Reallocating Resources to Focused Factories: A Case

Study in Chemotherapy

Peter Vanberkel, PhD Candidate

University of Twente

Netherlands Cancer institute – Antoni van Leeuwenhoek Hospital

Outline About Focused Factories

Case Study

Decision Support Tool

Focused Factories History

US Factory in the 1960

FocusedFactory

focus, simplicity and repetition breeds competence. – Skinner 1973

We produce everything!We produce Nothing Well

We produce fewer things!We produce them all Well

2006Manufacture

AndAssembly

Assembly

Pomegranate Phone: UltimateDo EVERYTHING phone(www. PomegranatePhone.com)

iPhone: Does less but doesEverything Well

General Hospitals

Health Care Focused Factories

Specialized Hospitals Specialized Clinics

Focused Factories within Hospitals

Poly Clinics

RadiologyOR

Chemotherapy

Radiotherapy

Patient Type Focused Factories?

Breast Cancer

Skin CancerColon Cancer

Lung Cancer

Prostate Cancer

Focus on Service? Or Patient? Or Mix?

Breast Cancer

Skin CancerColon Cancer

Lung Cancer

Prostate Cancer

OR

Radiology

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

Presentation Focus…

Chemotherapy (Existing)

Breast CancerChemotherapy

Non Breast CancerChemotherapy

Economies of Scale?or

Economies of Focus?

About Chemotherapy Dept.

Appt.Request

Pnt. Arrives

Pnt. inWait Room

Pnt. inBed for

TreatmentPnt.

Leaves

Appointment:• Clinic Runs Smoothly when beds areUtilized at 90%

• Nurses can manage• Waiting Room time is reasonable

• Currently 30 beds

Access Time:< 5% of patientsShould wait morethan 1 days

F/UNew

About Chemotherapy Dept.

Appt.Request

Pnt. inWait Room

Pnt. inBed for

TreatmentPnt.

Leaves

F/UNew

Black Box

Service Rate: (Patients / day)Depends on:

• Appointment Length• Number of Beds

Arrival Rate: (Patients / day)Poisson(70.2)

Pnt. Arr

Output / Performance:• Access Time• Bed Utilization

Service Rate

P1 P2 P3 P4

Expo (1/λ)Capacity Distribution inPatients / day: Poisson(λ)

Expo (1/λ) Expo (1/λ)Capacity Distribution inPatients / day:Int[Poisson(λ)/2]

Beds Poisson

1 2

)(

Appt. Length = 90 mins Appt. Length = 60

Model Output / Performance Lqn = (Lqn-1+ Arrivalsn – Servedn)+

Wait Time Distribution

Utilization = Beds Used / Total Beds

Scenario

Existing Chemotherapy

BC Chemotherapy

No Efficiency Improvement Expected Due to Focus

Model InputsService Rate: 2.7 Pnts/dayArrival Rate: 72.1 Pnts/day

Beds: 30

Model OutputsBed Utilization: 90%Access time >1 day: <5%

Service Rate: 2.5 Pnts/day

NBC Chemotherapy

Service Rate: 2.8 Pnts/day

Bed Utilization: 90%Access time >1 day: <5%

Bed Utilization: 90%Access time >1 day: <5%

Beds: ?

Beds: ?

Arrival Rate: 29.6 Pnts/day

Arrival Rate: 42.6 Pnts/day

Breast Cancer Chemo

Beds Bed Util% of Patients with

Access Time > 1

17 96.2% 27.9%

18 91.1% 9.1%

19 86.8% 3.8%TargetsMet

Non Breast Cancer Chemo

Beds Bed Util% of Patients with

Access Time > 1

11 96.6% 34.9%

12 88.7% 9.1%

13 81.5% 2.5%TargetsMet

Results

Existing Chemotherapy

BC Chemotherapy

Beds: 30 NBC Chemotherapy

Beds: 19

Beds: 13

EqualPerformance

Centralized Service Decentralized Service

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

General Considerations for FF1. Proportional Sizes of the decentralized

groups

2. Variability in Appointment Length

3. Efficiency Improvement Due to Focus

4. Different Performance expectations for different patients

Advantages of Methodology Uses Data that is commonly available from outpatient Scheduling SystemsApplicable 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

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

Give Drug A Orally

Decision Support Tool

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

Discussion & Questions?