During an intensive three-month period in fall 2011, UW-Madison graduate students Renaldo Blocker (left) and Sacha Duff (right) worked long hours in the emergency department of Cedars-Sinai Medical Center in Los Angeles. Whenever a victim of a car accident, stabbing or other incident arrived, they would accompany trauma teams from the moment patients arrived until their surgery was finished.
While the two carried trauma pagers and wore hospital scrubs, they weren’t medical students.
Rather, they are systems engineers, and they were in the hospital collecting data for Industrial and Systems Engineering Professor Doug Wiegmann (center), who is midway through a project to reimagine how operating rooms—and operating room staff—work.
Research applying industrial engineering principles to healthcare is central to the Department of Industrial and Systems Engineering (ISyE). Such research in the department dates back to the 1970s, when Professor David Gustafson decided to devote his entire career to it. In fact, ISyE faculty were among the first industrial engineers to engage in what’s now called health systems engineering research. Today, more than a dozen professors in the department conduct some kind of healthcare research, whether as a core focus or an application against which they can test new methodologies.
In the United States, ISyE at UW-Madison stands out because it consistently has been involved in health systems research throughout the past four decades, says Professor and Chair Vicki Bier.
This longevity has its advantages. The department is attractive to graduate students because it offers a well-established master’s program in health systems engineering, while undergraduates are required to take a health systems course. Faculty members also offer a short course in the summer to educate health professionals. And when faculty candidates come for interviews, Bier can introduce them to the chief operating officer of UW Hospital. “They’re not starting from scratch when they need medical collaborators,” Bier says.
Additionally, ISyE faculty are encouraged to publish in medical journals to enhance the impact of their research. They receive significant funding from the National Institutes of Health and other healthcare-related entities; the departmental total currently hovers around $65 million in active grants and projects. Directed by Gustafson, who now is a professor emeritus, the Center for Health Enhancement Systems Studies (CHESS) alone secures more than $10 million per year in grants to create online tools to help people with chronic and terminal conditions, as well as to improve healthcare more generally.
Despite the long tradition of emphasis on healthcare research in industrial and systems engineering at UW-Madison, that focus is just now catching on at other institutions. And applying traditional industrial engineering in a very people-centric way enables UW-Madison researchers to address issues such as patient safety and developing decision-support tools to empower patients. “Healthcare is the new manufacturing,” says Bier. “But we have a greater awareness of and sensitivity to what’s different about working with patients—instead of parts in a factory.”
Its history, as well as its disciplinary adaptability, set the UW-Madison industrial and systems engineering health systems program apart. “That gives us a huge competitive edge—not only in healthcare research, but in terms of collaboration at the UW Hospital, and in recognition at the UW medical school,” says Associate Professor Oguzhan Alagoz, who joined the College of Engineering faculty in 2005 because of its reputation for healthcare research.
Alagoz says he now sees other institutions imitating UW-Madison’s interdisciplinary approach, thanks in part to the rising profile of problems in healthcare and the increasing availability of grant money for solving them. In engineering, he says, there’s plenty of expertise for improving everything from daily healthcare operations, such as managing blood supplies, to clinical decision-making—for example, which treatments are best for a particular patient. “It may appear that doctors can make these decisions easily,” he says. “But now that we have more and more technology in healthcare, it is very difficult to consider all of the outcomes in treatment options.”
Alagoz has worked closely with radiologists, gastroenterologists and other clinicians at UW Hospital to develop mathematical models created from healthcare data to help physicians make decisions. He has the expertise to decide which models to use, and how to shape them perfectly to fit the problem and available data. “In systems engineering, we consider the system as a whole,” says Alagoz. “Medical professionals don’t necessarily know what kind of theoretical model to use and how to design it so it’s going to be a valid representation of the system.”
He says his medical school colleagues’ willingness to collaborate is a big factor in the success of both his—and their—research. “I can come up with great mathematical models, but I am pretty much useless if I don’t have a good clinical collaborator who says, ‘Cite this problem, cite that work,’ and will guide me in building and validating the model,” he says.
