Estimating optimal Staffing LEVels
Healthcare
The healthcare industry is a complex domain with many stakeholders having different interests and goals, which often are contradictory; for example, healthcare shall be affordable and equal, be high quality, and at the same time be efficient. The healthcare sector is divided into different providers such as home care, primary care, hospital clinics and private specialists, etc. This results in an increased complexity, as the different healthcare providers need to collaborate in order to fulfill their missions.
There is several different collaboration strategies employed in healthcare all round the world including the "Value" Based Models.
Value Based Models, and Goal Models
Value Based Models and Modeling provide one of the instruments for analyzing and designing alternative ways of collaboration in healthcare is to use value models. A value model focuses on values, and describes actors that collaborate, assets that are valuable for the actors, and the exchanges of these assets. Value models provide efficient instruments for comparing and evaluating alternative collaboration strategies, or optimizing existing ones. In addition, value models relate values of patients with values of other actors in the network of healthcare providers and stakeholders. Especially, understanding the values of patients is essential to designing care cycles and measurement instruments.
Value Based Models have the following inherent limitation:
In order to overcome these limitations, value models need to be combined with goals and action models. A major advantage of basing action analysis and design on value and goal models is that we ensure that the actions do realize the intended effects of patients and other actors in the network of healthcare providers.
[TBD]
Traditionally, bed capacity has been the preferred unit of planning for hospital care, although revenue for hospital services is increasingly based on measures of activity such as diagnosis-related groups. The problem with capacity measure based on only ‘bed’ numbers is bed numbers or bed occupancy does not provide a good measure of the services provided inside hospitals, given the wide variation in medical procedures mix and thus treatment costs of those occupying the beds.
Healthcare service capacity defined in terms of patient flows, whether in batches or as flows, followed by identification of those elements that can constrain them (the bottlenecks) is a more appropriate model. The constraints to optimal flow could then be; the number of beds, surgical operating theaters, diagnostic equipment or particular specialist staff, etc. Anything that eases throughput by releasing the bottleneck potentially adds value to the system. However, improving the efficiency of only one part of the system may not improve overall efficiency. In order to optimize flow we need to separate different flows of patients, work and goods, enabling each to move according to its own logic and pace. For hospitals, this means that the focus should be on similar processes (not on similar clinical conditions).
The healthcare industry is a complex domain with many stakeholders having different interests and goals, which often are contradictory; for example, healthcare shall be affordable and equal, be high quality, and at the same time be efficient. The healthcare sector is divided into different providers such as home care, primary care, hospital clinics and private specialists, etc. This results in an increased complexity, as the different healthcare providers need to collaborate in order to fulfill their missions.
There is several different collaboration strategies employed in healthcare all round the world including the "Value" Based Models.
Value Based Models, and Goal Models
Value Based Models and Modeling provide one of the instruments for analyzing and designing alternative ways of collaboration in healthcare is to use value models. A value model focuses on values, and describes actors that collaborate, assets that are valuable for the actors, and the exchanges of these assets. Value models provide efficient instruments for comparing and evaluating alternative collaboration strategies, or optimizing existing ones. In addition, value models relate values of patients with values of other actors in the network of healthcare providers and stakeholders. Especially, understanding the values of patients is essential to designing care cycles and measurement instruments.
Value Based Models have the following inherent limitation:
- Value models do not show how values are related to existing actions in healthcare. This may be important since many problems in healthcare are caused by unsatisfactory structuring and distribution of healthcare actions among healthcare providers.
- Value models by themselves do not work as tools for suggesting new actions that improve creation of value for patients and collaborating healthcare providers.
In order to overcome these limitations, value models need to be combined with goals and action models. A major advantage of basing action analysis and design on value and goal models is that we ensure that the actions do realize the intended effects of patients and other actors in the network of healthcare providers.
[TBD]
Traditionally, bed capacity has been the preferred unit of planning for hospital care, although revenue for hospital services is increasingly based on measures of activity such as diagnosis-related groups. The problem with capacity measure based on only ‘bed’ numbers is bed numbers or bed occupancy does not provide a good measure of the services provided inside hospitals, given the wide variation in medical procedures mix and thus treatment costs of those occupying the beds.
