SIP INTERIM REPORT

On An Analytical study on Application of Queuing Analysis model to Healthcare with special reference to Wockhardt Hospital Surat At Adventist Wockhardt Hospital, Surat Submitted to The School of Management, Sumandeep Vidyapeeth In the partial fulfillment for the award of the MBA Degree

Submitted by RAM BABU SHARMA SM2010-2012 Under the Guidance of

Faculty Guide

Company Guide

Md. Mahtab Alam Lecturer School of Management Sumandeep Vidyapeeth Piparia, Vadodara

Mr. Pranav Kumar Deputy Manager - Admin Adventist Wockhardt Heart hospital, Surat Gujarat

June, 2011

SELECTION OF TOPIC
Why? In recent time Wockhardt Hospital, Surat is providing various types of health check up package. In these process patients are normally supposed to follow the rule of hospitals i. e. queue at the registration counter and then after at service providing places. From these two places patients are spent a lot of time which is not productive at all. So this study tries to find out the average waiting time per customer in the queue and in the system. After finding the average waiting time the study will suggest how to minimize the average waiting time and cost at the hospital. It becomes helpful interms of quality of services which is providing by the hospitals and it will also improve the customer satisfaction level. Whom.? The study on this topic will be beneficial for both the Hospital as well as the Patient. This study will suggest that how to improve the service time and waiting time in the hospital so the patients could get faster services in comparison to present service facilities. Hospital will be also benefited from this particular study. Patient satisfaction will obviously goes up due to providing quick and faster services which will attract more patients in the hospitals. This topic is suggested by Mr. Pranav Kumar [Company guide.] Where..? This particular study will be conducted at Wockhardt Hospital Surat with the help of only special kind of patients i.e. [Patient those who are coming only for health check within the category of various package] When.? The time limit for this study will be 20 days. Form 10th June 2011 to 30th June 2011 data were collected with the help of patient and administrator. How? Queuing Analysis model will be the main tools and techniques for this particular study in which the following thing will be included.     Arrival Pattern of Customer Arrival rate of customer Service Channel [Service Type and Pattern] Time required for services and time spent on that services.

Chapter - 1 Queuing Analysis: An Introduction Queueing theory is generally considered a branch of operations research because the results are often used when making business decisions about the resources needed to provide service. It is applicable in a wide variety of situations that may be encountered in business, commerce, industry, healthcare, public service and engineering. Applications are frequently encountered in customer service situations as well as transport and telecommunication. Queueing theory is directly applicable to intelligent transportation systems, call centers, PABXs, networks, telecommunications, server queueing, mainframe computer of telecommunications terminals, advanced

telecommunications systems, and traffic flow.

With rapid change and realignment of healthcare system, new lines of services and facilities to render the same, severe financial pressure on the healthcare organizations, and extensive use of expanded managerial skills in healthcare setting, use of queuing models has become quite prevalent in it. Queuing models are used to achieve a balance or trade-off between capacity and service delays.

An important point to be noted before proceeding with further discussion is that most sort of health services have the capacity to serve more patients (average) than they are called to over the long term, so the customer waiting lines is a short term phenomenon and the employees who serve (servers) customers may be frequently inactive while they wait for the customers to arrive. Another fact worth mentioning here is that the key word in queuing models is average. It takes the average of the random numbers of patients arriving randomly, of the service time, arrival intervals, etc.

TYPES OF QUEUING SYSTEM: There are basically four types of queuing system and different combinations of the same can be used for very complex networks.

