BSU Clinic Simulation

Banyan State University Medical Clinic

Banyon State University (BSU) operates a walk-in medical clinic to meet the acute medical needs of its 13,000 students, 1,200 faculty and staff members, and covered relatives.  The clinic is staffed by one doctor and one nurse and operates 8 hours a day, 5 days a week.  The doctor and nurse do not take a lunch break, but rather use gaps between patient arrivals to eat lunch and take other short breaks.  Because patients often do not arrive right when the clinic opens and because they must visit with a nurse before seeing the doctor, the doctor’s official start time is 45 minutes after the clinic opens.  Patients arriving at the clinic are served on a first-come first-served basis.

As part of a new total quality management (TQM) initiative, BSU conducted an in-depth 40month study of its current operations.  A key component of the study was a survey, distributed to all students, faculty, and staff.  The purpose of the study was to identify and prioritize areas most in need of improvement.  An impressive 44% of the surveys were returned and deemed usable.  Follow-up analysis indicated that the respondents to the survey were representative of the population served by the clinic.  After the results were tabulated, it was determined that the walk-in medical clinic was located at the bottom of the rankings, indicating a great deal of dissatisfaction with the clinic. 

Preliminary analysis of the respondents’ comments indicated that people were reasonably satisfied with the treatment they received at the clinic but were very dissatisfied with the amount of time they had to wait to see a care giver.  To gain additional insight into the problem, a team of students was asked to study the problem as part of a course project.  In addition to determining the general issues, they were asked to determine the desirability of a new, computerized patient record system (CPRS) to aid in reducing waiting times.  The student team initially collected data on the pattern of arrivals at the clinic and the various services times (discussed in more detail later).  The team determined that on a typical day, inter-arrival times were uniformly distributed between 6 and 20 minutes.  After arriving at the clinic, patients complete a form that requests background information and the reason for the visit.  The staff collects these forms and retrieve the patients’ records from the basement.  The team determined that the time to retrieve patient records follows a normal distribution with a mean of 4 minutes and a standard deviation of 0.75 minute.  Retrieved patient records are placed in a pile from the clinic’s nurse in the order that the patients arrived at the clinic. 

When the nurse finishes with the current patient, the file of the next patient is selected and the patient is directed to the nurse’s station.  Here the nurse further documents the problem and takes some standard measurements such as temperature and blood pressure.  Then the nurse places the patient’s file at the bottom of a stack of files for the doctor.  When the doctor finishes with a patient, the file on the top of the stack is selected and the next patient is called to the examining room.  The team determined that the processing times of the nurse closely approximate a normal distribution with an average of 10 minutes and standard deviation of 2.3 minutes.  Likewise, it was determined that the time required for the doctor to examine and treat the patients also closely approximates a normal distribution with a mean of 17 minutes and a standard deviation of 3.4 minutes.

Simulate an 8 hour day (i.e., 480 minutes).  Calculate the following summary results:

Number of Patients

Average Time in the System

Average Waiting Time

Next, extend your simulation model to include the alternative of using computerize records.  Using computerized records simply means that there would be no time (i.e., zero time) associated with retrieving patient records.  In other words, the patient could be seen by the nurse immediately (if the nurse is available) or as soon as the nurse is finished with the previous patient.  To incorporate the computerized record system on the same spreadsheet you will simply use the same columns that generated inter-arrival times, nurse service time, and doctor service time.  In other words, you will simply change the logic in appropriate formulas to correctly represent the situation where there is no time associated with the retrieval of records.  This means simulating the time the nurse’s exam begins, the time the doctor’s exam begins, the time the patient is finished, the time in the system, and the total waiting time.  For this (computerized records) alternative, calculate the same results (i.e., number of patients, average time in the system, and average waiting time) for comparison purposes with the current system. 

This first simulation (of both the current system and the computerized system) represents replication #1.  After you have recorded the results (number of patients, average time in the system, and average waiting time, run 9 more replications and calculate the results. 

Present a summary table of the results for the 10 replications (i.e. the equivalent of two weeks of operation) and use this summary table as the basis for the rest of your work.

Your deliverable for this project will be two items:  a memo to the president of Banyan State University (Thomas Kourpias) from your team with a copy to Dr. Marsha Williams, VP University Health Services.  Your memo should contain the following four components:  introduction, analysis, recommendations/conclusions, and limitations.  Your memo should be accompanied by your Excel spreadsheet with the simulation model.  Keep in mind that you will be evaluated on the basis of the content of the spreadsheet as well as of its design/layout, professionalism, and.  Be sure to organize your spreadsheet so that the data inputs and the results are located at the beginning of the spreadsheet to facilitate use and understanding by the reader (the president and the VP of Health Services.  The accuracy of your analysis (as evidenced by the supporting simulation model) will carry a significant weight in the project grade.

Your presentation should cover the same topics but your explanation will be more elaborate, particularly with respect to how the simulation was designed and how the results can be interpreted.  In other words, you should “walk the listener through the simulation process” during your presentation.  This means you will need to open your spreadsheet during your presentation.  The presentation should be clear and focused and should include information about how the simulation model can be used if any of the parameters change.  Most importantly, however, will be the conclusions you draw or the recommendations you make.  These conclusions should be logical and justified by the simulation results.  If appropriate, after referring to the spreadsheet itself, you can incorporate “screen shots” of particular portions of the spreadsheet in your presentation to facilitate your presentation/explanation.

Your presentation will be limited to a minimum of 7 minutes and a maximum of 10 minutes.  Variations from this time frame will incur deductions. Do not start your presentation until the instructor tells you to start.  Presentation times have been assigned randomly, and you do not have to be present for the rest of the teams’ presentations.  Your time slot is cast is concrete, so be sure to arrive in sufficient time for your scheduled time slot.  Late arrivals will be docked in terms of grade and in terms of time.  There will only be a one-minute transition time between team presentations so be sure to have everything ready ahead of time.  It is strongly recommended that you show up to the class room earlier in the day to save your presentation and excel files on the computer to assure that everything will be ready at the time your presentation is scheduled to begin.

These presentations will be evaluated on the basis of professionalism of the presenter (i.e., dress appropriately, speak clearly, avoid “hmmmmms”, etc.), slide content (appearance, readability, transitions, color, etc.), adherence to the time line, message (appropriate background, explanation of methodology, explanation of results, conclusions and recommendations, limitations/concerns, etc.).

Project submissions will be comprised of the following:  the memo to the president, the Excel spreadsheet model, and PowerPoint slides.  The memo and the PowerPoint slides are to be submitted as hard copy and electronic copy.  The Excel spreadsheet should only be submitted electronically.