1. Jonathan Atzmon, ISE/ETM Dr. Joan Burtner, Advisor Last Revised 03/03/15 Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 1 1 2

2. Background Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 2 Modeling and simulation (M&S) allows for the evaluation of process improvement activities Variety of applications of M&S History of M&S Arena expands the M&S market

3. Summary of Research 1) A Review of the Literature Concerning Queuing Theory 2) A Review of the Literature Concerning Modeling and Simulation 3) Process Improvement Using Arena Simulation Software 4) Discrete Event Simulation for Healthcare Organizations: A Tool for Decision Making 5) A Guide for Building Hospital Simulation Models 6) Study on the Effect of Different Arrival Patterns on an Emergency Department’s Capacity Using Discrete Event Simulation 7) Emergency Department Simulation and Determination of Optimal Attending Physician Staffing Schedules 8) Designed to Fail: How Computer Simulation Can Detect Fundamental Flaws in Clinic Flow 9) A Simulation Model of a Hospital’s Clinical Laboratory 10) Using Queuing Theory and Simulation Model to Optimize Hospital Pharmacy Performance Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 3

4. Home Screen Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 4 General Arena (version 14.5) Model

5. Default Menu Bar & Toolbar Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 5 General Arena (version 14.5) Model

6. Flowchart of the General Model Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner6 General Arena (version 14.5) Model

7. Create Module Located in the Basic Process template panel Create Module Generates entities that flow through the model Name = Entities Arrive to Process Entity Type = Entity Type of Time Between Arrivals = Schedule Schedule Name = Arrival Schedule Schedule Module (Arrival Rate, Duration) = (40, 1); (35, 1); (25, 2); (0, 1); (35, 1); (25, 2); and (35, 1) Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 7 General Arena (version 14.5) Model

8. Process Module Located in the Basic Process template panel Simulates an amount of time for an entity to perform or undergo some type of procedure Name = Process Logic Action = Seize Delay Release Resources Type = Resource Resource Name = Process Resource Quantity = 1 Delay Type = Triangular Units = Minutes Minimum = 1 Value (Most Likely) = 2 Maximum = 3 Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 8 General Arena (version 14.5) Model

9. Variable & Failures Variable Placed above the Process module Indicates the current number of entities in the queue waiting to be processed by the Process Resource Failures File/Template Panel/Advanced Process Allows for the simulation of resource downtime Resource Module Failure Name = Resource Failure Failure Rule = Preempt Failures Module Type = Time Up Time = 4 hours Down Time = 1 hour Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 9 General Arena (version 14.5) Model

10. Decide Module Located in the Basic Process template panel Simulates decision-making based on chance or a condition Name = Decide Type = 2-way by Chance Percent True (0 – 100) = 15 Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 10 General Arena (version 14.5) Model

11. Dispose Module Located in the Basic Process template panel Removes entities from the model Records entity statistics for the report Name = Entities Depart Process Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 11 General Arena (version 14.5) Model

12. Record Module Located in the Basic Process template panel Name = Record # of Entities Sent to True Node Type = Count Value = 1 Counter Name = # of Times Entities Sent to True Node Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner12 General Arena (version 14.5) Model

13. Assign Module Located in the Basic Process template panel Name = Change Entity Picture Assignment Type = Entity Picture Picture.Box Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 13 General Arena (version 14.5) Model

14. Plot of the Measure of Interest Data Series tab/Add button Series 1 Properties/Source Data/Expression Basic Process Variables/Queue/Current Number in Queue Axes tab Maximum value of the Time (X) Axis = 540 MajorIncrement value of the Time (X) Axis = 60 Maximum value of the Left Value (Y) Axis = 40 AutoScaleMaximum = False Titles tab Header’s Text = Number in Process Queue Legend tab Uncheck the Show Legend menu option Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 14 General Arena (version 14.5) Model

15. Running the Model Run/Setup Project Parameters Project Title Analyst Name Statistics Collection Reports Category Overview Replication Parameters Replication Length Base Time Units Number of Replications Run/Check Model Play button Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 15 General Arena (version 14.5) Model

16. Reduction of the Queue Length Scenario 1 – Base Scenario No changes to general model previously defined Scenario 2 – Probability Distribution of the Process Use Arena’s Input Analyzer to develop a probability distribution of the Process delay Data file in the format Formatted Text (Space Delimited) File/New File/Data File/Use Existing Fit/Fit All Weibull distribution with scale parameters (β, α) = (0.734, 0.795) Scenario 3 – Increased Capacity of the Resource In the Resource module, change the capacity of the Process Resource from one to two Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 16 Arena’s Input and Output Analyzer

17. Reduction of the Queue Length (Continued) Number of Replications = 100 Statistic module Name = # Entities in Process Queue Type = Output Expression = NQ(Process.Queue) Report Label = # Entities in Process Queue Output File = scenario# For # is 1, 2, or 3 Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner17 Arena’s Input and Output Analyzer

18. Reduction of the Queue Length (Continued) One-Way Analysis of Variance (ANOVA) Objective = Determine which scenario resulted in the smallest number of entities in the Process queue Procedures Arena’s Output Analyzer/Analyze/One-Way ANOVA Add the three data files (one for each scenario) with the replications lumped Comparison Method = Tukey Confidence Level = 0.95 Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner18 Arena’s Input and Output Analyzer

19. Reduction of the Queue Length (Continued) One-Way Analysis of Variance (ANOVA) Purpose = Compare the mean number of entities in the Process queue for each of the three scenarios Hypotheses H_0: μ_1 = μ_2 = μ_3 H_1: At least one scenario differed in the mean number of entities in the Process queue Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner19 Arena’s Input and Output Analyzer

20. Reduction of the Queue Length (Continued) One-Way Analysis of Variance (ANOVA) Results Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner20 Arena’s Input and Output Analyzer

21. Research Opportunities Business, industry, education, healthcare, and government Process Improvement Tools One-Way ANOVA Control Charts Check Sheets Pareto Charts Cause-and-Effect Diagrams Defect Concentration Diagrams Scatter Plots Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 21

22. Further Opportunities Resources Courses: ISE 403 – Modeling and Simulation; ETM 607 – Modeling and Simulation Dr. Scott Schultz; Dr. Pablo Biswas YouTube Other Applications Fit a statistical distribution to a data set using Arena’s Input Analyzer Other modeling capabilities such as forklifts and conveyor belts Reminder = ONE directory folder per project Atzmon ETM 691.001, Simulation in Healthcare, Spring 2015, Dr. Joan Burtner 22