SimLean Educate A generalised simulation of a theatre process

Purpose of the Session –To explore common issues that occur within healthcare systems –To understand their impact upon patient flow –To consider ways of improving patient flow Key areas we will explore are: Managing demand Using resources effectively Providing a smooth process for patients and staff 2

A GENERALISED DAY CASE THEATRE PROCESS 3

4 Simulation model at 08.00

Number of patients waiting for reception 8 patients waiting for preparation Fully occupied holding bay All theatres in use Red colour shows that patient is ready for next step 5 simulation model at 13:55 Run model 2 batch »

6 2 batch

As the model runs it gathers information about the sizes of queues, the utilisation of resources and the number of activities performed. We can then view these as charts either in the model or later on a spread-sheet. Non-lean practices often produce surges in activity and large queues. There is no benefit to the patient in this and it can cause problems for staff too. 7

What does your car park tell you about your process? 8

What does your waiting room tell you about your process? 9

Do your appointments match your process? 18 patients arrive at 8am 20 patients arrive at 1pm 10 Patient arrival - twice a day: 8am and 1pm

The rate of treatment is fairly constant DAY 1 Hourly discharge: 4,7,4,2,3,3,4,4,6,2 In overtime 11

Hurry them up and make them wait? Time of day (hour) DAY 1 Number of patients per hour: 19,15,8,4,22,19,16,12,8,2 Number of patients is related to waiting time 12

Putting it together: Patient flow What are the issues with this process? Day 1Day 2 Day 3 Day 4Day 5 13

A valuable service or a waste of time? What is the patients’ experience? How much of their time is wasted? 14 What was Patient 2’s experience? What was Patient 19’s experience?

A valuable service or a waste of time? How much time are staff waiting for colleagues? How much time are staff waiting to access equipment? 15 How much extra effort does a blocked patient need?

Common Problems We stress the system with large surges of demand. Queues build up because resources aren’t always ready. There is little flow in the pathway, many patients just experience stop-start. 16

Vision Remove the waste and reveal the value. Find ways of stabilising the process: –Smooth out the demand; –Separate the exceptional from the routine; –Provide the right resources at the right time. Avoid stressing our people so that they can focus on care and treatment. 17

Educational Interludes 1. Smoothing Demand (Level the Load) –What happens if we move from 2 batches of patient arrivals to 6 batches? 2. Prioritise Patients (Balancing Flow) –The need to balance flow when patients are prioritised 3. Resource shortage (Focus on Value) –What happens when resource availability becomes depleted 18 Each of these can be viewed separately as an ‘interlude’. Please download from