In the OR with Dale Schroyer

Dale%20Schroyer

Dale Schroyer – Sr. Consultant & Project Manager

I generally find that in healthcare, WHEN something needs to happen is more important than WHAT needs to happen.  It’s a field that is rife with variation, but with simulation, I firmly believe that it can be properly managed.  Patient flow and staffing are always a top concern for hospitals, but it’s important to remember that utilization levels that are too high are just as bad as levels that are too low, and one of the benefits of simulation in healthcare is the ability to staff to demand.

Check out Dale’s work with Robert Wood Johnson University Hospital where they successfully used simulation to manage increased OR patient volume: 

About Dale

Since joining ProModel in 2000, Dale has been developing simulation models used by businesses to perform operational improvement and strategic planning. Prior to joining ProModel Dale spent seven years as a Sr. Corporate Management Engineering Consultant for Baystate Health System in Springfield, MA where he facilitated quality improvement efforts system wide including setting standards and facilitating business re-engineering teams. Earlier he worked as a Project Engineer at the Hamilton Standard Division of United Technologies.

Dale has a BS in Mechanical Engineering from the University of Michigan and a Masters of Management Science from Lesley University. He is a certified Six Sigma Green Belt and is Lean Bronze certified.

NEW! ProModel’s Patient Flow Solution:

http://patientflowstudio.com/

ProModel Healthcare Solutions:

http://www.promodel.com/Industries/Healthcare

Teaching Process Management Using ProModel

ProModel Guest Blogger:  Scott Metlen, Ph.D. – Business Department Head and Associate Professor at University of Idaho

Scott Metlen, Ph.D.

Scott Metlen, Ph.D.

Understanding process management, the design, implementation, management and control, and continuous improvement of the enterprise wide set of an organizations processes is the key to well deployed strategies. It was not until Tim Cook made Apple’s total set of processes world class including all supply chain linked processes (Brownlee, 2012) that Apple hit its amazing climb to become the world’s highest valued company; even though the company had cutting edge products before his arrival. Gaining effective understanding of process management is not easy due to the strategic variability inherent in the portfolio of products that companies sell, and in markets they service. This strategic variability (Rajan, 2011) in turn drives variability in many processes that an organization uses to operate. For instance, different markets require different marketing plans supported by different processes.  Order processes often vary by product and target market. Employee skill sets differ by product requiring different hiring and training processes. Different products, whether it be services or goods that have a slight variation require, at the very least, an adjustment to the production process. Adding to, and often caused by the variability just mentioned, are multiple process steps, each with different duration times and human resource skills.  Depending on what product is currently being produced, process steps, process step order and duration time, interdependency between the process steps, and business rules all vary. Where a product is in its life cycle will drive the experience curve, again creating variation across products. In addition, the numerous interfaces with other processes all vary depending on the product being produced. All of these sources of variability can make process management hard to do, teach, and learn. One tool that helps with process management in the face of variance is discrete event simulation and one of the best software suites to use is ProModel. ProModel is a flexible program with excellent product support from the company.

Effective process management is a multi-step process. The first step of process management is to determine the process flow while at the same time determining the value and non-value added process steps. Included in the process flow diagram for each step are the duration times by product and resources needed at each step, and product routes. Also needed at this time are business rules governing the process such as working hours, safety envelopes, quality control, queueing rules, and many others. Capturing this complex interrelated system begins by visiting the process and talking with the process owner and operators. Drawing the diagram and listing other information is a good second step, but actually building and operating the process is when a person truly understands the process and its complexities.  Of course many of the processes we want to improve are already built and are in use. In most cases, students will not be able to do either of these. However, building a verified and validated simulation model is a good proxy for doing the real thing, as the model will never validate against the actual process output unless all of the complexity is included or represented in the model. In the ‘Systems and Simulation’ course at the University of Idaho students first learn fundamentals of process management including lean terms and tools. Then they are given the opportunity to visit a company in the third week of class as a member of a team to conduct a process improvement project. In this visit students meet the process owner and operators. If the process is a production process, they walk the floor and discuss the process and the delta between expected and actual output. If the process is an information flow process, such as much of an order process, the students discuss the process and, again, the delta between expected and realized output. Over the next six weeks students take the preliminary data and begin to build a simulation model of the current state of the process. During this time period students discover that they do not have all the data and information they need to replicate the actual process. In many cases they do not have the data and/or information because the company does not have that information or how the model is operated is not the same as designed. Students then have to contact the process owner and operators throughout the six weeks to determine the actual business rules used and/or make informed assumptions to complete their model.

