Simulation and Six Sigma in Healthcare

SIMULATION in SIX SIGMA

Abdulkadir Atalan

PhD Student

Clemson University

Department of Industrial Engineering

2014

Briefly Six Sigma

“Six Sigma is a disciplined program or

methodology for improving quality in all aspects of

a company’s products and processes.” (Source: Promodel)

Six Sigma Tools

SIMULATION

FMEA

KANBAN

KAIZEN

TQM

DOE

CAUSE & EFFECT

RISK MANAGEMENT

HYPOTHESIS

TESTING

QFD/HOUSE OF

QUALITY

ETC….

Simulation

“Simulation refers to a broad collection of

methods and

applications to mimic

the behavior of real

systems, usually on a

computer with

appropriate

software”. (Source: Kelton, 2004)

Why Simulation in Six Sigma?

Simulation is just one of the many Six Sigma software tools used during an initiative; however it is one of the most important. Within

the analyze and improve stages of the DMAIC methodology, or the analyze and design stages of the DMADV methodology, simulation is a powerful software tool because of benefits it provides. • Simulation takes into account process variances, uncertainties and

interdependencies

• Simulation can test many alternative solutions quickly and easily

• Simulation takes the subjectivity and emotion out of decision

making

• Animation features make simulation a good tool to help sell others on the best solutions

• Reusable models encourage continuous improvement

(Source: Promodel)

Simulation Application Areas

• Has been used

– Manufacturing facility

– Bank operation

– Airport operations (passengers, security, planes, crews, baggage)

– Transportation/logistics/distribution operation

– Computer network

– Business process (insurance office)

– Fast-food restaurant

– Supermarket

– Communications

• Is becoming widespread in healthcare delivery as well.

Why Simulation?

Less Expense: If we apply proposed solution scenarios

directly clinic which might be expensive such as schedule

modifications and additional bed, rooms or staff. There might

be a chaos.

What if Scenarios: Simulation has ability to test what-if

scenarios in a model of your facility.

Time Consuming: Simulation can simulate weeks worth of

operations in minutes, allowing you to quickly insight into

how proposed solutions cases can effect overall productivity

over long periods.

Provided With Statistical Analyzes: Give more detail

statistical and mathematical information which gives us high

level of confidence.

Simulation Steps

• Create Workflow Charts

• Collect Necessary Historical

Data

• Form Simulation environment

based on real physical area.

• Run Whole System into

Software one to one.

• Create possible Case scenarios.

• Analyzes results.

Simulation Software

Most common used:

• SIMUL8: Software for discrete event or process based simulation.

• Arena: Discrete & Continuous systems, 2D,3D Animation, Based

on SIMAN

• Flexsim: Discrete-event, Object-oriented simulator; developed in

C++ using Open GL, Animation: 2D, 3D, Virtual reality

• ProMod: Manufacturing Systems, Simulation & Animation (2D &

3D)

• ExtendSim: Block-diagram approach, Versions for mixed and for

continuous only, C programming language

• AnyLogic: discrete event, using

• Etc…. “ Many do have trial versions”

Case Study

We compare performance measures between the

two cases to asses the impact of the additional

activity.

Figure: Flexsim Software Screenshot

Using Distribution for Activities

Patient Arrival Patient Check-in Nurse Triage Time Patient Urine TestPhysician

Consultation Check Out

Patient Departure

Patient Arrival Patient Check-in Nurse Triage TimePhysician

Consultation Check Out Patient Departure

Process Time Assigned

Arriving Patient Exponential (0.0, 10.0, 0)

Check-in Uniform (3, 5, 0)

Triage Triangular (3, 15.0, 5, 0)

Treatment by Physician Uniform (20, 30, 0)

Check-out Uniform (3, 5, 0)

Simulation Output

Number of patients in waiting room vs. time

Resources Utilization Rate

Case Scenarios

Flexsim: Design of Simulation Scenarios

Arena: Design of Simulation Scenarios

Optimization

“Simulation is a powerful “what-if” technology that allows you to

model and experiment with several alternative scenarios so that

you can select the one that best meets your objectives.” (Source: Arena OptQuest)

Comparison of Cases

Without Extra Test

With Extra Test

Ave Patient Waiting Time (min)

Ave Patient Waiting Time in Clinic (min)

Ave Exam Room Utilization (percentage)

Note that adding a 3 minutes test can increase patient waiting

and total time 15 to 20 minutes

Conclusion

Using Simulation Tool to show

the target of Six Sigma:

• Improving patient flow process

• Decreasing patient waiting time

• Increasing patient satisfaction

• Reducing process cost

• Increasing resources utilization

THANK YOU!