Steve Harrison Wednesday 20 th January 2014 Seminar Room 2 MEC Basic Queue Theory and Gantt Charts.
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Transcript of Steve Harrison Wednesday 20 th January 2014 Seminar Room 2 MEC Basic Queue Theory and Gantt Charts.
![Page 1: Steve Harrison Wednesday 20 th January 2014 Seminar Room 2 MEC Basic Queue Theory and Gantt Charts.](https://reader035.fdocuments.in/reader035/viewer/2022070404/56649f395503460f94c55ccd/html5/thumbnails/1.jpg)
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Steve HarrisonWednesday 20th January 2014Seminar Room 2 MEC
Basic Queue Theory and Gantt Charts
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Topics
• Variation – A recap
• Basic Queue theory
• Gantt Charts – Process Building Blocks
• Other Variation Concepts
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“If I had to reduce my message for management to just a few words, I’d say it all had to do with reducing variation.”
W. Edwards Deming
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Variation – what to do?
5
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Common Cause Variation
Reduce variation: Increase precision - make the process even more reliable.
Not satisfied with median performance (result): Redesign process to get a better result
Special Cause Variation
Identify the Cause: If Positive: Maximise, optimise, replicate, standardise. If Negative: Minimise, eliminate.
6
Application – Responding to Variation
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Variation and Queues
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Variation & Queues
Consecutive Patients
Pro
cedu
re T
ime
(Min
utes
)
50%
100% 80%
80% rule is the most efficient balancing waiting and waste
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How to calculate
• =(((Max – Min)/100)*80 )+ Min
• 23 – 7 = 16
• 16/100 = 0.16
• 0.16*80 = 12.8
• 12.8 + 7 = 19.8
• 19.8 approx 20mins
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Plan Cycle Time = 20m
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Role Cycle Time at 80%
Lung Function 15m
Weight & Nurse 10m
Dietician 20m
Dr 20m
Others 15m
Cycle time at 80% - PDSA 1M
ore
Var
iabl
e
Mor
e R
elia
ble
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1.15 1.30 2.00 2.30 3.00 3.30 4.00 4.30 5.00
Patient 1L L L W N D D D D Dr Dr Dr Dr O O O
Patient 2L L L W N D D D D Dr Dr Dr Dr O O O
Patient 3L L L W N D D D D Dr Dr Dr Dr O O O
Patient 4L L L W N D D D D Dr Dr Dr Dr O O O
Patient 5L L L W N D D D D Dr Dr Dr Dr O O O
Patient 6L L L W N D D D D Dr Dr Dr Dr O O O
Patient 7L L L W N D D D D Dr Dr Dr Dr O O O
Patient 8L L L W N D D D D Dr Dr Dr Dr O O O
Patient 9L L L W N D D D D Dr Dr Dr Dr O O O
Patient 10L L L W N D D D D Dr Dr Dr Dr O O O
Patient 11L L L W N D D D D Dr Dr Dr Dr O O O
Patient 12L L L W N D D D D Dr Dr Dr Dr O O O
Patient 13L L L W N D D D D Dr Dr Dr Dr O O O
Patient 14L L L W N D D D D Dr Dr Dr Dr O O O
Patient 15L L L W N D D D D Dr Dr Dr Dr O O O
Patient 16L L L W N D D D D Dr Dr Dr Dr O O O
Patient 17L L L W N D D D D Dr Dr Dr Dr O O O
Patient 18L L L W N D D D D Dr Dr Dr Dr O O O
1.15 1.30 2.00 2.30 3.00 3.30 4.00 4.30 5.00
Patient 1L L L W N D D D D Dr Dr Dr Dr O O O
Patient 2L L L W N D D D D Dr Dr Dr Dr O O O
Patient 3L L L W N D D D D Dr Dr Dr Dr O O O
Patient 4L L L W N D D D D Dr Dr Dr Dr O O O
Patient 5L L L W N D D D D Dr Dr Dr Dr O O O
Patient 6L L L W N D D D D Dr Dr Dr Dr O O O
Patient 7L L L W N D D D D Dr Dr Dr Dr O O O
Patient 8L L L W N D D D D Dr Dr Dr Dr O O O
Patient 9L L L W N D D D D Dr Dr Dr Dr O O O
Patient 10L L L W N D D D D Dr Dr Dr Dr O O O
Patient 11L L L W N D D D D Dr Dr Dr Dr O O O
Patient 12L L L W N D D D D Dr Dr Dr Dr O O O
Patient 13L L L W N D D D D Dr Dr Dr Dr O O O
Patient 14L L L W N D D D D Dr Dr Dr Dr O O O
Patient 15L L L W N D D D D Dr Dr Dr Dr O O O
Patient 16L L L W N D D D D Dr Dr Dr Dr O O O
Patient 17L L L W N D D D D Dr Dr Dr Dr O O O
Patient 18L L L W N D D D D Dr Dr Dr Dr O O O
1.15 1.30 2.00 2.30 3.00 3.30 4.00 4.30 5.00
Patient 1L L L W N D D D D Dr Dr Dr Dr O O O
Patient 2L L L W N D D D D Dr Dr Dr Dr O O O
Patient 3L L L W N D D D D Dr Dr Dr Dr O O O
Patient 4L L L W N D D D D Dr Dr Dr Dr O O O
Patient 5L L L W N D D D D Dr Dr Dr Dr O O O
Patient 6L L L W N D D D D Dr Dr Dr Dr O O O
Patient 7L L L W N D D D D Dr Dr Dr Dr O O O
Patient 8L L L W N D D D D Dr Dr Dr Dr O O O
Patient 9L L L W N D D D D Dr Dr Dr Dr O O O
Patient 10L L L W N D D D D Dr Dr Dr Dr O O O
Patient 11L L L W N D D D D Dr Dr Dr Dr O O O
Patient 12L L L W N D D D D Dr Dr Dr Dr O O O
Patient 13L L L W N D D D D Dr Dr Dr Dr O O O
