Michigan MedicinePerformance Improvement

Cost-Benefit Analysis of Current Radiation Dosimeter Badge Process

Final Report

Submitted to:

Ms. Debborah Burch Radiology Quality Assurance Coordinator

Michigan Medicine

Ms. Carali Van OtterenIndustrial Engineer, Performance Improvement

Michigan Medicine

Ms. Yuting DingIndustrial Engineer, Performance Improvement

Michigan Medicine

Dr. Mark Van OyenIOE 481 Professor

University of Michigan College of Engineering

Submitted By:

IOE 481 Project Team 1Mr. Bogart LipeMr. Derin OzenMs. Sarah Park

Ms. Madison Speck

Submission Date: April 17, 201818W1-final report

Table of Contents

Executive Summary 1

Key Issues 5

Goals and Objectives 5

Project Scope 6

Observations and Interviews 6

Self-Collection Forms 7

Time Studies 7

Literature Search 7

Findings and Conclusions: Data Collection 8

Observations and Interviews 8

Self-Collection Form 9

Time Studies 9

Design Methods 10

Process Map and SIPOC 11

Cost-Benefit Analysis 12

Current Value Stream Map 14

Findings and Conclusions: Design Tools 15

Process Map and SIPOC 15

Cost-Benefit Analysis 15

Current Value Stream Map 15

Design Requirements, Constraints, and Standards 16

Design Requirements 16

Design Constraints 16

Design Standards 17

Constraints and Standards Matrix 19

Recommendations 21

Expected Impact 24

References 26

Appendices 28

Appendix A: Visual Representation of Interview Data 28

Appendix B: Self-Collection Form 31

Appendix C: SIPOC Diagram 32

Appendix D: Current Value Stream Map 33

Appendix E: Instadose Costing Information Provided by Client 34

Appendix F: Labor Cost Calculations for Cost-Benefit Analysis 35

Appendix G: Cost of Badges Calculations (Current and Instadose) for Cost-Benefit Analysis 37

Appendix H: Total Cost Calculations and Savings Calculations for Cost-Benefit Analysis 38

Appendix I: Expanding Analysis to Entire Hospital Calculations 39

List of Figures and Tables

Figure 1: Time Study Results …..……………..9

Figure 2: Current State Process Map ………………..11

Figure 3: SIPOC Diagram ………………..12

Table 1: Cost-Benefit Analysis of Current Badge Process ………………..13

Figure 4: Current Value Stream Map ………………..14

Figure 5: Constraints & Standards Matrix ………………..19

Table 2: Cost Data for Instadose System ………………..22

Figure 6: Pugh Selection Matrix ………………..23

Figure A-1: Badge Storage Location for IR Department Graph ………………..28

Figure A-2: Graph of How Often IR Employees Wear Their Badge in the Procedure Room ………………..29

Figure A-3: Instances of Late and Lost Badges in the IR Department ………………..30

Table F-1: Summary of Annual Labor Costs for the Badge Collection and Distribution Process ………………..36

Table G-1: Summary of Yearly Costs for the Current Badge and the Instadose Badge ………………..37

Table H-1: Summary of Total Savings by Switching to the Instadose Badge System ………………..38

Table I-1: Summary of Total Cost for Current Badge in the Entire Hospital ………………..39

Table I-2: Summary of Total Cost for Instadose Badge in the Entire Hospital and Total Savings per Year if Instadose Implemented ………………..40

Executive Summary Regulations require that all employees exposed to ionizing radiation must wear a radiation dosimeter badge in order to record their exposure. These badges need to be collected in order to record the dosage on each badge. This collection process has many inefficiencies and results in lots of excess cost and labor. The Radiation Quality Assurance Coordinator of Michigan Medicine has asked a team of IOE 481 students to analyze the current radiation badge collection process and perform a cost-benefit analysis.

Background The radiation badge collection process at Michigan Medicine has been considered inefficient by many of the hospital employees involved. The project team has been asked to design and analyze a cost-benefit analysis regarding the cost and state of the current process. The Interventional Radiology (IR) Department was examined, which includes the 106 dosimeter badges worn in this department. The IR employees are required to wear their badges whenever they are in a procedure room and must store the badges properly at the end of the work day.

The employees are also responsible for exchanging their old badges for new ones during the monthly collection period. After the badges have been exchanged, they are mailed to the Radiation Safety Office (RSO), where they are collected before being sent to Landauer, the company that supplies the badges. Landauer then records the radiation exposure data and sends the results back to Michigan Medicine. Overall, it takes just over a month for employees to receive their radiation exposure results.

The inefficient collection process adds to the cost of the overall system. In addition to that, the length of time to receive results makes it difficult to quickly adjust radiation exposure practice in reaction to a high dosage reading. The goal of this project was to perform a cost-benefit analysis for the current process so a recommendation could be made on how the system could become more efficient and less costly.

Data Collection MethodologyIn order to make this recommendation, the team conducted interviews and observations, time studies, and self-collection forms. In addition, the current state was thoroughly analyzed and a literature search was performed.

Observations and Interviews The team observed the interventional radiology department for a total of 15 hours and interviewed 22 different employees, including technologists, nurses, and doctors. The Radiation Safety Office was also observed in order to understand the process the badges go through once they are arrive at the office.

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Self-Collection FormA self-collection form was distributed to the badge collectors in the IR department. The form had each badge collector record how much time they spent completing each badge collection task. The form was distributed for the February and March collection periods.

Time StudiesThe team observed the Radiation Quality Assurance Coordinator as she completed the initial steps of the badge collection process and recorded the time spent on each step. These tasks included collecting the badge board, sorting badges, and returning the badges.

Literature Search Literature was reviewed to gain a better understanding of other radiation dosimeter programs at other hospitals. The research also provided insight regarding the amount of time other institutions take to return radiation exposure results to employees.

Data Collection FindingsThe team found that the hospital staff would like to improve the return of exposure results by making it faster and more accurate. The self-collection form and time studies prove that late badges are the most concerning issue with the current badge system. Badge collectors spent nearly 6 hours tracking down missing badges each month, whereas all other dosimeter badge related tasks took 58 minutes in total. Overall this leads to 177 FTE hours being spent to collect badges each year. It is clear that collecting late badges is an issue.

