Nasser Ameer 11049 Terkee Al-Rodan 10961 Final Project: Case 9 Advanced System Simulation 24/05/12

1. Introduction 1.1. Description of our project. 1.2. Resources needed in the system. 2. Problem Statement 2.1. Problem Statement, Specifics 2.2. Potential Layout 2.3. Objective of this project 3. ARENA Model 3.1. The Model 3.2. Additions to the system 4. Results 4.1. Results 4.2. Analysis 5. Improvements 5.1. System Layout Redesign. 5.2. Variable Resource allocation. 5.3. New Results 5.4. Comparison 6. Conclusion

Introduction: Description of our project: Our project is based on a case study given to use in class, the first Case 9. Case 9, required us to simulate a 24/7 Clinic that carried out 5 processes. First, patients would check in, they are then directed into one of three different departments, the nurse station, the examination rooms or the lab and X-ray department. When finished the patients checkout, through the checkout department. Finally, we where supposed to run the system for thirty 24 hour days. The following report aims to thoroughly describe a simulation system in terms of stating the requirements and the creation of that system. After which, it will move on to stating the results of the system, in terms of time. Finally, this report will then suggest certain improvements to make the process more efficient and effective. Resources needed for this system: Seeing that this is a clinic we will need five basic resources: Receptionists: they are responsible for the check in process of the patients. Nurse: they are needed to carryout certain task, and help aid the doctors. Doctors/Exam Room operators: they are the main resource for this process, in other words they are needed for the treatment of the patients. Lab Technicians: they are the people who operate the machines, such as the X-ray machines Check out Administrator: they are the opposite of the receptionist, in that they are responsible for checking out the patients.

Problem Statement: Problem Statement, Specifics: As we described above the problem is to simulate 24/7 clinic for thirty 24hour days. The main issue with this system is the freedom of the patients to go where they want after they finish one of the processes, note this my lead to a patient going to the same station more than once. In other words, once a patient enters the systems there is no specified path the customer must go on, it is only the probabilities of where customers can go next that indicates the coming point on the path. The follow points are the specifics of the system: Inter-arrival times are exponentially distributed, with mean 5.95 minutes. There are 3 exam rooms All Queues follow the FIFO queue discipline. They require: o Average total time in system. o Average number of Patients. o The throughput of the system. o Average waiting time of the patients o Resource utilization o A graph showing the number of patients currently in the clinic. o A counter that counts the throughput of the system. The following table contains the processing times for each of the tasks, and the probabilities for each of the possible corresponding tasks.

Potential Layout: The following image is a potential layout for the clinic:

R= Reception NS= Nurse Station ER= Exam Room

LX= Lab and X-ray CO= Check Out Project object: Our objective for this project is to reduce: The total time a customer spends in the system Reduce the waiting time of the customers Increase the throughput of the system Ensure that all resources are utilized between 40-90%

ARENA Model: Using the information above we where able to create the following model,

Please note, that the process times used are all in minutes and have already been stated above. Furthermore, all decides are two way by chance unless stated otherwise. Patients Arrive: This is done via the create module, with the inter-arrival value of Expo(5.95) minutes.

Sign in and Waiting room: This is done through the use of a process module, which uses the Seize Delay Release action and has a one receptionist as a resource. Furthermore, the delay time was giving in the table above.

Where to Out of Sign in and Waiting Room? The following block is a decide module, with the true branch entering the nurse station, with a probability of 98.88 %. The false branch is connected to examination module.

Nurse Station: This is a process module, with a Seize delay release action and a resource of one nurse.

Where to out of Nurse Station? This is another decide, where true leads to examination, with a percentage of 91.67%, and false leads to Lab and X-ray.

Examination:

This is a seize delay release process module, with one exam room resource and a delay as stated above. Furthermore, go to the resource module in the basic process area, and change the capacity of the exam room to 3.

Where to out of exam room? This decides is an N-way by chance, where the false lead to check out and the true leads to the Nurse station, Exam room or Lab and X-ray, respectively.

Lab and X-ray: This section is a seize delay release process module, with one Lab technician and delay times given above.

Where to out of lab and X-ray? This is another decide module where true leads to the Nurse station, with an 83.33% chance, and False leads to the checkout counter.

Check Out: It is a Seize Delay Release process, where there is one Checkout Administrator and a delay, which is provided in the table above.

Go Home: This is the dispose module called Go Home.