Once the model has been validated and the students have a deep understanding of the process, students start modeling process changes that will eliminate waste in the system, increase output, and decrease cost. Examples of methods used to improve the process include changing business rules, adding strategically placed buffers and resources, and reallocating resources. To determine the most effective way to improve the process, a cost benefit analysis in the form of an NPV analysis is completed. The students use the distribution of outputs from the original model to generate appropriate output and then compare that output to output pulled from the distributions of each improvement scenario. This comparison is then used to determine a 95% confidence interval for the NPV and the probability of the NPV being zero or less. Finally, several weeks before the semester is finished, students travel to the company to present their findings and recommendations.

Student learning on these projects is multifaceted. Learning how to use ProModel is the level that the students are most aware of during the semester, as it takes much of their time. However, by the end of the semester they talk about improving their ability to manage processes, work in teams, deal with ambiguity, manage multiple projects, present to high level managers, and maintain steady communication with project owners.

Utilizing external projects and discrete event simulation to teach process management has been used in the College of Business and Economics at the University of Idaho for the past six years. As a result, the Production and Operation area has grown from 40 to 150 students and from five to 20 projects per semester. More importantly, students who complete this course are being sought out and hired by firms based on the transformational learning and skill sets students acquired through the program.

References:

Rajan Suri. Beyond Lean: It’s About Time. 2011 Technical Report, Center for Quick Response Manufacturing, University of Wisconsin-Madison.

Brownlee, John. Apples’s Secret Weapon 06/13/2012. http://www.cnn.com/2012/06/12/opinion/brownlee-apple-secret/index.html?hpt=hp_t2. 12/301/2014.

Scott Metlen Bio:

http://www.uidaho.edu/cbe/business/scottmetlen

 

Demystifying System Complexity

Charles Harrell, Founder ProModel Corporation

Charles Harrell, Founder ProModel Corporation

One can’t help but be awe struck, and sometimes even a little annoyed, by the complexity of modern society. This complexity spills over into everyday business systems making them extraordinarily challenging to plan and operate. Enter any factory or healthcare facility and you can sense the confusion and lack of coordination that often seems to prevail. Much of what is intended to be a coordinated effort to get a job done ends up being little more than random commotion resulting in chance outcomes. Welcome to the world of complex systems!

A “complex system” is defined as “a functional whole, consisting of interdependent and variable parts.” (Chris Lucas, Quantifying Complexity Theory, 1999, http://www.calresco.org/lucas/quantify.htm) System complexity, therefore, is a function of both the interdependencies and variability in a system. Interdependencies occur when activities depend on other activities or conditions for their execution. For example, an inspection activity can’t occur until the object being inspected is present and the resources needed for the inspection are available. Variability occurs when there is variation in activity times, arrivals, resource interruptions, etc. As shown below, the performance and predictability of a system is inversely proportional to the degree of interdependency and variability in the system.

Untitled-1

Suppose, for example, you are designing a small work cell or outpatient facility that has five sequential stations with variable activity times and limited buffers or waiting capacity in between. Suppose further that the resources needed for this process experience random interruptions. How does one begin to estimate the output capacity of such a system? More importantly, how does one know what improvements to make to best meet performance objectives?

Obviously, the larger the process and greater the complexity, the more difficult it is to predict how a system will perform and what impact design decisions and operating policies will have. The one thing most systems experts agree on, however, is that increasing complexity tends to have an adverse effect on all aspects of system performance including throughput, resource utilization, time in system and product or service quality.

For Charleys new blog

ProModel and Medmodel are powerful analytic tools that are able to account for the complex relationships in a system and eliminate the guesswork in systems planning. Because these simulation tools imitate the actual operation of a system, they provides valuable insights into system behavior with quantitative measures of system performance.

To help introduce process novices to the way interdependencies and variability impact system performance, ProModel has developed a set of training exercises using an Excel interface to either ProModel or MedModel. Each exercise exposes the initiate to increasingly greater system complexity and how system performance is affected. Additionally, these exercises demonstrate the fundamental ways system complexity can be mitigated and effectively managed.