Design MethodsA process map, SIPOC, and value stream map were designed to help the team understand the current process and determine where in the badge collection process possible improvement could be made. Additionally, a cost-benefit analysis was created to determine the current cost of the badge collection process.

Design Methods FindingsThe design tools created emphasized that the time spent collecting late badges is a major issue with the current system. In addition, the team found that the total labor costs for the current badge collection process is $6,699. The total cost came out to be $6,959 per year.

RecommendationThe team has developed both short term and long term recommendations to reduce cost and make the dosimeter badge system more efficient. The short term recommendation is for the hospital to hire a low-cost, part-time intern to collect badges each month instead of the current badge collectors. The long term solution considered is a transition to an electronic badge that was introduced to the team by the client. This electronic badge alternative is called the Instadose

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badge and it is a permanent badge that does not require any monthly collection or distribution. Instead, it uses Bluetooth technology to wirelessly collect radiation dose data on a daily basis.

Cost information for the Instadose badge was given to the team and can be seen in Appendix E. Using this information, a cost analysis of implementing the Instadose badge was completed and it was estimated that the Instadose system would cost roughly $3,592 per year, which is a $3,333 savings from the current badge process.

A Pugh Matrix was then designed to compare the short term and long term recommendations to the current process to determine which process would best suit the needs of the IR department. From this, it was found that the overall score for the electronic badge system was 140 as opposed to the score of 40 for the alternative of making adjustments to the current system. The major advantages to the Instadose badge are that there is no time spent collecting badges, which eliminates the associated labor cost, and that the radiation exposure results will be returned significantly faster than the current system.

The team therefore recommends that the Interventional Radiology department transition from the current badges used to the Instadose electronic badges. The Instadose system would save the hospital money in the long run and would also improve the speed of result return which would help the employees practice safe radiation exposure.

Introduction

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Michigan Medicine requires that employees exposed to ionizing radiation during procedures wear dosimeter badges to measure the amount of exposure they receive over time and record the exposure while performing radiology procedures. However, inefficiencies exist in the badge collection process that occurs monthly and quarterly, which results in wasted time and excess cost of labor. The Radiology Quality Assurance Coordinator would like to know the cost of the current badge collection process to determine if a new process should be implemented, while also taking into account other aspects of the system. A team of IOE 481 students has been asked to analyze the current dosimeter badge collection process to determine the cost of the process and provide recommendations for improvement. The team developed a cost-benefit analysis and used collected data to evaluate if the current badge collection process is cost effective. The recommendation will determine how the current radiation dosimeter badge system could be improved to make it more efficient and less costly. In making a determination, the IOE team will analyze current costs and survey the dosimeter badge system as a whole. This report details the team’s recommendation and conclusion, as well as the steps taken to reach those.

Background

Currently the Michigan Medicine employees exposed to ionizing radiation during procedures are required to wear a dosimeter badge to measure their radiation exposure. The employees assigned dosimeter badges must wear their badge during the radiation exposing procedures. This involves wearing the badges on their protective lead properly and making sure the badges are not exposed to uncontrolled environments, such as being taken on an airplane or left in a cold car. The employees must also return the badges to their designated collection boards for exchange either monthly or quarterly. At this time they pick up their new badge that has been distributed by their badge collector. After the badges are returned to the boards, the badge collectors gather them and record whose badges have been turned in on time and whose are missing. Many times, the badge collector tries to track down the employees with missing badges to make sure all badges are turned in on time. The badges are then mailed to the Radiation Safety Office on the University of Michigan south campus, where they are counted again and sent to Landauer, the company who records the data from badges and consolidates all of the radiation exposure into a report. It then takes about 3 weeks for the employee radiation exposure results to be sent back to the hospital.

The hospital attempted to improve the dosimeter badge process in 2014 by improving training and radiation safety knowledge. However, many problems are still observed today. The employees forget to turn the badges in each month or quarter. It has also been observed by the Radiology Quality Assurance Coordinator that badges are sometimes not worn at all, not worn correctly, and accidentally exposed to uncontrolled environments. During the badge collection

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and transportation process, the badges can get lost, and when they arrive at to Landauer on time, it takes just over a month to obtain results. By the time the results have been received, the information is not as useful because the employees cannot remember the specific circumstances when they were exposed to unusually high levels of radiation.

Many of the employees have expressed dissatisfaction with the current process for the reasons mentioned above. The collection process adds to the cost to overall cost because it requires hours of labor and these employees could be using their time in much better ways. The length of the collection process makes it difficult to draw conclusions from the radiation exposure data since the exact procedure with high exposure levels occurred so long ago. A cost-benefit analysis of the current process, as well as an evaluation of the steps the badge progresses through in the entire system, will help determine how the hospital can reduce cost and make the dosimeter badge system more efficient.

Key Issues

The following key issues are driving the need for this project.

● Badge collectors spend hours collecting and distributing badges, tracking down missing badges, and mailing the badges to the Radiation Safety Office

● Employees forget to turn their badges in for collection by the required date● Landauer takes weeks to return radiation exposure readings after receiving the badges

from the Radiation Safety Office● Employees forget to wear badges or wear them incorrectly and actual radiation exposure

is not recorded● Dosimeter badges are sometimes exposed to uncontrolled environments and produce

inaccurate data● Employees are dissatisfied with the current process

These issues require a lot of labor which adds to the cost. The badge collection employees must be paid, and the length of time before results are received makes the interpretation of results even more difficult and adds to the amount of time wasted in the process. Issues with employees not wearing and handling their badges correctly leads to less accurate radiation exposure results.

Goals and Objectives

The goals of this project are to perform a cost-benefit analysis on the current dosimeter badge collection process by determining the actual cost of the current process as well as determining all steps the badge goes through in the system. This cost will be used to determine the cost effectiveness of the current process and to recommend how the system can be improved. To conduct the cost-benefit analysis, the team performed the following tasks:

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● Identified the cost of employee time for collection● Analyzed process of badge transportation to the Radiation Safety Office and Landauer

regarding time and labor hours needed● Identified what happens to the badge during the period between distribution to employee

and collection ● Understood employee opinions on the current process● Identified benefits and costs of transitioning to an electronic dosimeter badge system

With the collected information, the team developed recommendations whether the current process is cost effective and how improvements can reduce cost and improve efficiency. This would improve employee satisfaction and the usefulness of results obtained, as well as reduce cost for Michigan Medicine.

