CASE QUESTIONS:

1 Where is the bottleneck in the process? What are the capacity constraints at the clinic?
2 How does the process perform in terms of throughput, flow time and inventory?
3 How is variability affecting the clinic and how can it be controlled?
4 What would you recommend to improve the process and why?
 UTILIZATION & BOTTLENECK COMPUTATION
* Highest utilization = Bottleneck we only have to identify one

Patients coming in everday 80

Follow-up 60% 48 `------------------>

New 40% 32 `------------------>

Staff Availability

1 Front Desk
a Registration 3 clerks 8:30 am to 11:30 am
b Verification 3 nurses 8:30 am to 12:45 pm

2 Radiology Department
a X-ray imaging 6 technicians 8:30 am to 12:30 am
b Development of x-ray By machine 8:30 am to 12:30 am
c Diagnostic reading and comments 3 radiologists 8:30 am to 12:30 am

3 Hand-off to x-ray to clinic

a Collection of x-ray 3 same 3 nurses 8:30 am to 12:45 pm
b Direct patients/filing/exam room prep 1 nurse 8:45 am to 01:00 pm

4 Examination room
1 surgeon 8:45 am to 01:00 pm
*only one works at a time 2 senior residents 8:45 am to 01:00 pm
1 cast technician 8:45 am to 01:00 pm

Findings:
1 The two highest utilizations are -
X-ray imaging and development at 91%
Cast technician at 94%
Surgeon 111%
2 So now we use a second analysis to choose between these two - which is the impact analysis
X-ray imaging and development has the highest possibility of time reduction
So we go with this bottleneck and suggest improvements

Robin - comments at P20 and P29

 Total X-ray required 73 Treated By
X-ray required 85% 41 Surgeon
X-ray not required 15% 7 Senior Resident
Cast Technician

X-ray required 100% 32 Surgeon

Cast Technician

Process Time as per Staff Estimate Number of Patients

Total Time
Time Available per
Available (in New Patient Follow-up Patient New Patient
person (in minutes)
minutes)
14 9
180 540 5 5 32
255 765 9 4 32

23 23
240 1440 11 11 32
7 7 32
240 720 5 5 32

4 4
255 765 2 2 32
255 255 2 2 32

24 20
255 255 7 4 32
255 255 0 7 0
255 255 17 13 8

impact analysis
 30% 15
70% 33
15% 8

100% 32
25% 8

Number of Patients Actual Output (in terms of time taken to complete activity)
Utilization = Actual
Follow-up Patient New Patient Follow-up Patient Total Output / Maximum
Potential

48 160 240 400 74%

48 288 192 626 82%

41 352 451 803 91%

41 224 287 511 part of imaging above
41 160 205 365 51%

41 64 82 same 3 nurses
48 64 96 160 63%

15 224 60 284 111%

33 0 231 231 91%
8 136 104 240 94%
Total Waiting Time as per Patient Estimate Possible Time Reduction

New Patient Follow-up Patient SD New Patient Follow-up Patient

30 25 4 16 16

58 58 22 35 35

3 3 2 -1 -1

38 33 19 14 13