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In the modern race to innovate, the health care industry is lagging decades behind manufacturing and other service industries.

Michael Carter is ready to launch a game of catch-up.

As head of the new Centre for Research in Healthcare Engineering at the University of Toronto, Dr. Carter's job seems simple on paper, but a lot tougher to execute: Replace the isolated elements of the system with a more efficient, productive health care system that gets everyone pulling in the same direction and makes the best use of limited resources.

"Every time I go into a hospital, I'm looking at it with a different eye," Dr. Carter says. "Everywhere I look I see opportunities for improving efficiency. ... It's not just cutting costs. It's really important to have the system set up properly."

All too often, Canadians hear stories about hospitals without enough beds, patients waiting in long queues for care, and those that simply give up and head to the United States for treatment. Dr. Carter believes it all stems from the biggest problem facing the health care industry: co-ordination difficulties.

"Nobody ever designed the health care system. Nobody ever sat down and said, 'This is how we should deliver care.' It's sort of piecemeal," he says. "Most of the people I meet are putting in 110 per cent — the problem is they're all pulling in different directions. We don't have co-ordination between people, between departments. The emergency room isn't talking to wards, the hospital isn't talking to the GPs."

The research centre, launched in January as an initiative of the UofT's mechanical and industrial engineering department, builds on the work Dr. Carter has been doing for the past 18 years. He is credited with forecasting demand for hip and knee replacement surgeries, modelling the impact of colorectal cancer screening in Ontario, and reducing ambulance delays in Toronto.

His focus is on using math and technology to re-engineer how the system works: "We're trying to bring engineering and quantitative methods into health care."

A lot of what he's trying to do with the centre is taking ideas that car companies used 20 years ago and applying those strategies to health care today. The only difference is the bureaucracy involved.

"If I went to General Motors and I said, 'I can save you $1-million a day,' they would do it tomorrow. The CEO would just say, 'Sorry guys, this is what we're doing,'" Dr. Carter says. "If I went into health care and said 'I can save you $1-million a day,' they'll say, 'We'll have to chat about it.'"

One of the centre's topics involves making emergency care more efficient through a pilot project at Scarborough Hospital, in Toronto's east end. Computer kiosks now let patients update their condition while waiting to see an emergency room doctor.

Those arriving at the emergency ward still check in with a triage nurse. But when they are in the waiting area, they can update their condition themselves instead of waiting for a nurse to come by. An alert will pop up on the nurse's computer screen and the patient's information is updated and care is reprioritized if needed.

"It doesn't get people in any faster. What it does do is ... improve the patient experience and reduces the workload on triage nurses so they can spend more time actually working on the more serious cases," Dr. Carter says.

Another project involves working with a consortium in Alberta to calculate what the demand will be over time for doctors, nurses and other health care professionals, depending on disease prevalence and population changes in that province.

Dr. Carter knows that process changes do not take place overnight. And he know there are good reasons why health care is behind manufacturing in terms of innovation: priorities are usually decided for medical reasons, rather than financial.

But some of the problems he has run into over the years make him shake his head. One Toronto hospital, for example, was turning away patients because there weren't enough beds. He was called in and, with some students, did a simulation analysis (in other words, used mathematical methods to analyze the situation). They found that patients in intensive care should have been in a step-down unit with less intensive care, and those in the step-down unit should have been in a ward.

"Health care is so complicated that the people who are working in the ICU are not co-ordinating with everybody else," Dr. Carter says. "It's a system problem. It's a communication problem."

He is not alone in looking for efficiency in the health care system. Colleagues in other parts of the country are working on other initiatives. For example, the University of British Columbia's Centre for Health Care Management has projects to enhance health care delivery and productivity.

Dr. Carter hopes that through the new centre he heads, he will be able to co-ordinate resources and there will be a place to share knowledge, especially as the sector continues to look for more ways to deliver care more efficiently.

Companies, too, are getting involved. Business intelligence software has been used for decades to make commercial organizations more efficient, and recently, the health care industry has begun using it. SAS Canada, for example, has more than 50 hospitals in Ontario using its software for clinical research projects, more efficient use of resources, or better understanding of costs.

In the United States, waste in the health care sector amounts to about 30 per cent of the budget, Dr. Carter notes. There are no similar figures in Canada, but he suspects it's pretty close.

He was once called to a Toronto-area hospital that was booking patients for 30-minute appointments and needed help reducing its waiting list. His analysis found that the average patient was in the doctor's office for 17 minutes. By booking 20-minute appointments, productivity would improve.

"There's a lot of waste in health care and it's not intentional," he says. "It's duplicate tests, it's the waste of having people wait around. … It's the wrong resource at the wrong place at the wrong time."

New technologies or management systems won't replace the expertise of health care professionals, of course. But they do allow a hospital to better manage its resources, says Pat Finerty, vice-president of alliances and business development at SAS Canada.

"[Just as] e-banking was the rage in the mid-'90s, and integrating various lines of business in the banking industry was the major challenge, so today e-health is absolutely a top priority initiative in all the major health systems in Canada," Mr. Finerty says. "Integrating hospitals' and agencies' and ministries' information management is again a huge issue."