Project Scope

The project included an observation of the dosimeter badge system with a focus on the badge collection process for the Interventional Radiology Team, including the doctors, nurses, and technologists (techs). The process was observed from the new badges being delivered to the Radiation Safety Office to the point when radiation exposure results have been received by Michigan Medicine from Landauer. This includes the collection process of the badges as well as the lifetime of the badge from the point where an employee picks up a new badge to the point where they turn in the badge for collection.

The team did not analyze what Landauer does with the badges and will only pay attention to the time it takes to receive results. The team also did not study the dosimeter badge process in departments other than Interventional Radiology.

Data Collection and Methods

In order to determine where improvements could be made to the current radiation dosimeter badge process, the team collected and analyzed both quantitative and qualitative data through observations and interviews, self-collection forms, time studies, and through conducting a literature search.

Observations and Interviews

Fifteen hours of observations of the radiation dosimeter badge process in the Interventional Radiology Department has been completed by the team. The team’s observations of the Radiation Safety Office have also been completed. The data received from these observations aided the team in developing a total process time for the badge collection process. In addition to observations, the team also completed the goal of 22 interviews with staff members in the

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Interventional Radiology Department and analyzed the data received from those interviews. The data from these interviews assisted the team in gaining a fundamental knowledge about how the staff uses the badges on a daily basis as well as aiding in the team creating a cost-benefit analysis of the current badge collection process.

Self-Collection Forms

The team has distributed self-collection forms to the three badge collectors and distributors in the IR department. The aim of this study was to learn how long the collection and distribution processes take and to quantify an opportunity cost of time spent tracking down badges. These forms have been distributed and received for the monthly collections that occurred in February and March. The team has documented the data from the forms and analyzed the data and included the labor cost and opportunity cost of time to collect badges in the cost-benefit analysis of the current radiation dosimeter badge system

Time Studies

Team members have shadowed the badge collection personnel as they gathered the radiation dosimeter badges. Staff members were timed from the moment they leave their office to collect the badges to the moment they return to their office with all the collected badges and put them into a mailing envelope in the mailbox.

Literature Search

A literature search was conducted by the team. The team has identified four institutions that use radiation dosimeters in a way similar to the process at Michigan Medicine. At Brown University [1], Iowa State University [2], Stanford University [3], and Vanderbilt University [4], dosimeter badges are also worn on the collars, waists, fingers, and center of the torso by doctors, nurses, and techs that are exposed to radiation during treatments and procedures. At three of these institutions, badges are collected quarterly. Stanford University is the exception, where a majority of dosimeters are exchanged monthly with only some exchanged on a 3-4 month basis.

The team also learned more about the badge collection process by reviewing further literature pertaining to the timeliness of dosage results being obtained by institutions that implement the use of dosimeter badges.

At the hospital level, Brown University’s Radiation Safety Office receives the dosage reports “several weeks after the end of a monitoring period” [1]. In addition, the University of California, Irvine collects badges quarterly and reports that results from badges typically take 60 days to be received [5]. Brown University’s processing time of several weeks aligns with the respective process at Michigan Medicine. However, the University of California, Irvine

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experiences a higher wait time for results than a typical cycle at Michigan Medicine, as Michigan Medicine rarely has to wait 60 days or more based on the observations collected.

The team also found information regarding the timeliness of results from the offices that handle and process the dosimeters. IC Care [6] as well as Stanford Dosimetry [7], both radiation dosimeter badge services, report that their institutions take two weeks to send back dosage results after collecting the badges. The result return information from IC Care and Stanford Dosimetry is useful to this project if Michigan Medicine’s Radiation Safety Office has similar wait times for results. There may be opportunities to address reasons for Michigan Medicine waiting in excess of four weeks for results, if it truly only takes the Radiation Safety Office two weeks to process dosages.

Findings and Conclusions: Data CollectionUpon the completion of the project with the Performance Improvement Department within Michigan Medicine, the team developed a series of findings and conclusions.

Observations and Interviews

Staff InterviewsThe interviews conducted with the IR Department gave an insight into the current state of the badge collection process. The interviews showed that most of the personnel was actually quite satisfied with the current process and were indifferent to changing the process. Several members have mentioned that they were having a hard time understanding the dose results they received and have suggested that these reports should provide a better explanation. The staff members also liked the idea of getting quicker dosage results with the electronic systems which would make them consider using shielding and taking preventive action to reduce their dosage during procedure. These interviews also provided the team with useful compliance information such as how frequently the badges are used during procedures or where the staff members store their badges during after-hours. The graphical representation of the data collected may be found in Appendix A.

Radiation Safety Office ObservationSome of the most important data collected during the project came from the Radiation Safety Office (RSO). The observation showed that Michigan Medicine pays Landauer $10 per person per year. This cost is not dependent on the number of badges that each person has and is a constant. This annual cost also includes the transportation costs (to and from Landauer) and the cost of processing the badges at Landauer. The annual cost of the currently used badges would be $260 for the whole IR department. It also takes approximately 2 hours per month for the RSO staff to sort and send 2415 dosimeters badges, coming from all across the Michigan Campus, to Landauer. The team estimated the RSO staff salary and assumed that it would be $64,250

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annually. Proportioning the total amount of time spent monthly to the number of badges coming from the IR Department only (106 badges) results that the RSO spends $2 per year. The cost figures may be seen visually in Figure 4.

Self-Collection Form

The self-collection forms (Found in Appendix B) aided the team with determining the number of full-time employee hours spent while collecting the badges. These forms were given to 2 administrative personnel (A manager and an assistant senior) within the IR department covering the end-of-month badge collection periods of January and February. The forms showed that, on average, roughly 14 hours of working could have been prevented each month if the electronic badges were to be used, which eliminates the badge collection process completely. When this number is extrapolated to a year, it shows that a total of about 168 FTE hours could have been prevented. The salary range that the team has gathered from the client, the outcome of the self-collection forms, the annual cost of badges, and the salary of the employees at the RSO show that the total labor cost of the current badge collection process is roughly $6,700.

