SimLean Educate Interlude 1 – Level the Load Using an example of a generalised simulation of a theatre process

2 The generalised Day Case theatre process Run the model »

2 batch

Day 1Day 2 Day 3 Day 4Day 5 4 Patient flow: 2 Batch

Patient profiles: 2 Batch 5

6 Holding - 32 minutes Discharge - 46 minutes Average Queue Times Reception -14 minutes Patient queueing times: 2 Batch

Level the Load? Let’s look at spreading arrivals across 6 batches Sounds scary? How about a small change: Patients arriving at 8:00, 8:30, 9:00 Patients arriving at 13:00, 13:30 and 14:00 7 Run the model »

6 batch

9 The number of patients on the premises is never more than 17 (compared to 24 under 2 Batch) Fewer morning patients remain in the system at 1pm (less stress on staff and patient) Little effect on departure pattern as same amount of work to be done 2 Batch 6 Batch Impact on Patient flow

10 6 Batch2 Batch In treatment79 mins79 mins Waiting77 mins52 mins Blocked34 mins30 mins Visit times190 mins161 mins Averages 2 Batch6 Batch Improve d patient value Comparison of Patient profiles

11 Improve d patient value 2 Batch and 6 Batch 13.3% booking in Averages 2 Batch 14 mins 6 Batch 4 mins Queue for Reception

12 2 Batch6 batch 42% other 48% 38% blocked32% 20% work20% Averages 2 Batch 32 mins 6 Batch 16 mins Queue for Prepare and Hold

13 Averages 2 Batch 46 mins 6 Batch 49 mins Queue for Discharge Process

14 2 Batch6 batch 35% other 37% 5% blocked3% 60% work60% 2 Batch6 batch 68% other 71% 17% blocked14% 15% work15% Patient flow through Theatre and Recovery

Summary We have made a slight change toward spreading patient arrivals and levelling the load. This small change has been shown to: –Reduce patient queuing times –Reduce the number of patients on the premises Is the principle of ‘levelling the load’ something you could use? Do you think this small change goes far enough? 15

Interlude insight If you always do what you always did-you'll always get what you always got 16

THE SLIDES THAT FOLLOW ARE FOR FURTHER INSIGHT 17

Patient flow (numbers) 2 Batch6 Batch 18

Does 6 Batch cause later finish times? 19 Day 1Day 2 2 Batch - Time View Theatre finish time on Day 2

Does 6 Batch cause later finish times? 20 2 Batch - Time View 6 Batch - Time View  Theatre Finish Times 