ProModel is offering these exercises to students and practitioners who are seeking an introduction to simulation and systems dynamics.

 

For more information please contact ProModel Academic

Sandra Petty, Academic Coordinator  spetty@promodel.com

Busy Season at ProModel

Keith Vadas

Keith Vadas – ProModel President & CEO

I am pleased to report ProModel’s second quarter was very positive.  Like many businesses in the US we find ourselves on a serious upswing this Summer of 2014.  Our consultants are working on several projects in a variety of industries, including ship building, power management, retail, manufacturing, food processing, and government contracting.  In all of these projects our experienced team of consultants is working to improve efficiency, save money, and make better decisions for their clients.

ProModel’s DOD projects continue to thrive.  It is hard to believe it has been eight years since we started working with FORSCOM (US Army Forces Command)   on AST (ARFORGEN SYNCHRONIZATION TOOL).  LMI-DST (Lead Materiel Integrator – Decision Support Tool) with the LOGSA Team (US Army Logistics Support Activity) is also going strong.  Our agile team of software developers keeps improving the development process within ProModel and it shows. Just recently the NST Airframe Inventory Management Module was Granted Full Accreditation by the Commander, Naval Air Systems Command.

The time is also ripe for opportunities in Healthcare.  Our patient flow optimization capabilities are perfect for helping hospitals and outpatient clinics improve efficiencies.  Now that the Affordable Care Act has been around for a couple of years, its impact is being felt by healthcare organizations around the country.  The expanded insured-base, and the need for improved processes and different care models is making it absolutely necessary to consider the value of modeling and simulation.  ProModel continues to work with several facilities including Presbyterian Homes and Services, and Array Architects who enhance the flow in Healthcare Facilities design by using MedModel simulation in their design processes.

To better support our base of existing customers, we just released ProModel/MedModel 2014 in July and PCS Pro 2014 at the end of Q1.  EPS 2014 (Enterprise Portfolio Simulator) was released in Q2  and includes a new easy to use, web-based rapid scenario planning tool – Portfolio Scheduler.  You can check this tool out online at – http://portfoliostud.io/#.

There continue to be lots of exciting things happening at ProModel.  We have an outstanding team of consultants and software developers-designers just looking for an opportunity to PARTNER with you to help you meet the next business challenge, or solve the next unexpected problem.

Finding Impartiality in S/W Applications

Rob Wedertz - SME, NST

Rob Wedertz – Director, Navy Programs

As long as I can remember I’ve been a fan of and often used the expression, “I don’t want to build the microwave, I just want to press cook”.  (I’ve never been able to remember when or from whom I first heard it – my apologies for the lack of attribution).  While I’ve sometimes been fascinated by the inner workings and origin of things, in the end I’ve come to adopt the modern world and the pace at which it moves.  I simply don’t have the time of day to dig into the underbellies of things and investigate the underpinnings of how they work nor their interdependencies.  My aversion to such activities was upended when I joined ProModel and led (as a PM) our development team’s efforts to support Verification, Validation, and Accreditation at the behest of our sponsor’s modeling & simulation accreditation agent.  While I do not intend to “build the microwave” here, I would like to describe how I learned that the act of “pressing cook” must be accompanied by complete and total impartiality of the software application.

Software, in a variety of formats, is often used to tell a story.  When it comes to entertainment-based software, and for the sake of the longevity of it, the story should be a very good one.  Thus the reason many folks spend countless hours trying to “level up” (it’s all about the journey, not the destination).  During my college days, I was exposed to Pascal and learned that the methodology (computer language) for telling a story was via if, then, else, while, etc. statements.  Truth be told, I didn’t particularly enjoy trying to figure out how to make the computer say “hello” via that methodology.  Again, I am more of a “show me the story” kind of person, than a “how did you make the story” kind of person.  In that regard I’m quite fond of the software that exists today.  My iPad is a bevy of mindless apps that keep my 5 year old entertained while putting miles on the family wagon.  However, when it comes to decision-support software, the stuff under the hood REALLY does matter and is often as equally important as the story itself.  Through the VV&A journey we’ve traveled to date, I’ve become more and more focused on inner-workings of “the microwave”, both out of necessity and surprisingly out of curiosity.

