Integral process optimization of the plaster cast room at AMC

Hoogwout, Siebe-Thijs (2010) Integral process optimization of the plaster cast room at AMC.

Abstract:INTRODUCTION This report describes the research of the plaster cast room in the outpatient clinic Orthopedics, Traumatology, and Plastic Surgery at Academic Medical Center, Amsterdam. The cast room annually treats 6,300 patients, which include both inpatients and outpatients. This research focuses on the improvement of the cast room process regarding the interaction between patient flow and capacity. PROBLEM DESCRIPTION The cast room has an unbalance in patient waiting time, quality of labor, and quality of care. Hereby, the workload during the week as well as during shifts is not balanced. In addition, the cast room capacity in terms of personnel is not constant as Orthopedic Cast Technicians (OCTS) encounter unscheduled unavailability during the day. The combination of peaks in workload and continuous changes in capacity result in patient waiting time. In addition, the quality of care decreases during busy periods as a result of disturbances during patient treatment. Hereby, quality of labor decreases as shifts both combine high peaks in workload and moments of idle time. The quality of labor further decreases as a result of overtime. RESEARCH OBJECTIVE The objective of the research is to design and evaluate several recommendations to improve the performance and service level of the current cast room performance as well as balance the OCT workload per shift. This research uses average patient waiting time and the average number of patients seen within 20 minutes of waiting as the service level measures. RESEARCH APPROACH First, this research provides a detailed context analysis of the current cast room process, its actors, and its performance according to the key performance indicators patient waiting time, utilization, and overtime. We connect the findings regarding the cast room performance to the literature and our practical insight of the situation. Hereby, we formulate several recommendations to improve the current situation. These recommendations vary in required commitment, dedication, and resources to improve the current situation. This research focuses on the recommendations regarding appointment planning, staff scheduling, and patient prioritization. We group our recommendations in three interventions:  Intervention 1: Less invasive improvement actions Intervention 1 combines recommendations regarding improvements in communication and behavior of both the OCTs as the DAs. The goal of intervention 1 is to decrease or remove delay in the cast room process. Hereby, we mean delay as a result of lack in communication between the OCTs and DAs, as well as timeliness of the OCTs at the start of shifts.  Intervention 2: Redesign of the agenda system and of the appointment scheduling Intervention 2 provides a redesign of the agenda system in combination with several rules of thumb regarding appointment scheduling to spread patients over a shift. Furthermore, we try to schedule patients around peak 4 moments to stimulate the balance in workload during the entire shift. Hereby, the goal of intervention 2 is to balance the workload for OCTs throughout the shift. Intervention 2 also uses intervention 1.  Intervention 3: More invasive improvement actions Intervention 3 requires additional personnel resources and commitment compared to interventions 1 and 2. Hereby, the sub-interventions of intervention 3 include further alterations in the agenda system regarding the slot duration, improvement in communication regarding the lack in appointment scheduling of walk-in patients and same-day patients, reducing the percentage of no-shows and cancellations, and adjustments in the outpatient clinic capacity to further improve the performance of our interventions in the cast room. Intervention 3 also uses intervention 1 and 2. RESULTS We use a computer simulation model to analyze the current situation and evaluate our (sub)-interventions, extensions, and capacity evaluation. We determine a base situation as representation of the current situation. The service level of the base situation is 72.3% with an average patient waiting time of 18.3 minutes. Hereby, the average OCT overtime for the morning and afternoon equals 4.3 minutes and -7.6 minutes respectively. We compare our interventions with this base situation according to 95% confidence interval to evaluate if changes are significant. Intervention 1 increases the service level to 77.7% with an average patient waiting time of 13.9 minutes. The OCT overtime remains 4.3 minutes overtime in the morning, and increases to -11.1 minutes undertime in the afternoon. Furthermore, we find that we decrease the patient waiting time at the start of shifts. Intervention 2 increases the service level to 81.3% with an average patient waiting time of 11.4 minutes. The OCT undertime increases to 13.7 minutes overtime in the morning, and decreases to -0.6 minutes undertime in the afternoon. The best case of Intervention 3 increases the service level to 95%, which is our target service level. However, this situation is hard to implement. The best case situation assumes the elimination of OCT unavailability, the extensive use of a DA to reduce or remove process delays and disturbances, and the spread of specialists’ consulting hours. Hereby, the OCT overtime decreases to -6.7 minutes overtime in the morning, and to -46.3 minutes n the afternoon. CONCLUSIONS & RECOMMENDATIONS We find that the best case situation improves the service level to 95% and the average patient waiting time to 2.9 minutes. However, the best case situation is hard to implement, certainly on a short notice. Intervention 1 shows that we can improve the current situation with low invasive improvement actions with a reduction of 21% of the average patient waiting time. Furthermore, the adjustments regarding appointment scheduling contribute to the spread of workload for OCTs. We recommend to implement intervention 1 and 2 as soon as possible, as they do not require additional (financial) resources. Intervention 3 indicates the importance of controlling cast room capacity as well as reducing disturbances and variance during treatments. Hereby, we adjust capacity to deal with these occurrences (see Section 4.5.3). Those adjustments require additional financial resources. Therefore, we also recommend that the OCTs collaborate with the outpatient clinic stakeholders to adjust the current capacity levels so that no additional financial resources are required. Furthermore, the increase in coordination of external tasks around peak moments contributes to the desired performance as well.
Item Type:Essay (Master)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Industrial Engineering and Management MSc (60029)
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