Healthcare service capacity defined in terms of patient flows, whether in batches or as flows, followed by identification of those elements that can constrain them (the bottlenecks) is a more appropriate model. The constraints to optimal flow could then be; the number of beds, surgical operating theaters, diagnostic equipment or particular specialist staff, etc. Anything that eases throughput by releasing the bottleneck potentially adds value to the system. However, improving the efficiency of only one part of the system may not improve overall efficiency. In order to optimize flow we need to separate different flows of patients, work and goods, enabling each to move according to its own logic and pace. For hospitals, this means that the focus should be on similar processes (not on similar clinical conditions).
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Staffing
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Service Capacity Design
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Strategy Formulation
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Implementation
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Execution
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Rightsizing Staffing Levels
Estimating the right staffing levels and labor requirements (rightsizing) is an operational planning function which involves systematic review of staffing mix and levels, tasks and work processes to determine the appropriate number (quantity) and mix of staff (workers) needed to meet organizational goals in areas such as medical practice, quick service and full service restaurants, barber shops and salons, etc. This process is organization-specific (i.e., for a specific medical practice for example) and is influenced by the expectations of the organization, internal limiting factors (constraints), organizational culture, strategic goals and objectives, and operational goals.
Rightsizing means managing employees as resources, at a level that better fits your organizational needs. Rightsizing involves creating a simulation model of the business operations that enables evaluation of the organization's value creation and delivery systems. The evaluation involves analysis of simulation results in the form of output models that inform decisions in the following areas:
Problem Model
In healthcare, patients are treated at different places; during treatment patients may have to pass through different rooms (e.g., emergency room, medical checkup or examination room, pathology test room, surgical Operation Theater/room, and even reception). If in these all areas, one station takes more time, ultimately patients have to wait more. This problem can be alleviated if particular customer care bottleneck areas are streamlined using TOC in order to improve efficiency and productivity of the whole system.
Simulation Output & Analysis
The simulation output provides staffing resource utilization and workload information, and associated overall business (throughput) performance information to inform staffing decisions. Operations Analytics Simulation provides you the evidence to allow you to make bold, confident decisions because you are sure you are making the right choice.
Estimating the right staffing levels and labor requirements (rightsizing) is an operational planning function which involves systematic review of staffing mix and levels, tasks and work processes to determine the appropriate number (quantity) and mix of staff (workers) needed to meet organizational goals in areas such as medical practice, quick service and full service restaurants, barber shops and salons, etc. This process is organization-specific (i.e., for a specific medical practice for example) and is influenced by the expectations of the organization, internal limiting factors (constraints), organizational culture, strategic goals and objectives, and operational goals.
Rightsizing means managing employees as resources, at a level that better fits your organizational needs. Rightsizing involves creating a simulation model of the business operations that enables evaluation of the organization's value creation and delivery systems. The evaluation involves analysis of simulation results in the form of output models that inform decisions in the following areas:
- Benchmarking the current state - Determining if there are opportunities for change or improvement based on organizational data compared to peer groups.
- Analyzing current productivity - Understanding the current productivity levels of staff and support staff.
- Analyze current operational model - Determine the model by which the organization operates. This includes the staff number and function allocated to each position/role, customer (patient) check-in and check-out processes, customer record management, scheduling procedures and telephone processes.
- Analyze process performance - Create and run simulation models of the value creation and delivery operations processes; identify areas of capacity improvements and bottlenecks.
- Take action - Share the simulation data with decision makers and stakeholders, and act of any suggested changes
Problem Model
In healthcare, patients are treated at different places; during treatment patients may have to pass through different rooms (e.g., emergency room, medical checkup or examination room, pathology test room, surgical Operation Theater/room, and even reception). If in these all areas, one station takes more time, ultimately patients have to wait more. This problem can be alleviated if particular customer care bottleneck areas are streamlined using TOC in order to improve efficiency and productivity of the whole system.
- Create Patients' profiles and service demand model - This includes Patients' booked appointments for healthcare service.
- Create the work schedules for the types of resources decisive for delivering services needed and requested by patients with appointments.
