In the early 2000s, a hospital in America’s south east faced the problem of increasing delays in moving patients through their Emergency Department, with a lot of that time spent idly waiting around.

The hospital’s management wanted to get a handle on this problem.

How did they do it? Especially in the context of growing demand for their services, and rising costs?

The hospital in question engaged outside assistance to help them get answers to questions such as:

  • will an additional 30 inpatient beds relieve the patient backlog? and
  • by how much do we need to reduce lab test turnaround times to significantly affect overall patient length of stay?

(Length of stay is the hospital version of turnaround time; you may recall I wrote about turnaround time – the amount of time it takes to complete a service – earlier this year.)

Working closely with the client, the consultants mapped the processes of patient entry, care and exit, and developed a simulation model to replicate the current (‘as is’) scenario.

After the model had been tested and validated, experiments were conducted on it to determine the impact of changing the resources allocated to different parts of the process: being seen by a triage nurse, radiology tests, blood tests, being attended by a physician, etc.

What did they find?

The model showed that…

  • adding 30 more inpatient beds will potentially cut Emergency Department length of stay in half, and
  • lab test turnaround time had to reduce by 20 percent before patient length of stay was significantly affected.

The hospital now has a powerful tool which it can use repetitively to improve decision-making.

So why do I label this simulation-based learning?

Simply because in performance improvement projects such as this there is a lot of tacit learning that occurs along the way.

As the participants in this case point out, typically organisational staff have never seen their processes described (much less modelled) end to end: they know only fragments of the process without seeing how what they do fits into the overall process.

Developing process maps as part of a performance improvement effort thus provides new perspectives and learning. But the learning is embedded in day-to-day management of processes, in contrast to dedicated training and L&D (learning and development) efforts which typically occur offsite or away from the day-to-day running of the organisation’s business.

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As managers and executives we are custodians of the systems that impact people’s lives in various ways: the health system that brings healing to an elderly man; the justice system that settles a commercial dispute over a major contract or a child’s custody; the accountant who gives financial advice to a professional providing for her family.

Isn’t it worth doing what we can to improve their lot by improving these systems? And, as a secondary benefit, enjoying the personal and professional benefits that accrue to us in the course of doing this?

I contend that improving performance along the lines described above is one of (if not the) key task of management, and that doing so anchors management’s attention to where it produces the greatest results for clients. In turn this helps set the organisation up for success.

I would be delighted to assist you in this noble endeavour.

Please contact me on 0414 383 374 or by return email so we can discuss.

I look forward to hearing from you.

With best regards,

Michael Carman
Director | Michael Carman Consulting


Reference: Martin J. Miller, David M. Ferrin and Jill M. Szymanski ‘Simulating Six Sigma Improvement Ideas for a Hospital Emergency Department’ Proceedings of the 2003 Winter Simulation Conference, 2003.

© Michael Carman 2013