Optimizing Outpatient Cancer Infusion Center Access Operations Using a Systems-Based Approach; The Socio Technical Factors that Influence Hospital Wait Times

The life saving capacity of a hospital is only as powerful as a patient's ability to be seen for treatment. In my Capstone Project for my systems engineering undergraduate degree, my team and I analyzed an outpatient infusion center to determine ways to increase throughput. This project was undertaken to analyze the current workflows of the center and suggest improvements to increase efficiency and support patients and providers. To complement this work my STS research paper seeks to understand the sociotechnical factors that affect hospital wait times. This topic was chosen because of the prevalence of long hospital wait times and its direct connection with my capstone research. The two topics are very intertwined. My Capstone project focuses on a specific cancer center and seeks to understand various aspects of operations. On the other hand my STS research paper dives into the causes of wait times in hospitals across America. My technical Capstone report was conceived with the help of my capstone advisor who had strong ties to UVA Health and access to many administrators within the Emily Couric Clinical Cancer Center (ECCCC), which is the cancer center for UVA Health. Therefore much of the analysis and synthesis our team provided was requested directly by employees of the cancer center we were analyzing. The first phase of our project featured analysis of the ECCCC’s electronic health records to better understand scheduling and capacity. From here the team conducted in person observations to better understand workflow and patient experience. Throughout the project our team met with hospital administrators and employees and discussed our current analysis and avenues for further exploration. This process of iteratively analyzing data, presenting to key stakeholders, and repeating produced results that were oriented towards the goals of hospital employees and admins. Through this process our team collated key takeaways. To begin, there was a severe lack of data reporting at the ECCCC. Many fields concerning appointments were consistently wrong or missing in the center's electronic health records. Almost concerning statistic gleaned was that the Center’s utilization was only 44 percent. Additionally from direct observations and interviews the team identified scheduling imaging as a major bottleneck towards treatment. Finally no-shows and late cancellations were identified as factors which negatively affect hospital throughput. In conclusion our team decided that a weeklong time study of the hospitals operations would be pivotal in verifying data validity and analyzing operations. For my STS research project, my guiding question was what are the sociotechnical factors that affect hospital wait time. This question was borne out of an interest in hospital operations from my Capstone project and my personal experiences of waiting exceedingly long in hospitals. Additionally almost everyone will be at a hospital at some point whether for themselves or in support of a loved one. If I could contribute research that would improve the effectiveness of healthcare in any way I knew it would positively impact many. To answer this question I underwent a lengthy review of the literature, and further analyzed all the raw data I had collected through my capstone project. Through the use of Actor Network Theory I was able to understand the different Actors within the ECCC and the networks of influence they exert on each other. To begin I realized that the Epic electronic health records system that the hospital had employed was a key system that exerts influence on the hospital operations. Additionally a lack of transparency and communication from check in attendant to patient results in a perceived longer wait time for patients. Through my time observing providers in the hospital, data analysis, and interviews with center staff I became aware of the vast complexity and diversity of the hospitals operations.

School of Engineering and Applied Science

Bachelor of Science in Systems Engineering

Technical Advisor: Dr. Rupa Valdez

STS Advisor: Pedro Francisco

Technical Team Members: Lauren Petty, Justin Ortega, Simona Brkic, Jameson Knotts