Our software applications tell stories that often culminate in multi-million dollar and in some cases, billion dollar implications, not necessarily to the good.  Not only must the story be stringently accurate, it must also be 100% impartial (or agnostic) to those who might be directly impacted by the results.  We accomplish that impartiality by ensuring that we never begin our development processes with an end result in mind.  That is not to say that we do not begin with an end-state in mind (i.e. – what is that you want to know?)  The difference is nuanced in print, but significant when it comes to applying the right level of acumen and forethought into software development.  The true genius of leveraging software applications to solve complex problems is that once you’ve figured out “where and why it hurts”, you can use predictive analytics, modeling, and regression analysis to attack the root of the ailment.  In my simplistic mind, our software is being used to treat the condition rather than the symptom.

The rigor that has been applied to the VV&A of our specific DoD program of record is staggering when compared to similar applications.  And it should be.  While many software developers are not particularly fond of documenting source code and defining why a certain script was used, in the end it has made both our customers and us extremely confident about our methodologies, processes, and coding standards.  Frankly, (although I’d never admit it to the folks who raked us through the coals) we’ve become a better development team because of it.  Combine the penultimate requirements associated with VV&A with our use of the Agile/SCRUM development methodology, we’ve accomplished the delivery of an application that withstands painstaking scrutiny and is adaptive enough to answer evolving customer demands and utility.  In the end, the vetting our software application has endured at the hands of the accreditation agent is not the value added propositions our customer demanded, although it was a necessary evolution.  What really matters is that we’ve produced a traceable software application that is impartial.  It may not always give you the answer you want, but it will always give the answer that you need – the truth.

The ProModel Training Experience

RPriceHere at ProModel we realize that successful use of our tools usually begins with great training. To that end, we have a variety of training options available. The course you choose will depend on your product and situation. These options are described on our Training page. This post is about our classroom based trainings, our facilities, and what you can expect if you choose to join us! Regardless of your experience with business travel, it’s usually nice to know what to expect when you reach your destination.

We have regularly scheduled classes held in Allentown, Pennsylvania, and Orem, Utah. These classes usually last two or three days (depending on the course) and run from 8:30 am to 5:00 pm local time, with an hour break for lunch.

Our classrooms are set up with a computer for each student and a projector screen at the front. Your instructor will demonstrate and explain new concepts and then allow you time for hands-on implementation of the exercises on your training computer. If you bring your own laptop or wireless device, you are welcome to use our classroom Wi-Fi connection to access the internet during breaks.

Usually we have between three to six students in a class at a time, so you’ll have plenty of time and attention from our instructors, as well as an opportunity to get to know other ProModel customers and hear of their experiences and applications of the tool. We provide drinks and snacks throughout the day, but then “set you free” to grab lunch on your own. Frequently students will explore new restaurants together, but we understand that some clients need time on their lunch hour to catch up with business at the office.

We’ll start with a walkthrough of the Orem Training Facilities. You’ll want to fly into the Salt Lake City International Airport (SLC). Our office is less than an hour south of the SLC airport. For a Google map with directions to our office (and other local amenities), click here. You know you’re in the right place if you see this building:

It might be white and covered with snow, but don’t worry about the weather, that just means good skiing in the mountains. Seriously, though, Utah is well prepared for snowy conditions and getting around in winter weather is not usually a problem. The snow typically melts within a day or two in “the valley” (where we are) and sticks around up in “the mountains.” Our offices are in the east side of building C. You can take the elevator or the stairs to the third floor. As you exit the elevator (or stairs), you’ll be in our lobby. The entrance to our Orem training room is right there in the lobby.

The training room is equipped with computers for each student.

And a beautiful view out the window of Mount Timpanogos (which rises to 11,749 ft):

Allentown Office

If you plan on joining us in Pennsylvania, you can view a Google map with our location and surrounding amenities by clicking here. If flying, you may want to consider flying in to Lehigh Valley (ABE) – a very short drive to the office, Philadelphia (PHL), or Newark (EWR).

You know you’re in the right place when you see this building:

Our offices are on the third floor (just like in Orem–we must like the third floor). Just head down the hall and you’ll see the entrance to the Allentown training room on your left.

In both offices we have kitchen facilities you are welcome to use, including a microwave, fridge, K-cup coffee machine, and complimentary snacks.

