Industrial and Operations EngineeringCourse 481: Projects in Hospital Systems

Winter Term Project 7

PROJECT 7: ORGANIZATIONAL ANALYSISOF THE MEDICAL SERVICE PLANS AT THE

UNIVERSiTY OF MICHIGAN MEDICAL CENTER

28 April 1989

MEMORANDUM

‘10: Richard J. Coffey, Ri. D.Instructor, IOE 481

F14: Neal E. GilbertProject CoordinatorIOE 481—89—7

DATE: April 29, 1989

SUBJ: 1)JEC1’ 7 FINAL RERX?I’: (GANIZATIONAL ANALYSIS

Attached is “80%” of the final report on Proiect# 7. I literally have no ideaif we will ever receive the remaining part from Rick Sutkiewicz. I met withRick on 20 Apr to discuss his part which he promised to Pach by 23 Apr 89.

On 23 April 1989, I met with Pach Bombach, Mahesh Desai and Rajan Shah to discuss the final report. Although Roger Schaub was absent, he previously showedhis part to all three attendees, and promised to deliver his final version by3:00 pa 23 Apr 89. During the 23 Apr 89 meeting, I told Pach, Mahesh and Rajof my discussion with Rick. Rick was neither at the meetin nor had contactedPach on 23 Apr 89. Since Rick no longer has a phone, neither Pach, his otherteammates nor I can easily contact him. Under these circumstances, I told theteam members assembled to prepare the final report as individual reports.

Roger Schaub contacted me on Monday with his part. I reviewed it quickly andindicated he needed to beef up two summary sections: a description of that byRajan and that by Rick. I told Roger he could turn in his part to me by Fri,28 Apr 89 (which he did). He too could not contact Rick although he had evenleft a handwritten note at Rick’s residence.

To date, neither the team nor I have heard from or have been able. to contactRick Sutkiewicz. Rick’s unavailability significantly compromises Pach Bombach’sreport, and to a lesser degree, Roger Schaub’s report. Pach conducted/managedthe David Whitten interview but Rick recorded it. Pach. has tried to interpretthe interview from memory; Roger has tried to summarize the data element designfrom talking to Pach, Mahesh and Ra.j about what Rick was supposed to do.

Under these circumstances, regretfully, I have to turn in the final report forPro.ject# 7 as four of five individually prepared reports.

Enclosure: 4 of 5 reports

Part 1 of 5: “Executive Summary” by Roger SchaubPart 2 of 5: The Prince and the Art of War by Rajan Shah

Part 4 of 5: Data Interpretation by Pach BombachPart 5 of 5: DBMS-CAD Roadmap by Mahesh Desai

P.S. Part 3 of 5 should haye been Data Base Data by R.Sutkiewicz.

TO: Neal E. Gilbert— JOE 481, Project 7 Coordinator

( FROM: TEAM 7, JOE 481

DATE: April 15, 1989

SUBJECT: Final Summary of IOE 481, Project 7

INTRODUCTION

IOE 481, Project 7, was established to investigate the relationships between,and within, the several organizational elements of the University of MichiganMedical Center. In the end, the goal of the team was to provide a workingprototype that would ifiustrate both tabular and graphic structures of thehospitals, and portray the many different relationships.

As outlined in the proposal, there were several steps necessary toaccomplish this task. Since the data collection would be performed byinterviewing several very senior managers of the various organizationalelements, much time was spent preparing for the interviews.

THE “PRINCES”

To begin the project, we read Niccolo Machiaveffi’s The Prince, or Sun Tzu’sThe Art of War. These books were important to us for several reasons:

1. They helped us identify ourselves as princes.2. They helped us function better in our relationship with

Neal Gilbert, the project coordinator.3. They helped us to better understand Dr. Coffey.4. They gave us a background unfamiliar to most

engineers, who do not read such books.5. They helped us realize how the project would become

a prince.6. They gave us a better understanding of the prince-type

relationships within the MSP’s.

As stated in Rajan’s report, these books helped ifiustrate the types ofpersonalities we would deal with, both within our group and with themanagers we would encounter. They pointed out the basis of how the“Prince” personality works, how the individual might behave toward us, orreact to certain question types, and how we should approach theseindividuals.

INTERVIEW DEVELOPMENT

Before arranging the interviews, much time was spent developing elements

lists, which describe several managerial characteristics of interest to ourstudy, to help us focus on the types of roles and relationships we wereinterested in. With the elements list, we were able to develop the questionsthat would best obtain information on these roles and relationships. Afterdesigning the interview format, we rehearsed the interview several timesbefore we were ready to perform the actual interviews. For example, we

performed an alpha-test interview with Dr. Coffey. This was the first major

trial for our interview format. At this alpha-test interview, Dr. Coffeyindicated that the format of our questions did not flow well.

After further revision, we performed a beta-test interview to practice thestyle of our question presentation. Structurally, we looked at differentformats for each question, and ensured we understood the meanings of thewords used in our questions. The results of one interview actually executedwith an MSP manager are found in Pach’s summary, along with herinterpretations of the data obtained from that interview.

TRANSFORMING THE DATA *

The data obtained from the interviews is information vital to our project, butit does not help us much until we can find some way to put it into a database.For example, in the interview with Dan White, he discussed his abffity toinfluence. With the people he supervises, such as billing personnel, he haseasy influence because they work for him. But he pointed out his abffity toinfluence other MSP’s by citing a paper he sent through the medical school.What we need to do in formatting our data, is to find ways to quantify thesetypes of relationships, so a person using our database can easily see thedifferences between the various relationships. Using the database, a personought to easily be able to see where Dan White stands in relation to theMedical Center as a whole.

