Simio 2021 December
Student Competition
Simio Clinic and Urgent Care
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Overview
The Simio Clinic and Urgent Care (SCUC) is an institution that provides a variety of
medical services including wellness check-ups, minor trauma aid, lab testing, and
orthopedic care. The facility is prepared for both scheduled appointments and
unplanned arrivals. Patients are regularly slated for primary care appointments, but
the SCUC also treats unscheduled people in need of medical attention. Unscheduled
patients cannot wait days or weeks for an appointment, so the SCUC staff will assess
their condition and if possible, treat them at that time or send them to a hospital for
emergency care.
The SCUC administration is planning to expand its network and add a new facility. They
are requesting a team to assist in preparing for the construction and opening of the
new center. The administration wants to determine staffing levels and schedules to hire
employees for the new location. They are also seeking guidance regarding the number
and position of rooms for the layout. To acquire this information the team must review
historical activity logs to account for patient arrival patterns, treatment times, and
patient demographics.
The SCUC would like the team to provide staffing models assessing the tradeoffs
between patient satisfaction and cost of operation. Patient satisfaction is gauged by
metrics such as the time patients spend in the facility and how many patients leave
the facility without being treated. The administration would like to sustain reasonable
patient satisfaction levels but avoid overstaffing and empty treatment rooms which
increase operating costs. Additionally, the administration is considering investing in
new equipment but first would like to determine how it would affect key metrics.
Facility and Employees
This new urgent care center will be open 7 days a week starting at 7am. The facility
closes to new patients at 9pm but remains open until all patients have been seen.
Consequently, staff members in all departments are scheduled to stay until 10PM.
Past 10PM, only employees required for patients currently in the building are required
to work overtime. Any employees that are required to work beyond their scheduled
shift will receive overtime pay. Overtime pay is 150% of the staff member’s standard
rate. Staffing rules require 9-hour shift patterns with a 60-minute mid-shift break for all
employees. Table 1 shows the schedule patterns that are currently followed.
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Table 1: Typical shift schedule for staff.
Shift Type Working Periods
Shift Type Working Periods
Early 7am – Noon, 1pm – 5pm
Late Noon – 4pm, 5pm -10pm
The facility will be staffed by one or more of each of the following medical
professionals: nurses, general physicians, receptionists, imaging technicians, orthopedic
physicians, orthopedic technicians, and lab technicians. Table 2 provides the hourly rate
for each employee.
Table 2: The hourly cost for each type of employee.
Caregiver Cost per Hour
Receptionist $13
Nurse $35
Orthopedic Technician $25
Imaging Technician $21
Physician $90
Orthopedic Physician $110
Lab Technician $20
The facility will be comprised of a registration area, waiting room, triage area, and
rooms that can be used for exams, imaging, lab tests, and procedures. Rooms and
stations in the SCUC facilities require specialized machinery and equipment, which
have large maintenance and utility costs. The equipment in each type of room/station
varies, so each room/station accrues different costs. When the facility is opened each
day, all the equipment is powered on and it will remain on until the facility is closed at
the end of the day. While the equipment is powered on, each room incurs a cost at a
constant hourly rate. Table 3 provides the hourly rate of cost per room/station.
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Table 3: The hourly cost for each type of room or station.
Room/Station Cost per Hour
Triage Station $11
Exam Room $17
Procedure Room $30
Imaging Room $45
After each room/station has been used, the room/station must be cleaned and set up
for the next patient. In an exam room or at the triage station, this is done by a nurse. In
the imaging room, these tasks are managed by an imaging technician. In the procedure
room, the clean-up tasks are dependent on the patient that was last using the room.
If the patient was treated for an orthopedic diagnosis, an orthopedic technician
completes these tasks. In all other cases, a nurse oversees post procedure cleanup.
Patient Information
At the SCUC, patients are scheduled for one of three types of appointments. One
type of appointment is for a standard checkup/exam such as physicals, vaccinations, or
treatment follow-ups. The two other types of appointments are either for lab work or
an x-ray and casting. All other patients at the SCUC are unscheduled patients.
