Optimizing Rehab Patient Scheduling

Summary

This example used process-simulation for optimizing rehabilitation patient scheduling. A proof of concept scheduling model for a major healthcare system provider in the Southeastern US, Eastern Health Systems, Inc. was constructed using SIMPROCESS to compare process characteristics like patient throughput, staff productivity, labor costs, etc. in order to assess the effectiveness of centralized versus decentralized rehabilitation patient scheduling. The model developed was based on data made available by healthcare experts and was built using an iterative approach and was validated with the subject-matter-experts. Credibility of the simulation was established by comparing model results to the empirical (actual) set of data. A centralized scheduling alternative was further developed that is also discussed here.

Goals and Objectives

The primary goal of this effort was to use process-simulation as a mechanism for experimenting with improvement ideas in the healthcare area. A centralized scheduling scenario was developed in this context. A second goal of this initiative was to show that an engineered approach could potentially provide additional value to subsequent, traditional project management processes.

Examples of those processes include:

  • Alternative options analysis for implementation strategies, including business process changes
  • Identification of change management and training needs to support any changed business processes
  • Product evaluation and selection for multiple vendor solutions
The following constructs are also discussed.
  • Business Process Reengineering (BPR)
  • Event-Simulation
  • Queuing Theory

Methodology/Approach

In our approach to redesigning the rehabilitation outpatient workflow we used a repeatable process that is part of our BPR methodology. This is a formalized process that will help the healthcare provider modernize and improve their processes/supporting information technology requirements. SIMPROCESS was used to speed up the data gathering, simulate “What-If” scenarios, and provide key metrics for decisions on “To-Be” process planning. Figure 1 below provides an overview of the BPR methodology.

Figure 1 - BPR Methodology
Figure 1 – BPR Methodology
This approach is based on five phases that are executed iteratively through each business area to provide an incremental approach to BPR. The incremental approach has proven to be more risk-adverse than “big-bang” top-down approach to reengineering. The five phases defined are:

Understand the Current Healthcare Business Environment

This phase focuses on setting expectations, identifying scope of the project, defining goals of the BPR effort, and defining the problems to be focused on during the BPR analysis. The BPR was performed in increments to produce benefits rapidly and to reduce risk by breaking the process into more manageable pieces.

Model the Current Healthcare Processes (“As-Is”)

This phase focuses on the analysis of the existing legacy healthcare processes and in developing the “As-Is” models. The legacy processes, organizational structure, and roles of the organizations were documented, measured, and base lined for comparison to the “What-If” models (centralized rehabilitation patient scheduling). Metrics required to support development of the “As-Is” rehabilitation patient scheduling model were collected through a series of interviews and workshop sessions with healthcare experts.

Items that were captured using SIMPROCESS include:

  • Process flow
  • Frequency of actions
  • Level of effort for each action
  • Resources performing each action
  • Source of information for each action
  • Cost information
The first-cut “As-Is” rehabilitation patient scheduling model was validated and verified by the process owners (the healthcare provider). Validation involved review and consensus that the process flow, resources, and level of effort were acceptable. Once the process flow was validated then the results of the simulation (quantities, task times, and staff productivity) were verified with the knowledge experts. The results of the “As-Is” rehabilitation patient scheduling model provided a quantitative baseline against which alternatives were evaluated.

Visualize and Measure Alternatives (“What-Ifs”)

This phase focuses on the analysis of potential BPR improvements that were considered for implementation. Improvements typically include organizational changes, resource assignments, roles and responsibilities, process flow changes, insertion of technologies, improved access to information, and changes to policies/procedures. The “What-If” rehabilitation patient scheduling model was specifically developed to experiment with changes in the scheduling process. The centralized alternative model metrics were captured and compared to the baseline for potential quantitative benefits such as savings in cost and patient throughput. The most important metric produced from the simulations was Activity-Based Cost (ABC). The ABC metric is a key ingredient in the development of a ROI for the “What-If” rehabilitation patient scheduling model and in justifying the development of the “To-Be” plans for implementation.

 Plan the Transition (“To-Be”)

This phase focuses on choosing the best value scenarios from the “What-If” modeling and developing implementation plans for them. The metrics from the “What-If” model will provide the basis for the choices and will assist the healthcare provider in deciding which alternative should be implemented to get the most ROI. Other considerations are also factored into the decision process. Such factors as degree of reorganization, cost of training, cost of process implementation, time to implement, cost of new technology insertion, etc. are examples of additional input to the decision process. For example, a “What-If” scenario that clearly provides huge ROI benefits may be too risky to be implemented first due to the organizational or cultural impact. In this example, a lesser ROI-based “To-Be” implementation may be planned as the first increment to avoid risk of cultural change and revisited later in the implementation stages.

Manage Transition and Monitor Performance

This phase focuses on the actual implementation of the improvements. The simulation model would be used to assist in the identification of development phases and for planning the transition. SIMPROCESS would be used to ensure that the process is not broken as changes are fielded and implemented.

Model Overview

Top-Level Processes

Figure 2 shows the top-level view of the healthcare simulation model. The model uses labels to display the number of (1) “Total Rehabilitation Patients”, (2) “Total Rehabilitation Visits”, and (3) “Average Rehabilitation Visits/Patient”. Icons representing Entities (i.e., patients) flow through the sub-processes where delays capture the amount of work time required for Resources (i.e., clerks, doctors, etc.) to perform a given task. For this effort the processes that were considered “core” were (1) Rehabilitation Scheduling and (2) Rehabilitation Therapy.

Figure 2 - Top Level Processes
Figure 2 – Top Level Processes
“Rehabilitation Scheduling” Process Details

The rehabilitation scheduling process box icon contains the following sub-processes: (1) Scheduling and (2) Registration. See Figure 3.

Figure 3 - Details of “Rehabilitation Scheduling” Process
Figure 3 – Details of “Rehabilitation Scheduling” Process
“As-Is” Rehabilitation Patient Scheduling Alternative (Decentralized)

Figure 4 below represents the details of the legacy scheduling process alternative (Scheduling Process – As-Is).

Figure 4 - “As Is” Rehabilitation Patient Scheduling Alternative
Figure 4 – “As Is” Rehabilitation Patient Scheduling Alternative
“What-If” Rehabilitation Patient Scheduling Alternative (Centralized)

Figure 5 below represents the details of the centralized scheduling process alternative (Scheduling Process Icon – To-Be-1). The “pre-registration” step is removed and included as part of the “collect patient data” activity.

Figure 5 - “What-If” Rehabilitation Patient Scheduling Alternative
Figure 5 – “What-If” Rehabilitation Patient Scheduling Alternative
Model Settings

This model was set to run for a ten-day period for one replication. Costs were reported at the end of the simulation run. Statistics were captured for the patient arrivals, patients in process, and patients completed.

Conclusion

The healthcare simulation model provided insight into the process map and allowed for the subject-matter-experts to refine the flow based on the results of the baseline. Model metrics were collected through a set of interviews and workshop sessions and performance characteristics such as rehabilitation patient turn-around-time and labor costs were discussed with the knowledge experts periodically. An alternative was further developed to experiment with a centralized rehabilitation patient scheduling solution.

The results indicated that there were no major bottlenecks or discrepancies with the proposed solution. The composite labor cost decreased by 30% with a 60% increase in patient throughput.