SimulationUsingPromodel
SimulationUsingPromodel
Using ProModel
4th Edition
SAN DIEGO
Bassim Hamadeh, CEO and Publisher
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Foreword xxv
Acknowledgments xxvii
1 Introduction to Simulation 3
1.1 Introduction 3
1.12 Summary 21
References 31
Further Reading 32
2 System Dynamics 33
2.1 Introduction 33
2.3.1 Entities 36
2.3.2 Activities 36
2.3.3 Resources 36
2.3.4 Controls 37
2.4.1 Interdependencies 38
2.4.2 Variability 39
2.9.2 Spreadsheets 49
2.10 Summary 54
2.11 Review Questions 54
References 56
3 Simulation Basics 57
3.1 Introduction 57
3.6 Summary 84
References 86
4 Discrete-Event Simulation 87
4.1 Introduction 87
References 113
5 Data Collection and Analysis 115
References 159
References 190
7 Model Verification and Validation 191
References 207
8 Simulation Output Analysis 209
References 241
9 Comparing Systems 243
References 274
10 Simulation Optimization 275
References 297
11 Design of Simulation Experiments 301
Runs 304
Replication 304
References 317
12 Modeling Manufacturing Systems 319
References 340
References 363
References 381
Part 2 LABS 383
Reference 579
8 Simulation Output Analysis 581
Reference 706
14 Modeling Service Systems 707
Index 804
S imulation is a computer modeling and analysis technique used to evaluate and improve
dynamic systems of all types. Imagine being in a highly competitive industry that is burdened
by outdated technologies and inefficient management practices. In order to stay competitive,
you know that changes must be made, but you are not exactly sure what changes would work
best, or if certain changes will work at all. You would like to be able to try out a few different
ideas, but you recognize that this would be very time-consuming, expensive, and disruptive to
the current operation. Now, suppose that there was a way you could make a duplicate of your
system and have unlimited freedom to rearrange activities, reallocate resources, or change
any operating procedures. What if you could even try out completely new technologies and
radical new innovations all within just a matter of minutes or hours? Suppose, further, that
all of this experimentation could be done in compressed time with automatic tracking and
reporting of key performance measures. Not only would you discover ways to improve your
operation, but it could all be achieved risk free—without committing any capital, wasting any
time, or disrupting the current system. This is precisely the kind of capability that simulation
provides. Simulation lets you experiment with a computer model of your system in compressed
time, giving you decision-making capability that is unattainable in any other way.
This text is geared toward simulation courses taught at either an undergraduate or a grad-
uate level. It contains an ideal blend of theory and practice and covers the use of simulation in
both manufacturing and service systems. This makes it well suited for use in courses in either
an engineering or a business curriculum. It is also suitable for simulation courses taught in
statistics and computer science programs. The strong focus on the practical aspects of sim-
ulation also makes it a book that any practitioner of simulation would want to have on hand.
This text is designed to be used in conjunction with ProModel simulation software, which
may or may not accompany the book, depending on how the book was purchased. ProModel
is one of the most powerful and popular simulation packages used today for its ease of use
and flexibility. ProModel was the first fully commercial, Windows-based simulation package
and the first to introduce simulation optimization to maximize the performance of a system.
ProModel is used in organizations and taught in universities and colleges throughout the world.
While many teaching aids have been developed to train individuals in the use of ProModel,
this is the only full-fledged textbook written for teaching simulation using ProModel.
xxv
Simulation is a learn-by-doing activity. The goal of this text is not simply to introduce
students to the topic of simulation, but to develop competence in the use of simulation. To
this end, the book contains plenty of real-life examples, case studies, and lab exercises to
give students actual experience in the use of simulation. Simulation texts often place too
much emphasis on the theory behind simulation and not enough emphasis on how it is used
in actual problem-solving situations. In simulation courses we have taught over the years, the
strongest feedback we have received from students is that they wish they had more hands-on
time with simulation beginning from the very first week of the semester. The book expressly
addresses this feedback.
This text is divided into two parts: a section on the general science and practice of simula-
tion, and a lab section to educate readers in the use of simulation with ProModel. Additionally,
numerous supplemental materials are available on the Cognella website. While the book is
intended for use with ProModel, the division of the book into two parts permits a modular
use of the book, allowing either part to be used independently of the other part.
Part I consists of study chapters covering the science and technology of simulation. The
first four chapters introduce the topic of simulation, its application to system design and
improvement, and how simulation works. Chapters 5 through 11 provide both the practical
and theoretical aspects of conducting a simulation project, including applying simulation opti-
mization. Chapters 12 through 14 cover specific applications of simulation to manufacturing,
material handling, and service systems.
