Tools for Data Driven Decisions

FOR OFFICIAL USE ONLY2

Agenda• The Toolkit• Designing for Outputs• Understanding Tool Inputs

• Data sources• Data collection• Tool parameters

• Spreadsheet Tools• Analytical Models• Simulation Models

FOR OFFICIAL USE ONLY3

Context, Purpose, Outcome

1) Context: Navy Medicine faces key operational decisions that can be made easier with the appropriate use of data through tools

2) Purpose: Guidance will be provided in choosing the right tool for the problem at hand, and examples of successful tools used for performance improvement will be discussed

3) Outcome: Identification of opportunities for decision tools and the appropriate application of these tools will lead to more confidence in future decision making

Tool Choice

"When the only tool you have is a hammer, every problem begins to resemble a nail."

– Abraham Maslow

FOR OFFICIAL USE ONLY4

FOR OFFICIAL USE ONLY5

The Toolkit• Spreadsheet Models• Analytical Models• Simulation• Other Support Tools

FOR OFFICIAL USE ONLY6

Designing for the Outputs

• What does the customer want out of the tool?• What questions are to be answered?

• What is a usable tool for the customer?• IT skill level• Angle of interest

• What decisions will be made with this tool?• Day-to-day operations?• System-wide planning?• Facilities/Construction?

• Beware of tendency to overdesign!

FOR OFFICIAL USE ONLY7

Understanding Tool Inputs

• Data inputs must match tool choice• Will the tool be “live” or based on a snapshot of

available data• Availability of input data impacts fidelity of output

• Quantity of data• Granularity of data• Quality of data

• Examples of data sources:• Less specific: M2• More specific: Local data pulls (CHCS, Operating Room

systems, Essentris)• Custom to needs: Manual data collection

FOR OFFICIAL USE ONLY8

Electronic Data Mining

• Reasons for electronic data mining• Existing processes can be described by the

data they generate• Allows for massive sample sizes

• Examples of electronic data sources• Coarse information: M2• Detailed information: CHCS, Essentris, S3, etc.• Custom information: data from specially built

applications such as a discharge board or triage board

FOR OFFICIAL USE ONLY9

Manual Data Collection

• Reasons for manual data collection• Validation of system data• Needed data not available in system

• Examples of manual data needs• Process times • Hourly volume counts

• Processes for manual data collection

FOR OFFICIAL USE ONLY10

Tool Parameters

• Queue types• What are processes for serving customers?

• Levers• Resources such as staff or rooms• Volumes• Process changes including sequencing and

scheduling

• Process types• Can be statistically described

• Acceptable service levels• What is acceptable wait time?• What is acceptable turn away rate?

Tool Parameter Examples

• Scheduling modalities• Templates• Random• Shortest case first

• Queuing• Number of queues• Number of servers

• Process types• Sequencing and

location of process steps

• Capacity• Rooms• Staff

• Service Levels• Wait time• ALOS• Resource

utilization• Patients deferred

FOR OFFICIAL USE ONLY11

FOR OFFICIAL USE ONLY12

Spreadsheet Tools

• Software tools widely available• Users familiar with interface• Distributable• Ability for modification• Less robust when representing dynamic

systems

FOR OFFICIAL USE ONLY13

Birth Volume Tool

• What is the primary question?• “How many births should be expected in

catchment area X?”

• Who are expected tool users?• High level decision makers, not “in the weeds”

• What decisions will be made with this tool?• System-wide planning• What-if ? analysis

FOR OFFICIAL USE ONLY

14

Birth Volume Tool

• Solution implemented: Spreadsheet Model

Select whether you want to use the baseline for % direct care, population change and fertility rate. If not, select “No” and enter data in blue cells

Forecast Results

Learn more at Population Based

Healthcare Delivery Design

(II) Session:Wednesday 1100-1200

FOR OFFICIAL USE ONLY15

OR Volume Tool• What is the primary question?

