The MedNOW clinic provides convenient healthcare services for a wide range of non-emergency medical issues. The clinic is located in Miramar 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

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 area.

Medical Diagnostics There are three areas of medical diagnostic testing, they work independently of each other, each with its own staff. Analysis of historical records produced the following information regarding demand for diagnostics and test time

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.

Assignment: 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 PI team has been put together to identify opportunities to improve patient flow at the clinic. Their report 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 currently made my MDs.

4. Buy additional testing equipment

5. Hire additional MDs MedNOW has hired you as a consultant to assist with the analysis of the clinics service delivery. They presented a set of specific questions below that would like to see addressed.

Q- Draw the process flow diagram for the entire process at the MedNow Clinic. Follow formal notation to depict the workflow and show processing times for each task on the diagram

1. What is the capacity at each work center? Show your work with detailed calculation of capacity.
2. What is the capacity utilization at examination and diagnostics work centers? Show your work.
3. How many patients can be processed at the clinic on a daily basis? What is the bottleneck of the process?
4. Consider the MD examination station. Why do customers have to wait for an MD?
5. Consider the five proposals for process change suggested by the PI team. Evaluate each of the five proposals in terms of its potential impact on the capacity of MedNow to see more patients? Explain briefly which initiative you would recommend for implementation?

0.4 Probability Time 0.4 8 minutes 0.2 10 minutes 2 minutes Test time Proportion of test requests Diagnostic 1 6 minutes 5 in 9 Diagnostic 2 8 minutes 1 in 3 Diagnostic 3 30 minutes 1 in 9 0.4 Probability Time 0.4 8 minutes 0.2 10 minutes 2 minutes Test time Proportion of test requests Diagnostic 1 6 minutes 5 in 9 Diagnostic 2 8 minutes 1 in 3 Diagnostic 3 30 minutes 1 in 9