To Capture Increased Demand

Posted on February 3, 2012

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Imagine your hospital has a department that is absolutely maxed out, say imaging. Your PET and CT are taxed, and your MRI is running all day. Patients are backed up with a wait. You are turning patients away, sending them across town to a strip center MRI you do not own. Worse, the patient volume does not appear to be a blip because it has been like this for over six months. How can you handle this excess demand?

Mechanically speaking, the hospital needs to figure out how to move more units (patients) through their system (imaging) with their resources (equipment, staff, rooms and time).  A hospital has three options:

  1. Overload the System.  Overload is great as a short-term solution, like a factory hiring temp workers or instituting a third shift to meet an order—“mandatory overtime”. For an imaging department, this might mean expanding the schedule times each day, really early to really late seven days a week. Or cheating on some of the buffers that you like to build in— ramp up in the morning, scheduled maintenance, lunchtime—to squeeze a few more scans in. Unfortunately when you overload, eventually something ‘redlines’ and part of the system breaks down because everything is functioning at maximum capability, longer.
  2. Increase Capacity.  To increase capacity usually means to build, aka a capital project. For imaging at least, there are short-term capacity options like renting a portable MRI and parking it next to your building. It is a stop-gap solution because it costs money to rent, it is not physically connected to your facility, and quality or reliability may suffer. A new building project is slow, expensive, stressful, and should be a last resort action because of those attributes.
  3. Increase Throughput.  To get more patients through a system given a certain block of time, while using the same infrastructure (nothing new), hospitals must improve efficiency. This means studying where the bottleneck (greatest limiting factor) is that prevents more from getting done, and it smooth out the treatment process. Efficiency analysis may reduce the steps to treat a typical patient. If this shortens treatment time even by a few minutes, that time savings is multiplied by the number of patients, and throughput increases:  more people can be treated in the same amount of time without increasing costs for more equipment. 

But how is this really studied and executed accurately?  Simulation.  I have chronicled the growth in simulation, and its ability to assist in both existing operations, and in new facility design. When coupled with Lean and / or Six Sigma analysis, it can be a pretty compelling package.

Simulation means taking existing operations data (travel times, activities at each patient handling, etc.), modeling it in 3D, and animating it for all to see and understand. Much can be learned by both recording what currently happens in a department, what should happen, and what can happen better.  Simulation makes visible many work-related actions that are invisible or hard to observe.  It can help verify a program prior to design or construction, also test potential solutions by modeling real scenarios and how they would work—before they are built or accidentally developed further.

Without simulation, it is incredibly difficult to make decisions because there is no confirming or backup data, only gut feelings and observations. Many market forces are likely to increase demand for services in the near term, and only so many patients can be deflected to satellite facilities. For hospitals not flush with cash, efficiency is the only affordable option to improve care, patient satisfaction and absorb additional demand. Healthcare needs  increased efficiency, and simulation is the tool to help achieve it.

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