COMPUTERIZING THE DATA

In order to properly display our data, we would need to find the rightComputer Aided Design (CAD) system and database. In the CAEN labs, wediscovered a system called 1-DEAS (Integrated Design and EngineeringAnalysis System), found on the Apollo. Within 1-DEAS were two sub-systemscalled Geomod and the Pearl Data Transfer Task. Geomod is the actual toolthat will allow us to design 3-dimensional objects for structuralpresentations. With it, we can design the 3-D model that will represent theMedical Center organization, turn it for viewing from several angles, and cutit to observe internal relationships. Pearl is the relational database thatallows us to take our tabular data and form it into our 3-D model. A moredetailed discussion of the 1-DEAS system is found in Mahesh’s report.

Finally, we needed to determine how the qualitative information obtainedfrom the interviews would be translated into quantitative data acceptible forour CAD to form the 3-D model.

KEY FACTORS TO SUCCESS

With a project like this, there are several key factors necessary to make it asuccess:

1. Attitude-- of the team members must remain positive.2. Availability of a CAD system and database capable of our task.3. Communication-- between team members.4. Cooperation-- among team members, and from the

various departments.5. Effort-- on the part of all team members.6. Leadership-- of the team.

Two of the factors mentioned above, leadership of the team members and

cooperation, are probably the core of this, and most, projects. It is difficultto have a team of five leaders. One leader must emerge to take control. Thisperson does not necessarily have to work harder or longer, but they do needto be the person responsible for coordinating the efforts of all the member.This leadership is essential to provide optimum efficiency in group progress.

Cooperation among the team members is imperative. For it to be a groupproject, each step needs to have input and effort from all members. If oneperson does not cooperate, he can become a hinderance to the progress ofthe team. Cooperation works very closely with leadership, for leadership isthe ability of one person to motivate others to accomplish a task, andcooperation is the team members working together to accomplish the task.

PROBLEMS

In our project, we had several things that worked, and several that did not.From the start, we had cooperation and leadership problems. Thecooperation problems primarily seemed to stem from time conflicts of theteam members. As a result, one team member found himself left out in thecold when he was unable to make team meetings. As a result, the teammembers attempted to continue without him.

Another problem in cooperation seemed to be that each team member hadhis own perceptions of how the project should be approached. For thisreason, team members seemed to act on their own, and then reported anyfindings to the team, without input from any other members. And even atthis time, members still are not doing a commendable job of sharing theirefforts with other team members. For example, not one weekend meetinghas been held yet, at which all team members were in attendance. And atthe extreme, another team member has seemingly removed himself fromthe group by being unreachable, and making no visible attempts at contact.

The other big problem is leadership. Throughout the project, no personstepped up to take control of the group. No prince emerged to take theproject to the top. Frequently, individual members would attempt to takecontrol by demanding that the project be done their way, but they providedno guidance or motivation needed of a leader.

While these two problems were never overcome, another primary constraintseemed to be the time remaining for the project to be completed. Withlittle time left in the project, the team readied itself for the data collection.At this time, the team received its most severe setback yet. Aftercompleting only one interview, it was learned that all of the remaininginterviews would be cancelled. The primary reason for this appears to bethat the various departments saw the project as a threat to the security oftheir organizational elements.

Their were also other smaller, yet still important, problems in the executionof the project. We never used time wisely. When the team members wereable to get together, too much time was spent squabbling over who shoulddo what next. Instead of each team member sharing his information withthe team, members merely made reports to the others and said what heplanned to do next. Very little input was given by the other members. As aresult, meetings were held frequently just to “catch up” on what the othermembers were doing. As a result, the project progressed very slowly, sothat there were just two weeks left when the interviewing was to begin.

Another problem was the size of the group. With five people in the group, itwas nearly impossible to schedule a meeting that could be attended by allmembers. The size also made it difficult to divide the workioads equally, -

thus upsetting members who were given heavier loads. Having five in thegroup is likely another reason why communication was poor, and the groupdisorganized.

When the project began, no team members had a sufficient background inorganizational analysis and design. As a result, we frequently lost touch withwhat we were dealing with, and what we were trying to accomplish. This isalso a likely reason why we had trouble identifying the aspects of managerialrelationships that our project was trying to focus on.

LESSONS LEARNED

Even though we were never allowed to complete the project as designed,several lessons were still learned. First, and possibly most important, welearned about teamwork. We discovered that it is not always an easy thing toestablish, but without it, the task is extremely difficult to accomplish. Wediscovered that it is not always easy to meet, and work, with members of aproject team. But if there is any hope of the project being a success,sacrifices must be made. All team members must participate with equaltime, enthusiasm, attitude, and motivation.

We learned the importance of leadership. A team of five members willaccomplish little if there is no one to lead it. If no person is assigned tolead, one person must rise above the others to provide the organization andmotivation necessary to move the team in the appropriate direction.Without such leadership, our project moved very slowly while five littleprinces tried to decide what to do next.

We gained some real-world experience about organizations. This was atough lesson to learn, but we discovered that powerful people are often veryprotective of their organization, and are therefore quite uncooperative. Thisillustrated to us how severely politics within an organization can hurt thework of others, and possibly inhibit progress.

