Reallocating Resources to Focused Factories: A Case Study in Chemotherapy Peter Vanberkel, PhD Candidate University of Twente Netherlands Cancer institute – Antoni van Leeuwenhoek Hospital

Outline About Focused Factories Case Study Decision Support Tool

Focused Factories History US Factory in the 1960 Focused Factory focus, simplicity and repetition breeds competence. – Skinner 1973 We produce everything! We produce Nothing Well We produce fewer things! We produce them all Well

2006 Manufacture And Assembly

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General Hospitals Health Care Focused Factories Specialized Hospitals Specialized Clinics

Focused Factories within Hospitals Poly Clinics Radiology OR Chemotherapy Radiotherapy

Patient Type Focused Factories? Breast Cancer Skin Cancer Colon Cancer Lung Cancer Prostate Cancer

Focus on Service? Or Patient? Or Mix? Breast Cancer Skin Cancer Colon Cancer Lung Cancer Prostate Cancer OR Radiology

Research Question General: How can we quantify the impact of decentralizing a centralized service? Chemotherapy Case Study: Design a decentralized service (Breast Cancer and Non Breast Cancer) that maintains the performance of the existing centralized department

Presentation Focus… Chemotherapy (Existing) Breast Cancer Chemotherapy Non Breast Cancer Chemotherapy Economies of Scale? or Economies of Focus?

About Chemotherapy Dept. Appt. Request Pnt. Arrives Pnt. in Wait Room Pnt. in Bed for Treatment Pnt. Leaves Appointment: Clinic Runs Smoothly when beds are Utilized at 90% Nurses can manage Waiting Room time is reasonable Currently 30 beds Access Time: < 5% of patients Should wait more than 1 days F/U New

About Chemotherapy Dept. Appt. Request Pnt. in Wait Room Pnt. in Bed for Treatment Pnt. Leaves F/U New Black Box Service Rate: (Patients / day) Depends on: Appointment Length Number of Beds Arrival Rate: (Patients / day) Poisson(70.2) Pnt. Arr Output / Performance: Access Time Bed Utilization

Service Rate P1P2P3P4 Expo (1/λ) Capacity Distribution in Patients / day: Poisson(λ) Expo (1/λ) Capacity Distribution in Patients / day: Int[Poisson(λ)/2] Appt. Length = 90 minsAppt. Length = 60

Model Output / Performance Lq n = (Lq n-1 + Arrivals n – Served n ) + Wait Time Distribution Utilization = Beds Used / Total Beds

Scenario Existing Chemotherapy BC Chemotherapy No Efficiency Improvement Expected Due to Focus Model Inputs Service Rate: 2.7 Pnts/day Arrival Rate: 72.1 Pnts/day Beds: 30 Model Outputs Bed Utilization: 90% Access time >1 day: <5% Service Rate: 2.5 Pnts/day NBC Chemotherapy Service Rate: 2.8 Pnts/day Bed Utilization: 90% Access time >1 day: <5% Bed Utilization: 90% Access time >1 day: <5% Beds: ? Arrival Rate: 29.6 Pnts/day Arrival Rate: 42.6 Pnts/day

Breast Cancer Chemo BedsBed Util % of Patients with Access Time > %27.9% %9.1% %3.8% Targets Met

Non Breast Cancer Chemo BedsBed Util % of Patients with Access Time > %34.9% %9.1% %2.5% Targets Met

Results Existing Chemotherapy BC Chemotherapy Beds: 30 NBC Chemotherapy Beds: 19 Beds: 13 Equal Performance Centralized Service Decentralized Service

Case Study Conclusion A decentralized Chemotherapy Service requires a total of 32 beds to ensure the same performance as the existing 30 bed centralized Service

General Considerations for FF 1.Proportional Sizes of the decentralized groups 2.Variability in Appointment Length 3.Efficiency Improvement Due to Focus 4.Different Performance expectations for different patients

Advantages of Methodology Uses Data that is commonly available from outpatient Scheduling Systems Applicable in other Focused Factory Decisions Can determine the min Economies of Focus Applicable in other outpatient environments Can be easily adapted to answering a variety of questions related to different treatment plans for a certain segment of the patient population

Other Applications Impact of Different Drugs with faster infusion times Impact of Less Frequent Return Appts Impact of Different Working hours Impact of Growing Demands Impact of Dedicated Lab service

Give Drug A Orally

Decision Support Tool

Future Research Determine the combined advantages of multiple departments decentralized to a Focused Factory.

Discussion & Questions?