Single Channel Single Phase system: In which there is a single queue of customers waiting for service and only one phase of service is involved. An example is flu vaccination camp where a nurse practitioner is the server who does all the work (paper work and vaccination). Single ChannelMultiple Phase System: In this case theres still a single queue but the service involves multiple phases. For example a PCPs office. Patients first arrive at the registration counter, get the registration done and then again wait in a queue for being seen by the physician or for ancillary services. There is queue formation or waiting time involved at each phase of the system. Multiple Channel-Single Phase System: In this type of queuing system, customers form multiple queues, waiting for the service which involves only one phase. Customers also have the liberty to switch from one line to the other. An example is customers waiting at the pharmacy store, railway ticket reservation counter. Multiple Channel-Multiple Phase System: This type of system has numerous queues and a complex network of multiple phases of services involved. This type of service is typically seen in a hospital setting, ER, multi-specialty outpatient clinics, etc. For example in an hospital outpatient clinic, patient first forms the queue for registration, then he/she is triaged for assessment, then for diagnostics, review, treatment, intervention or prescription and finally exit from the system or triage to different provider.

So why use the queuing theory in first place the answer is to minimize total cost to the system (tangible and intangible). These costs can be divided into two broad categories:

Costs associated with patients or customers having to wait for the service:  Loss of business to HCO, as some patients might not be willing to wait for the service and may decide to go to the competing organizations.

Costs incurred by society for example increased interventions and cost due to delay in care or the value of patients time.

Decreased patient satisfaction and quality of care.

Costs of providing the service (Capacity Costs).   Salaries paid to employees. Salaries paid to employees or servers while they wait for service from other server, for example waiting for the pathology report, radiology report, labs, etc.  Fixed costs cost of waiting space, facilities, equipment, and supplies.

Queuing System Characteristics: Queuing system characteristics are summarized in the tables and diagrams below:

Waiting Line Characteristics:

Queuing System Notations: As queuing theory is a mathematical theory there are several mathematical notations used in it. Few of the basic notations used in queuing model calculations are enumerated in the table below. Notation u Lq L Wq W 1/ Po Pn Description Arrival Rate Service Rate Average number of customers waiting for service Average number of customers in the system (waiting or being served) Average time customers wait in line Average time customers spend in the system System Utilization Service Time Probability of zero units in the system Probability of n units in the system

There are several possible ways of improving patient flow, and thereby reducing waiting time for the patients. These include (1) Increasing the number of servers; (2) Managing the arrival rate; and (3) Optimizing the service rate.

The number of servers can be increased by hiring more admitting clerks. This is the most obvious by not necessarily the best decision. Although increasing the number of servers provides immediate results, the most effective approach to improvement should involve optimization of all three variables mentioned above.

Chapter 2 Literature Review

In some studies, researchers have generated models that were able to make accurate predictions of quantities such as waiting room times and patient care times. One of such model that was developed by Rossetti et al. (1999) used the Emergency Department at the University of Virginia Medical Center in Charlottesville as a case study model. This model was used to test alternative ED attending physician staffing schedules and their impacts on patient flow and resource utilization.

The application of basic queuing principles and models to the hospital inpatient admitting process has been studied by Green (2003). Kaplan, Sprung and Shmueli (2003) used the queuing modeling to analyze the impact of various admissions policies to ICU facilities. Nevertheless, there seems to be a lack of research on using queuing analysis and simulation of the patient flow and service process in the Admitting Department as in an independent queuing system.

Over the past thirty years, a significant amount of research has been done in the area of discrete event simulation modeling in health care. Resent innovations in object-oriented models enable the construction of large integrated systems that become powerful tools for analysis of and innovations in health care systems (Jun, et al, 1999).

Law and Kelton (2001) proposed an algorithm of a successful computer simulation study. This algorithm includes the following key steps: 1. Problem formulation, 2. Data collection and the conceptual model design, 3. The validation of the model, 4. The constructions of the computer representation of the model, 5. The verification of the model, 6. The design of experiments needed to address the problem, 7. Production runs using the computer model, 8. The statistical analysis of the data obtained from the production runs, and 10. The interpretation of the results.

A number of researchers (Banks and Carson, 1987; Mahachek, 1992; Vissers, 1998; Isken et al., 1999; Eldabi and Paul, 2001; Harper, 2002; Morrison and Bird, 2003; and others) have addressed the core principles for performing a discrete-event simulation study of a healthcare system. Discrete-event simulation models that have been used to analyze healthcare systems have been primarily focused on the Patient flow (PF) analysis and optimization.