CONCLUSION

In the end, we feel we have still given Management Systems some valuedhelp. If this project is to resume again in the future, Management Systemswill have a helpful elements list, and a good, basic interview format. Also, bydiscovering the 1-DEAS system, we have given Management Systems a CADthat will be able to build their model.

While we give Management Systems the few, small tools mentioned above,we have, by our own actions and those of the department heads, givenourselves several valuable lessons about teamwork, leadership,communication, effort, attitude, motivation, sefflessness, etc. We alsodiscovered that the books written several centuries ago by Machiaveffi andSun Tzu are still alive today, and are still as applicable as they were whenthey were written. Had we all read these books in the early stages of thisproject, and paid attention to what they were saying, we may have had bettercontrol and organization of our project. Though the interviews may stifi

have been cancelled, we would have been able to find out much sooner.

)

Analysis of The Prince and The Art of War

Rajan ShahUniversity of MichiganCollege of Engineering

JOE 481 (team 7)Richard Coffey

&Neal Gilbert

April24, 1989

H ... .....

H •..:..

- In the following book reports I would like to discuss the major concepts

the authors are conveying and then show the relevance and correlation of

these concepts to a real world application such as our project. Due to the

uniqueness and sensitivity of the project, a careful understanding of

ourselves, the MSP’s and the people who run them, was needed. The Prince

& The Art of War helped us tremendously in obtaining that understanding.

The Prince by Niccolo Machiaveffi

Machiavelli’s The Prince was written at a time when Italy was

undergoing political turmoil and unrest (approximately 1515). The country

went from being a fmancial and influential powerhouse to a crumbling

nation. With no political preparation nor military backup it saw itself

conquered. The Prince is in response to this lack of leadership and

strength. Machiaveffi felt that through the intervention of a prince Italy

could become united into a consolidated state. The prince would be in

charge of insuring the success and the well being of the state. Through this

idea the basic themes of The Prince are brought out.

Machiavelli believes that the highest achiet,ement ofman is the state.Nothing is superior to the state and its preservation offreedom.. Everyone

including the leader and the people must cooperate in the creation andmaintenance of it. The sole responsibility of the prince is to keep it strong

and securefrom outside intrusion.

- Throughout the project many “princes” were identified and each had their

own personifications of the “state” and the methods by which it was

governed.

- Each member of our team was a prince in his/her own right. However,

instead of cooperating as a team in achieving the goal of the project, weacted individually, only concerned with our grades. This were downfall inthe beginning and possibly through the end.

- Each department of the MSP had an administrator who was a prince, i.e.Dan White. His state was the department he ran. He, along with his staff,

1

worked together in maintaining the function and maintenance of the

department. No outsider could challenge his responsibifity. This

possibly was the reasoning that cancelled our project. We were seen as

intruders by wanting to “analyze” the department.***note: for the rest of the report the word prince when not highlighted

implies either a director, manager,- or administrator of a department.- Our project coordinator and our professor were also princes. Their

responsibility was the project’s outcome and the performance of the team.

They decided how the project should be handled and it was our job as ateam to run it.

- In some respects the project itself could be seen as a prince. It had itsown direction and we were obliged to perform by its rules (“contract”)

Machiavelli discusses three importantfactors which affect the princesability tofulfill his responsibility. They are virtue, military power, andfortune. With correct manipulation ofeachfactor the prince would beaccomplish his task.

Of the threefactorsfortune is the least useful because it is variable andusually uncontrollable. It is not directed or influenced by anyone thereforeexpecting it is hopeless. Fortune can be good or bad and you must respondcorrectly with bothforms. A good prince should be preparedfor it. When itis good use it but doni rely on it because it may change its course. When itis bad conquer it by being impulsive rather than cautious.

- Fortune or luck, whether good or bad, occasionally does occur within thedepartments. If the prince is prepared for it he could use in his favor.For example, if the prince of a department was told that he wouldreceive funds from the university and, after already making necessarydecisions, didn’t get It due to an unexpected error would he be ready tomake alternate decisions quickly while stifi saving himself and thedepartment.

- Fortune played an important part within our team as well. We didn’texpect the timing conflict within our group. This caused many delays

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and obviously lack of deliverance. We should have been prepared and set

specific “must” times to meet. We also weren’t impulsive when deciding

the fate of one of our members when he clearly showed lack of

participation.

The secondfactor is military power. It is the building block and theprotector of the state. ‘The mainfoundation ofall states, new, old, ormixed,... are good arms’fpage 34). Simply persuading men to get thingsdone is not enough because they are basically inconstant. They neverappreciatefavors and they are always quickfor change. Only a princewho has substantial mWtwj power can maintain his dominion.

- We fit this description perfectly. We were asked to analyze the MSP butdidn’t quite know why we were doing it. It may have been because we

didn’t want to know or it was simply not clarified in the beginning and wetook it for granted. It also may have been because clearer explanation wasnot given by our coordinator.

- Within the departments the military power could be referred to manythings. The connections the prince has or the various committees heholds, displaying his authority or the way his department is structured.

Machiavelli mentions various types ofarmies a state may have ofwhich theworst types are mercenary and auxiliary. Mercenary troops consist ofpaidmenfrom the state. They are disunited, unfaithful and without disciplineand are always suspect to mutiny or revolt. Auxiliary troops are menfrom apowerful neighbor. They are useless because the prince is entirely left intheir hands. f the win he wins, jf the lose he loses. The best army is oneconsisting ofnative troops. These areformed by citizens or subjects whoarefaithful to the cause and loyal to the prince. They are therefor victoriesandfor defeats as well. They are willing to serve their prince andfightforthe cause at any cost.