Time Studies

The time study was performed to determine how long each task in badge collection takes relative to the others. The Quality Assurance Coordinator was observed on January 29, 2018 and recorded how long she spent performing each of the required tasks. The results of the time study are shown below in Figure 1.

Figure 1: Time Study Results

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The time study results show that the largest portion of time is spent tracking down and collecting missing badges. The badge collectors could complete the badge collection process much more efficiently if it was not for the missing and late badges. These results help the team conclude that the collection of missing badges is what makes the current process so inefficient, and therefore, this should be eliminated to improve the system. The other tasks, although menial, did not take very much time so they are not considered an issue when it comes to evaluating the current process.

Design MethodsThis project aims to quantify the current costs of the dosimeter badge collection process and to compare this current total cost with alternatives. The project will affect the various people involved in the Interventional Radiology (IR) Team as well as the radiation dosimeter collectors, distributors, and processors. The team assumed the following during the analyses:

● The team focused on only the monthly badges within the IR Department so that the team would have the opportunity to observe multiple collection cycles within the span of the project.

● The team received two ranges of annual salary values from the administration instead of single numbers. The annual salary of the individuals Admin Manager & Admin Assistant Senior that were used in the cost-benefit analysis were the mean values of these ranges. The annual salary of the RSO officer was assumed to be the average of the two administrative personnel in the IR Department.

● The team assumed that one set of time study would be sufficient to accurately describe the distribution process of the monthly badges due to the short timespan of the project.

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Process Map and SIPOC

A process map and SIPOC were used to help understand all aspects of the current situation of the badge collection and distribution process. The process map is shown below in Figure 2.

Figure 2: Current State Process Map

The process map starts at the point where Michigan Medicine receives new badges from Landauer. The map then identifies the steps the badges go through, such as being distributed, worn, turned in, and sent to the Radiation Safety Office. The final step in the process map is Michigan Medicine receiving the dosimeter badge results. The process map helps to understand every step the badges actually go through, and not just the ones they are supposed to, especially the aspect of badges being turned in late. Late badges are not supposed to happen, however, they can drastically alter the badge collection process. This process map helps to define the differences in the badge collection process when badges are turned in late versus on time.

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A SIPOC was also created to better understand the current process. The SIPOC is shown below in Figure 3, and can also be seen as a larger version in Appendix C .

Figure 3: SIPOC Diagram

The SIPOC diagram was used to understand the inputs, outputs, and the process involved with badge collection and distribution. The SIPOC helps to understand all aspects of the badge collection and distribution process and where improvements potentially could be made. The outputs also help define what the end goal of the process is and what the final result should be.

Cost-Benefit Analysis

The cost-benefit analysis performed is summarized below. This cost-benefit analysis accounts for all costs incurred by the entire current dosimeter badge system, including the labor costs from the badge collection process. This analysis was completed in order to determine the total cost of the current badge system and the results are summarized in full below in Table 1.

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Labor Costs

Average Annual Salary

Number of Hours Spent Collecting and Distributing

Badges per Month

Annual Hours Spent

Collecting Badges

Total Annual Hours

Worked

Percentage of time spent

yearly collecting badges

Cost of Collection per

year

Administrative Manager $81,000.00 12.27 147.28 2000 7.36% $5,965

Administrative Assistant Senior $47,500.00 2.46 29.50 2000 1.48% $701

RSO Member $64,250.00 2 24 2000 1.20% $34

Total Annual Labor Cost $6,699

Current Badge

Current cost per

person per year

Number of team members Total cost for current badges per year

$10 26 $260

Total cost of current system $6,959

Table 1: Cost-Benefit Analysis of Current Badge Process

Further detail regarding the specific calculations in the determination of the cost benefit analysis can be found in Appendix F and G.

Current Value Stream Map

A current value stream map was created by the team and is shown below in Figure 5. A current value stream map was developed by using the data from the cost-benefit analysis and the self-

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collection forms. It was designed in order to summarize the badge system as a whole and to quantify the time and cost of each step of the system. The value stream map shows every step taken, starting from the receiving of badges by the Radiation Safety Office from Landauer and ending with the IR staff receiving results for the previous month’s batch of badges. The full details of each step can be found below.

Figure 4: Current Value Stream Map

A larger version of the current value stream map can be found in Appendix D.

Findings and Conclusions: Design ToolsThe process map, SIPOC, cost benefit analysis, and current value stream map have all been analyzed and the relevant conclusions are described below.

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Process Map and SIPOC

Based upon the designing of the process map and SIPOC discussed previously, the team deduced several findings. First, there are many steps involved in the collection and distribution of dosimeter badges. As shown in the process map, late and missing badges only further complicate this already tedious process. From the SIPOC, it was found that there are many different entities involved in the overall collection process. There are numerous suppliers with corresponding inputs for each step. Likewise, for every process step there are multiple outputs and customers. The combination of both involve effective communication and full cooperation from all sides, which is complicated by compliance issues with returning badges on time.

From the process map and SIPOC, the team has concluded that the badge collection process can be incredibly tedious and complicated. The team believes an effort must be made in order to simplify and improve the process, and if possible, eliminate most if not all steps of this collection process.

Cost-Benefit Analysis

As described prior, the team completed a cost-benefit analysis. From this analysis, the team found that an inordinate amount of money was being allocated to labor costs of having full-time salaried employees collecting the badges monthly. However, this amount of money each year is not an effective use of funds, since the team members tasked with collecting badges are not utilizing the full extent of their abilities, as collecting badges are a tedious yet simple task. The team members responsible for collecting badges should be using their time for much more impactful tasks, rather than tracking down other team members for missing or late badges.