• “How do changes in volume and capacity impact OR utilization”

• Who are expected tool users?• Experienced analysts with report outs to

decision makers

• What decisions will be made with this tool?• System-wide planning• What-if ? analysis

FOR OFFICIAL USE ONLY

16

OR Volume Tool• Solution implemented: Spreadsheet Model

Click to Include

Procedures Have Same %

Click to Adjust Procedures

Your Considered

Volume

Average Case Time (hours)

Percentage Accepted

Accepted Volume

Total Case Room Hours

a a 494 4.80 100% 494 2373 IIIIII

a a 3314 2.99 50% 1641 4910 IIIIIIIIIIIII

a a 1332 2.58 50% 666 1720 IIII Chart data

a a 741 3.57 100% 741 2643 IIIIIIICase Room Hours

Target Room

a a 607 2.18 97% 592 1291 III Average Historic Volume (Step 1)53018.5 36144.0

a a 885 1.76 50% 439 773 II Considered Volume (Step 2)53018.5 36144.0

a a 2693 3.24 50% 1337 4328 IIIIIIIIIII Accepted Volume (Step 4)36116.3 36144.0

a a 453 1.93 34% 154 298

a a 1184 2.68 50% 587 1572 IIII

a a 831 2.70 50% 414 1118 III

a a 70 2.35 14% 10 22

a a 1265 3.26 50% 637 2077 IIIII

a a 607 3.67 65% 392 1439 III

a a 3042 3.80 100% 3042 11552 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

a

a

a

Total Accepted Case Room Hours11,145 36,144 36,116 Current scenario enables all case volume to be scheduled. There are 27

hours avilable to schedule more cases.

Unmatched

Urology_GU Surgery

Total Accepted Volume (count)

Target Utilization (in Hours)

Vascular

VIP and WW

Other Diagnostic_Therapeutic

Percent of HoursMOR Service Category

Cardiothoracic

General Surgery

GYN Surgery

Neurosurgery

Obstetrics

Ophthalmology

Orthopedic Surgery

Otolaryngology

Plastic_Recon Surgery

36,144

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

55,000

60,000

Average HistoricVolume (Step 1)

Considered Volume(Step 2)

Accepted Volume(Step 4)

Room

Cas

e Ti

me

in H

ours

FOR OFFICIAL USE ONLY17

OB Bed Sizing• What is the primary question?

• “What is the facility capacity?”

• Who are expected tool users?• Experienced analysts with report outs to

decision makers

• What decisions will be made with this tool?• Setting facility volume targets• Construction needs

FOR OFFICIAL USE ONLY18

OB Bed Sizing• Solution implemented:

• Spreadsheet model

• Spreadsheet model has many assumptions• Assumptions reduce data needs while

providing reasonable answer• Model can highlight the need for

additional analysis if results are borderline

FOR OFFICIAL USE ONLY19

OB Procedure Scheduling Model

• What is the primary question?• “How should inductions and c-sections be

scheduled to level demand”

• Who are expected tool users?• Experienced analysts with report outs to

decision makers

• What decisions will be made with this tool?• A recommended schedule template for c-

sections and inductions

FOR OFFICIAL USE ONLY20

OB Procedure Scheduling Model

• Solutions implemented• Analytical model produces a new template for

scheduled procedures that levels day of week peaks

FOR OFFICIAL USE ONLY21

Simulation Tools

• Software tools not widely available• Limited familiarity with tools• Very robust representation of dynamic

systems• Can require extensive data as inputs• Can provide very granular results

FOR OFFICIAL USE ONLY22

OB Simulation Model

• What is the primary question?• “What is the capacity of our facility?”

• Who are expected tool users?• Experienced analysts with report outs to

decision makers

• What decisions will be made with this tool?• Setting facility targets• Construction needs

FOR OFFICIAL USE ONLY23

OB Simulation Model

• Solution implemented:• Simulation identified the bottleneck was MBU

beds

• Additional analysis:• “Assuming process and facility

reconfigurations that alleviate the bottleneck, what is the new capacity”

• Solution recommended:• Reclaim non-used LDRP rooms and keep

vaginally delivered patients in the same room for entire stay

FOR OFFICIAL USE ONLY24

Pharmacy Simulation Model

• What is the primary question?• “What processes/equipment are required to

meet performance criteria at a given volume”

• Who are expected tool users?• Experienced analysts with report outs to

decision makers

• What decisions will be made with this tool?• Staffing decisions• Facility decisions• Equipment decisions

FOR OFFICIAL USE ONLY25

Pharmacy Simulation Model

• Solution implemented:• Simulation model• Complex input needs• Complex output processing needs

FOR OFFICIAL USE ONLY26

Simulation User Interface

• Run all possible scenarios and present results in spreadsheet model• Method for reducing

demands on users• Limit input requirements

for front line

FOR OFFICIAL USE ONLY27

Dynamic Decision Support Tools

• OB Forecasting Tool• Answers the question “Should I accept or

defer this patient”• Used by front line staff• Dynamically updated with live data