- Our team displayed the characteristics of all three types of armies. Eachtype of army serves a different prince. We were the mercenary troops for

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the project because we would get the job done, with ignorance, and

receive payments (our grades) for the completion. We were the auxiliary

troops for our coordinator and professor because they were basically leftin our hands. If we blew the interview with the prince and hedisapproved of our tactics, the project would be cancelled and thecoordinator would be left in the dark. His and the professor’s reputationis also blown. However, in the same respect, we could be seen as nativetroops because we were the students that had been guided and preparedand therefore were loyal to the project and our coordinator.Within the department there also exist different types of armies fordifferent tasks. Mercenary troops may be paid employees who have noinput as to the direction and function of the department. They work for aspecific task and are paid. Since they are not involved with managing,hence having little authority and their life are not on the line, they areable to concentrate on their job better and therefore are needed by theprince, auxiliary troops could be people (princes?) from other

( departments. They are sometimes needed to do things that they are onlycapable of doing. However they aren’t relied on too often. Native troopsare also needed by the prince in maintaining the department. Thedirector relies on their advice constantly and therefore their authority andpositions also become valued more.

In orderfor the people to believe in the prince he must posses someattributes that make him special. This is Machiavellis thirdfactor, virtue. Itis the capability of the prince to achieve and maintain the welfare andsecurity ofthe state. Virtue implies the princes courage, talent, strength,ability and most importantly intelligence. It is simply the necessary qualitiesneeded directlyfrom within.

- Since politics is involved, hence manipulation of power, in maintainingunification and content within the state, a prince is required to beinteffigent in choosing, ingenious in intuition and swift & precise in hisactions.

- The prince in charge of the department must be able to take risks and

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make decisions when put on the spot, i.e. Dan White decide to try

participated management, something new. A prince must display some

special talent or skill that separates him from the rest. His authority must

be defined clearly.

- Many of these qualities of a prince were obviously lacking within our

group, especially courage, leadership and authority causing

disorganization.

- This understanding of the many attributes of a prince helped us in

developing the questions. From this idea we knew we had to concentrateon leadership, authority, supervision.

Machiavellifeels that since politics is the art ofcoordinating and directingthe activities of men within the state a good prince should be a master ofthat wt

How the outcomes ofhis actions are viewed by his subjects andfriends willcause either content and confidence or discontent and doubt. Therefore theway he acts is always under scrutiny. However, as long as thefinal result ofhis decision is seen as beneficialfor the w4fare of the state, the means bywhich he does it is less scrutinized. This is because people, in general,judge what they see, hence the performance and result, and not what theyfeeL

- No one would questions the prince’s method of running his department ifthey could see that it produced efficient results.The interviewing aspect of our project may have been cancelled becausethe princes felt that were questioning their domain of authority.

The prince must do whatever necessaryfor the state. He should not care inkeeping his promises and breakfaith when required. He should be cruelrather than merciful because it is better to befeared than loved. Being lovedis simply a token ofobligation and thefeelings can be changed whenconflicts ofinterest arise. Beingfeared ofpunishment, however, gives himrespect and loyalty. He must strive to befeared such that jfhe can’t be loved

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he avoids hatred because hatred would cause dissention, conspiracies andcertain destruction.

- This is simply the displaying of the princes authority. For Example, hiringand firing or assignment of duties. People are afraid because he has thepower to kick them out.

- As a team we should have questioned our coordinator’s ideas or methodsmay have been afraid to jeopardize our grades.

The princec power should be acknowledged by displaying his strength inthe area offoreign affairs. He should avoid being neutral and declare himselfanfriend or an enemy. This is so because indecisiveness at crucial momentsmay cause doubt of leadership. How he selects hisfriends and subordinatesis also important They must befaithful and Loyal to him because he relieson their advise in running the state. He must choose afew prudent menwho will be allowed to speakfreely and truthfully to him. By choosingappropriate council he achieves two thingsfor himself He not only has agovernment which consists ofmen ofhis choice, he also maintains authority.

- The prince of the department must be able talk with other princes in theMSP without hesitation.

He must choose some loyal and faithful friends and worker so he can getan unbiased opinion. These would be the important contacts.

The Art of War by Sun Thi

Sun Tzu’s The Art of War is dramatically comparable to The Prince. Theyboth feel that a strong army is of vital importance to the state. Where in thePrince, Machiaveffi discusses the necessary factors for the maintenance ofthe state and a need for an army to prevent outside intrusion Sun ‘ftudescribes the tactics necessary to destroy the army (foundation) henceconquering the state. Sun Tzu believed that careful preparation before the

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battle and correct decision making during the battle one could insurevictory:

“...the moral strength and Intellectual faculty of man aredecisive in war, and that If these were properly applied

war could be waged with certain success.” (page 39)

In preparation before the war Sun Tzu presentsfive elements that involveknowing yourseif the enemy, and the conditions ofbattle. Thefirst elementis moral Influence. It is what causes the people to be in harmony with. theirleader. This is needed so that they will serve them in ljfè and deathsituations withoutfear ofdeath. When treatedfairly, impartially, and inconfidence they are willing to accompany without reservation.

- This was similar to the organization of the group that we so desperatelyneeded. No one felt obligated to the project and therefore showedignorance. If we developed some sort of plan or schedule or personalpurpose maybe the project could have come a little further.Within the departments obviously there is a need for organization andpurpose. If there isn’t a purpose no one will know why they are doingwhat they’re doing. If there is no organization the department simplycannot function properly.