Current Value Stream Map

After designing the current value stream map, the team was able to clearly see the entirety of the badge collection process. From this tool, the team was able to see which processes take the most time to complete and which processes cost the most. It was found that Step 8 in the badge collection process, where administrators have to track down badges that have not been turned in on the badge boards, takes the most time to complete at 6 hours and 36.25 minutes and incurs the most cost at $256.19 per month. Furthermore, it was found that the total non-value added time for the badge collection process totaled up to 8 hours and 56.75 minutes. This helps the team design a recommendation by showing just where there are issues or reworks in the process that take both time and money. Recommendations provided will attempt to reduce both the non-value added time in the process as well as the overall cost.

Design Requirements, Constraints, and StandardsThe team evaluated the design requirements, constraints, and standards to make sure the recommendation created is feasible and fits all requirements.

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Design Requirements

There are numerous requirements for the design of this project. In order for a dosimeter badge process to be considered effective by the team, it must have the following characteristics:

● Defined costs for collection, distribution, and processing of dosimeters● Cost effective process● Timely return of results of the dosage readings● High compliance (95% and above)

Clear costs for the collection, distribution, and processing of the dosimeters is a key requirement. This will allow for accurate representations of the costs and allow for more transparency in the process. Next, the design must be cost effective and be monetarily feasible for the hospital. Timely return of results is an important requirement. If results of the dosages take an extended period of time, it will increase the possible time of being exposed to a dangerous dosage without any chance to take action. For example, if results take three months to return, three months of likely the same potential dosage will occur with no knowledge of it taking place. This is disadvantageous for every affected worker in the hospital, and must be taken into account in the design. Efficient collection and return of the badges will allow for corresponding conclusions and countermeasures to take place. Finally, compliance refers to workers’ tendency to follow guidelines regarding wearing, using and storing the dosimeter badges.

Design Constraints

A number of constraints for the project have been found. First, the number of workers at Michigan Medicine to track serves as a constraint, as there are thousands of workers in the hospital. This has been addressed by focusing on the 26 workers in the IR Team. Next, as the process happens monthly, it proved difficult to gain a large amount of data, possibly limiting the data’s effectiveness at finding a robust conclusion.

A constraint on the badges themselves includes the size of the badge. The badge should not be bulky to the point where workers will be discouraged to wear them, but also not too small that the badges are not easily lost or misplaced. This constraint will be set primarily through workers and their preferences. Finally, the largest constraint to the project proved to be the time available for the entire journey of the design. There were three total months available to work on this design, which forced the team to work diligently and efficiently throughout the project in order to complete the work tasked to the team.

Design Standards

US Department of Agriculture: Office of Homeland Security & Emergency Coordination Radiation Safety Division (RSD) [8]

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This standard explains how the dosimeters should be used by the operators (medical staff) in terms of where to wear it on the body and where to store the badges when not in use. The team has found that there is no 100% compliance with these standards and will consider making relevant changes to the training modules for the new system.

US Department of Energy [9]

This standard states the occupational radiation dose limits set by the US Department of Energy. It states that a total effective dose of 5 rems (0.05 Sieverts) should not be exceeded in a year. The standard also states that the sum of the equivalent dose to the whole body for external exposures should not exceed 50 rems (0.5 Sieverts) and that the equivalent dose to the lens of the eye should not exceed 15 rems (0.15 Sieverts). This is relevant to the project since the team is trying to quantify and monetize the negative effects of high radiation doses to the human body. In order to do this analysis the team needs to be familiar with the dose requirements.

Michigan Department of Licensing and Regulatory Affairs Radiation Safety Section Dosimetry in Extremity Fluoroscopy (Mini C-Arms) [10]

This standard states that the medical personnel that are present during an extremity fluoroscopy operation, but who are not the ones performing the operation on the patient but rather assisting the operators, are not required to wear a radiation dosimeter. This standard is rather interesting because during observations the team has seen that the nurses, technologists, visitors and research fellows who are present during such interventional radiology operations were required to wear badges on top of their lead aprons.

Michigan Department of Licensing and Regulatory Affairs Radiation Safety Section Ionizing Radiation Rules Governing the Use of Radiation Machines [11]

This standard is about the occupational dose criteria that necessitates a registrant (or an institution) to monitor the dose of an individual. The standard states that any adult that is likely to receive a dose equal to 10% of the occupational dose limits in 1 year is required to wear a dosimeter badge. This standard is relevant to the project as the team can see the lower bound of radiation exposure of the medical personnel since everyone was required to wear a badge.

OSHA Clinical Services Radiology [12]

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This standard explains the potential health hazards of being exposed to acute and chronic high doses of radiation. The standard also explains which factors affect the degree of radiation exposure. This standard is relevant to the project because the team is required to monetize the negative effects of high radiation exposure on human health and in order to do so the team needs to be familiar with potential negative health effects of high exposure.

University of Michigan Safety Standard [13]

This safety standard states the responsibilities of the medical personnel to create a safe environment. The standard basically states that everyone should leave the Hospital “as healthy as when they arrived”. This standard is very important for the project since it shows how committed the U-M Medicine is to the safety of the personnel and it motivates the team to improve the system to meet this standard.

Constraints and Standards Matrix

The team searched for Design Standards on the internet from Mar 3 2018 to Mar 15 2018 using keywords such as “radiation safety” and “protocols dosimeter badges”. The relevant standards are summarized in Figure 5 and are as discussed in further detail below:

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Figure 5: Constraints and Standards Matrix

Requirements (soft constraints) in detail: ● (R-C-1)The project aims to design a process that will not compromise the current

standard of safety currently employed by the current dosimeter badge process. ● (R-D-1)The team’s newly designed process will be created with the main goal being to

reduce the cost of the overall process to the hospital while maximizing the benefits.

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● (R-E-1)One aspect of the new design is that it has to be easily implemented into the hospital system. This could mean that the team comes up with two different designs, one that can be easily implemented and one as a more long term project for which the hospital to consider.

● (R-F-1)The design that the team proposes should consider the users and have their acceptance of the new design delivered.

● (R-H-1)Designs that the team delivers should reduce the total time the badge collection process takes, which means that the people involved in the collection of the badges should have more.

Constraints in detail: ● (C-B-1)Several ethical constraints exist in relation to this project. The new design must

ensure the following: proper reading of radiation doses staff receive, timely return of radiation results, and ease of reading radiation dose results.

● (C-C-1)The project solution the team delivers should follow all health and safety regulations that the current process follows.