Part II is the lab portion of the book containing exercises for developing simulation skills
using ProModel. The labs are correlated with the study chapters in Part I so that Lab 1 should
be completed along with Chapter 1 and so on. There are 14 chapters and 14 labs. The labs are
designed for hands-on learning by doing. Readers are taken through the steps of modeling a
situation and then are given exercises to complete on their own.
This text focuses on the use of simulation to solve problems in the two most common types
of systems today: manufacturing and service systems. Manufacturing and service systems
share much in common. They both consist of activities, resources, and controls for processing
incoming entities. The performance objectives in both instances relate to quality, efficiency,
cost reduction, process time reduction, and customer satisfaction. In addition to having
common elements and objectives, they are also often interrelated. Manufacturing systems are
supported by service activities such as product design, order management, or maintenance.
Service systems receive support from production activities such as food production, check
processing, or printing. Regardless of the industry in which one ends up, an understanding of
the modeling issues underlying both systems will be helpful.
xxvi
Acknowledgments
N o work of this magnitude is performed in a vacuum, independently of the help and assis-
tance of others. We are indebted to many colleagues, associates, and other individuals
who had a hand in this project. John Mauer (Geer Mountain Software provided valuable
information on input modeling and the use of Stat::Fit. Dr. John D. Hall (APT Research, Inc.
helped to develop and refine the ANOVA material in Chapter 10. Kerim Tumay (Kiran Analytics
provided valuable input on the issues associated with service system simulation.
We are grateful to all the reviewers of past editions not only for their helpful feedback, but
also for their generous contributions and insights. For their work in preparation of this fourth
edition, we particularly want to thank: Krishna Krishnan, Wichita State University; Robert
H. Seidman, Southern New Hampshire University; Lee Tichenor, Western Illinois University;
Hongyi Chen, University of Minnesota, Duluth; Anne Henriksen, James Madison University;
Leonid Shnayder, Stevens Institute of Technology; Bob Kolvoord, James Madison University;
Dave Keranen, University of Minnesota, Duluth; Wade H Shaw, Florida Institute of Technology;
and Marwa Hassan, Louisiana State University.
Many individuals were motivational and even inspirational in taking on this project: Lou
Keller, the late Rob Bateman, Richard Wysk, Dennis Pegden, and Joyce Kupsh, to name a few.
We would especially like to thank our families for their encouragement and for so generously
tolerating the disruption of normal life caused by this project.
Thanks to all of the students who provided valuable feedback on the first, second and
third editions of the text. It is for the primary purpose of making simulation interesting and
worthwhile for students that we have written this book.
We are especially indebted to all the wonderful people at ProModel Corporation who
have been so cooperative in providing software and documentation, especially Christine
Bunker-Crawford. Were it not for the excellent software tools and accommodating support
staff at ProModel, this book would not have been written.
Finally, we thank the editorial and production staff at Cognella Publishing: Mieka Portier,
Rose Tawy, Tony Paese, and Abbey Hastings. They have been great to work with.
xxvii
Part I
Study Chapters
1 Introduction to Simulation
2 System Dynamics
3 Simulation Basics
4 Discrete-Event Simulation
6 Model Building
9 Comparing Systems
10 Simulation Optimization
1
Chapter
Chapter 1#
Introduction to Simulation
1.1 INTRODUCTION
On March 19, 1999, the following story appeared in the Wall Street Journal, p. A1:
Captain Chet Rivers knew that his 747–400 was loaded to the limit. The giant plane,
weighing almost 450,000 pounds by itself, was carrying a full load of passengers and
baggage, plus 400,000 pounds of fuel for the long flight from San Francisco to Australia.
As he revved his four engines for takeoff, Capt. Rivers noticed that San Francisco’s famous
fog was creeping in, obscuring the hills to the north and west of the airport.
At full throttle, the plane began to roll ponderously down the runway, slowly at first
but building up to flight speed well within normal limits. Capt. Rivers pulled the throttle
back and the airplane took to the air, heading northwest across the San Francisco Pen-
insula towards the ocean. It looked like the start of another routine flight. Suddenly the
plane began to shudder violently. Several loud explosions shook the craft and smoke
and flames, easily visible in the midnight sky, illuminated the right wing. Although the
plane was shaking so violently that it was hard to read the instruments, Capt. Rivers
was able to tell that the right inboard engine was malfunctioning, backfiring violently.
