Utilization of Process Improvement Methodologies to Optimize Simulation Operations

Abstract

Lean and Six Sigma methodologies provide tools for process evaluation and improvement. Baseline operational metrics of the simulation process at a high-volume academic center were defined and recommendations for an optimized future state were developed. The purpose of the current project is to report results of pilot studies conducted under the optimized future state.Patients were prospectively tracked from arrival through simulation completion to determine operational metrics associated with pilot studies. The simulation schedule was adjusted to include three patients in two-hour time blocks rather than one patient every hour to reduce dependence on upstream activities, including patient arrival, consent, and IV placement. One person was assigned to facilitate patient transfer through pre-simulation processes. Patients were brought to the simulation suite upon completion of upstream processes to reduce transition time. Start-to-end and start-to-start cycle times were defined as the total patient time in the simulation suite and the time between consecutive patients entering the simulation suite, including pre-simulation processes, respectively. Transition time was defined as non-value-added time between patients when the suite was not operational. Utilization was calculated by dividing machine uptime, defined as the time a patient is on the simulation table, by total time monitored. Baseline operational metrics were determined during a prior study. Statistical analysis was performed using Minitab v19.2. Of note, for the purpose of utilization and start-to-start cycle time comparisons, baseline metrics did not include downtime associated with lunch.Results of baseline and pilot metrics are based on 19 patients tracked in February 2020 and 17 patients tracked in October and November 2020, respectively. Start-to-end cycle times were similar in both baseline and pilot studies at 31 ± 15 and 30 ± 11 minutes, P = 0.833. Start-to-start cycle times were reduced during pilot studies from 57 ± 26 to 40 ± 12 minutes, P = 0.041, primarily driven by improvements in transition time, which was reduced from 27 ± 28 to 7 ± 5 minutes, P = 0.016. As a result, machine utilization was improved from 52.8 ± 3.4 to 73.7 ± 2.9%, P = 0.0004.Initial analysis of baseline metrics noted significant delay associated with pre-simulation processes with recommendation to de-couple operations where possible. The combination of an adjusted arrival schedule and addition of a person to facilitate patient movement resulted in significant improvements in transition time and utilization. During the pilot study, the optimized process was able to complete three patients in a two-hour block with no difficulty noted and the person responsible for patient movement had time available for additional responsibilities. Next steps include extended pilot studies with plans for utilizing off-line immobilization set-up to reduce start-to-end cycle times.