Patient 14L L L W N D D D D Dr Dr Dr Dr O O O
Patient 15L L L W N D D D D Dr Dr Dr Dr O O O
Patient 16L L L W N D D D D Dr Dr Dr Dr O O O
Patient 17L L L W N D D D D Dr Dr Dr Dr O O O
Patient 18L L L W N D D D D Dr Dr Dr Dr O O O
1.15 1.30 2.00 2.30 3.00 3.30 4.00 4.30 5.00
Patient 1L L L W N D D D D Dr Dr Dr Dr O O O
Patient 2L L L W N D D D D Dr Dr Dr Dr O O O
Patient 3L L L W N D D D D Dr Dr Dr Dr O O O
Patient 4L L L W N D D D D Dr Dr Dr Dr O O O
Patient 5L L L W N D D D D Dr Dr Dr Dr O O O
Patient 6L L L W N D D D D Dr Dr Dr Dr O O O
Patient 7L L L W N D D D D Dr Dr Dr Dr O O O
Patient 8L L L W N D D D D Dr Dr Dr Dr O O O
Patient 9L L L W N D D D D Dr Dr Dr Dr O O O
Patient 10L L L W N D D D D Dr Dr Dr Dr O O O
Patient 11L L L W N D D D D Dr Dr Dr Dr O O O
Patient 12L L L W N D D D D Dr Dr Dr Dr O O O
Patient 13L L L W N D D D D Dr Dr Dr Dr O O O
Patient 14L L L W N D D D D Dr Dr Dr Dr O O O
Patient 15L L L W N D D D D Dr Dr Dr Dr O O O
Patient 16L L L W N D D D D Dr Dr Dr Dr O O O
Patient 17L L L W N D D D D Dr Dr Dr Dr O O O
Patient 18L L L W N D D D D Dr Dr Dr Dr O O O
PDSA - Plan
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PDSA - Plan1.15 1.30 2.00 2.30 3.00 3.30 4.00 4.30 5.00
Patient 1L L L W N D D D D Dr Dr Dr Dr O O O
Patient 2L L L W N D D D D Dr Dr Dr Dr O O O
Patient 3L L L W N D D D D Dr Dr Dr Dr O O O
Patient 4L L L W N D D D D Dr Dr Dr Dr O O O
Patient 5L L L W N D D D D Dr Dr Dr Dr O O O
Patient 6L L L W N D D D D Dr Dr Dr Dr O O O
Patient 7L L L W N D D D D Dr Dr Dr Dr O O O
Patient 8L L L W N D D D D Dr Dr Dr Dr O O O
Patient 9L L L W N D D D D Dr Dr Dr Dr O O O
Patient 10L L L W N D D D D Dr Dr Dr Dr O O O
Patient 11L L L W N D D D D Dr Dr Dr Dr O O O
Patient 12L L L W N D D D D Dr Dr Dr Dr O O O
Patient 13L L L W N D D D D Dr Dr Dr Dr O O O
Patient 14L L L W N D D D D Dr Dr Dr Dr O O O
Patient 15L L L W N D D D D Dr Dr Dr Dr O O O
Patient 16L L L W N D D D D Dr Dr Dr Dr O O O
Patient 17L L L W N D D D D Dr Dr Dr Dr O O O
Patient 18L L L W N D D D D Dr Dr Dr Dr O O O
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PDSA – Do & Study
Cystic Fibrosis
Redesign - Treating the System
Clinic redesigned to new template shown below.
Follow Up frequency by band standardised - PDSA to help
increase capacity and meet growing demand
US Microsystems work focused team onto Adherence
Waiting reduced from mean of 40
mins to 8 mins
Improvements in clinic flow and pa-
tient experience also had a positive
effect on DNA rate for the service,
reducing rate from 16.3% to 8.3%
Clinic Redesign
Adherence—making the invisible visible
DNA improvement
Research project initiated into im-
proving adherence considering barri-
ers and evidence based interven-
tions
Remote monitoring of nebulised IVs
downloaded from web –displayed
on run charts to detect changes
Redesign of annual review process. Un-
necessary diagnostic tests and scans re-
moved saving an estimated £15k
Process re ordered as below to reduce
variation and improve the efficiency of the
process.
Reduction in time spent at hospital from a
full day to a half day for most patients
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Demand is increasing....
More slots needed...
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80% = 21mins
3hrs = 8 Patients
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80% = 21mins
3hrs = 8 Patients
80% = 18mins
3hrs = 10 Patients
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80% = 21mins
3hrs = 8 Patients
80% = 18mins
3hrs = 10 Patients
80% = 14mins
3hrs = 12 Patients
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HOW DO YOU REDUCE COMMON CAUSE VARIATION?
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GSM
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More Queuing....
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Capacity required = 27
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Capacity required = 27
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Capacity required = 49(5 beds less than separate units ~£400,000)
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Lung Cancer Clinic
28
13 + 11 = 24
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Lung Cancer - pooled
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And Finally - More Queuing....
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Which is best?
C Q
C Q
C Q
S
S
S
C Q
S
S
S
C QC Q
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And Finally - Which is best?
C Q Long
C QShort
S
S
C QLong
S
S
S
C QShort
C QLong
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DISCUSSION
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THANKS!