The second element is the weather. What is the influence brought bynaturalforces? How does the cold of the winter or the heat of the summeraffect military operations. Understand the ‘time’(weather conditions) of thebattle and prepare accordingly.

- We had to prepare ourselves by knowing what we were heading into.Knowing the environment of the MSP’s and the way the operate and theirgoals were important even before developing the questions.

The third element is the terrain. This is understanding the distance oftravel and whether traversing is going to be with ease or difficulty. fyoucan tell the degree ofease or difficulty you can estimate the size of theforces to be deployed and possible detours.

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- We had to know what areas of the department we were going to interview.Also if the interview could not be completed what other ways could we

obtain the necessary infonnation.

Thefourth element is the command. This is the virtues of the general(similar to prince). His qualities ofwisdom, sincerity, humanity, courage,and strictness. A good general should be able to recognize changingcircumstances and react appropriately. He should treat his men withsincerity such that receiving rewards and punishments are clear. In doingso he must also discipline his troops so that they are afraid ofpunishmenLHe should love mankind and the resources nature has to offer. Finally heshould be able to gain victory by seizing all opportunities without hesitation.

- This was the key ingredient that was lacking in our team. We neverdefmed a clear leader. We all had our own ideas of accompllshing theproject and the idea of group effort was not recognized until it waspossibly to late. A leader was needed to provided us with guidance andorganization. Simply having the coordinator to tell whatto do was notenough. This problem delayed our project work plan.The qualities mentioned by Sun Tzu’s general is similar to Machiavelli’sprince. The leader/general/administrator/ should posses these andother qualities in order for him to be seen as the “head hancho”. This wasalso important in understanding before the interviews. Atleast we wouldhave an idea of his character or personality before even talking to him/her.

Thefifth andfinal element Sun Tzu presents is the doctrine. This is theorganization of the army, the delegation ofauthority to the officers, and theassignment ofduties. What are his responsibilities? Are the appropriateofficers in charge?

- How well the prince assigns tasks, delegates authority and responsibffitywill directly influence the performance of the department.

The general who mastered thesefive elements is assured to win even beforethe battle.

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An army can be successful, tfnot before, during the war as well. By seeing

how you enemy acts you can employ appropriate maneuvers. This providesthe element ofsurprise. Seeing the enemys weaknesses and strengths andcomparing them with your own, you’ll have an idea as to where you stand.Being defensive where he is strong and offensive where he is weak will allowyou to save lives ofmany men. Finding his vulnerable spot and attackingwithout recourse is acting quick such that he has no time to prepare.

Showing your weaknesses as strengths and strengths as weaknesses will

make him confused, rendering him to take haphazard actions. Avoiding theareas ofwhere the possibility ofdanger is prevalent also will save lives.

Seize all opportunities given to you because they may not come again. Makethe enemyfeel confident and then destroy him. This will not only reducethe size of his army but will revoke his confidence.

- These are the tactics involved in interviewing. By being evasive, indirect

and inferior we would possibly leave the prince vulnerable. So obtaining

the answers could have become less difficult. We would, however, have tobe careful because it could backfire.

- We also had to be careful of the danger spots. These were the areas thatmay have caused him to become suspicious and reluctant in providing uswith appropriate answers or even an interview for that matter.

Both books helped us in many ways. Without them we might have beenstill without a clue. They pushed us into realizing the necessary ingredientsof a team, a leader, the departments, and the princes that run thedepartments. This helped us in defining our goals and in understanding thepolitics involved in running a specific department. They helped us inpreparing the questioris and gave us insight as to the way we should actwhen going into that sort of environment. We identified our capabilities as ateam and as individuals. The applications of both books are not only meantfor the political environment but in any working environment.

9

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INTERPRETATION OF DATAEYEBALL 2

Pacharintra Bombach

Industrial and Operations EngineeringSpecial Projects Hospital Systems

April 24, 1989

-(

On April 3, 1989, an interview with Mr. Dan White(pseudonym), a clinic administrator for one of the two largestMichigan Service Practices, in the University of Michigan MedicalCenter. The purpose of this segment of this report is to analyze thedata obtained from the interview The discussion will be dividedinto three sections: 1) interpretation of the concept design,i.e. theinterview process, 2) the analysis of the raw data, and 3) outline ofconclusions that may be of particular interest to managementpersonnel

INTERPRETATION OF CONCEPT DESIGN

Interpretation of the concept design will show the rationale forchoosing the interview as the process for obtaining the data... Duringthe question formulation stage of this project, it became evident thatour interests and our questions were perhaps beyond the timeconstraints and issue sensitivity of any data collection process. Wedecided that interview process would yield the best results accordingto the reasons listed below:

1) Interviews would allow interviewee to volunteer information that was not directly asked for, informationthat may be very insightful. As an example, Dan Whitecompared his department with the other large MSP interms of management attitudes and practices.

2) Interviews would allow the project group anindication of the response to the project’s goals andapproach. This gives us a chance to clarify our intent anddismay any misconceptions.

3) Interviews would facilitate data acquisition. In otherwords would solve the problem of ignored surveys, a noresponse.

4) Through interviews, we could get a feeling of thepersonality of the department by observing thepersonality and management style of the clinicadministrator.

5) Through the interviews, we could observe a person’sbody and get a better indication if questions are vague orinsulting

6) Our time commitment to the interview processemphasizes the importance of this project. That is aninterview seems to convey more importance than ansurvey.

