When Deborah Flint, director of Performance Engineering at the Kirklin Clinic of UAB Hospital, tackles a project to shorten wait times, streamline a process or improve clinic flow, she and her team have a number of tools they can use for maximum effectiveness.

One of these tools is a computer simulation program, Flexsim HC. "The computer simulation helps evaluate different scenarios we may have identified using Lean Six Sigma," she said. [See article in March issue.] "It helps us validate whether a new approach works. It allows us to see the impact before we pilot an idea. If we don't get good results, we decide not to implement it."

Users enter rooms, furniture and even staff into the program. "It's a visual display," Flint said. "It's almost like a little 3-D video game. You can watch the patient come in the door, check in, sit in the lobby and go back to the exam room. And you can watch the providers come in."

One example of a project the team might tackle is the problem of patients arriving faster than the clinic can process them at intake. If most providers arrange their schedules on the hour and half hour, the patient influx for the clinic peaks at those times. "You can end up with 10 people arriving in an area that only has two people to process them, or only two nurses to bring them back for intake. They get backed up," Flint said.

Her team's job is to develop processes that will smooth out the patient arrival and allow for a more even intake and less waiting time for patients. They may encourage practitioners to set appointments at 10 or 20 minutes after the hour, for instance. "We figure out what might work, and then we run the model in the computer simulation to see if that helps before we implement changes," Flint said. "Changing provider schedules is labor intensive. With simulation, we can test ideas and have a higher confidence they will work.'"

Flint also participates in a monthly webinar with other Flexsim HC users to share stories, modeling techniques, and results.

"Healthcare planners need an evaluative tool that can handle staffing, resource allocation, systems design and every other aspect of healthcare management," said Lou Keller, Jr., director of Healthcare Systems Applications for Flexsim Software Products, Inc. "Animation is the one tool that simulation brings to the planner's table that no other evaluative method can compete with. It serves not only as a means of validating the performance of the model but as both a research and teaching tool as well. It can enable a manager to see not only what's going on, but often why, without opening a single report.

"A blueprint is a representation of where things are done. A simulation is a representation of how things are done in that where thing. So the blueprint is solid, but not dynamic. The simulation takes into account all the variances that can be associated with patient care. The combination gives you a great tool for planning."

"Physicians like data," Flint said. "More often than not, they are open to change once they can see it, and that's where simulation really helps."

Keller praised Flint's application of the program at Kirklin. "She set out to develop simulation programs for all the clinical environments, so they can pull them out any time they want to look and see what changes will do to the characteristics of the clinic. It's like having a drawer full of blueprints," he said.

There are other simulation programs on the market besides Flexsim, but Keller stressed the importance of using one dedicated to healthcare. "Hospitals aren't factories, he said. "There is no product that leaves the front door when a patient checks out. Thinking of a hospital that way, or of a patient as a product, not only does a massive disservice to the patient, but it also robs the provider of the individuality we depend on to achieve quality care.

"Debbie's mission is not to speed things up. We aren't asking doctors to shave off 15 minutes from an appendectomy or have a quicker examination of a patient. Her mission is to determine where the impediments are that keep the system from operating the way it is supposed to operate."