Use of Queuing

Decision
Models in
Analysis
Health Care
 Queuing
Theory

“ .. Is the mathematical approach to the

analysis of waiting lines in healthcare
settings…”

Most of healthcare systems have excess

capacity to accommodate random
variations, so queuing analysis can be
used as:
Short term measure, or
For facilities and resource
planning
 Uses of
simulation
Queuing
inanalysis
healthcare
and

 Walk in patients in clinics

 Emergency room arrivals
 Phone calls from physician offices to HMO
 Outpatient clinics and outpatient surgeries
 Physician offices
 Pharmacy
 Inventory Control
 Healthcare resource and infrastructure
planning for disaster management
 Public health, etc..
 Costs of
waiting lines or
queue

 Cost associated with patients having

to wait for service

 Loss of business to HCO

 Costs incurred by society

 Decreased patient satisfaction

 Cont..

Capacity costs: costs of maintaining

the ability to provide service
 Salaries paid to employees/servers
while they wait for service from
other server
Fixed costs - Cost of waiting space,
facility, equipment and supplies
 Health Care
Service Capacity
and Costs

If the organization decides to increase the level of service provided, cost of

providing services would increase, if it decides to limit the same, costs associated
with waiting for the services would increase. So the manager has to balance the
two costs and make a decision about the provision of optimum level of service, the
lowest point in total cost curve in the diagram, which is frequently guided by the
policies of the organization.
 Queuing System
Characteristics

 Population Source:
Infinite Source
Finite Source
 Number of Servers:
Capacity of each server (channel)
Number of servers
 Arrival Pattern: Poisson distribution
or negative exponential distribution
 Service Patterns: service time and rate
 Queue Discipline: first come first
serve, urgency, appointment, etc..
 BASICS OF
QUEUING
THEORY

Setting Input process Out process

Hospital Arrival of the patient at the Assessment, triage,
registration counter provision of services,
discharge

PCP Office Arrival at registration Assessment by PCP,

counter or front office desk prescription and tests, and
collection of bills at the exit

ER Ambulance arrival Assessment, triage,

assessment, triage to the
inpatient setting or
discharge after treatment
 Types of
queuing
systems

It can be
single line-single phase

single line-multiple phase

multiple line-single phase or

multiple line-multiple phase service

Cont..

single line-single phase

Single-line, multi-phase system

Cont..

multiple line-single phase

or

multiple line-multiple phase service

 Measures of
Queuing System
Performance

 Average number of patients waiting

(in queue or in system)
 Average waiting time
Capacity utilization
 Cost of given level of capacity
 Probability that an arriving patient
will have to wait and for how long
Queue
process
 Diabetes
Patients
Example

Single server: arrival rate – 4 pts/hr

Service rate – 5pts/hr

Multiple server: arrival rate – 9 pts/hr

service rate –5pts/hr

operational cost-$40/hr

waiting cost -$75/hr

Cont..
 Inputs:

Parameter Value Value Value

M/M/s

Arrival
rate(lambda) 9 9 9

Service rate(mu) 5 5 5

Number of
Servers 2 3 4

Server cost
Rs/time 40 40 40

Waiting cost
Rs/time 75 75 75
 Results:

Value
Parameter
2 3 4
Nurses Nurses Nurses

Average server utilization 0.9 0.6 0.45

Average number in the queue(Lq) 7.67 0.53 0.11

Average number in the system(Ls) 9.47 2.33 1.91

Average time in the queue(Wq) 0.85 0.06 0.01

Average time in the system(Ws) 1.05 0.26 0.21

Cost (Labor + # waiting*wait cost) 655.5 159.91 167.89

Cost (Labor + # in system*wait

cost) 790.53 294.91 302.89
 Sensitivit
y Analysis

Performance measure 2 Nurses 3 Nurses 4 Nurses

Pt. arrival rate 9 9 9

Service rate 5 5 5
Overall system utilization 90% 60% 45%

L (system 9.5 2.3 1.9

Average number in the queue(Lq) 7.7 0.5 0.1

Average time in the system(Ws) 1.05 0.26 0.21

Average time in the queue(Wq 0.85 0.06 0.01
Probability of zero units in the system 5.30% 14.60% 16.20
(Po) idle
Probability of n units in the system 85.30% 35.50% 12.80%
(Pw) busy

Total system cost in $ per hour 790.53 294.91 302.89

 Interpretatio
n of results:

We can interpret from the sensitivity analysis that it

would be most efficient to have three booths with three
nurse, which not only minimizes the total cost incurred
but also minimizes the waiting costs. So the option of
three booths with three nurse is an optimal solution with
optimum tradeoff between the two types of cost
involved in queuing models.
 Limitatio
ns

Takes average of all variables

 Based on assumption that service time is known
 Service times are independent from one another
 Service rate is known
 Service rate is greater than arrival rate
 Arrivals are served on first come first serve basis
 Service times are described by the negative
exponential probability distribution
 Used for short term phenomenon and is
deterministic
Thank You