INTERPRETATION OF RAW DATA:

1) General tone of Interview Mr Dan White was direct andspecific in his responses to the questions. In a couple ofinstances, his “in charge” personality was slightly intimidating.He seemed forthright and self assured. Mr. White made a pointto describe his organization and his management style asparticipative. He described the organization as a family andthat he sees everyone in his organization as having a good dealof autonomy. Mr. White also showed that he is personallyinterested in the education of the House Officers and attendssome of their interviews. He indicated this was not typical ofadministrators.

2) Mission statement and Departmental Objectives: Themission statement emphasized a commitment to education,research, and administration. Terms such as efficiency,expertise and new programs indicate the progressive nature ofthis department. One of the departmental goals involvesgaining an expertise in the treatment of a “broader range” ofproblems on and off campus. This indicates expansion anddirection for the future.

3) Structure of the Organization: Autonomy is possible in thisorganization in large part because each individual has technicalexpertise in certain areas. This means, there is someone who ishead of information services, finance, practice operation,personnel, and development. Thus, there is one person that iscontacted for billing and one person that handles facilitymanagement. The person in charge of billing would also be theperson to train additional personnel.

4) Dan White’s responsibilities include organizing andplanning of the departmental budget, coordinates with sectionadministrators in monthly meetings and establishes fees for

services provided by the department. He shares information,coordinates personnel on projects and makes decisionsconcerning the budget. Mr. White said he works in conjunctionwith the department chairman when doing strategic planning.His supervisory role consists of exercising various degrees ofsupervision. He mentioned that our definitions of degrees ofsupervision were vague.

5) Physicians autonomy: Dan White indicated that physiciansreceive much of their direction from those in the medicalschool. For example, a pay incentive program was acceptedand implemented through the influence of persons in themedical school. Ideas for new fields of research are generatedby physicians or physicians with a interest in the new field arerecruited. He also indicated that the physician workload isdetermined within the medical school.

6) Outside contacts: Dan White has meeting with other V

administrators monthly. He indicated that he is in contactwith other administrators in the Medical Center and relies onthem as peers. Mr. White also mentioned that he has contactswith administrators across the country. He also is a participantto the Quality Forum and other hospital committees.

MANAGEMENTS INTEREST?

1) The medical center is a highly political environment. Thisadministrator seemed to be aware of this. It seemed clearfrom the interview that the administrator relies on his/hercontacts to keep abreast of new approaches to problems and togain allies when decisions need to made.

2) This administrator seemed to have a progressive ideastoward management. He mentioned the idea of trying toincorporate a team concept.

3) In setting up a new program, the department views its roleas the initial planners but the hospital as the implimentor. Thismay be due to cost or liability.

4) Mr. White indicated there is a solid line relationshipbetween himself and the nursing administrator. He also *

expressed that the nursing administrator might think that it istoo solid!

5) Mi. White mentioned that physicians who wished to go to• conferences were provided expense accounts through their

appointments in the medical school. Administrators within thedepartment would have to request funds from Mr. White to go.

6) The budget is divided to give each section its own budget.Generally each section head is in charge of his/her budget.

• Rarely, are additional funds requested.

In summary, the interview process lead to important insightsinto how this department works. Some of the information wasascertained from the generated questions but much of it was gainedfrom what the interviewee volunteered. The interview spurred ourinterest in the relationship each department has with the medicalschool as well as the hospital.

11. DsAi

PROTOTYPE / FINAL IMPLEMENTATION

Once the interviews have been completed and the data has been arranged insome particular fashion, the next step Is to input the data Into a database.After all the data has been entered into a database management system(DBMS), there must be an Interface to a computer aided drafting system(CAD) which has the capabifities to plot selected data in various geometricalforms. As a result of circumstances beyond our control, we did notImplement nor prototype the final stage of this project. However, I haveanalyzed the steps needed to do so. Before I discuss these particular steps, Iam going to present an overview on DBMS and CAD.

DATA BASE MANAGEMENT SYSTEMS (DBMS)

A database is an updatable storage of information. Extending this definitiona bit further, a DBMS is a general-purpose software system which canmanage databases for very large class of the possible applications. The majoradvantage of a DBMS is that it makes use of artificial Inteffigence (Al). TheDBMS uses its hierarchical logic to define relations. A database has tofollow one of the four following models:

(_S

tiS

(1) BINARY:

(2) RELATIONAL:

the information is represented by logicalassociations/relations between pairs ofobjects and by classification of objects intocategories (sometimes called SEMANTICBINARY or CONCEFI’UAL BINARY)

the information is contained in tables andthese data are associated through these tables

(3) NETWORK: the infoiEmation is represented by a directedgraph of records

(4) HIERARCHICAL: the information is represented by a tree ofrecords

In this project application, we will be using a relational DBMS. The best wayto.explain a relational DBMS in detail is to discuss an example. Figure 1shows sample data in relational form.

