1. Magee Rehabilitation
Gaspar Clinic
July-August, 2013
Robert Rodgers

2. Outline
1. Data Collection
2. Simulate
3. Process Analysis

3. Defined Patients Track

4. Patient Track Detailed

5. Data Collection Results
• Spent 5-6 weeks in
Gaspar
• Collected data on
each day
• Min, Max, Avg
across all Physicians
• Note on Ranges0 1 0 1 1 2 11 4 6 3
15 15
22.5 5.7
8.2
3.9
16.7 16.1
2.3
18
41
43
24
57
59
10
0
10
20
30
40
50
60
70
80
Wait for Registration Registration Wait for Room Nurse Time Wait for Dr Doctor Time Scheduling
Min/Max Time in Patient Track
Min Median Avg Max

6. Ex1: Value added + Non-value added
• Pie within a Pie
• Good example
• Low waits
• Quick Treatment*
• Can we eliminate wait
to reduce LOS?
Nurse Time
6%
Doctor Time
23%
Wait For
Physician
18%
Wait For Registration
7%
Registration
16%
Wait For
Room
23%
Scheduling
7%
Other
71%

7. Bar Graph of VA/NVA
• Bar Graph
Representation
• Low Wait Times
• Stacked Bar to see
LOS
0
5
10
15
20
25
30
35
40
45
Rommel
Wait For Registration
Registration
Wait For Room
Nurse Time
Wait For Physician
Doctor Time
Scheduling
Value Added
Treatment
Non Value Added
Wait Times

8. Stacked Bar Graph
• Remove wait (waste) – Questions?
0
5
10
15
20
25
30
35
40
45
Rommel
Scheduling
Doctor Time
Wait For Physician
Nurse Time
Wait For Room
Registration
Wait For Registration
0
5
10
15
20
25
30
35
40
45
Rommel
Scheduling
Doctor Time
Nurse Time
Registration

9. Ex2: Value added (VA)+ Non-
value added (NVA)
• Less than
optimal
• Wait for
Physician
Nurse Time
4%
Doctor Time
27%
Wait For
Physician
42%
Wait For
Registration
4%
Registration
8%
Wait For Room
12%Scheduling
3%
Other
69%

10. Bar Graph of VA/NVA
• High wait for
physician time
• Volume?
• Scheduling?
• Leaving the 1st floor
for longer than
‘optimal’ time?
0
5
10
15
20
25
30
35
40
45
Kupfer
Wait For Registration
Registration
Wait For Room
Nurse Time
Wait For Physician
Doctor Time
Scheduling
Non Value Added
Wait Times
Value Added
Treatment

11. Stacked Bar Graph
• Remove wait – change of 40 minutes (60%?)
0
10
20
30
40
50
60
70
80
Kupfer
Scheduling
Doctor Time
Wait For Physician
Nurse Time
Wait For Room
Registration
Wait For Registration
0
10
20
30
40
50
60
70
80
Kupfer
Scheduling
Doctor Time
Nurse Time
Registration

12. Why Simulate?
• Simulate Change
• Without the cost
• Establish Benchmarks
• Continuous Improvement
• Base model
• Suggested Change
• Payer Pressure/Healthcare Reform
• ACA – reimbursement affected by outcome and satisfaction
• National Deficit

13. What are the benefits to simulate?
• Efficiency
• Improved workflow
• Eliminate Waste (Lean)
• Statistical Norms (Reliability)
• Increase Satisfaction
• Patient (Reduced wait time)
• Staff (Productivity)
• Increase Revenue
• Decrease costs
• Increase volume
• Sell Ideas/Change

14. What are the results recorded
in Gaspar?
• Outputs
• Patient History: Appt
Time, Distance
Traveled, Milestones.
• State History: Patient
Queues, Processing, Transportati
on, Elevators and more.
• Activities: Start, Finish, Process
Times, Wait Times.
• (Not recorded) Total Costs, Fixed
Costs, Procedural Costs, Staffing
Costs, Acuity.
• Data Export to Excel

15. Time to Simulate!
• Statistical Analysis
• End of Part 1