Using Arena Simulation Software to Improve Healthcare Processes

Insert Photo Here

Carley Jurishica Arena US Healthcare Account Manager

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

Who am I?
Carley Jurishica cjjurishica@ra.rockwell.com 312.952.6869
BS Industrial Engineering and Masters in Engineering Management - Northwestern University Extensive Arena consulting and training experience Experience in Healthcare Simulations Developed several real-world emergency department models with Arena Published Paper Emergency Department Simulations: Medicine for Building Effective Models.

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

Wake Up Call

(1st ring)

Emergency health care in serious condition

System in poor capacity to deal with public health disasters, analysis finds WASHINGTON - The nations emergency care system itself is ailing, warns a new health care analysis. The emergency health care systems in serious condition. We have a safety net for health care that is frayed, said Dr. Stephen Epstein, an emergency care physician at Beth Israel Deaconess Medical Center in Boston. Epstein was a member of the American College of Emergency Physicians task force that studied the nations emergency care. Their report is being released Tuesday. The panel found a system that is overcrowded, with access to emergency care declining and with poor capacity to deal with public health or terrorist disasters. The number of emergency departments has declined by 14 percent since 1993 despite an increasing number of people coming to them for treatment, the report said.
Copyright 2009 Rockwell Automation, Inc. All rights reserved. 3

Wake Up Call

(2nd ring)

FOR IMMEDIATE RELEASE Engineers and Health Professionals Should Work Together To Address Quality and Cost of Health Care WASHINGTON -- The U.S. health care industry has neglected engineering strategies and technologies that have revolutionized quality, productivity, and performance in many other industries, says a new report from the National Academies' National Academy of Engineering and Institute of Medicine. This "collective inattention" has contributed to serious consequences in health care -- nearly 100,000 preventable deaths per year, outdated procedures, about a half-trillion dollars wasted annually through inefficiency, costs rising at roughly three times the rate of inflation, and 43 million people uninsured. Health care professionals and engineers should work more closely together to address these challenges, said the committee that wrote the report.

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

Healthcare Customers
Atlantic Health System Beaver Medical Center Borgess Medical Center Calgary Regional Health Authority Cookeville Regional Medical Center Danbury Health Systems Erasmus University Good Samaritan Kaiser Foundation Mayo Clinic Hollywood Memorial Mt. Carmel OSU Medical Center Rush North Shore Hospital St. Elizabeth's St. Vincents (NY) Vancouver Coastal Health Authority Akron Childrens UMass Memorial Health Care Iowa Health System Bay Medical Center Beth Israel Hospital British Columbia Children's Cincinnati Children's Clinic Cooper Health System Denver Health Georgetown University Jackson Memorial Lehigh Valley McGill University Montefiore University New England Medical OhioHealth Sentara Health System St. Paul University of Iowa York Hospital Cerner Montefiore Medical Center
5

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

Top 10 Strategic Technologies for 2010

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

Success at Sentara Healthcare

Awarded CIO magazines top 100 Innovative organizations for use of simulation technology

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

Agenda

1. Overview of Arena 2. Simulation in healthcare 3. Example and modeling environment 4. Questions

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

Company Background
Rockwell Automation (NYSE: ROK)
A leading industrial automation solution provider and controls manufacturer. Approx. $4.5B Annual Revenues 20,000 Employees worldwide The former Systems Modeling Corporation was acquired in April, 2000 by Rockwell. Founded 1982 SIMAN language (1982) w/ Cinema animation (1985) Arena (1993)
Over 350,000 users worldwide and growing. US government & Peugeot are largest domestic & Intl customers Taught at over 900 universities worldwide Arena textbooks in five languages

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

Arena in Academia
Four Arena textbooks (in English): Simulation with Arena (Kelton, Sadowski, Sturrock) Applied Simulation Modeling (Seila, Ceric, Tadikamalla) Simulation and Analysis with Arena (Altiok, Melamed) Process Analysis and Improvements (Seppanen, Kumar, Chandra) Arena textbooks also in Japanese, Korean, Spanish, German & Portuguese References: Introduction to Simulation using SIMAN (Pegden, Shannon, Sadowski) Simulation and Analysis (Kelton, Law) Taught at most universities that offer Industrial / Systems Engineering and Operations Research programs. Over 900 universities globally. Rockwell sponsors the annual IIE Student Simulation Contest.

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

10

New Textbook
Healthcare Operations: Quantitative Methods for Quality and Performance Improvement,
Authored by Daniel B. McLaughlin and Julie M. Hays Purchase Amazon.com Publisher is Health Administration Press, a division of the Foundation of the American College of Healthcare Executives Chapter on Simulation with Arena and released with Arena demo CD

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

11

Arena resources and reference materials are available around the world.