S S# SNAME STATUS CITY JSi Smith 20 London

S2 Jones 10 Paris

S3 Blake 30 Paris

P PNAME COLOR WEIGHT CITY

P1 Nut Red 12 London

P2 Bolt Green 17 Paris

P3 Screw Blue 17 Rome

P4 Screw Red 14 London

Si P1 300

51 P2 200

Si P3 400

S2 P1 300

S2 P2 400

S3 P2 200

SF’ S# P# QTY

P

Figure 1 - Sample data in relation format

From figure 1, it can be seen that the data is organized into three tables:S(suppliers), P(parts), and SP(shipments). The three tables S. P. and SPeach contain information about suppliers, parts, and shipments,respectively. Each of these tables is actually a special case of the constructknown in mathematics called a relation. Rows of the table are called tuples.The most concept in relational theory is that of domain. A domain Is allpossible values from which the values appearing in a given column aredrawn. You can see that these relations S and SP have a domain, (suppliernumber), In common. Another crucial feature of the relational datastructure is that associations between tuples are represented solely by datavalues in columns drawn from a common domain. The fact that supplier S3and P2 are located in the same city, for example, is represented by theappearance of the same value in the CITY column for the two tuplesconcerned. It is a standard characteristic of the relational approach torepresent data in the form of tables. For the purposes of this project, ourrequirements imply that we must use the relational approach in order toview all of the possible “relationships”.

COMPUTER AIDED DRAFTING (CAD)

Computer Aided Drafting (CAD)/Computer Aided Manufacturing (CAM) maybe best described functionally in Figure 2 below.

Figure 2- CAD/CAM Functions

We will only be concerned with the left half of Figure 2, which representsCAD.

Numerical

Control

Geometric

Modeling

Analysis

Testing

Drafting

N/

/

//N

Process

PlanningCommon

Database

Robotics

Factory

Management

Modern CAD systems are based on interactive computer graphics (ICG). - —

Interactive computer graphics simply denotes a user-oriented system inwhich the computer is employed to create, transform, and display data inthe form of pictures or symbols. In CAD, geometric modeling is concernedwith a computerized mathematical description of the geometry of an object.The mathematical description allows the image of the object to be displayedand manipulated on a graphics terminal through signals from the CPU of theCAD system.

In order for CAD to produce output, there must be a model structurepatterned after their suggested data base organization. The following listrepresents a building block approach to model formulation:

1. Basic graphic elements (points and other elements)

2. Geometry (shape) of the model component and their layout intheir layout in space

3. Topology or structure of the model - how the variouscomponents are connected to form the model

4. Application - specific data

There are many types of models. One such possible data structure involvesstoring the coordinates of the geometry. Also, boolean operations can beused to construct the geometric model as shown below.

-J

Alternate forms include the graph-based model. The graph based model inFigure 5, on the following page, is composed of a series of points and lineswhich establish relationships among the points, edges, and surfaces of thegeometric element. Only the points (vertices) are contained as spatial datain the record. However, the relationships that connect the edges tovertices, face to edges, and the solid to faces are also recorded.

Figure 4- Boolean operation (Not C and (A or B))

(a)

Figure 5 - Example of a graph based model

This turns out to be a compact way to define a solid. This is ideal for thisproject application, since this allows slicing and rotating of a solid sphere.With this general overview in mind, I will discuss how all this may beapplied to our project.

APOLLO COMPUTER SYSTEM (I-DEAS software package)

The Integrated Design and Engineering Analysis System (1-DEAS), which isa software package in the Apollo computer system, is the key toimplementation of this project. The Apollo computer system may be used inany of the CAEN Labs at the University of Michigan. Within 1-DEAS there is a“Pearl” relational data base and a “Geomod” CAD package. Below, I haveshown a “road map” of the necessary steps for further Implementation of theprojef

“ROAD MAP”1-DEAS/Pearl CREATE DATA MODEL

Pearl Data Traiisfer

I-DEAS/Pearl LOAD TO PEARL DB

Select Eleme&s

1-DEAS/Geomod LOAD TO GEOMOD FILE

II-tJEAS/Geomod GEOMETRICAL OUTPUT

FIgure 6 - “Road Map” of steps needed to complete project

PEARL DATA BASE MANAGER

The Pearl relational data base manager is what our model will require. Thedata In Pearl is stored In rectangular tables and most commands operate onone or more of the tables. Some of the commands use new tables as a resultof the operation. Each database contains any number of tables and each tableconsists of any number of rows of data. Names are used to designate tablesand columns (attributes). A null or missing data value is displayed by aspace. This value is used by Pearl whenever a valid data item is unavailable,as may be in the case of some information not given out in the interview.

After opening a database, the next step is to create and manipulate tables.Upon entering the CREATE command, Pearl will prompt you for a name foreach column, the data type, and the length of the column. In addition, Pearlwill also prompt you for units, class, and type for precision of the columns.The table Is given a name only when it is stored.

Once the table have been created and data has been inserted, you may relatethe tables. Subsetting based on specified criteria, sorting into a specifiedorder, and combining tables according to specified constraints arecapabilities provided in Pearl. You must note that In sorting tasks, thenumber of the row is descriptive only and Is not permanently associatedwith the data in it. For example, when you sort a table, the rows will beautomatically be renumbered sequentially; therefore, the data in row 13before the sort will not necessarily be the same data after the sort. Amongother operations to be performed on table is appending of two tables inwhich you can add rows from one table to another table. Several operationsfrom mathematical set theoiy are used for data manipulation. The logicaloperations performed are intersection, difference, exclusive or, and union.

However, to use the DBMS you must first use the Pearl Database Transfertask to load your model into an 1-DEAS Pearl Relational Database. The PearlData Transfer task will also allow you to read geometric data and relatedtopology from other products, systems, and formats into a Pearl Database,and from there, transfer it into an 1-DEAS Geomod Model ifie. In order totransfer data between your Model file and the Pearl relational database youmay use the following commands:

FUNCTION COMMANDOpen Pearl Databa.s OPEN_DATABASEClose Pearl Database CLOSE_DATABASESelect entities to be transferred ENTiTY SWSTransfer model to Pearl database LOAD_PEARL_DBTransfer model data to Modelfile UNLOAD_TO_MODEL_FILE

Before transferring entities to the Pearl relational database, you’ll need tocreate an 1—DEAS relational data model in the relational database. In orderto completely understand the Pearl data transfer task, you must referencethe 1-DEAS User’s Guide, which may be purchased at Dollar Bifi Copying.

