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Agenda• The Toolkit• Designing for Outputs• Understanding Tool Inputs
• Data sources• Data collection• Tool parameters
• Spreadsheet Tools• Analytical Models• Simulation Models
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Context, Purpose, Outcome
1) Context: Navy Medicine faces key operational decisions that can be made easier with the appropriate use of data through tools
2) Purpose: Guidance will be provided in choosing the right tool for the problem at hand, and examples of successful tools used for performance improvement will be discussed
3) Outcome: Identification of opportunities for decision tools and the appropriate application of these tools will lead to more confidence in future decision making
Tool Choice
"When the only tool you have is a hammer, every problem begins to resemble a nail."
– Abraham Maslow
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The Toolkit• Spreadsheet Models• Analytical Models• Simulation• Other Support Tools
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Designing for the Outputs
• What does the customer want out of the tool?• What questions are to be answered?
• What is a usable tool for the customer?• IT skill level• Angle of interest
• What decisions will be made with this tool?• Day-to-day operations?• System-wide planning?• Facilities/Construction?
• Beware of tendency to overdesign!
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Understanding Tool Inputs
• Data inputs must match tool choice• Will the tool be “live” or based on a snapshot of
available data• Availability of input data impacts fidelity of output
• Quantity of data• Granularity of data• Quality of data
• Examples of data sources:• Less specific: M2• More specific: Local data pulls (CHCS, Operating Room
systems, Essentris)• Custom to needs: Manual data collection
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Electronic Data Mining
• Reasons for electronic data mining• Existing processes can be described by the
data they generate• Allows for massive sample sizes
• Examples of electronic data sources• Coarse information: M2• Detailed information: CHCS, Essentris, S3, etc.• Custom information: data from specially built
applications such as a discharge board or triage board
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Manual Data Collection
• Reasons for manual data collection• Validation of system data• Needed data not available in system
• Examples of manual data needs• Process times • Hourly volume counts
• Processes for manual data collection
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Tool Parameters
• Queue types• What are processes for serving customers?
• Levers• Resources such as staff or rooms• Volumes• Process changes including sequencing and
scheduling
• Process types• Can be statistically described
• Acceptable service levels• What is acceptable wait time?• What is acceptable turn away rate?
Tool Parameter Examples
• Scheduling modalities• Templates• Random• Shortest case first
• Queuing• Number of queues• Number of servers
• Process types• Sequencing and
location of process steps
• Capacity• Rooms• Staff
• Service Levels• Wait time• ALOS• Resource
utilization• Patients deferred
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Spreadsheet Tools
• Software tools widely available• Users familiar with interface• Distributable• Ability for modification• Less robust when representing dynamic
systems
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Birth Volume Tool
• What is the primary question?• “How many births should be expected in
catchment area X?”
• Who are expected tool users?• High level decision makers, not “in the weeds”
• What decisions will be made with this tool?• System-wide planning• What-if ? analysis
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Birth Volume Tool
• Solution implemented: Spreadsheet Model
Select whether you want to use the baseline for % direct care, population change and fertility rate. If not, select “No” and enter data in blue cells
Forecast Results
Learn more at Population Based
Healthcare Delivery Design
(II) Session:Wednesday 1100-1200
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OR Volume Tool• What is the primary question?
• “How do changes in volume and capacity impact OR utilization”
• Who are expected tool users?• Experienced analysts with report outs to
decision makers
• What decisions will be made with this tool?• System-wide planning• What-if ? analysis
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OR Volume Tool• Solution implemented: Spreadsheet Model
Click to Include
Procedures Have Same %
Click to Adjust Procedures
Your Considered
Volume
Average Case Time (hours)
Percentage Accepted
Accepted Volume
Total Case Room Hours
a a 494 4.80 100% 494 2373 IIIIII
a a 3314 2.99 50% 1641 4910 IIIIIIIIIIIII
a a 1332 2.58 50% 666 1720 IIII Chart data
a a 741 3.57 100% 741 2643 IIIIIIICase Room Hours
Target Room
a a 607 2.18 97% 592 1291 III Average Historic Volume (Step 1)53018.5 36144.0
a a 885 1.76 50% 439 773 II Considered Volume (Step 2)53018.5 36144.0
a a 2693 3.24 50% 1337 4328 IIIIIIIIIII Accepted Volume (Step 4)36116.3 36144.0
a a 453 1.93 34% 154 298
a a 1184 2.68 50% 587 1572 IIII
a a 831 2.70 50% 414 1118 III
a a 70 2.35 14% 10 22
a a 1265 3.26 50% 637 2077 IIIII
a a 607 3.67 65% 392 1439 III
a a 3042 3.80 100% 3042 11552 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
a
a
a
Total Accepted Case Room Hours11,145 36,144 36,116 Current scenario enables all case volume to be scheduled. There are 27
hours avilable to schedule more cases.
Unmatched
Urology_GU Surgery
Total Accepted Volume (count)
Target Utilization (in Hours)
Vascular
VIP and WW
Other Diagnostic_Therapeutic
Percent of HoursMOR Service Category
Cardiothoracic
General Surgery
GYN Surgery
Neurosurgery
Obstetrics
Ophthalmology
Orthopedic Surgery
Otolaryngology
Plastic_Recon Surgery
36,144
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
55,000
60,000
Average HistoricVolume (Step 1)
Considered Volume(Step 2)
Accepted Volume(Step 4)
Room
Cas
e Ti
me
in H
ours
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OB Bed Sizing• What is the primary question?
• “What is the facility capacity?”
• Who are expected tool users?• Experienced analysts with report outs to
decision makers
• What decisions will be made with this tool?• Setting facility volume targets• Construction needs
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OB Bed Sizing• Solution implemented:
• Spreadsheet model
• Spreadsheet model has many assumptions• Assumptions reduce data needs while
providing reasonable answer• Model can highlight the need for
additional analysis if results are borderline
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OB Procedure Scheduling Model
• What is the primary question?• “How should inductions and c-sections be
scheduled to level demand”
• Who are expected tool users?• Experienced analysts with report outs to
decision makers
• What decisions will be made with this tool?• A recommended schedule template for c-
sections and inductions
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OB Procedure Scheduling Model
• Solutions implemented• Analytical model produces a new template for
scheduled procedures that levels day of week peaks
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Simulation Tools
• Software tools not widely available• Limited familiarity with tools• Very robust representation of dynamic
systems• Can require extensive data as inputs• Can provide very granular results
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OB Simulation Model
• What is the primary question?• “What is the capacity of our facility?”
• Who are expected tool users?• Experienced analysts with report outs to
decision makers
• What decisions will be made with this tool?• Setting facility targets• Construction needs
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OB Simulation Model
• Solution implemented:• Simulation identified the bottleneck was MBU
beds
• Additional analysis:• “Assuming process and facility
reconfigurations that alleviate the bottleneck, what is the new capacity”
• Solution recommended:• Reclaim non-used LDRP rooms and keep
vaginally delivered patients in the same room for entire stay
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Pharmacy Simulation Model
• What is the primary question?• “What processes/equipment are required to
meet performance criteria at a given volume”
• Who are expected tool users?• Experienced analysts with report outs to
decision makers
• What decisions will be made with this tool?• Staffing decisions• Facility decisions• Equipment decisions
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Pharmacy Simulation Model
• Solution implemented:• Simulation model• Complex input needs• Complex output processing needs
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Simulation User Interface
• Run all possible scenarios and present results in spreadsheet model• Method for reducing
demands on users• Limit input requirements
for front line