AND ENGINEERING

FINAL EXAMINATION, April 24, 2017

DURATION: 2.5 hours

Fourth Year - MIE

MIE 561S - HEALTHCARE SYSTEMS

Exam Type: A

Examiner - Carolyn Busby

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MIE 561S Healthcare Systems Final Examination

Instructor: Carolyn Busby This is a closed-book exam. Calculators are not permitted. Answer all questions in booklet(s) provided. Please answer the mini case in a separate book.

Monday April 24, 2017 6:30 p.m. to 9:00 p.m.

Comprises 40% of final grade

Total of 40 marks

Marks

1. The Shouldice Hospital has a unique structure. Discuss positives and negatives 8 of this structure for patients, surgeons, the Shouldice Hospital, and the

healthcare system as a whole. Do you believe the Ontario government should encourage the establishment of non-profit focused-factory hospitals? Why or why not?

2. Many of the guest speakers discussed barriers to change in the healthcare 8 system. Choose two barriers, discuss why they exist, and what we can do to

manage these barriers when working in healthcare. Chose one area of healthcare that you believe would benefit most from engineering help and explain why you chose it.

3. Answer one of the two following questions; 6 a. Kevin Leonard discusses the barriers to IT in healthcare in "Information

Systems for Healthcare: Why we have not had more success. The Top 15 reasons". List and describe three of these reasons.

OR b. Brent McGaw from Canada Health Infoway discussed planning and

implementation of healthcare IT solutions in Canada. List two areas where improvements have been made in recent years two key considerations when implementing IT solutions in healthcare. One future vision of Health Canada Infoway

4. Michael Rachlis discussed why some physicians are resistant to quality 2 assurance. How does the evolution of Medicare influence this resistance?

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Marks

5. Mini-Case: Eye Clinic 16 Introduction

A specialty Ophthalmology Clinic at The Hospital for Sick Children (SickKids) sees on average 55-60 patients each 8-hour day the clinic operates, with the number of patients increasing every year by approximately 5%. As the number of patients have increased, so too has the patients' waiting time. The need to decrease patient wait times and increase the clinic throughput has become a concern to patients and staff. Long waiting times are particularly difficult for this patient group since most are under 6-months old, are accompanied by their caregiver and possibly siblings, may have to be fed, or changed, or fall asleep while waiting! The Ophthalmology Clinic is currently seeking to improve their clinic's patient throughput and decrease patients' overall waiting time to increase patient satisfaction. It is believed that improvements can be made to the flow that would alleviate the current Wait times and allow the clinic to serve an increasing number of patients.

Clinic Staff: Staff working in the clinic include: A Registration clerk, an Orthoptist, a Resident, a Fellow, an Ophthalmologist (Physician) and a Medical Imagining Specialist. Orthoptists are ophthalmology technicians that do an initial eye exam. Residents are medical students who have earned their medical degree and are now learning to be ophthalmologists. Fellows are fully licenced ophthalmologists that are learning the subspecialty of this clinic. Depending on the level of experience of the fellow and the complexity of the patient, a physician follow-up might not be required after seeing the fellow. A consultation with a resident must always be followed by a consultation with a physician. Consultations with fellows and residents are meant to educate the clinicians and speed up the time the patient spends with the physician (although time spent with the physician and fellow/resident combined will be greater than simply seeing the physician directly). Since Sick Kids is a teaching hospital, time for fellows and residents to learn must be included in the process.

Patient Flow Patients are often double or triple booked for appointments as the demand for the sub-specialty increases. Therefore, when a patient arrives at the clinic for their appointment, they take a numbered ticket and wait to be called to check-in at registration. Once registered, a registration clerk adds the patient's chart to the chart rack shared by all clinicians containing active patients in the clinic. Patients are directed to the waiting room to wait to be called by an orthoptist or a fellow. Figure 1 shows the possible clinician consultation pathways patients may take.

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Crirrent Situation 85% Avg. Wait TIrr = 12

Figure 1: Patient Pathways After each consultation with a clinician the patient is brought back into the waiting room, and ideally the patients chart should be placed back in the chart rack. As each clinician finishes with a patient they return to the chart rack and look through them for a patient to treat next. Consultation time is given in the table below (Table 1).

Table 1 - Average time spent per patient per Medical Professional

féss1oñl --

AVera ge time (mins) Fellows (F) 11.17 Medical Imaging Specialist (Ml) 14.53 Orthoptist (0) 15.22 Physician (P) 7.20 Resident (E) 20.59

Variability Variance in treatment time is dependent on several factors including the type of patient and treatment needs such as imaging and dilation. See table 2 for throughput time based on patient type.

le 2 - Average throueheut time ner Patient t e (mtns)

Add On - Emerg I 957

Follow Up 123.43

New Patient 140.55

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Patients needing dilation (drops that enlarge the pupil so the back of the eye can be examined) will incur a medically necessary wait time of 20-30 minutes while the dilation takes effect. 10% of patients have dilation which can be ordered by any of the clinicians. However, any required imaging would be done first.

Imaging presents another challenge as this resource is shared with another clinic. Patients who have undergone imaging see the physician after the images have been processed. Once images are completed the file is again returned to the chart rack with image results.

Preliminary Analysis The clinic has done some preliminary analysis of their data and has provided it below.

Patients actual arrivals to their

appointment times 2889%

30%

25% 2000%

20% 15.93%

17 04%

15%10.74%

10% 741%

50/

0%

30+ min 15-30 mm 0-15 mm 0-15 min 15-30 min 30+ mm

before before before after after after

Appoinment Pattern and Average Patients Wait Time

=0 Z C C C C C C C C C C C C C C C C 0 C C 0 C C

0 0 C C C C C 0 C 0 C C C C C C C C C C C C C Ln C L C C Ln C C IJ C Lfl C LJ C Ln C LJ 0 C UI

% IP 0l:

- -1 '-

Appointment Time

3:00:00

2:30:00

2:00:00 1:30:00

1:00:00

0:30:00

0:00:00

son 08.12.2014 - Number of Patients —08.12.2014 - Average Wait Time

Sick Kids would like you to advise them on how to approach their problem.

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Your report should be brief, about 3-4 pages double-spaced (approximately 1,000 words). It should be written in the standard case report format adopted for this class and should include: introduction, situation & problem statement; solution recommendations & evaluation; conclusions and future research (do not include executive summary). Clearly you are not expected to develop your solutions to the extent that you would in a normal case study, but you should be able to outline the problems and possible root causes and offer suggested solutions paths with as much speëification and justification as possible. Clearly state any assumptions.

REMEMBER TO ANSWER THE CASE IN A SEPARATE ANSWER BOOK

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