Adding Queuing Thinking To Your Toolkit

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Adding Queuing Thinking to Your ToolkitEuSEM Munich, Germany 15-18 September 2008 Dave Eitel MD MBAdaveitel@comcast.netIs the Problem Flow? Is the Problem Flow? Or Non-flow? Non-flowWe need new ways of thinking about non-flowAdding Queuing Thinking to Your Tool SetQueuingThe point to recognize is that queuing is an important problem that affects us all both directly and indirectly. But just as importantly queuing is a solvable problem. The solution may not be simple, but with some understanding and an ability to put itself in the customers shoes, an organization can substantially reduce waiting times at little or no expense. Page 3, Queuing Methods for Services and Manufacturing Randolph Hall 1991 Queuing Thinking Queuing means waiting in a line for service (of any kind) Have any of you ever experienced anything like this?Queuing Systems(Service Systems)Any queuing system consists of arriving entities in our case, patients (or patient types) - and one or more servers providing service of some kind to these arriving patients VisualizationAny service system (queuing system) can be described as followsQueuing Systems(Service Systems) Any queuing system:Arrivals ? Queue ? Service ? DepartCustomers arrive at a service system (like an ED, or a CCU, or a regular medical floor or your hair dressers shop, the bank or a grocery store). If there are no servers available to serve them, the customers join a queue to wait for service. When a server becomes available, the customer enters the system, completes service, and departs. Queuing Systems(Service Systems) Any queuing system:Arrivals ? Queue ? Service ? DepartNote that queues can also form within the service system when any particular server is not readily available to serve the customer within the service system.Queuing Thinking= waiting system thinking = service system thinking= demand ? resources needed ? flow thinking= demand and capacity matching thinkingQueuing Thinking and Queuing ManagementQueuing MANAGEMENT = demand and capacity matching If you remember nothing elseQueuing ThinkingRequires understanding some core principles: Demand absolutely the 1st thing for any health care manager or executive to understand Capacity Profound impacts of variation and interdependency on throughput capacity The important role of bottlenecks on throughput capacityDemandYou just never know what is going to come into the ED!DemandYou just never know what is going to come into the ED!How many of you think this to be the case?Introduce here the concept of prediction of service loadRandom does not mean unpredictableUnderstanding variability [variation] is key to predictionLet me show you what I meanHave a look at the red lines the rate of incoming by hour of the day for different days of the week. Demand STOCHASTIC means randomly occurring. Although we cannot control the occurrences of random events, we can predict the likelihood of their occurrence, and the consequences of these events.Bateman: System Improvement Using Simulation:Fifth Edition 1997Like thisDemandSundays look like SundaysTuesdays look like TuesdaysDemandWhere do these arrival patterns (arrival distributions) come from anyway?DemandWhere do these arrival patterns (arrival distributions) come from anyway?Patient Registration SystemsWe all have them!DemandED Demand Analysis? Capacity Is a major issue for all hospitalsIt is the major issue, right now, for many of themIt declares itself at the hospitals front door - the Emergency DepartmentThe crisis has been incorrectly labeled ED Overcrowding this is a misnomerYour ED Today?Your ED Today?The approach of most hospitals today to disaster surge planning and managementThe Problem is Hospital CapacityMore specifically, the problem is hospital service capacity: i.e. hospital capacity to serveCapacity is the ability to deliver service over a particular time period... Capacity is determined by the resources available to the organization in the form of facilities, equipment and labor. Service Management 5th Edition Fitzsimmons and Fitzsimmons Grocery Store Science It is time to bring a little grocery store science into health careGrocery Store Science It is time to bring a little grocery store science into health careGrocery Store ScienceIn 1916 in Memphis Tennessee Clarence Saunders created a paradigm shift in grocery store science by opening Piggly Wiggly, the first self-service grocery store; he patented his method in 1917. The store incorporated shopping baskets, self-service branded products, and checkouts at the front. (The data from all those front-end turn styles and checkout counters became the forecasts for the customer arrival and departure patterns for each store in the chain).www.geography.about.comA Long L