Additions to the system: As stated above a graph is required to show the current number in the system. To do so, select the plot icon on the ARENA toolbar, add a new data series with the name Patients in Clinic, and the expression EntitiesWIP(Patient) to show us the number of Patient currently in the system. Furthermore, make sure that the x-axiss maximum value is 43200 minutes, with a major increment of 10000 minutes.

As for the graphics used, they are added through the use of the resource button on the toolbar. These were not requested for the simulation but were added for effect. Finally, the throughput counter is added from the variable button on the tool bar and counts the number of people who leave the system, i.e. the number out for the checkout counter.

Results: Here are the results of the system, see the actual overview report at the back of the report: Average total time in system = 117.88 minutes Average number of Patients. = 19.5 patients The throughput of the system. = 7,151 Patients Average waiting time of the patients = 82.17 minutes Resource utilization:
Utilization 93.350% 71.810% 62.250% 88.570% 91.770%

Resource Nurse Receptionist Lab Technicians

Check out Administrator

Exam Room

Utilization
100.000% 90.000% 80.000% 70.000% 60.000% 50.000% 40.000% 30.000% 20.000% 10.000% 0.000%

Utilization

Analysis: From the data above we can see that:

Around 70% of the time customers are waiting in the system.

35.710 82.17 117.88 69.706%

Non-waiting time Wait time Total time Percentage wait time

Non-waiting time Wait time

The Nurses and the exam rooms are over Utilized

Improvement: System Layout Redesign: To improve the system we decided to structure it more, in other words, recreate the system by making it more linear, through the reduction in the number of paths that can be taken by the customer. We did this by shifting the position of the first nurse station, so that it is after the reception, making it mandatory for the customer to go to a nurse station straight after check in. By doing so, the patient will then go in to a decide, where 91.7% of the patients go to the examination station after he/she is finished from the Nurse station, and the rest of the patients can go to the lab and X-ray department. Furthermore, once the customer finishes examination then a new decide is added, where 47.06% of customers are re-examined. The rest of the customers will then move on to a new nurse station, again making it mandatory for the patient to enter this process after examination. After which the customer go through another decide, where 95.6% of patients checkout, the other customers go to the lab and X-ray departments. Where, after they finish, they are presented with another decide, through which 83.33% of the customers go to the first Nurse station, and the rest go to the checkout. Please note that due to the new nurse station, Nurse Station 2, the capacity of the nurses needs to be two. This can be done in the resource module.

Variable resource Allocation: After we ran the new system we saw that the queue length for the checkout station can become very crowded. Therefore, we added an administrator that will dispatch up to 2 on-call checkout administrators, should the number of people in the checkout queue go over 10.

Results: Average total time in system = 68.03 minutes Average number of Patients. = 11.49 patients The throughput of the system. = 7,295 Patients Average waiting time of the patients = 32.32 minutes

Comparison: Utilization:
Resource Nurse Receptionist Lab Technicians Utilization 75.780% 73.180% 52.920% 88.920% 78.460%

Check out Administrator

Exam Room

As you can see all values are within the optimal range of 45-90% in terms of utilization. Which is better than the original.

Utilization
90.000% 80.000% 70.000% 60.000% 50.000% 40.000% 30.000% 20.000% 10.000% 0.000%

Utilization

100.000% 90.000% 80.000% 70.000% 60.000% 50.000% 40.000% 30.000% 20.000% 10.000% 0.000%

93.350%

88.570% 88.920% 75.780%

91.770% 78.460%

71.810% 73.180% 62.250% 52.920%

Nurse

Receptionist

Lab Technitians

Check out Administrator

Exam Room

Time:
Reduction Same 39.333% 57.711%

Non-waiting time Wait time Total time Percentage wait time

35.710 32.32 68.03 47.508%

As you can see in the table, the total and waiting times have decreased drastically, making this a more efficient system.

Non-waiting time Wait time

Conclusion: In conclusion, this report simulated a 24 hour 7 days a week clinic for 30 days. It then analyzed the results obtained from that simulation and tried to improve it. Furthermore, the improvement included a redesign of the system, through the addition of an extra nurse station, which would make it more linear, and the addition of a administrative official that would bring in up to two more checkout administrators to help with spikes in demand. Finally, by carrying out these improvements we were able to reduce the total time and waiting time of the customer, and ensure optimal utilization of all resources.