Determining server capacity by minimizing the costs in a healthcare queuing system is a special case of system design. Most of the research assigns costs to patient waiting time and to each server. After modeling the system using queuing theory, minimizing costs reduces to an exercise of finding the resource allocation that costs the least or generates the most profit.

Keller and Laughhunn (1973) set out to determine the capacity with minimal costs required to serve patients at the Duke University Medical center. They find that the current capacity is good but needs to be redistributed in time to accommodate patient arrival patterns.

Young (1962a, b) proposes an incremental analysis approach in which the cost of an additional bed is compared with the benefits it generates. Beds are added until the increased cost equals the benefits.

Shimshak et al. (1981) consider a pharmacy queuing system with preemptive service priority discipline where the arrival of a prescription order suspends the processing of lower priority prescriptions. Different costs are assigned to wait-times for prescriptions of different priorities.

Chapter 3 Research Methodology 1. Objectives and purpose of the study: a. The main objective of the study is to minimize cost of providing services including cost associated with waiting time. b. To provide faster and quicker service to the patient in comparison to the current situation. c. To apply the queuing Analysis model to a particular Hospital and to suggest hospital management authority for improving steps to be taken.

2. Benefits of the study: This particular study will be beneficial for both, Hospital and Patients. The Hospital benefits include; quicker and faster services, reducing the service providing cost, to know the arrival pattern of the customer which will enhance the greater customer satisfaction. Higher satisfaction will lead to attract more patients and consequently generate more revenue.

3. Types of research design: The research design for this study will be Descriptive in nature due to the awareness level of queuing analysis model. This theory is known to everyone so the only task is to apply the model into a particular organization.

4. Unit of Analysis: Unit of analysis for this study will be Individual [Patients] as well as Organizational [Wockhardt Hospital Surat].

5. Methods of data Collection: Combination of Primary & Secondary methods of data collection will be used for this particular study. Primary data will be collected through the patients with the

help of closed ended questionnaire. While the secondary data will be collected from the hospital registration counter regarding the arrival pattern, approximate service time, etc.

6. Sampling if applicable: No any sampling design will be applicable in this study. Total number of patient during the specified period will be the sample for this study.

7. Appropriate tools for data analysis: Arrival Rate Service Rate 1 Average number of customers waiting for service 2 Average number of customers in the system (waiting or being served) 3 Average time customers wait in line 4 Average time customers spend in the system 5 System Utilization 6 1/ Service Time 7 Po Probability of zero units in the system 8 Pn Probability of n units in the system Note: The study will apply separate formula from serial number 1 to 8 separately u Lq L Wq W

8. Limitations of the study: Time Duration: Time is one of the most important limitations for this particular study which is considering only 20 days. Season: This study will going to be conducted in the month of June. It might be possible that due to the change in season arrival rate as well as service rate may get changed due to various reasons. Generalization: Generalization of this study will be limited to the Wockhardt Hospital Surat only. The outcomes of the study cant be generalize for other hospitals.

References: 1. Agnihothri, S.R. and Taylor P.F. (1991) Staffing a centralized appointment scheduling department in Lourdes Hospital. Interfaces 21, 1-11. 2. Albin, S.L., Barrett, J., Ito, D. and Mueller, J.E. (1990) A queueing network analysis of a health center. Queueing Systems, 7, 51-61. 3. Brahimi, M. and Worthington, D.J. (1991) Queueing models for out-patient appointment systems a case study. The Journal of the Operational Research Society, 42, 733-746. 4. Green, L. (2006a) Queueing analysis in healthcare, in Patient Flow: Reducing Delay in Healthcare Delivery, Hall, R.W., ed., Springer, New York, 281-308. 5. Gupta, I., Zoreda, J. and Kramer, N. (1971) Hospital manpower planning by use of queueing theory. Health Services Research, 6, 76-82. 6. www.google.co.in