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Basic Queue Theory and Gantt Charts. Steve Harrison Wednesday 20 th January 2014 Seminar Room 2 MEC. Topics. Variation – A recap Basic Queue theory Gantt Charts – Process Building Blocks Other Variation Concepts. - PowerPoint PPT Presentation
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Steve HarrisonWednesday 20th January 2014Seminar Room 2 MEC
Basic Queue Theory and Gantt Charts
Topics
• Variation – A recap
• Basic Queue theory
• Gantt Charts – Process Building Blocks
• Other Variation Concepts
“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
Variation – what to do?
5
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
Variation and Queues
Variation & Queues
Consecutive Patients
Pro
cedu
re T
ime
(Min
utes
)
50%
100% 80%
80% rule is the most efficient balancing waiting and waste
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
Plan Cycle Time = 20m
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
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
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
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
Demand is increasing....
More slots needed...
80% = 21mins
3hrs = 8 Patients
80% = 21mins
3hrs = 8 Patients
80% = 18mins
3hrs = 10 Patients
80% = 21mins
3hrs = 8 Patients
80% = 18mins
3hrs = 10 Patients
80% = 14mins
3hrs = 12 Patients
HOW DO YOU REDUCE COMMON CAUSE VARIATION?
GSM
More Queuing....
Capacity required = 27
Capacity required = 27
Capacity required = 49(5 beds less than separate units ~£400,000)
Lung Cancer Clinic
28
13 + 11 = 24
Lung Cancer - pooled
And Finally - More Queuing....
Which is best?
C Q
C Q
C Q
S
S
S
C Q
S
S
S
C QC Q
And Finally - Which is best?
C Q Long
C QShort
S
S
C QLong
S
S
S
C QShort
C QLong
DISCUSSION
THANKS!
