(This post is part 2 of an interview with Dr Michael Carter. Part 1 can be found here)
Q: If you take a step back and look holistically at the healthcare industry in Canada as compared to the rest of the world, how are we doing?
The UK has done lots of really good operations research-type modeling on healthcare problems. They’re way ahead of us. The National Health Service in the UK, since the 1950′s, have had an operations research department with a few hundred people employed full time. We have nothing like that in Canada, and it’s quite disappointing.
I am, at the same time, very hopeful. When I started this about 20 years ago, I would go to a hospital and tell them I had students that would work for free. They’d say: ”Go away, we’ve got no time”. But now, my phone is ringing off the hook. I’ll tell people that I need $10,000 to pay some graduate students to do the work and they’ll say: “Yes, that’s fine”. I think every major hospital in Toronto has a small group of engineers doing industrial engineering type work in process management, process improvement, simulation, etc. It’s changing at a snail’s pace, but there is a small group of people in every healthcare organization that understands what we are trying to do, and that believes in what we believe in.
Your PhD is from the Combinatorics and Optimization department at the University of Waterloo. How did you get into healthcare operations research?
My background is in mathematics. I actually went to Waterloo because I wanted to get into computers which were fairly new at that time. I did co-op in computer science, and when I was finished the one thing I knew for sure was that I did not want to be a programmer. So I switched to optimization; I was really interested in the applications of mathematics to practical problems. I did a lot of work in timetabling and scheduling. I worked in production scheduling with IBM, Dofasco, Nortel, places like that. I did some work on nurse scheduling. And I did some theoretical stuff.
The turning point was around 23 years ago. I got involved with a project – operating room scheduling and planning with the Hospital for Sick Children, Sunnybrook, Toronto Western, Toronto General and Mount Sinai. It was a two year project: we were developing a simulation model to figure out how they should be scheduling their operating rooms, which doctors on which days. That’s when I realized just in talking to people how bad things were. I remember asking one of the managers about the process for admitting a patient. And she looked at me and told me “every patient is different”. And I realized that every time a patient came in, the doctors and nurses sat there and asked themselves…what should we do with this one…? But the thing is, at that time Sick Kids was doing 5000 tonsils and adenoids operations a year. The operation took 12 minutes. It was a production line, and yet the mentality of it was that it was a job shop. They had absolutely no processes, in fact, they’d never heard of them.
Today, if you walk in to a hospital and ask the nurses, they’re all familiar with process mapping. But 20 years ago, it was unheard of and that scared the daylights out of me. And, honestly, at the time, there were no researchers in Canada that were focused on healthcare, nobody. And I just decided that it was a tragedy, and that somebody had to do something. So I basically stopped my research, and told myself that I was going to do going to do everything I can.
But I needed someone to give me money. And that was an uphill battle on its own. I went to NSERC (Engineering Research Council), and asked them for money, and I told them I wanted to do research on healthcare. They said go to the Medical Research Council. MRC was only interested in funding cancer and other diseases. Today, CIHR and NSERC are fighting over each other to fund healthcare engineering research.
Over time, this became a passion. I’m going to change the healthcare system. And I’m not going to change it myself – I’m going to change it by getting students fired up about the problem and getting hospitals fired up about hiring engineers. A few years ago and I did a count, and there were 17 universities in Canada with at least one person focused on healthcare process-related research. Last year, I counted 35 graduate students here in MIE doing operations research in healthcare. I think that we’re creating a strong critical mass that is going to change things (pause) that is changing things.
Why should young people consider a career in industrial engineering/healthcare?
I think that a lot of young people are attracted to finance and other industries for the money, and the salaries in healthcare are generally lower than those in other industries. But the real appeal for me, and I think for the students that I have is that I believe that we are really making a difference and saving lives. I think that there’s a tremendous personal satisfaction to this kind of work. I also think it requires a certain kind of personality. I mean, if you get frustrated easily because people don’t do what you tell them to then you probably don’t belong in the healthcare industry. These things are not going to change quickly. So you have to be able to go with the flow, and work with other people, and see things from other points of view and not just yours. And change is so slow and painful. But the long-term implication of what we’re doing is just huge.
Healthcare is 11% of our GDP in Canada. 11 cents to every dollar spent in Canada goes to healthcare. Hamilton was the steel capital of Canada 10 years ago. At its peak, there were more people in Hamilton working in healthcare than there were people working in steel. Healthcare dwarfs things like automotive and telecom. The Ministry of Health in Ontario, if it was a private company, would be the second largest company in Canada. There’s this huge conglomerate of healthcare organizations…and as of today, there are still too few resources put into the engineering, modelling and planning side.
Dr. Don Berwick, former CEO of IHI in the U.S., says that 30% of costs in healthcare are just plain waste. I believe that the same is true here in Canada. So maybe if we really worked at it, we could reduce healthcare costs by 30%. And since healthcare is about 10% of our GDP and 50% of our provincial budget…opportunities are out there, and the effects of finding them and making changes are just monstrous. So if you like a challenge and you really want to feel like you’re doing something important, this is the place for you.