- Create operating schedules for the organization including shifts, break cover, and etc. modeled as constraints on design capacity.
- Create organizational work processes for the organization unit and dependent organizations (as actors). The activity and task definition include average duration time as well as low and high times.
- Define Patients' flow (routings) model.
- Create roles and roles responsibility assignment policies and models - this defines the formal model of organization behavior.
- Run simulation and analyze output results.
Simulation Output & Analysis
The simulation output provides staffing resource utilization and workload information, and associated overall business (throughput) performance information to inform staffing decisions. Operations Analytics Simulation provides you the evidence to allow you to make bold, confident decisions because you are sure you are making the right choice.
Determining Hospital Surgical Service Capacity
The Basic Problem
The hospital has a current backlog of people on a waiting-list that need hernia surgery. The hospital needs to decide on the best way to increase service and surgical capacity to stop the waiting list from growing and to eventuallu start reducing and working off the backlog. In addition, the hospital will like to expand the scope of its services and add the capability to handle drop-in (walk-in) patients in addition to the appointments.
Simulation Models
Healthcare service capacity is defined in terms of patient flows, whether in batches or as flows, followed by identification of those elements that can constrain them (the bottlenecks). In some cases, this could be the number of beds, operating theaters, diagnostic equipment or particular specialist staff, etc. Anything that eases throughput by releasing the bottleneck potentially adds value to the system. However, improving the efficiency of only one part of the system may not improve overall efficiency. Patient care networks are grounded in the concept of flow (defined in terms of processes and categories) across the whole system. Patient Care networks describe optimal packages for particular syndromes and, ideally, encapsulate measurable inputs and outcomes.
The simulation enables users to examine the behavior of a simulated version of the domain system model, and evaluate alternative configurations.
Customer (Patient) Demand Model
The customer demand models (derived from forecasts and/or sales orders) are transformed into master production schedules; or for Lean Manufacturing the demand modelis defined in terms of the “pacemaker” processes. The point of scheduling signifies the start of the “pacemaker” process for each on-demand product, or master scheduled item. The planned volume and product mix represented by the “pacemaker” processes in Lean is equivalent to a master schedule.
Forecasting is critical in determining cycle time (takt time) for the production and manufacturing operations. Forecasting is used in a number of ways including:
The takt time for each product is derived from the customer orders or forecasts (such as illustrated in Figure below), and is used in determining the pace (rate) of production required to meet customer demand.
Process and Resource Configuration Model
In order to assess the impact of different strategies, and recommend rational staffing levels, users must consider the following factors:
c) The effect of factors such as patient arrival patterns, type of illness, and level of assistance required by patient on staff assignment in a hospital.
A simulation profile is a copy of a production or operations domain model that you use to actually run the simulation. Each simulation profile that you create for a simulation model (snapshot) is based on the domain model as it existed at the time when the simulation model was generated. You can generate formal models from the domain models guided by the organization operating system model. The Operating System Model is the abstract representation of how an organization operates across process, organization, technology domains in order to deliver value defined by the organization in scope. These prescriptive generated models are incorporated into the simulation models and executed. The simulation output is evaluated analytically using the EPCAD Visualization Workbench decision framework.
The Basic Problem
The hospital has a current backlog of people on a waiting-list that need hernia surgery. The hospital needs to decide on the best way to increase service and surgical capacity to stop the waiting list from growing and to eventuallu start reducing and working off the backlog. In addition, the hospital will like to expand the scope of its services and add the capability to handle drop-in (walk-in) patients in addition to the appointments.
Simulation Models
Healthcare service capacity is defined in terms of patient flows, whether in batches or as flows, followed by identification of those elements that can constrain them (the bottlenecks). In some cases, this could be the number of beds, operating theaters, diagnostic equipment or particular specialist staff, etc. Anything that eases throughput by releasing the bottleneck potentially adds value to the system. However, improving the efficiency of only one part of the system may not improve overall efficiency. Patient care networks are grounded in the concept of flow (defined in terms of processes and categories) across the whole system. Patient Care networks describe optimal packages for particular syndromes and, ideally, encapsulate measurable inputs and outcomes.
