How software simulations can test process efficiencies against design options By Kristyna Culp
New processes and procedures, renovations, expansions and new facilities are all aimed at the same goals: to improve the patient experience, to reduce waiting times and to move patients through the system as efficiently as possible. Computer simulation models can allow healthcare administrators to test various operational and physical design scenarios for any department and service line and enable the system to reach these goals.
Building a baseline model To embark on a simulation project, the team must start with the existing conditions. The health system management team commissions the development of a baseline model that simulates the operational and physical design interactions of the area of focus. Simulation models can be created for particular processes within a department, for the entire department or even the entire hospital or system. This data-based analysis of current operations can identify and quantify process bottlenecks and process waste and capacity issues for both the physical design and staffing model. A baseline model presents a graphic rendering of the physical layout of the focus area and includes icons that represent patients, nurses, doctors, staff, beds, waiting areas, treatment/procedural spaces, desks and equipment.
Once the baseline model is set, the team can begin to test potential solutions, both long and short term. The team can then prioritize and group the solutions based on budget, anticipated changes in patient use rate, volume and acuity and staffing models. Any physical design solution should be based on sound and efficient processes and allow the management team to meet future volumes and goals. The simulation model can show when operational improvements have gone as far as they can, when physical design changes are absolutely necessary and what those changes need to be.
In one case, a hospital’s imaging department had expanded in a sprawling and haphazard manner. Even though the department had sufficient imaging equipment, the support space was insufficient and poorly located. The scattered layout, which spanned two floors, required extra minutes for patients, technicians, nurses and radiologists to navigate. Over a year, the extra travel time added up to significant revenue losses.
The imaging management team requested a simulation modeling study to test how they could work within the confines of the existing space and provide improved patient care, safety and experience. The model focused on imaging patients who received invasive procedures and therefore required pre- and post-procedural space. The model included patient volume by type and hour of the day, modality in use, time spent throughout the process and staffing required to complete the procedure and the complete patient experience.
In studying the model, the management team created three pre/post areas segmented by patient type. This created improved patient flow, safety and staffing, but did not add to the existing footprint of the department. In the process of creating the models, the team discovered a scheduling issue that, once addressed, allowed the imaging team to level load the day and thus improve the patient and staff experience.
Modeling a surgical department Surgical departments are taxed with various operational and physical design issues. What capacity can the current facility manage relative to case mix, scheduling, patient projections and inpatient and outpatient service model? Or, given a new strategic and marketing plan, what operational model and accompanying facilities are necessary to meet the projected needs? Case mix may be different in the future due to healthcare reform, the influx of baby boomers or changes in technology. The marketing strategy will influence the mix of inpatients and outpatients treated on a given campus. Outpatient services could be handled exclusively in ambulatory centers off the main hospital campus, freeing up the hospital for inpatient services only. Each of these scenarios can be fully vetted with a simulation model to test capacity needs, efficiency potential, scheduling and staffing requirements.
Block scheduling in the OR, which typically holds a time segment during the week for a particular surgeon, whether or not he or she uses the block, has been shown to be an inefficient practice, but it tends to be the traditional standard. A simulation model can test the effect of changing the block schedule and/or adding extended operating hours. Simulation modeling can also indicate whether ORs are the appropriate size and layout. In recent years, the trend was to make everything — including ORs — bigger and bigger, but with healthcare reform and a changing payment framework this trend is unlikely to continue.
Without sufficient collaboration from staff, planning leaders may overlook operational issues that dramatically inform the design. Needing specific supplies for particular case types is a central focus in the OR environment and the materials flow must address this. Simulation modeling can address materials flow at a very detailed level and help staff create the most efficient cleaning processes, supply volume and type, scheduling and staffing model for the sterile processing department. The volume and location of pre- and post-surgery beds is another good focus area for simulation. If the pre and post areas are co-located and properly sized, patient volume can flex into the post areas in the morning and into the pre-op areas in the afternoon as the schedule changes throughout the day. Managing that schedule relative to case mix, procedure time and prep and recovery time is another good use of the model. This allows management to test various scenarios to determine the most efficient use of the ORs and to level load as much as possible.
In another example, a modeling client saw its pre-anesthesia testing move to a facility across the street from the operating rooms as the hospital grew over the years. Administrators wanted to consolidate the two spaces to streamline patient access and minimize confusion. The goal was to move the pre-anesthesia testing space back across the street and place it next to the operating suite, but the only space available was one-fifth the size of the existing space. The administrators commissioned a model to explore the possibility of fitting all the pre-anesthesia patient volume, equipment, interview spaces and workspace into the much smaller footprint. Together the simulation modeler, architect, clinical staff and administrators created a model to visualize a solution.
The modeling work began with a review of surgical data. This analysis allowed the client to not only consolidate pre-anesthesia testing with the rest of surgical services, but the model also proved that more volume could be managed and more services provided in much less space by efficiently managing the schedule and the patient process. The model also enabled the department to right-size the staffing needs so, for example, the number of lab technicians could be matched to the number of expected lab draws. The new layout, when combined with new procedures, provided insight into how the facility might grow in the future and showed this client and the clinical staff that sometimes less is more.
Modeling scenarios and budgets Healthcare construction is expensive and design budgets have never been tighter. As expensive as construction is, operating costs make up 80–90 percent of the total lifecycle cost of a building. Simulation modeling is a crucial tool to make sure architecture is built around efficient operations that are focused on the patient and family needs and include staff input. Both overbuilding and underbuilding are costly propositions. A robust simulation model can not only right-size a construction project but also ensure that the operational processes meet the ongoing operational budget. Staffing, scheduling, patient volume and acuity, capacity and efficiency are all melded into one model to help make the best decisions moving forward.
Modeling can be a powerful servant in the complex tasks of managing hospital processes and procedures, as well as for managing departments, hospitals and healthcare systems.
Kristyna Culp is managing principal and director of operations with FreemanWhite. She can be reached at 704-586-2345 or firstname.lastname@example.org.