All new arrivals will first visit the registration desk, where they will speak to the
receptionist to acquire check-in paperwork. They will travel back to the waiting area to
fill out the papers, then return to the registration desk to complete their check-in. A co-
pay is required upon check-in.
While in the waiting room, patients occasionally decide that they want to leave without
being seen (LWBS). A patient’s LWBS tolerance time is defined as the length of time
a patient will wait after completing check-in, before deciding to cancel their co-pay
and exit the clinic. This tolerance time can vary based on the severity of the patient’s
condition.
Patients arriving for unscheduled treatments will be triaged by a nurse. While waiting
to be triaged, patients will stay in the waiting room. Patients with an appointment will
not be triaged but will also remain in the waiting room until a nurse is available to assist
them to their next location. All patient movements to or from a triage area, exam room,
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procedure room, or imaging room require assistance by a nurse. Patients requiring lab
work do not travel to the lab. Instead, the technician will travel to the location of the
patient, collect the samples, and return with the samples to the lab. Patients will depart
the facility and will be notified of lab results after the tests are complete.
Patients who are feeling unwell may be moving at slower than average walking speeds
when traveling throughout the building. Some patients might also require additional
aid if they have limited mobility. Wheelchairs are always readily available at the SCUC.
It is estimated that 50% of geriatric patients will need a wheelchair during their visit.
Additionally, about 50% of patients who have come in with a severe orthopedic
injury will need a wheelchair due to the location of their trauma. The patients with
wheelchairs will move on average 0.5 meters per second.
As patients arrive at the reception desk, they are helped in order of their arrival. At
reception, a quick assessment is made to determine if a patient should be considered
“urgent” or “stable”. Patients labeled as “urgent” will be called back to triage by the
nurse before patients labeled as “stable”. Once a patient’s condition is assessed at
triage, they are assigned a numeric priority. Table 4 specifies the types of patients,
along with their priority. Nurses use a patient’s priority to determine who is moved
into an open room so that more critical patient types are seen first. A smaller number
indicates a more critical patient condition.
Table 4: The patient types treated at the SCUC and their associated ID and priority.
Patient Type Type ID Priority
Mild Sickness 1 5
Standard Sickness 2 4
Injuries Ortho-setting/casting 3 2
Injuries Ortho- Non setting/casting 4 3
Injuries – Laceration 5 2
Injuries – Minor Cut Bruise 6 3
Cardio problems 7 1
Severe Non-Treatable 8 1
Scheduled Appointment 9 5
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Activity and Patient Data
Since the new facility is not yet operational, the team will be unable to make decisions
based on data from the actual facility. Therefore, the administration has prepared
historical data from another SCUC location, known as SCUC West, for the team
to analyze. The new SCUC location will perform many of the same treatments and
procedures as the existing SCUC West location, so SCUC West’s data can be used to
generalize how the new facility might operate.
Files given to review include SCUC West ‘s patient records which share information on
demographics such as age and gender. Patients 65 and older are considered geriatric
patients while patients under the age of 18 are considered pediatric patients. These
demographics could impact treatment times for certain procedures. For example,
patients in the 18-64 age range might be observed for longer after cardio treatment
since cardio issues are more likely to begin developing in this age range.
SCUC has also prepared patient logs from SCUC West’s patient treatment database.
The logs contain timestamped patient activities starting when they request check-in
paperwork and ending when they complete checkout. The log includes information
about rooms and staff required for each task. Due to the equipment required, some
procedures are only done in a procedure room, not an exam room.
SCUC facilities use a system to display and record the statuses of the rooms. Statuses
indicate if the room is available, unavailable, or being cleaned. This allows the
caregivers to know if a patient can be moved into a room or if the room must be
sanitized and set up for the next patient. The time a room is unavailable might not
reflect the total time it is in use, as caregivers are not always readily available to start
cleaning. The log collecting the timestamps and status changes for rooms from the
SCUC West location is included in the provided data.
Because the new urgent care is located in a new area, the administration anticipates a
notable change in patient demographics, which in turn will affect the mix and average
service times of patients. Table 5 shows the established SCUC West’s estimated age
demographics and the new locations predicted age demographics. In addition to age
demographics, the estimated service population of the new location is significantly
larger than the SCUC West location. The estimated service population of the SCUC
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West is 154,000, while the estimated service population of the new location is 223,000.
