F1 Rapid Fire: Making Sense of Health Care Dollars - A. Muniak and S. Raschka

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  • methods are mostly based on approaches from other industries (e.g. IT, forestry, transportation) and were adapted to healthcare realized by including HFE methods into the procurement process Costs per ADE were ranged between $ 2013 and $ 5857 and increasing output per worker and therefore education and training and a reduction in turnover
  • by performing Human Factors Engineering methodologies during the procurement process
  • F1 Rapid Fire: Making Sense of Health Care Dollars - A. Muniak and S. Raschka

    1. 1. A Cost-Benefit Analysis of Human Factors in Healthcare Procurement Stefanie Raschka, Graduate Student, University of Cologne Allison Muniak, M.A.Sc Human Factors Specialist, Vancouver Coastal Health Quality Forum 2012 Breakout Session F1 March, 9th 2012
    2. 2. Agenda1. Background2. Objective3. Methods4. Results5. Discussion 2
    3. 3. Agenda1. Background2. Objective3. Methods4. Results5. Discussion 3
    4. 4. 1. Background1.1 Human Factors• Designing for human use• A body of information about human abilities, human limitations, and other human characteristics that are relevant to design 4
    5. 5. 1. Background1.1 Human Factors Human characteristics: Physical, cognitive and psychosocial m ste Identification of Implementation of Problems Solutions Sy an m Hu Design: Human-machine, human-environment, human-job and human-organization 5
    6. 6. 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
    7. 7. Agenda1. Background2. Objective3. Methods4. Results5. Discussion 7
    8. 8. 2. Objective2.1 Human Factors and Health Economics Human Factors Engineering Health Economics ► Enhancing performance, ► Maximizing social safety, and satisfaction benefits under consideration of maximal efficiency and equity 1. Heuristic Evaluation ► Cost-Benefit Analysis 2. Usability Testing ► Cost-Effectiveness Analysis 3. Clinical Evaluation ► Cost-Utility Analysis Are Human Factors evaluations worth it? 8
    9. 9. 2. Objective2.2 Case Introduction – Epidural Pumps• 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 9
    10. 10. 2. Objective2.2 Case Introduction – Procurement Drivers• Cost• Estimated life cycle of product• Vendor support• Convenience of maintenance• Having the latest & greatest• Clinical opinion
    11. 11. 2. Objective2.3 Human Factors in Healthcare Procurement 11
    12. 12. Agenda1. Background2. Objective3. Methods4. Results5. Discussion 12
    13. 13. 3. Methods3.1 Assumptions for Analysis Evaluation based on a hospital-centered 1 approach The performance of HFE methodologies leads to: Selected Heuristic Evaluation, Usability •Error prevention and 2 Evaluation, and Clinical Evaluation reduction of adverse drug events The developed cost analysis was adapted •Increasing productivity 3 •Reduction of skill from other industries requirements •Increasing employee Benefits based on cost avoidance and satisfaction 4 opportunity costs 13
    14. 14. 3. Methods3.2 Health Economics of Human Factors MethodsHeuristic Evaluation Usability EvaluationPrevention of adverse drug Video analysis (timeevents differences, ease-of-use)Comparison based on MAUDE Failure ratesdatabase research  Level of frustration/satisfaction leads to increased productivity Identification of yearly costs and benefits in monetary unitsCost Evaluation Clinical EvaluationCapital costs User-interface survey5-year life cycle costs User/Employee satisfaction asPersonnel costs (HF group) a part of TQM approachReduced productivity Turnover reduction 14
    15. 15. 3. Methods3.3 Initial Benefit of Heuristic Evaluation Clinical Risk Clinical Impact and Economic outcome Usability outcome Management Outcome measurement measurement Severity Rating Risk Consequence Score (Non-monetary) Costing (monetary) Costs for error2 = minor usability Delay, interruption of 1 workflow correction problem (ineffective time) Cost for AE due to Delay, interruption of3 = major usability increased length of 2 or 3 workflow, potential stay, increased problem Adverse Event treatment effort, increased medication costs, Delay, interruption of physical, 4 = usability psychological 4 or 5 workflow, potential catastrophe Adverse Event impact on patients, family members and staff 15
    16. 16. Agenda1. Background2. Objective3. Methods4. Results5. Discussion 16
    17. 17. 4. Methods4.1 Cost evaluation Acquisition costs 5-year lifecycle costs1. Equipment andMaterial • Lifecycle costs for capitalCapital Costs $ 452,717 $ 3,470 per year5-year life cycle costing $ 511,320 • The 5-year lifecycle costs2. Personnel Costs for capital are summed upHFE evaluation group $ 7,896 to $ 14,475 • The total 5-year lifecycle3. Reduced productivity costs were $ 578,255Down time $ 504Education/Training $ 3,600Overall Costs $ 976,037 17
    18. 18. 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
    19. 19. 4. Results4.2 Cost-benefit comparison in Year 1 Benefits Costs 19
    20. 20. 4. Results4.3 Cost-benefit analysis on a 5-year life cycle 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 20
    21. 21. 5. Discussion Demonstrates the potential of cost savings/benefits Limitations: -Adaptation of methods due to availability of data -Other correlations that may be impacting quality outcomes Provides opportunity for further cost-benefit evaluations Human Factors Engineering is an investment on a long-term evaluation and can provide an considerable benefit for the organization 21
    22. 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 Raschka Allison MuniakS.Raschka@gmail.com Allison.Muniak@vch.ca 22
    23. 23. Backup 23
    24. 24. 3. Methods3.1 Health Economics for Heuristic Evaluation Yearly/Singe values Year 1 Year 2 Adverse Drug Events PreventedEducation Time $ 3,060.00 • Based on the MAUDE databaseIncreased likelihood 826 adverse events has beenof adverse events 15 reported to the FDA for pumpAdverse Drug A,C,DEvents 5 • 60-70% of usability problems canCosts for adverse be detected by Heuristicdrug events $ 5,857.00 EvaluationTotal Earnings $ 442,335.00 $ 442,335.00 • The likelihood of a reported adverse drug events was 15-Additional costs ofcapital $ 210,257.15 times higher for pump D (financial rated 1st) compared to pump AAditional life-cyclecosts $ 49,919.70 (heuristic rated 1st) • Opportunity costs by performing aTotal Costs $ 210,257.15 $ 49,919.70 Heuristic Evaluation beforeProfit $ 232,077.85 $392,415.30 purchasing 24
    25. 25. 3. Methods3.2 Health Economics for Usability Evaluation Time on average Reduction of maintenance time [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 • A reduction of 5 minutes maintenance time per pump Range [0:01:57-0:04:10] [0:01:39-0:04:50] • Increasing productivity could lead Case 2 0:03:22 0:03:40 to savings of $ 65,700 per year • For example reduction of one full Range [0:01:20-0:05:44) [0:02:00-0:06:18] time position in nursing 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] 25
    26. 26. 3. Methods3.3 Health Economics for Clinical Evaluation Average Score Category 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 Reduction in turnover • 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 26

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