We wish to develop a model to support decision$-$making for Pungo Clinic, an outpatient clinic that is open for

$16$ hours per day. Our data shows that patients arrive according to exponentially distributed inter$-$arrival

times with a mean of $3\mathrm{.}0$ minutes. Assume the first patient arrives at time $0\mathrm{.}0.$

The clinic has multiple stations where patients might be directed for service. All patients enter the clinic and

are given some paperwork to fill out on their own. When the patient has finished filling out the paperwork

they submit it for processing at the sign$-$in station, which is staffed by a single receptionist. After sign$-$in$,$ a

patient is directed to the nurse$$s station for an initial exam with a nurse. After the initial exam, $50\%$ of the

patients are directed to an exam with the next available physician$$s assistant $($PA$),40\%$ are directed to an

exam with the next available physician, and the remaining $10\%$ are finished receiving medical care and can go

to the check$-$out station. When a patient finishes an exam with a PA$,90\%$ are ready to leave the clinic $($and

go to the check$-$out station$)$ while the other $10\%$ are directed to see the next available physician. When a

patient finishes an exam with a physician, they are ready to leave and are directed to the check$-$out station.

All patients will check out when they are finished receiving medical care and then leave the clinic.

Filling out the paperwork takes the patient TRIA$(1,2,4)$ minutes. The Sign$-$In station is staffed by one person

who takes TRIA$(1,1\mathrm{.}5,3)$ minutes to sign$-$in a patient. The Nurse$$s Station is staffed by a two nurses who take

TRIA$(2,4,8)$ minutes to treat a patient. There are two identical physician$$s assistants $($PAs$)$ who take

TRIA$(5,10,18)$ minutes to examine a patient. There are two identical physicians who take TRIA$(5,12,22)$

minutes to treat a patient. The Check Out station has one person ensuring you pay before you leave and this

takes TRIA$(1,2,5)$ minutes.

Pungo Clinic has experienced low patient satisfaction $($based on recent surveys$),$ so they are looking to

increase patient $($customer$)$ satisfaction levels. We are evaluating possible changes to the clinic and you have

been asked to provide an analysis and recommendation.

We have three options for improving the operation of the clinic:

$1)$ Add one additional nurse to the nurse$$s station.

$2)$ Change the physician examination process, resulting in a new service time of TRIA$(6,13,19).$

$3)$ Have the PAs perform an expanded set of procedures in the exam room, resulting in a slightly longer

service time $($new service time of TRIA$(5,12,20),$ but cutting the probability of a patient being sent to

the physician in half $($new probability is $5\%$ vs $10\%$ previously$)$

Your job is to create a model of the clinic$$s operations, simulate it under the $$baseline$($current$)$ conditions,

and then simulate it with the optional changes. Assume all improvement options have the same cost.

You must choose a set of performance metrics that you think are appropriate and state why you believe they

are appropriate. In the end, you must make a decision about what to do $($which option to pursue, or to do

nothing$)$ and use performance data to back up your decision.

The report must follow the format specified in the report format guideline $($see below$).$ Remember that what

you turn in should be a professional document. That means a single, well organized, document that is in

some sort of binder.

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