We hope this information helps you feel welcome and excited for a visit to our training facilities. If you have any questions about travel, accommodations, training content or schedules, please don’t hesitate to call or email.

General Training course information can be found here and additional company facility and travel information can be found here.

Rochelle Price, Director of Training Services

rprice@promodel.com

801-223-4667

Enhancing Flow in Healthcare Design with Simulation

Guest Blog Post  - Written by Noah M. Tolson - AIA, LEED AP BD+C, Lean Green Belt -Principal and Practice Area Leader, Planning

Guest Blog Post by Noah M. Tolson – Array Architects Principal and Practice Area Leader, Planning – AIA, LEED AP BD+C, Lean Green Belt

Discrete Event Simulation (DES), which has been utilized across industries for several decades, provides a virtual environment to track and visualize patients, equipment and providers as they move through the steps of care. It is an important tool in supporting Lean Design in the healthcare environment.

In order to achieve the desired physical environment, healthcare architects rely on a vast amount of data – and the tools for harnessing that data are becoming more advanced. Just as BIM (Building Information Modeling) optimizes early decision-making in the design phase, so to can Discrete Event Simulation (DES) influence the design of workflow and patient flow prior to construction.

At Array, we have found that this virtual environment gives us the ability to test a multitude of ‘what if’ scenarios with our clients to understand the impact that different layouts have on workflow, patient flow and resource utilization. The result is an increased confidence that the design will support current needs, as well as provide insight on incorporating flexibility into the design to accommodate the inevitable changes that will come in the future.

There are three key advantages DES provides over other methods of analysis:

 

1)      Real life variability can be applied to critical key measurements such as:  patient demand, times to complete key tasks, wait times for key resources or simply waiting for care, etc.

 

2)      Naturally occurring constraints exist when the demand for services/resources exceeds capacity. DES models allow constraints to be included by identifying the interdependencies between resources available and resources required.

 

3)      DES models simulate the passing of time (into the future) and record key metrics such as wait times, processing times, resource utilization and equipment utilization as they relate to varying patient demand and varying patient acuity. This helps with the daunting task of attempting to predict when the care is to be provided and by whom.

 

Utilizing Lean Design, architectural teams appropriately spend time observing and recording work flow and patient flow to document and understand the current state. Accurately predicting the future state work flow and patient flow has always been difficult to project and arrive at consensus because workflow analysis has traditionally been based on averages. While averages are a good place to start, they don’t tell the entire story. This is where DES, due to the advantages described above, is highly valuable. Using a DES tool like ProModel’s MedModel, Process Simulator or Patient Flow Simulator to model the various hospital processes in the new structure, we can provide much more insight into the effectiveness of potential designs. DES helps evaluate the workflow, resources and patient demand more realistically and simultaneously which allows healthcare decision-makers to be more confident in the design solutions.

Case Study

MedModel was recently used to help one healthcare organization evaluate a newly constructed 220,000 SF outpatient facility. The facility was intended to centralize the services of affiliated specialty practices and education & research centers. This five-floor clinic would allow 65 providers from 13 different practices throughout a specific region to converge in one patient-friendly location. Quality and service was expected to increase greatly by having referring physicians in one collaborative environment. Spreadsheet models were initially used to study the consolidation and facility design project, but provided only static information that relied heavily on the use of averages. This made it hard to accurately study the many complex processes that occur continuously in an outpatient setting. With the limited data available, physicians and administration had difficulty reaching consensus on space requirements and efficient room utilization. At issue, could the newly consolidated practices operate comfortably on the first and third floors, or did they need additional space? A MedModel solution proposed first and third floor designs of the clinic in order to analyze capacity and resources against the current data on patient flow from all the converging practices. The simulation examined the individual practices over a five day period (Monday through Friday) during regular business hours. The measuring criteria consisted of the following:

Exam room utilization

Physician and staff utilization

Number of patients in check-in

Time spent in check-in queue

Patient activity times

Number of patients in imaging queue

After multiple scenarios were run, the output data confirmed there would be sufficient room for the consolidation of practices on the first and third floors. In fact, the analysis showed that on certain days of the week there were not enough providers to fill the capacity on those two floors.

This is one example that illustrated the advantages of DES. Array and ProModel have used similar methods to more accurately project operational outcomes and compare design solutions.