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

12

What is Simulation?
Discrete Event Simulation
Models events that occur over time, and all variability associated with these events What is a Simulation Model? A mathematical model of a real or proposed system for the purpose of evaluating the systems behavior under variable conditions. What can Simulation do for you? Simulation allows users to draw inferences about:
a new systems behavior without building it. an existing systems behavior without disturbing it.

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

13

When Should We Use Simulation?

Test major changes to patient flow processes.
If my patient mix changes, how will it affect my system throughput? Why are all these patients waiting in the hallways? Do we need more staff? More beds? More EDs? How would bedside registration work for us? Will Team Triage reduce ED waiting times? What if the number of patients doubles, can our current capacity support an increase?

Answer these and other What if? questions before investing capital and without disrupting current hospital operations.

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

14

Why Simulate a Process? Low risk, high return Get it right the first time when changing or designing complex processes! Lean and Six Sigma initiatives
Value Stream Mapping identify & eliminate NVA activities Analyze the impact of variability DMAIC, DFSS, DMADV

Improve services & lower costs Avoid wasteful spending Visualize problems and solutions Communicate ideas Build consensus
Copyright 2009 Rockwell Automation, Inc. All rights reserved. 15

Variability: The Source of All Problems! Observe 3 scenarios of a simple, single server - single queue process:
Scenario #1: constant patient arrival rate, constant exam time Scenario #2: variable patient arrival rate, constant exam time Scenario #3: variable patient arrival rate, variable exam time

What impact does variability have on this simple process?

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

16

Advantages of Simulation Variability System Interactions Time Animation Bottlenecks Complexity System Discovery
Excel

Simulation

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

17

Queuing and Simulation

A queue is simply a line that entities (people, widgets) wait in Queuing calculations are the only way to truly estimate waiting times in systems Calculations by hand and using spreadsheets can be complex and time consuming Inherent in simulation software

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

18

Arena and Queuing

Single server system:

How much capacity should our new facility hold if the patient arrivals double? If the patient demand doubles, we should double our capacity. WRONG!
System Current Proposed Arrival Rate (patients/day) 48 96 Capacity (Beds) 10 20 LOS (hrs) (min,mode,max) (1,3.5,8) (1,3.5,8) Avg Wait Time (min) 38.8 +- 9.8 15.7 +- 5.2

o Millions may be wasted on excessive capacity! o Run scenarios to determine the optimal capacity

Better analysis tools are critical- spreadsheet analysis is not sufficient

Copyright 2009 Rockwell Automation, Inc. All rights reserved. 19

Arena Product Family Arena Basic Edition Entry level, Greenbelt simulation tool. Models most business processes at a high level of detail. Not suitable for modeling material handling or complex business processes. BE is a subset of all high end Arena products.
Basic Process

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

20

Arena Product Family Arena Basic Plus Enhance your Basic Edition models by animating the movement of people, objects, and/or material handling devices such as conveyors, transporters, or AGV's. Animate entity travel on imported AutoCAD drawings, maps, or custom pictures.
Basic Process Advanced Transfer

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

21

Arena Product Family Arena Standard Edition Advanced modeling power for handling complex processes with intricate design logic, control over entity movement, custom statistics, user-defined expressions, and interfacing with external data.
Basic Process Advanced Transfer Advanced Process

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

22

Arena Product Family Arena Professional Edition The flagship Arena product. A Blackbelt simulation tool that models nearly all business processes, in all domains, at any level of complexity.
Basic Process Advanced Process Advanced Transfer Flow Process OptQuest Template developer tools SIMAN

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

23

Arena Product Family

3D Player For unmatched visual impact. When animation is critical to successfully presenting a model

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

24

Arena Demonstration

1. 2. 3. 4. 5. 6.

Define basic process logic Define resources & entities & their costs Basic Animation Run model & view reports Define advanced process logic Advanced Animation

Copyright 2009 Rockwell Automation, Inc. All rights reserved.

25

Arena Products & Services

Arena software (ask your local sales representative for pricing):
Basic Edition Basic Edition Plus Standard Edition Professional Edition

Training:
Scheduled 4-day class at a Rockwell facility Onsite 3-day class

Project assistance for new users

project jumpstart service model building help @ daily rates turnkey simulation project services

Arena Success Package for new users:

Discounted: Software Support Training Project jumpstart service
Copyright 2009 Rockwell Automation, Inc. All rights reserved. 26

Contact me to discuss your specific modeling application.

Insert Photo Here Questions? 312.952.6869, cjjurishica@ra.rockwell.com

Copyright 2009 Rockwell Automation, Inc. All rights reserved.