● (C-D-1)The budget that the hospital has to spend on this project has not been specifically identified, but the design option that requires the least amount of funds initially while still creating more of a benefit than the current process in place was requested by the client.

● (C-H-1)The short, 12 week period that the team has to work on this project limits the amount of detail the team can go into the project and ultimately deliver to the client.

● (C-H-2)Full class loads taken by each individual team member limits the amount of time variation in which the team can spend observing the Interventional Radiology Department.

Standards in detail: ● (S-2-1)University of Michigan Hospital regulation’s state that employees “should leave

as healthy as when they came into work”[12]. Therefore, our solution needs to uphold these standards and not sacrifice the health of employees.

● (S-3-1)Radiation badges should be worn at all times when close to radiation sources, especially in medical procedures. Also, badges should be worn in the correct locations in order to read the radiation doses properly. [13]

● (S-6-1)OSHA requires all employees near radiation sources to be protected because of the harmful consequences of radiation exposure.

RecommendationsThe team has created two different recommendations to improve the radiation dosimeter badge system at Michigan Medicine. One recommendation involves short term improvements as well as long term improvements.

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Short Term Recommendation From the conclusions and findings above, it was determined that one major factor that is driving the cost of badge collection is the salaries of the badge collectors. The collectors performing these tasks are over-qualified and should be spending their time and energy on other tasks that their job description requires of them. Therefore, the team recommends that the hospital employ monthly interns to help in the collection process. These interns would be paid at a minimum wage and not need any benefits, since they would be employed monthly. This would cut the total cost of collection from $558 per month to $139 per month, a total yearly savings of $4,996. These savings is purely in regards to the collection process, since the other badge collectors would still be responsible for completing their other duties and still by salaried employees. However, by having an intern take on the work instead, the other badge collectors will be able to focus on their own work, which could include ensuring staff safety in regards to radiation protocols. The team believes that the opportunity cost of having the current badge collectors work on their own job requirements instead of requiring them to go around collecting the badges every month outweighs the additional cost of hiring a monthly intern to complete the collection. Therefore, as a short term alternative, the team recommends that the hospital employ a monthly intern to complete the badge collection process.

Long Term RecommendationAt the outset of this project, the client gave an alternative of changing to an electronic version of the dosimeter badges instead of using the current method. This electronic badge would be supplied by Mirion and is called the Instadose badge. Instadose badges would be a permanent badge system, not requiring the monthly collection as with the current badges. Instead, this badge would record radiation exposure throughout the day, then it would be placed on a designated badge board. A Bluetooth sensor located near this badge board would wirelessly record the data collected, then the badge wearer could access this data to see what radiation doses he/she received throughout the day. Implementing this type of badge would eliminate the monthly badge collection process.

The provider of the electronic badge, Mirion, gave our client a quote of how much it would roughly cost to implement their electronic dosimeter model, the Instadose badge. These prices are attached and can be found in Appendix E. The team took this cost data, calculated what it would cost to implement the system in the IR department, and then compared it to what the current badge collection process costs. Those results are detailed in Table 2.

Instadose Badge

Instadose cost per badge per

yearNumber of badges in IR department

Total Cost for Instadose badges per year (including two $100

sensors)

$32 106 $3,592

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Total cost of current system $6,959.35Cost of Instadose badges per year $3,592.00Savings per year as result of switching to Instadose

$3,367

Table 2: Cost Data for Instadose System

Table 2 summarizes what was calculated in performing the cost benefit analysis. Expanded calculations can be found in Appendix G and H. It was discovered that switching to the Instadose badge could save the hospital $3,367 per year. The team decided that, even though the estimated cost for the Instadose badge is significantly less than the cost of the current badge process, further analysis needed to be completed before suggesting this system as a viable alternative. Therefore, a Pugh selection matrix was created to compare the current badge process to both the short term recommendation and this Instadose alternative.

The Pugh selection matrix that was created is shown below in Figure 6. It shows which badge system has the best score in relation to the design requirements and the importance the team has assigned to each. These requirements were determined based on what the client had specified at the beginning of the project and the overall importance was deduced by the team after the hours of observations and interviews with IR staff. The importance levels were also verified by the client. The design requirements determined to be of the most importance were the following: low cost of badge collection and distribution, accurate dosimeter ratings, timely return of radiation results, timeliness of badge collection and distribution, and short time to implement the system. The datum in the Pugh selection matrix represents the current badge collection and distribution process, which serves as a baseline for which the two alternate systems are compared.

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Figure 6: Pugh Selection Matrix

After the different requirements were weighted and rated, the electronic process resulted in a total score of 140 and the short term recommendation to the current process had a score of 40. These results show that the electronic process is the best recommendation to make at this point in the analysis.

The major benefits of the electronic process in comparison to the current badge process and short term recommendation are that the results will be returned instantaneously and there will be no cost of collection since it would not be needed. The only drawback of the electronic process is that the electronic process will require a lot of time and work to implement because it would be a completely new system. However, this system is expected to be more useful and effective than the current badge collection process in place, and prove more advantageous to all staff members in the IR department. Therefore, the team ultimately recommends that the hospital considers

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switching to the Instadose dosimeter badges instead of remaining with the current badge process or employing a monthly intern.

Expected Impact

The team has examined the impact regarding both short term and long term recommendations. These impacts will overall help improve the radiation dosimeter badge system.

Short Term Recommendation ImpactHiring a new a monthly intern to do the badge collection instead of the current badge collectors would save money in the badge collection process specifically, but overall this alternative would not save the hospital money. However, it would allow the current badge collectors, who are all salaried employees who have other responsibilities, to focus on their required work and not have to spend a bulk of their time at the beginning of each month collecting these badges. This opportunity cost is considered to be worth the investment of hiring on a monthly intern, which is why it is considered an improvement to the current process.