The simulation enables users to examine the behavior of a simulated version of the domain system model, and evaluate alternative configurations.
Customer (Patient) Demand Model
The customer demand models (derived from forecasts and/or sales orders) are transformed into master production schedules; or for Lean Manufacturing the demand modelis defined in terms of the “pacemaker” processes. The point of scheduling signifies the start of the “pacemaker” process for each on-demand product, or master scheduled item. The planned volume and product mix represented by the “pacemaker” processes in Lean is equivalent to a master schedule.
Forecasting is critical in determining cycle time (takt time) for the production and manufacturing operations. Forecasting is used in a number of ways including:
- In push systems, the forecast is used to create a master schedule of products and parts to produce.
- In pull systems, the forecast is used to turn cycle times into targeted levels of inventory, to drive the process of determining resource capacity constraints.
The takt time for each product is derived from the customer orders or forecasts (such as illustrated in Figure below), and is used in determining the pace (rate) of production required to meet customer demand.
Process and Resource Configuration Model
In order to assess the impact of different strategies, and recommend rational staffing levels, users must consider the following factors:
- Average rates at which customers request for service including the breakdown of customer request/order types (e.g., for a coffee shop regular coffee vs. expression) – at different times of the day,
- Workforce (labor) resource schedules – [shift patterns, and breaks cover, taken as constraints or calculated by the simulation.
- Process capacities per patient type or service delivery type.
- The amount of variation on the service time required for a worker to serve each of the different patient and medical procedure types
- Service throughput by patient network elements
- Specialty staffing levels.
- Facility scheduling constraints (e.g., service offering mix and changes, service type, number of equipment such as radiology, etc.).
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c) The effect of factors such as patient arrival patterns, type of illness, and level of assistance required by patient on staff assignment in a hospital.
A simulation profile is a copy of a production or operations domain model that you use to actually run the simulation. Each simulation profile that you create for a simulation model (snapshot) is based on the domain model as it existed at the time when the simulation model was generated. You can generate formal models from the domain models guided by the organization operating system model. The Operating System Model is the abstract representation of how an organization operates across process, organization, technology domains in order to deliver value defined by the organization in scope. These prescriptive generated models are incorporated into the simulation models and executed. The simulation output is evaluated analytically using the EPCAD Visualization Workbench decision framework.
Strategy Implementation - Expanding Hospital Capacity
This is an 89 bed hospital specializes in hernia repair surgery, with on average 7,000 operations a year. The medical facilities consist of five operating rooms, a patient recovery room, a laboratory, and six examination rooms. It performs, on average, 150 operations per week, with patients generally staying at the hospital for 3 days. Operations are performed only 5 days a week, but the remainder of the hospital is in operation continuously to attend to recovering patients.
An operation at this hospital is performed by one of the 12 full time surgeons. Surgeons generally take about 1 hour to prepare for and perform each hernia operation, and they operate on four patients per day. Patients arrive at the clinic the afternoon before their surgery, receive a brief preoperative examination, and see an admissions clerk to complete paperwork. They are next directed to one of the two nurse’s stations for blood and urine tests and then are shown to their rooms. On the day of the operation, the patients are administered a local anesthetic, leaving them alert and fully aware of the proceedings. At the conclusion of the operation, the patient is encouraged to walk from the operating table to a wheelchair, which is waiting to return them to their room.
Many hospitals and healthcare centers take great pains to ensure a consistent level of service in order to sustain revenue levels. Overall, the objective is to deliver high levels of value via a flexible and “mass-customized” approach, where individualized service is provided by tailoring a standardized set of processes.
Strategic Issue and Problem
The hospital has a long waiting list of potential patients waiting to get surgical treatment for their hernia. In addition, the hospital wants to improve its outreach to the local community and provide walk in surgery services for members of the community to get surgical treatment. The hospital in considering whether and how to expand the reach of its services.
Strategy Evaluation and Control
In evaluating the various proposals for expanding capacity, due consideration is given to the current Operating Model elements such as culture that are prominent in the hospital's value proposition and competitive advantage - service delivery competency. The Operating Model defines a well-focused, and well-managed medical facility with a performance culture that makes it:
The hospital would like to preserve and leverage the competencies that give it competitive advantage over its competitors.