Conversely, Assistant Professor Enid Montague studies how human interactions can affect outcomes in healthcare. She focuses on trust between patients and their providers—and between patients, providers and the technology they all use.
As healthcare providers cope with caregiver shortages, technologies such as electronic health records are enabling doctors and nurses do more with the time they have. And, as more patients live longer and experience more complex health needs, new tools are needed to help them manage both their treatment and increasingly intricate networks of healthcare providers.
But, says Montague, it’s important to know how technology affects a patient’s relationship with his or her providers to ensure that relationship is strong. “When patients trust their doctors, they get better faster,” she says.
Montague’s research consists in part of observation that uses classical psychology: Her team analyzes video of doctor-patient interactions and measures physiological responses such as heart rate for subjects participating in scenarios at her lab. “We reduce them to measurable units to build these models of the interaction and then we look at certain outcomes, like the effects of having a small negative facial expression,” Montague says.
Using this information, Montague’s research group can make recommendations for clinician training that ensures the strongest possible relationships.
Montague’s team also is working on designing technology that can monitor a person’s health and wellness, help them manage long-term health problems such as asthma or diabetes, and persuade them to make changes to improve their overall health. For example, she says, a sedentary person’s surroundings could be fitted with tools to encourage them to move around more. “So if you sit for four hours without moving, the space is aware, and you get a phone call that says, ‘Hey, it’s 60 degrees out. Why don’t you go for a walk?’” says Montague.
Back to the hospital: Wiegmann recently received an additional $1.2 million in U.S. Department of Defense funding for his operating room research, in which he is studying the process of surgery from start to finish to find places where treatment flow is interrupted. For example, surgical teams might not communicate in ways that ensure tasks are completed correctly—a request isn’t heard, or there’s confusion about who should perform it. And, Wiegmann says, the wide variation in how healthcare can be performed means that there’s a dearth of standardization, which also creates confusion
when teams don’t work together consistently.
In addition to his healthcare research, Wiegmann also studies accident prevention in such settings as aviation. While there are plenty of differences between the two areas—for example, aviation is a much simpler, centralized system—he says healthcare can benefit from a human factors approach. “A lot of it is trying to come up with some way of improving the coordination of care, either through technology and communication devices, or other types of standardization of the process,” he says. “Industrial and systems engineering and healthcare human factors engineering provide the background and tools to help.”
The depth and breadth of UW-Madison ISyE healthcare research is virtually second to none. Faculty also conduct research in such areas as scheduling, patient safety, quality of life and quality of care, clinical decision-making, in-home healthcare, health information management, treatment optimization, and many others.
Through the multidisciplinary Systems Engineering Initiative for Patient Safety (SEIPS), for example, ISyE professors such as Pascale Carayon and Ben-Tzion Karsh work with faculty from the UW medical school to apply human factors, systems engineering and quality engineering to determine how patients benefit if clinicians use computer systems to order medications and procedures. They also assess risks in different aspects of patient care, and how intensive care unit teams can successfully collaborate when, as in the case of “virtual” ICUs, some nurses might be working miles away using specialized telemedicine software.
Associate Professor Jingshan Li is studying ways to reduce emergency room overcrowding. Through the Wisconsin Institutes for Discovery, Professor Michael Ferris develops computer algorithms that can be used to optimize radiation therapy, cancer treatment plans, and other health processes. And Moehlman Bascom Professor Patricia Flatley Brennan also is a registered nurse. In her Living Environment Lab, also housed in the Wisconsin Institutes for Discovery, she and her team observe human behavior in a virtual reality space that can simulate any environment—ranging from a kitchen to an operating room—to understand ways system changes and new devices can improve care and outcomes for patients.
Even those examples, says Bier, are just the tip of the proverbial iceberg. “When we go to meetings in the field, the typical reaction I get from other departments is, ‘Wow. How do you do everything you do in healthcare?’” she says. “UW-Madison is a place where many people build their entire careers around healthcare.”