Within 1-DEAS, Is also a CAD package call Geomod, which will interface withthe Pearl DBMS to produce geometrical output. Geomod has the following -

capabilities: -

1. Move an item to another location. This involves the translation of the item from onelocation to another.

2. Duplicate an item at another location. The copy function is similar to the move functionexcept that it preserves a copy of the item at its original location.

3. Rotate an item. This is the rotation transformation, in which the item is rotated through aspecified angle from its original orientation.

4. Mirror an item. This creates a mirror image of the item about a specified plane.

5. Delete an item. This function causes the selected segment of the model to be removedfrom the screen and from the data base.

6 Remove an Item from the display (without deleting it from the data base) This removesthe particular segment from the current image on the screen However it is not removedfrom the data base Therefore repainting the screen from the data base will cause thesegment to reappear.

7. Trim a line or other component. This function would remove the portion of the line thatextends beyond a certain point.

8. Create a cell out of graphic elements. This feature provides the capability to construct acell out of selected elements. The cell can then be added to the model in any orientationas needed.

9. Scaleanitem. Aselectedcomponentcanbescaledbyaspecifiedfactorinx,y,andzdirections. The entire size of the model can be scaled, or it can be scaled in only one ortwo directions.

The Geomod program is divided into three modules. The first module Iscalled Object Modeling, which allows the creation of three dimensionalobjects. Another module, called the System Assembly, allows the viewer toperform several activities. Among these activities are assembling the threedimensional model Into a system, viewing the three dimensional object fromany angle, turning the object in space, cutting or slicing the object, andanimating in real time. Finally, there is a Mechanism Solution module, butit is not included within the scope of our application. Data from this systemis stored in two distinct files. The ifie names are MF1 and MF2. In MF1 allthe model data is stored and in MF2 all graphical data Is held for randomaccess. This structure allows 1-DEAS to separate storage and retrieval ofdata into two different processes; processing of the model data, andprocessing of the graphical data. It is important to completion of the database that both of the files exist. Also, at Dollar Bifi Copying you can get the1-DEAS Geomod User’s Guide. Other guides available to help you betterunderstand the 1-DEAS software package include Apollo Manuels #201-204on 1-DEAS Software Package at all CAEN Labs on campus. I have provided alayout and summary of the system’s capabffities; however, to completelyunderstand the actual “process” of implementation in full detail it isnecessary to refer to the requested manuels.

OVERVIEW ON COMMANDS

I have compiled a list of some of the most common commands that youwould use in implementing our project.

OPENJ)ATABASE: allows you to open either a new or an existingdata base and provides an option for read onlyto prevent inadvertent writing to it

CLOSE_DATABASE: allows you to close a data base and provide anoption to save changes

STATUS: allows you to check the name of the currentPearl data base

LOAD_PEARL_DATABASE: allows you to load data into Pearl

NEW_OBJECT_TO_PEARL: allows you to write a new object into thePearl data base

ADD_VERSION_IN_PEARL: allows you to add a new version of an objectalready stored in the Pearl data base

DELETE_OBJECT_IN_PEARL: allows you to delete all versions of thespecified object from the Pearl data base

VERSION_PURGE: version of the specified object from the Pearldata base

WORKING_SET: allows you to store a Geomod working set inthe Pearl data base

UNLOAD_TO_MODEL_FILE: allows you to read data from Pearl into aGeomod Model File

GET_SURFACE_FROM_PEARL: allows you to get a surface from the Pearldata base, generates facets, and bring intoGeomod as an open object- After selectingGET_SURFACE_FROM_PEARL you can choose asurface with SELECT_FROM_ALL orSELECT_FROM_SET

GET_OBJECT_FROM_PEARL: allows you to get an object from the Pearldata base and bring it into Geomod

WORKING_SET_FROM_PEARL: allows you to get a working set from the Pearldata base and bring it into Geomod

BIBLIOGRAPRY

Date, C.J., An Introduction to Database Systems, Addison-Wesley PublishingCo., 1981.

Groover, Mikell, CAD/CAM Computer Aided Design and Manufacturing,Prentice Hall, Englewood Cliffs, NJ, 1984.

Hardeski, Michael, CAD/CAM Techniques, Reston Publishing Co., RestonVA, 1986.

Knox. Charles, CAD/CAM Systems - Planning and Implementation, MarcelDekker, Inc., New York, New York, 1983.

Medland, A.J., CAD/CAM in Practice, Prentice Hall, Englewood Cliffs, NJ.1984.

Preston, Edward, CAD/CAM Systems, Marcel Dekker, Inc., New York, NewYork, 1983.

Rishe. Naphtali, Database Design Fundamentals, Prentice Hall. EnglewoodCliffs, NJ, 1983.

Stocker, P.M., Database Role and Structure, Cambridge University Press,Cambridge, London, 1984.

Stover, Richard, An Analysis of CAD/CAM Applications, Prentice Hall,Englewood Cliffs, NJ, 1984.

Apollo Manuels #200-204 1-DEAS Software Package, Structural DynamicsResearch Corporation, Milford, Ohio, 1988.