Systems engineering reemerges as a hospital design tool

When Mike Souza was faced with making decisions about a multitude of details in the design of a new facility for the Massachusetts Eye and Ear Infirmary (MEEI) in Boston, he knew he needed help if he wanted to get the job done right the first time.

The solution? Souza, vice president for MEEI network development, reconnected with friend James Benneyan, a leading authority on health care systems engineering. Benneyan is the director of two health care systems engineering and process design centers, and a professor of industrial engineering and operations research at Northeastern University in Boston.

Benneyan's work and re­search focus on mathematical modeling of health systems to optimize their performance. His health care engineering program at Northeastern (www.coe.neu.edu/healthcare) develops and applies these methods to a range of issues within partnering health care organizations, including patient access, logistics, comparative effectiveness, quality and treatment. "Our objective basically is to help our partners improve by developing analytic tools — in this case, tools to help people who are designing or redesigning facilities understand before they build what the workflow will be like," Benneyan explains.

While health care largely phased out systems engineering in the '70s and '80s, the field is experiencing a resurgence because of a renewed focus on cost, access and flow and patient safety, Benneyan says.

In addition to the MEEI project, Benneyan's center is working on a number of other projects related to facility design, including two at Brigham and Women's Hospital (BWH), Boston.

One involves helping the hospital continue its transition to a full implementation of an electronic medical record system. "A current concern is how many computers they really need and where should they be located," Benneyan says. "They want to make sure they have access to EMR and order entry technology but also are concerned about space."

The Northeastern team analyzed BWH data related to how the number of computers is impacted by patient volume and equipment location, and how varying numbers affect underutilization and waiting times for usage. They now are utilizing modeling software to develop a more precise estimate of the number of computers needed.

Another project at BWH is helping to plan the number and location of on-call rooms throughout the hospital to give overnight residents a place to catch some sleep. Probability models have been developed to compute the number of rooms required to have sufficient capacity 95 percent of the time and help prevent over- and under-design.

As for the MEEI project, Souza says Benneyan's work has been invaluable. The three-story, 80,000-square-foot ambulatory care facility will include four outpatient operating rooms, an ophthalmology clinic, an otolaryngology clinic, a pharmacy, labs and café.

"We're making a $25 million investment in this building," Souza says. "To be able to model different scenarios, that's a whole lot easier than building it and saying this was wrong."

Even though the original MEEI facility gives the design team a foundation from which to work and help estimate patient and work flow, the new facility creates a unique set of conditions that systems engineering can analyze to aid in decision-making.

Benneyan's center developed a series of facility flow and congestion computer models to help determine lobby size, number of elevators and valets, parking lot size, and number of front desk staff and other support staff per doctor.

All these details impact patient and physician satisfaction, Souza says.