Long Term Recommendation ImpactThe Instadose alternative will be more cost effective compared to the current system in place. There will be no need for collection of badges, allowing for team members to utilize their time more effectively. The savings in labor cost greatly outweighs the added cost for badges under the Instadose system, resulting in over $3,000 in savings per year. The Instadose badges will also provide more timely dosage results, allowing team members in the IR department to take necessary precautions more quickly if he or she is receiving a high dose. In addition, we believe team members will comply with the wearing of the badge more often due to the useful and timely results, in comparison with the relatively slow process of receiving dosage results under the current state. As compliance rises, the accuracy of the dosage results will also be higher with the Instadose badges since workers will be wearing the badges more often and will receive a more accurate representation of the true amount of radiation they are being exposed to.

A transition to Instadose badges may take some time as well as training before full implementation, but the cost of training would not be substantial enough to make the Instadose alternative less cost effective than the current system. During the time spent in transition, we recommend hiring a part time student intern to work roughly 8 hours during the first week of every month in order to collect badges. As the department works towards implementing the new Instadose badges, the hiring of a low cost intern will prove useful, allowing the Administrative Manager to use his or her time more effectively. The benefit of the current badge collectors having time to do more important tasks for the team at the hospital will outweigh the miniscule added cost of hiring a temporary part-time intern.

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The analysis done by designing the Pugh selection matrix in the Design Methods section shows that switching to an electronic badge over the current system would be more beneficial based on the requirements and ratings assigned to each one. With the cost analysis in addition to the Pugh selection matrix findings, the team recommends that the IR department at Michigan Medicine transition to the electronic Instadose badges.

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References[1] Brown.edu. (2018). Cite a Website - Cite This For Me. [online] Available at: http://www.brown.edu/Administration/EHS/public/badge_usage.pdf [Accessed 25 Jan. 2018].

[2] Ehs.iastate.edu. (2018). Cite a Website - Cite This For Me. [online] Available at: https://www.ehs.iastate.edu/publications/factsheets/dosimetryuse.pdf [Accessed 25 Jan. 2018].

[3] Ehs.stanford.edu. (2018). Radiation Protection Guidance For Hospital Staff – Stanford Environmental Health & Safety. [online] Available at: https://ehs.stanford.edu/manual/radiation-protection-guidance-hospital-staff/dosimetry [Accessed 25 Jan. 2018].

[4] Medicine, V. (2018). Radiation Dosimetry (Monitoring Badges) | Vanderbilt Environmental Health and Safety. [online] Vumc.org. Available at: https://www.vumc.org/safety/rad/radiation-dosimetry [Accessed 25 Jan. 2018].

[5] Ehs.uci.edu. (2018). EH&S Information. [online] Available at: https://www.ehs.uci.edu/programs/radiation/radfaq.html [Accessed 22 Feb. 2018].

[6] IC Care. (2018). IC Care FAQs. [online] Available at: https://www.iccare.net/radiation/faqs [Accessed 22 Feb. 2018].

[7] Stanforddosimetry.com. (2018). Dosimeter Badge Service FAQs. [online] Available at: http://www.stanforddosimetry.com/Badge_Service/badge_service_FAQs.html#WhenDoseReport [Accessed 22 Feb. 2018].

[8] “Dosimetry.” USDA | OHSEC | Radiation Safety Division | Dosimetry, www.dm.usda.gov/ohsec/rsd/dosimetry.htm.

[9] “Occupational Radiation Protection Program (10 CFR 835).” Department of Energy, www.energy.gov/ehss/occupational-radiation-protection-program-10-cfr-835.

[10] “LARA MI Occupational Safety & Health Administration Radiation Safety.” LARA - Radiation Safety Rules, http://www.michigan.gov/documents/lara/miosha-rss-118_Dosimetry_for_Extremity_Fluoroscopy_Mini_C-Arms_531828_7.pdf

[11] “LARA MI Occupational Safety & Health Administration Radiation Safety.” LARA - Radiation Safety Rules, http://www.michigan.gov/documents/lara/rss_irr_part3_525009_7.pdf

[12] “OSHA Clinical Services.” Hospital eTool - Radiology, https://www.osha.gov/SLTC/etools/hospital/clinical/radiology/radiology.html

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[13] “Safety, Health and Environmental Policy | Standard Practice Guides - University of Michigan.” UM Standard Practice Guides, https://www.spg.umich.edu/policy/605.01.

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Appendices

Appendix A: Visual Representation of Interview Data

Figure A-1: Badge Storage Location for IR Department Graph

The graph shown in Figure A -1 shows that over half of the IR department employees do not properly store their radiation dosimeter badges, which can result in exposure to extreme conditions which can alter radiation exposure readings.

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Figure A-2: Graph of How Often IR Employees Wear Their Badge in the Procedure Room

Figure A-2 represents shows that 23% of the employees in the IR department have issues always remembering or deciding to wear their radiation dosimeter badge while in the procedure room, even though badge wearing is considered mandatory.

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Figure A-3: Instances of Late and Lost Badge in IR Department

Figure A-3 shows the results regarding how many employees reported to losing their badge or turning their badge in late. 8 of the 22 people interviewed reported turning a badge in late and 4 of the 22 reported having lost their badge before.

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Appendix B: Self-Collection Form

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Appendix C: SIPOC Diagram

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Appendix D: Current Value Stream Map

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Appendix E: Instadose Costing Information Provided by Client

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Appendix F: Labor Cost Calculations for Cost-Benefit Analysis

1. Determined the annual salary of staff involved in the badge distribution and collection process:

Administrative Manager (associate) average yearly salary: $60,000 - $102,000 per year = $81,000 average yearly salary

Administrative Assistant Senior average yearly salary: $38,000 - $57,000 per year = $47,500 average yearly salary

Radiation Safety Office staff member average yearly salary: Did not receive actual data, team assumed salary ranged between that of the Administrative Assistant Senior and the Administrative Manager (associate)$47,500 - $81,000 = $62,350 average yearly salary

2. Determined the average number of hours spent on the badge process through the self-collection form data and information given by the Radiation Safety Office:

From the self-collection forms: Administrative Manager (associate) -

January to February collection period, spent 11.75 hours collectingFebruary to March collection period, spent 11.33 hours collecting Average time collecting per month = 11.54 hours Spends about 44 minutes distributing the new badges to the badge boards in the IR department 44 minutes = 0.73333 hours

Total time spent collecting and distributing badges per month = 11.54 + 0.73333 = 12.27333 hours Total time per year = 12.27333 * 12 = 147.28 hours

Administrative Assistant Senior - January to February collection period, spent 2.25 hours collectingFebruary to March collection period, spent 2.667 hours collecting Average time collecting per month = 2.4585 hours

Total time spent collecting per month = 2.4585 hoursTotal time per year = 2.4585 * 12 = 29.502 hours

From information given by the Radiation Safety Office:Radiation Safety Office staff member -

Total time spent distributing per month = 2 hours Total time per year = 2 * 12 = 24 hours

3. Assumed that each of the 3 persons involved in the badge collection and distribution process works 40 hours a week and 50 weeks out of the year (assumed 2 weeks given for vacations/sick days). Therefore, the total annual hours worked for each of them is 2000 hours per year.

