MAN6501:\tOperations\tManagement MAN6501:\tOperations\tManagement Problem\tSet\t1:\tProcess\tAnalysis\tand\tImprovement Instructions: 1. The case contains all of the necessary data to complete the assignment. If you believe critical data is missing, make an assumption. Any assumptions you make should be reasonable and consistent with other case data. 2. As a general rule, if you have a question about the \"correct\" interpretation of some aspect of the case or the assignment, you should just state your assumption and continue to work. In fact, these statements of logic will be used in the evaluation of your submission. MedNOW Clinic case The MedNOW clinic provides convenient healthcare services for a wide range of non-emergency medical issues. The clinic is located in Cambridge in close vicinity to a large hospital and serving a population with diverse ethnic backgrounds. Patients can walk-in or call in advance to schedule an appointment. The clinic operates 7AM to 7 PM on weekdays, with extended opening hours during the weekend. The clinic can do basic x-rays including chest x-ray and extremity x-rays (such as ankle, foot, arm and leg) and also provides lab services. On average 20 patients arrive at the clinic per hour, including walk-ins and appointments. Registration - The registration desk is continuously staffed with one person. They call the patient from the waiting room and create a patient record. The patient is then told to go back to the waiting room. The registration process takes on average one minute. Triage - The triage nurse calls the patients from the waiting room. They create a patient chart and register the check-in time. During triage the nurse determines the priority of patients' treatments based on the severity of their condition. The triage is staffed with one registered nurse (RN) and the average time for triage is about 2 minutes. On average, 10% of the patients require medical care that is not available at the clinic and need to be sent to a hospital in the vicinity of the clinic. The other patients are told to go back to the waiting room and wait for the doctor call. Examination - The clinic has four examination rooms and four MDs available at all time. An assistant calls the patients into the examination rooms and help the patient prepare for the examination. The examination time is highly dependent on the medical condition. Based on historical records the clinic has determined the following distribution for examination time: 1 MAN6501:\tOperations\tManagement Probability 0.4 0.4 0.2 Time 2 minutes 8 minutes 10 minutes In 50% of cases the MD completes the diagnosis, writes a prescription and the patient is ready to discharge. The other 50% of patients require some form of diagnostic and are sent to the medical diagnostic lab. Medical Diagnostics - There are three areas of medical diagnostic testing each with its own staff. Analysis of historical records produced the following information regarding demand for diagnostics and test time: Diagnostic 1 Diagnostic 2 Diagnostic 3 Test time 6 minutes 8 minutes 30 minutes Proportion of test requests 5 in 9 1 in 3 1 in 9 After the diagnostic test the patient is sent back to the waiting room and waits the doctor call. Re-examination - After diagnostics testing the MDs examine the test results sent by medical diagnostics. The analysis of the diagnostic results takes on average 6 minutes per patient. Then the MD calls the patient and spends on average an additional 6 minutes debriefing or prescribing treatment. The patient is then sent to the discharge desk. Discharge - The discharge desk is staffed with one person. They copy key information from the patient chart to the patient record system. On average it takes 2 minutes to complete the discharge process for one patient. Management is concerned with the ability of the clinic to meet expected demand in an efficient manner while providing adequate level of service. An internal Kaizen team has been put together to identify opportunities to improve patient flow at the clinic. They provided management with a report that lists the following possibilities: 1. Cross-train admin staff to work at both the registration and discharge stations 2. Cross-train the RN to do admin work associated with registration 3. Cross-train RN to handle some examinations and make routing decisions currently made my MDs. 4. Buy additional testing equipment 5. Hire additional MDs The Kaizen team also collected data from patients to assess the level of satisfaction with the clinic services. The table below shows the primary areas of dissatisfaction indicated by patients. 2 MAN6501:\tOperations\tManagement Percentage very satisfied Percentage of respondents rating dissatisfied or unacceptable Wait time for registration and triage 15% 10% Wait time for MD exam 5% 30% Communication with MD 50% 10% Greeting from receptionist 5% 30% Queries about possible questions 5% 10% Explanation about what to expect 2% 8% Finally they have collected data concerning the patient waiting time. The charts below show the average waiting time (in minutes) for triage and for MD examination (post-triage) during a onemonth period. Mean = 9.9 minutes Wait\tTime\tfor\tTriage Standard deviation = 4.806 30.0 20.0 10.0 0.0 1 3 5 7 9 11\t13\t15\t17\t19\t21\t23\t25\t27\t29 Mean = 25 minutes Wait\tTime\tfor\tMD\texam (post\ttriage) 60.0 40.0 20.0 0.0 1 3 5 7 9 11\t13\t15\t17\t19\t21\t23\t25\t27\t29 3 Standard deviation = 7.732 MAN6501:\tOperations\tManagement Questions: MedNOW has hired you as a consultant to assist with the analysis of the clinic's service delivery practices. They presented a set of specific questions below that would like to see addressed. 1. Draw the process flow diagram for the entire process at the MedNow Clinic. Follow formal notation to depict the workflow and show task times on the diagram. (20 PTS) 2. How many patients can be processed at the clinic on a daily basis? What is the bottleneck of the process? Show your work. (20 PTS) 3. Consider the MD examination station. Why do customers have to wait for an MD? Could the process benefit from the implementation of a pull system? Please explain and show your work. (15 PTS) 4. Consider the five proposals for process change suggested by the Kaizen team. How does each proposal impact MedNow capacity? Explain briefly (30 PTS) 5. Which initiative would you recommend for implementation (indicate only ONE)? What type of data would you require for applying a PDCA cycle to test and implement that initiative? Be specific (15 PTS) 4