He immediately shut down the engine, stopping the explosions and shaking.
However, this introduced a new problem. With two engines on the left wing at
full power and only one on the right, the plane was pushed into a right turn, bringing
it directly towards San Bruno Mountain, located a few miles northwest of the airport.
Capt. Rivers instinctively turned his control wheel to the left to bring the plane back on
William M. Carley, Selection from “United 747's Near Miss Initiates A Widespread Review of Pilot Skills,” The Wall
Street Journal. Copyright © 1999 by Dow Jones & Company, Inc. Reprinted with permission.
3
course. That action extended the ailerons—control surfaces on the trailing edges of the
wings—to tilt the plane back to the left. However, it also extended the spoilers—panels
on the tops of the wings—increasing drag and lowering lift. With the nose still pointed
up, the heavy jet began to slow. As the plane neared stall speed, the control stick began
to shake to warn the pilot to bring the nose down to gain air speed. Capt. Rivers imme-
diately did so, removing that danger, but now San Bruno Mountain was directly ahead.
Capt. Rivers was unable to see the mountain due to the thick fog that had rolled in,
but the plane’s ground proximity sensor sounded an automatic warning, calling “terrain,
terrain, pull up, pull up.” Rivers frantically pulled back on the stick to clear the peak, but
with the spoilers up and the plane still in a skidding right turn, it was too late. The plane
and its full load of 100 tons of fuel crashed with a sickening explosion into the hillside
just above a densely populated housing area.
“Hey Chet, that could ruin your whole day,” said Capt. Rivers’ supervisor, who was
sitting beside him watching the whole thing. “Let’s rewind the tape and see what you
did wrong.” “Sure Mel,” replied Chet as the two men stood up and stepped outside the
747-cockpit simulator. “I think I know my mistake already. I should have used my rudder,
not my wheel, to bring the plane back on course. Say, I need a breather after that expe-
rience. I’m just glad that this wasn’t the real thing.”
The incident above was never reported in the nation’s newspapers, even though it
would have been one of the most tragic disasters in aviation history, because it never really
happened. It took place in a cockpit simulator, a device which uses computer technology
to predict and recreate an airplane’s behavior with gut-wrenching realism.
The relief you undoubtedly felt to discover that this disastrous incident was just a simulation
gives you a sense of the impact that simulation can have in averting real-world catastrophes.
This story illustrates just one of the many ways simulation is being used to help minimize the
risk of making costly and sometimes fatal mistakes in real life. Simulation technology is finding
its way into an increasing number of applications ranging from training for aircraft pilots to the
testing of new product prototypes. The one thing that these applications have in common is
that they all provide a virtual environment that helps prepare for real-life situations, resulting
in significant savings in time, money, and even lives.
One area where simulation is finding increased application is in manufacturing and service
system design and improvement. Its unique ability to accurately predict the performance of
complex systems makes it ideally suited for systems planning. Just as a flight simulator reduces
the risk of making costly errors in actual flight, system simulation reduces the risk of having
systems that operate inefficiently or that fail to meet minimum performance requirements.
While this may not be life-threatening to an individual, it certainly places a company (not to
mention careers) in jeopardy.
• What is simulation?
• Why is simulation used?
• How is simulation performed?
• When and where should simulation be used?
• What are the qualifications for doing simulation?
• How is simulation economically justified?
The purpose of this chapter is to create an awareness of how simulation is used to visualize,
analyze, and improve the performance of manufacturing and service systems.
simulation itself optimizes, but scenarios that satisfy defined feasibility constraints can be
automatically run and analyzed using special goal-seeking algorithms.
This book focuses primarily on discrete-event simulation, which models the effects of the
events in a system as they occur over time. Discrete-event simulation employs statistical meth-
ods for generating random behavior and estimating model performance. These methods are
sometimes referred to as Monte Carlo methods because of their similarity to the probabilistic
outcomes found in games of chance, and because Monte Carlo, a tourist resort in Monaco,
was such a popular center for gambling.
The power of simulation lies in the fact that it provides a method of analysis that is not
only formal and predictive but is capable of accurately predicting the performance of even
the most complex systems. Deming (1989) states, “Management of a system is action based
on prediction. Rational prediction requires systematic learning and comparisons of predictions
of short-term and long-term results from possible alternative courses of action.” The key to
sound management decisions lies in the ability to accurately predict the outcomes of alternative
courses of action. Simulation provides precisely that kind of foresight. By simulating alternative
production schedules, operating policies, staffing levels, job priorities, decision rules, and the
like, a manager can more accurately predict outcomes and therefore make more informed
and effective management decisions. With the importance in today’s competitive market of
“getting it right the first time,” the lesson is becoming clear: if at first you do not succeed, you
probably should have simulated it.
