Inventory, Flow Rate, and Flow Time

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En provenance du cours de University of Pennsylvania

Health Care Innovation

35 notes

University of Pennsylvania

Health Care Innovation

35 notes

Cours 4 sur 4 dans Specialization The Business of Health Care

In this course, you’ll learn the foundational economic theories behind health care innovation and how to optimize your own health care practice or organization. Designed to help you gain a practical understanding of the theoretical frameworks of behavioral economics and operations management in the health care setting, this course will help you apply these frameworks to assess health care practices and apply innovation while managing risk. You’ll also explore the best practices for evaluating one’s innovative practices, using real-life examples of success to see the concepts in action. By the end of this course, you’ll have honed your skills in optimizing health care operations, and be able to develop the right set of evaluations and questions to achieve best innovative practices within your organization.

À partir de la leçon

Module 1

This module was designed to give you a foundational knowledge of health care operations and methods of optimization. You’ll examine the provider-patient relationship and learn how a provider can improve performance measures for the patient by analyzing the different types of performance metrics such as patient-centric, operations, and financial measures. Through discussing the different types of inefficiencies such as waste, variability, and inflexibility, you’ll be able to optimize performance and service. You’ll also learn how to gauge patient flow by flow rate, flow time, and inventory, and be able to map processes using a flow diagram and a Gantt chart. By the end of this module, you’ll be better able to calculate the financial viability of a health care provider using Key Performance Indicators (KPI) and create a framework to assess and optimize performance.

Introduction: The Patient Perspective7:45

Introduction: The Provider Perspective5:49

Trade-offs, Strategy, System Inhibitors10:35

Inventory, Flow Rate, and Flow Time6:28

Mapping Processes with Flow Diagrams6:43

Lean Operations and Waste10:02

The Curse of Variability11:23

Financial Viability12:52

Finding the Value Drivers11:54

Rencontrer les enseignants

Christian Terwiesch
Andrew M. Heller Professor at the Wharton School, Senior Fellow Leonard Davis Institute for Health Economics Co-Director, Mack Institute of Innovation Management
The Wharton School
Amol S. Navathe, MD, PhD
Assistant Professor of Medical Ethics and Health Policy
Department of Medical Ethics and Health Policy
David A. Asch, MD, MBA
Professor of Medicine and Professor of Medical Ethics and Health Policy
Department of Medicine
Roy Rosin, MBA
Chief Innovation Officer
Penn Medicine
Kevin Volpp, MD, PhD
Professor of Medicine, Division of Health Policy / Professor of Health Care Management
Perelman School of Medicine / The Wharton School

We've been talking about all the things that we will learn in this course, but

so far, we just talked from the comfort of my office.

Let's get out into the real world.

A little while ago, one of the interventional radiologist here at Penn,

had asked me to look at their patient flow.

But what do you look for when looking for patient flows?

Well imagine, you and I will take two folding chairs, coffee, donuts, and make

ourselves comfortable in front of Penn's Department of Interventional Radiology.

We also take a notebook and

while I'm eating my donuts you're going to take detailed notes.

Ready? So here we go.

At 7:35 AM the first patient shows up, patient goes in, door is shut.

That is all that we'll see for now.

I ask you to create a graph tracking the cumulative inflow of patients in blue,

and the cumulative outflow of patients in red.

Ten minute later, we're now at 7:45, the next patient shows up, and

at 8:10 the third patient comes.

Before the fourth person shows up at 9:30 AM,

however the first patient, the guy who'd came at 7:35, comes out of the department.

At 10 AM, I ask you a test question, how many patients are in the unit?

Sharp as you are, you would respond, three, because four went in and

one came out.

From then onwards, I stop asking stupid questions, and we just take our notes.

Only patient five surprises both of us as he got in and

out of the department in 15 minutes.

We later learned that he refused to sign the consent form.

At the end of our day in the hospital,

we have built a graph that looks something like this.

Again, the blue graph captures the cumulative inflow, and

the red graph is accumulative outflow.

These two graphs meet at the time the patient has left the unit.

First observe that we have taken care of 11 patients today,

we call this number the flow rate.

The flow rate measures how many patients we handled in a given period of time,

in our case, one day.

We can also think of a patient flow per hour,

about one patient flows through the process per hour.

But there a couple of more things this graph teaches us about the patient flow.

We can also compute the number of patients that are in the department at

any given moment of time.

This is simply the difference between the inflow curve and the outflow curve.

The number fluctuates between 0 in the morning 4 around 3 PM,

we call this number the inventory.

Sorry, I know this sounds really disrespectful to all patients, but

that's just the word.

Inventory is the number of patients in the process.

Finally, we can also see how long each patient spent in the process.

Some patients spent a long time, as did patient nine, for examples.

Other get in and out much faster, recall patient five thst was in and

out in 15 minutes.

We call this number the Flow Time.

The flow time measures how long it took the patient to flow through the process.

So let's review our new definitions.

To be general, we'll extend these definitions to include

other things that might flow through a process, not just patients.

So rather than talking about the patient as our atomic unit of analysis,

we'll just speak about a generic flow unit.

The following definitions work for all processes and operations.

For example, we could think about the flow of specimens through our pathology lab,

or the flow of insurance claims through our billing department.

So, for a generic flow unit we define flow rate, oftentimes also called throughput,

as the number of flow units going through the process per unit of time.

In our case it was 11 patients per day, 200 calls per hour in our call center,

30 insurance claims per day in our accounting department.

It always is flow units per unit of time.

Flow time is the time it takes a flow unit

to flow through the process from beginning to end.

When dealing with patients,

we often times refer to this number as the length of stay.

But flow time could be about 20 minutes that our caller spent on hold

in the call center, it could be 3 months that patients wait for their bill.

And then there is inventory.

Inventory is the number of flow units in a process at any given moment in time.

Again, I apologize for the term, when it comes to patients,

oftentimes people talk about the census, inventory is a more abstract word.

And I argue that this abstract word will help us in the remainder of this course.

Looking at any process is overwhelming, lots of stuff goes on, and for

us as observes it's really easy to get overwhelmed.

So we have to be very analytic about the process flow.

The three process measures we introduced today are the three most important measure

in any process analysis.

They themselves will not tell you how to improve the process, but will if

we don't understand these three measures, we really don't understand the process.

So I will hereby promote these three measures to the most

important operational metrics of this course.

You notice that none of these measures has any money attached to it now.

We will worry about money later, flow comes first.

Taiichi Ohno, of the Toyota production system,

allegedly said product has to flow like water.

Now let me reword this.

Do patients have to flow like water?

We want to keep things moving, and I'd like to think of hospitals as places

where patients flow to a healthier state of life.

Once we understand flow rate, inventory, and

flow time, we can move on to the next step.

We can ask ourselves, why these measures are what they are.

Why don't we take care of more patients?

Why does it take so long?

And what are all these patients doing right now here in my waiting room?

Lots of more questions we need to answer, but that's for another day.

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