Reallocating Resources to Focused Factories: A Case Study in Chemotherapy

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Reallocating Resources to Focused Factories A
Case Study in Chemotherapy

• Peter Vanberkel, PhD Candidate
• University of Twente
• Netherlands Cancer institute Antoni van
  Leeuwenhoek Hospital

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Outline

• About Focused Factories
• Case Study
• Decision Support Tool

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Focused Factories History
focus, simplicity and repetition breeds
competence. Skinner 1973
US Factory in the 1960
Focused Factory
We produce fewer things! We produce them all Well
We produce everything! We produce Nothing Well
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Manufacture And Assembly
Assembly
2006
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Pomegranate Phone Ultimate Do EVERYTHING
phone (www. PomegranatePhone.com)
iPhone Does less but does Everything Well
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Health Care Focused Factories
General Hospitals
Specialized Hospitals
Specialized Clinics
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Focused Factories within Hospitals
Radiology
OR
Poly Clinics
Chemotherapy
Radiotherapy
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Patient Type Focused Factories?
Skin Cancer
Colon Cancer
Breast Cancer
Lung Cancer
Prostate Cancer
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Focus on Service? Or Patient? Or Mix?
Skin Cancer
Colon Cancer
Breast Cancer
Lung Cancer
OR
Prostate Cancer
Radiology
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Research Question

• General How can we quantify the impact of
  decentralizing a centralized service?
• Chemotherapy Case Study Design a decentralized
  service (Breast Cancer and Non Breast Cancer)
  that maintains the performance of the existing
  centralized department

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Presentation Focus
Chemotherapy (Existing)
Economies of Scale? or Economies of Focus?
Breast Cancer Chemotherapy
Non Breast Cancer Chemotherapy
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About Chemotherapy Dept.
New
F/U
Pnt. in Bed for Treatment
Pnt. Arrives
Pnt. in Wait Room
Pnt. Leaves
Appt. Request
Access Time lt 5 of patients Should wait
more than 1 days

• Appointment
• Clinic Runs Smoothly when beds are
• Utilized at 90
• Nurses can manage
• Waiting Room time is reasonable
• Currently 30 beds

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About Chemotherapy Dept.
Black Box
New
F/U
Pnt. in Bed for Treatment
Pnt. in Wait Room
Pnt. Leaves
Pnt. Arr
Appt. Request
Arrival Rate (Patients / day) Poisson(70.2)

• Service Rate (Patients / day)
• Depends on
• Appointment Length
• Number of Beds

• Output / Performance
• Access Time
• Bed Utilization

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Service Rate
Appt. Length 90 mins
Appt. Length 60
P1
P2
P3
P4
Capacity Distribution in Patients /
day IntPoisson(?)/2
Capacity Distribution in Patients / day
Poisson(?)
Expo (1/?) Expo (1/?)
Expo (1/?)
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Model Output / Performance

• Lqn (Lqn-1 Arrivalsn Servedn)
• Wait Time Distribution
• Utilization Beds Used / Total Beds

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Scenario
Model Inputs Service Rate 2.7 Pnts/day Arrival
Rate 72.1 Pnts/day
Model Outputs Bed Utilization 90 Access time gt1
day lt5
Existing Chemotherapy
Beds 30
No Efficiency Improvement Expected Due to Focus
Service Rate 2.5 Pnts/day
Bed Utilization 90 Access time gt1 day lt5
BC Chemotherapy
Arrival Rate 42.6 Pnts/day
Beds ?
Service Rate 2.8 Pnts/day
Bed Utilization 90 Access time gt1 day lt5
NBC Chemotherapy
Arrival Rate 29.6 Pnts/day
Beds ?
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Breast Cancer Chemo
Targets Met
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Non Breast Cancer Chemo
Targets Met
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Results
Decentralized Service
Centralized Service
BC Chemotherapy
Equal Performance
Existing Chemotherapy
Beds 19
NBC Chemotherapy
Beds 30
Beds 13
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Case Study Conclusion

• A decentralized Chemotherapy Service requires a
  total of 32 beds to ensure the same performance
  as the existing 30 bed centralized Service

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General Considerations for FF

• Proportional Sizes of the decentralized groups
• Variability in Appointment Length
• Efficiency Improvement Due to Focus
• Different Performance expectations for different
  patients

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Advantages of Methodology

• Uses Data that is commonly available from
  outpatient Scheduling Systems
• Applicable in other Focused Factory Decisions
• Can determine the min Economies of Focus
• Applicable in other outpatient environments
• Can be easily adapted to answering a variety of
  questions related to different treatment plans
  for a certain segment of the patient population

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Other Applications

• Impact of Different Drugs with faster infusion
  times
• Impact of Less Frequent Return Appts
• Impact of Different Working hours
• Impact of Growing Demands
• Impact of Dedicated Lab service

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Give Drug A Orally
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Decision Support Tool
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Future Research

• Determine the combined advantages of multiple
  departments decentralized to a Focused Factory.

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Discussion Questions?