The administration expects this increase in service population to affect both the
number of scheduled patients and the number of unscheduled patients.
Table 5: The age demographics of the population each SCUC facility serves.
Pediatric Middle-aged Geriatric
Established location
(SCUC West) –
estimated age
demographics
25% 58% 17%
New location –
predicted age
demographics
9% 55% 36%
Analysis and Problem Deliverables
The primary objective of this project is to minimize the cost of the proposed new
facility in terms of the number of rooms and staffing levels to achieve a reasonable
level of patient satisfaction. The SCUC measures patient satisfaction using two metrics:
patient time in the clinic and the percentage of patients who leave without being seen
(LWBS). The administration does not have a quantitative goal for how long patients are
in the facility, but in general, would like to decrease the length of time. Although an
LWBS of 0% is ideal, this may be cost prohibitive to achieve. An LWBS of 10% or more is
considered unacceptable.
The SCUC administration would like evidence that shows the model is a good
representation of their future facility. Devise and implement a validation plan for the
project.
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Evaluation Questions:
1. The requirements for the new facility’s layout have not yet been determined.
With the growth of service population, the SCUC administration anticipates the relative
position and quantity of rooms may change. What staffing level and number of each
type of room results in the lowest cost while maintaining an acceptable LWBS level?
Include a recommendation about how rooms/stations might be placed for optimal
patient flow.
2. Offer alternative employee schedules showing tradeoffs between patient
satisfaction and cost. Should staffing levels change throughout the week?
3. Study the effect of hiring physician assistants (PA) for the new location. PAs have
an hourly rate of $55 and can cover the physician’s roles for patients that are mildly sick,
patients with minor and major lacerations, and patients with scheduled check-ups.
4. Since there are no scheduled appointments on weekends, demand for
orthopedic physicians might be reduced. Consider testing an approach where one or
more of the orthopedic physicians are on-call for part or all of Saturday or Sunday. If
on-call, it takes about 30 minutes for the orthopedic physician to arrive at the center. In
this scenario, they will receive 50% of their regular pay while on-call and 150% if called
in. If called in, they will continue to be paid 50% of their regular pay while traveling to
the facility.
5. The SCUC must be prepared for occurrences which might cause an influx
of patients to arrive. If all scheduled appointments for a day are canceled, what is
the anticipated maximum number of unscheduled patients that can be seen within
standard operating hours? Assume that no new patients will be accepted past closing
time. Adjust staffing levels accordingly, but the layout decided in the standard
operating plan must remain the same.
Challenge Problem A
The SCUC administration is considering adding a different type of room to the facility.
This will be a versatile space that is used to triage patients as well as perform exam
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room activities. The hourly cost for the hybrid room will be $21 per hour and the
cleaning time will be roughly similar to that of an exam room. Determine if the SCUC
should build any of these hybrid rooms. Will these replace any triage stations or exam
rooms from the initial layout design?
Challenge Problem B
The SCUC is evaluating if the addition of kiosks to automate the check-in and check-
out process would benefit the facility. These kiosks would be able to perform all the
same tasks as the registration desk. When checking in with a kiosk, instead of working
on paperwork while sitting in the waiting room, the patient will use the machine to
complete the required documents. The kiosk will also accept patients’ co-pay and can
refund patients if they choose to leave without being seen. When using the machine,
there is a 4% chance the check-in or check-out will fail. When a failure occurs, the
patient will need to restart the process with a receptionist. One kiosk will cost $1,845
dollars, and each year a $1,500 general service fee is required for software maintenance
which covers all kiosks. Should the SCUC invest in kiosk machines, and if so, how many?
How long before the SCUC would see a return on their investment?
Data File
Included in the SCUC West – Data Logs Excel workbook (SCUCWestDataLogs.xlsx) are
three sheets: Activity Log, Patient Data, and Room Log. The link to the file containing
the SCUC West data can be found below.
https://cdn.simio.com/StudentCompetition/2021_SCUCWestDataLogs.xlsx
https://cdn.simio.com/StudentCompetition/2021_SCUCWestDataLogs.xlsx