Focus your Performance Improvement Efforts Through Process Simulation

“A key component of Six Sigma projects includes Design of Experiments (DOE), whereby process improvements are planned and implemented. Traditionally, organizations will implement process improvements on varying levels of sophistication. At the lowest level, organizations shoot from the hip and implement what executives feel is the right thing to do. A more common approach is to implement best practices, assuming what works well for one hospital will work well for another. However, not all processes should be improved in the same way (Keen 1997). There are many published examples of success stories where process redesigns caused improvements in LOS. Truly, these efforts were wise investments.

However, it is unknown how much is invested in efforts which did not yield an improvement in LOS because these stories are typically never published. Is there a way to determine if process redesigns will improve patient LOS? This leads us to one of the most sophisticated DOE approaches, which is to simulate, or prototype, the proposed process improvement plan prior to implementation.”

• Miller, M et al (2003), SIMULATING SIX SIGMA IMPROVEMENT IDEAS FOR A HOSPITAL EMERGENCY DEPARTMENT, Proceedings of the 2003 Winter Simulation Conference, December 2003,

A standard finding in Lean/Six Sigma is that the lab turnaround time can be shortened. Perhaps the order sits at a nursing station and is then batched with other orders before being delivered to the lab. Or, the lab returns the results, and the physician is not notified for some variable period of time. Or, the lab simply has inferior equipment, and that’s about as fast as you’re going to get the results, unless you change the equipment. Then the Lean/Six Sigma practitioner says, “Ah-ha! We can reduce patient throughput by reducing turnaround time for the lab. If we stop batching, and we notify the physician upon delivery of results, and we get new equipment, lab turnaround time will be reduced.”

Two questions are left unanswered until the significant effort, and expense, to reduce the turnaround time has been expended. Does the reduction in lab turnaround time actually improve patient throughput? And, if there is an improvement in patient throughput, is enough improvement realized for the effort/expense?

Emergency Departments are complex systems. An improvement in one area may make absolutely no difference in patient throughput. A hospital could double the physicians on duty, but with no increase in beds, patient throughput might not change. Lab turnaround time could be cut in half, beds could be added, physicians could be added, but if admit times are not changed, patient throughput might not change. Something that works in one hospital, such as “fast-tracking”, might not work in your hospital, unless the acuities, arrivals, infrastructures, schedules, physician efficiencies, labs and processes are identical. Emergency Departments are complex: a change to a single variable might not make any difference, while changes to multiple variables may produce positive or negative results.

Simulation allows you to answer the two important questions before you spend the time and money “fixing” it. Will there be an improvement and if there is, how much improvement can we expect?

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