Using the Collective System Design Methodology to Improve a Medical Center Emergency Room Performance.

Emergency Room (ER) crowding is one of the more complex issues in the healthcare system worldwide. Crowding gives rise to long ER waiting times, patient dissatisfaction, and negative effects on a healthcare systems' performance. This paper focuses on the utilization of the Collective System Design (CSD) methodology to optimize the performance of an ER, which is of principal importance both from a life-threatening and an economic standpoint. The CSD technique is applied to detect areas of deficiency and to identify the functional requirements of the system to address those issues. The ER and system engineering specialists' team gathered data from the electronic medical center log and their system observation. The team determined the functional requirements and effective solutions, and implemented a continuous improvement plan to enhance ER performance. From a statistical standpoint, a significant decrease in the median of the door-to-doctor time measure (27 min vs 13 min) and a substantial improvement in the patients' level of satisfaction with the quality of health care (20th percentile vs 41th percentile) were observed after the implementation of the CSD methodology. The CSD methodology augments the implementation of lean tools by providing a language for defining the requirements and corresponding solutions for a system design. Using the CSD methodology, results in a significant increase in the ER's capacity to treat patients efficiently.

Food Footprint as a Measure of Sustainability for Grazing Dairy Farms.

Livestock productions require significant resources allocation in the form of land, water, energy, air, and capital. Meanwhile, owing to increase in the global demand for livestock products, it is wise to consider sustainable livestock practices. In the past few decades, footprints have emerged as indicators for sustainability assessment. In this study, we are introducing a new footprint measure to assess sustainability of a grazing dairy farm while considering carbon, water, energy, and economic impacts of milk production. To achieve this goal, a representative farm was developed based on grazing dairy practices surveys in the State of Michigan, USA. This information was incorporated into the Integrated Farm System Model (IFSM) to estimate the farm carbon, water, energy, and economic impacts and associated footprints for ten different regions in Michigan. A multi-criterion decision-making method called VIKOR was used to determine the overall impacts of the representative farms. This new measure is called the food footprint. Using this new indicator, the most sustainable milk production level (8618 kg/cow/year) was identified that is 19.4% higher than the average milk production (7215 kg/cow/year) in the area of interest. In addition, the most sustainable pasture composition was identified as 90% tall fescue with 10% white clover. The methodology introduced here can be adopted in other regions to improve sustainability by reducing water, energy, and environmental impacts of grazing dairy farms, while maximizing the farm profit and productions.

Evaluating the significance of wetland restoration scenarios on phosphorus removal.

Freshwater resources are vital for human and natural systems. However, anthropogenic activities, such as agricultural practices, have led to the degradation of the quality of these limited resources through pollutant loading. Agricultural Best Management Practices (BMPs), such as wetlands, are recommended as a valuable solution for pollutant removal. However, evaluation of their long-term impacts is difficult and requires modeling since performing in-situ monitoring is expensive and not feasible at the watershed scale. In this study, the impact of natural wetland implementation on total phosphorus reduction was evaluated both at the subwatershed and watershed levels. The study area is the Saginaw River Watershed, which is largest watershed in Michigan. The phosphorus reduction performances of four different wetland sizes (2, 4, 6, and 8 ha) were evaluated within this study area by implementing one wetland at a time in areas identified to have the highest potential for wetland restoration. The subwatershed level phosphorus loads were obtained from a calibrated Soil and Water Assessment Tool (SWAT) model. These loads were then incorporated into a wetland model (System for Urban Stormwater Treatment and Analysis IntegratioN-SUSTAIN) to evaluate phosphorus reduction at the subwatershed level and then the SWAT model was again used to route phosphorus transport to the watershed outlet. Statistical analyses were performed to evaluate the spatial impact of wetland size and placement on phosphorus reduction. Overall, the performance of 2 ha wetlands in total phosphorus reduction was significantly lower than the larger sizes at both the subwatershed and watershed levels. Regarding wetland implementation sites, wetlands located in headwaters and downstream had significantly higher phosphorus reduction than the ones located in the middle of the watershed. More specifically, wetlands implemented at distances ranging from 200 to 250 km and 50-100 km from the outlet had the highest impact on phosphorus reduction at the subwatershed and watershed levels, respectively. A multi criteria decision making (MCDM) method named VIKOR was successfully executed to identify the most suitable wetland size and location for each subwatershed considering the phosphorus reduction and economic cost associated with wetland implementation. The methods introduced in this study can be easily applied to other watersheds for selection and placement of wetlands while considering environmental benefits and economic costs.