Hospital Operating System
Traditionally, bed capacity has been the preferred unit of planning for hospital care, although revenue for hospital services is increasingly based on measures of activity such as diagnosis-related groups. The problem with capacity measure based on only ‘bed’ numbers is bed numbers or bed occupancy does not provide a good measure of the services provided inside hospitals, given the wide variation in medical procedures mix and thus treatment costs of those occupying the beds.
Healthcare service capacity defined in terms of patient flows, whether in batches or as flows, followed by identification of those elements that can constrain them (the bottlenecks) is a more appropriate model. The constraints to optimal flow could then be; the number of beds, surgical operating theaters, diagnostic equipment or particular specialist staff, etc. Anything that eases throughput by releasing the bottleneck potentially adds value to the system. However, improving the efficiency of only one part of the system may not improve overall efficiency. In order to optimize flow we need to separate different flows of patients, work and goods, enabling each to move according to its own logic and pace. For hospitals, this means that the focus should be on similar processes (not on similar clinical conditions).
This is an 89 bed hospital specializes in hernia repair surgery, with on average 7,000 operations a year. The medical facilities consist of five operating rooms, a patient recovery room, a laboratory, and six examination rooms. It performs, on average, 150 operations per week, with patients generally staying at the hospital for 3 days. Operations are performed only 5 days a week, but the remainder of the hospital is in operation continuously to attend to recovering patients.
An operation at this hospital is performed by one of the 12 full time surgeons. Surgeons generally take about 1 hour to prepare for and perform each hernia operation, and they operate on four patients per day. Patients arrive at the clinic the afternoon before their surgery, receive a brief preoperative examination, and see an admissions clerk to complete paperwork. They are next directed to one of the two nurse’s stations for blood and urine tests and then are shown to their rooms. On the day of the operation, the patients are administered a local anesthetic, leaving them alert and fully aware of the proceedings. At the conclusion of the operation, the patient is encouraged to walk from the operating table to a wheelchair, which is waiting to return them to their room.
Many hospitals and healthcare centers take great pains to ensure a consistent level of service in order to sustain revenue levels. Overall, the objective is to deliver high levels of value via a flexible and “mass-customized” approach, where individualized service is provided by tailoring a standardized set of processes.
Strategic Issue and Problem
The hospital has a long waiting list of potential patients waiting to get surgical treatment for their hernia. In addition, the hospital wants to improve its outreach to the local community and provide walk in surgery services for members of the community to get surgical treatment. The hospital in considering whether and how to expand the reach of its services.
Strategy Evaluation and Control
In evaluating the various proposals for expanding capacity, due consideration is given to the current Operating Model elements such as culture that are prominent in the hospital's value proposition and competitive advantage - service delivery competency. The Operating Model defines a well-focused, and well-managed medical facility with a performance culture that makes it:
- Highly productive surgeons - (averaging 300 hernia procedures/year versus industry average of 30/year for less focused hospitals.
- Sharing of knowledge and experience.
The hospital would like to preserve and leverage the competencies that give it competitive advantage over its competitors.
Hospital Operating System
Traditionally, bed capacity has been the preferred unit of planning for hospital care, although revenue for hospital services is increasingly based on measures of activity such as diagnosis-related groups. The problem with capacity measure based on only ‘bed’ numbers is bed numbers or bed occupancy does not provide a good measure of the services provided inside hospitals, given the wide variation in medical procedures mix and thus treatment costs of those occupying the beds.
Healthcare service capacity defined in terms of patient flows, whether in batches or as flows, followed by identification of those elements that can constrain them (the bottlenecks) is a more appropriate model. The constraints to optimal flow could then be; the number of beds, surgical operating theaters, diagnostic equipment or particular specialist staff, etc. Anything that eases throughput by releasing the bottleneck potentially adds value to the system. However, improving the efficiency of only one part of the system may not improve overall efficiency. In order to optimize flow we need to separate different flows of patients, work and goods, enabling each to move according to its own logic and pace. For hospitals, this means that the focus should be on similar processes (not on similar clinical conditions).
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