4. Determined the percentage of time spent annually collecting and distributing the badges: Administrative Manager (associate) -

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Percentage of time spent = 147.28 / 2000 = 7.36% Administrative Assistant Senior -

Percentage of time spent = 29.502 / 2000 = 1.48%Radiation Safety Office staff member -

Percentage of time spent = 24 / 2000 = 1.20%5. Determined the cost of collection per year for the IR department only by multiplying the

annual salary of each person involved in the process by the percentage of their time spent on the process.

Administrative Manager (associate) - Cost of collection per year = $81,000 * 7.36% = $5,964.84

Administrative Assistant Senior - Cost of collection per year = $47,500 * 1.48% = $700.67

Radiation Safety Office staff member - for this calculation, since the 2 hours per month included all badges, not just the IR department’s badges, an additional factor of (106 / 2415) was included to determine the cost for only the IR badges out of the total number of badges currently in use at the hospital.

Cost of collection per year = $64,250 * 1.20% * (106 / 2415) = $33.84

Total Annual Labor Cost = $5,964.84 + $700.67 + $33.84 = $6,699.35

A summary of the calculations are shown in the table below:

Labor Costs

Average Annual Salary

Number of Hours Spent Collecting and Distributing

Badges per Month

Annual Hours Spent

Collecting Badges

Total Annual Hours

Worked

Percentage of time spent

yearly collecting badges

Cost of Collection per

year

Administrative Manager

$81,000.00 12.27 147.28 2000 7.36% $5,965

Administrative Assistant Senior

$47,500.00 2.46 29.50 2000 1.48% $701

RSO Member $64,250.00 2 24 2000 1.20% $34

Total Annual Labor Cost

$6,699

Table F-1: Summary of Annual Labor Costs for the Badge Collection and Distribution Process

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Appendix G: Cost of Badges Calculations (Current and Instadose) for Cost-Benefit Analysis

1. Determined cost per person per year for each type of badge:Current badge - information given to the team by the Radiation Safety Office

$10 / person / year Instadose badge - information given the team from client, full document shown in Appendix C

$32 / badge / year2. Determined number of people or badges in the IR department. Two different metrics are

needed here for the two badges because the current system is priced per person and the Instadose system would be priced per badge.

Current badge - 26 staff members in the IR department

Instadose badge - 106 badges in the IR department

3. Determined total cost for the badges per year Current badge -

Cost per year = $10 * 26 = $260 per year Instadose badge - the total cost also includes the sensors needed to connect to the Instadose badges and record the data on them every day. One sensor is needed for every 50 badges and each sensor costs $100. It is assumed that 2 sensors will be required for the IR department.

Cost per year = $32 * 106 + $200 = $3,592 per year

A summary of the calculations are shown in the table below:

Cost of Badges

Current Badge

Current cost per person per year

Number of team members Total cost for current badges per year

$10 26 $260

Instadose Badge

Instadose cost per badge per year

Number of badges in IR department

Total Cost for Instadose badges per year (including two $100 sensors)

$32 106 $3,592

Table G-1: Summary of Yearly Costs for the Current Badge and the Instadose Badge

Appendix H: Total Cost Calculations and Savings Calculations for Cost-Benefit Analysis

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1. Determined the total cost of the current badge system by adding up the cost of labor per year (Appendix D) and the cost of badges per year (Appendix E)

Total cost of the current badge system = $6,699.35 + $260.00 = $6,959.352. Determined the savings per year by subtracting the total cost of the Instadose badge

system per year (Appendix E) by the total cost of the current badge system.Total savings per year = $6,959.35 - $3,592 = $3,367.35

A summary of the calculations are shown in the table below:

Total cost of current system $6,959Cost of Instadose badges per year $3,592Savings per year as result of switching to Instadose

$3,367

Table H-1: Summary of Total Savings by Switching to the Instadose Badge System

Appendix I: Expanding Analysis to Entire Hospital Calculations

Assuming that all hospital units work under the same system as the IR department, specifically that there are two badge collectors for every 26 staff members, the team has come up with the following calculations:

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Determined the total cost for the current system for the entire hospital:Total badge wearers in the hospital (information obtained from client) = 2415 Cost for the badges = $10 / person * 2415 badge wearers = $24,150Cost of the labor = (2415 / 26) * $6,699.35

Total cost for the current badge in hospital = $24,150 + $6,699.35 = $646,416.87

A summary of these calculations are shown below:

Total badge wearers in hospital 2415Current cost for badges $24,150Cost of labor $622,267Total cost for current system $646,417

Table I-1: Summary of Total Cost for Current Badge in the Entire Hospital

Determined the total savings for the entire hospital if switched to Instadose system: Total number of badges issued in 2017 (information obtained from client) = 16,000Total cost for Instadose badges = $32 / badge * 16,000 badges = $512,000Total cost for sensors needed = (16,000 badges / (50 badges / sensor)) * $100 / sensor = $32,000Total cost for the Instadose badge system = $512,000 + $32,000 = $544,000

Therefore, the total savings per year if the Instadose badge system is implemented is:

$646,416.87 - $544,000 = $102,416.87

A summary of these calculations are shown below:

Total cost for current system $646,417Cost for Instadose badges $512,000Cost for Instadose sensors $4,830

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Total Instadose badge system cost $516,830Savings per year $129,587

Table I-2: Summary of Total Cost for Instadose Badge in the Entire Hospital and Total Savings per year if Instadose Implemented

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