By using a computer to model a system before it is built or to test operating policies before
they are implemented, many of the pitfalls that are often encountered in the start-up of a new
system or the modification of an existing system can be avoided. Improvements that tradi-
tionally took months and even years of fine-tuning to achieve can be attained in a matter of
days or even hours. Because simulation runs in compressed time, weeks of system operation
can be simulated in only a few minutes or even seconds. The characteristics of simulation
that make it such a powerful planning and decision-making tool can be summarized as follows:
Because simulation accounts for interdependencies and variation, it provides insights into
the complex dynamics of a system that cannot be obtained using other analysis techniques.
Decisions should be of an operational nature. Perhaps the most significant limitation of sim-
ulation is its restriction to the operational issues associated with systems planning in which
a logical or quantitative solution is being sought. It is not very useful in solving qualitative
problems such as those involving technical or sociological issues. For example, it cannot tell
you how to improve machine reliability or how to motivate workers to do a better job (although
it can assess the impact that a given level of reliability or personal performance can have on
overall system performance). Qualitative issues such as these are better addressed using other
engineering and behavioral science techniques.
Processes should be well defined and repetitive. Simulation is useful only if the process being
modeled is well structured and repetitive. If the process does not follow a logical sequence
and adhere to defined rules, it may be difficult to model. Simulation applies only if you can
describe how the process operates. This does not mean that there can be no uncertainty in the
system. If random behavior can be described using probability expressions and distributions,
they can be simulated. It is only when it is not even possible to make reasonable assumptions
of how a system operates (because either no information is available, or behavior is totally
erratic) that simulation (or any other analysis tool for that matter) becomes useless. Likewise,
one-time projects or processes that are never repeated the same way twice are poor candi-
dates for simulation. If the scenario you are modeling is likely never going to happen again, it
is of little benefit to do a simulation.
Activities and events should be interdependent and variable. A system may have lots of activ-
ities, but if they never interfere with each other or are deterministic (that is, they have no
variation), then using simulation is probably unnecessary. It is not the number of activities that
makes a system difficult to analyze. It is the number of interdependent, random activities. The
effect of simple interdependencies is easy to predict if there is no variability in the activities.
Determining the flow rate for a system consisting of ten processing activities is very straight-
forward if all activity times are constant and activities are never interrupted. Likewise, random
activities that operate independently of each other are usually easy to analyze. For example,
• Project management
• Communication
• Systems engineering
• Statistical analysis and design of experiments
• Modeling principles and concepts
• Basic programming and computer skills
• Training on one or more simulation product
• Familiarity with the system being investigated
Experience has shown that some people learn simulation more rapidly and become more
adept at it than others. People who are good abstract thinkers yet also pay close attention to
detail seem to be the best suited for doing simulation. Such individuals can see the forest while
keeping an eye on the trees (these are people who tend to be good at putting together one-
thousand-piece puzzles). They can quickly scope a project, gather the pertinent data, and get
a useful model up and running without lots of starts and stops. A good modeler is somewhat
of a sleuth, eager yet methodical and discriminating in piecing together all the evidence that
will help put the model pieces together.
Step 1: Define objective and plan the study. Define the purpose of the simulation
project and what the scope of the project will be. A project plan needs to be developed
to determine the resources, time, and budget requirements for carrying out the project.
Step 2: Collect and analyze system data. Identify, gather, and analyze the data defining
the system to be modeled. This step results in a conceptual model and a data document
on which all can agree.
Define objective
Step 3: Build the model. Develop a simulation model of the and plan study
system.
Step 4: Validate the model. Debug the model and make sure it is Collect and analyze
a credible representation of the real system. system data
Step 6: Present the results. Present the findings and make rec-
ommendations so that an informed decision can be made.
Validate model
Each step need not be completed in its entirety before moving
to the next step. The procedure for doing a simulation is an iter-
ative one in which activities are refined and sometimes redefined
Conduct
with each iteration. The decision to push toward further refine- experiments
ment should be dictated by the objectives and constraints of the
study as well as by sensitivity analysis, which determines whether
additional refinement will yield meaningful results. Even after the Present results
Following is a list of sample design and operational questions that simulation can help
answer. They are intended as examples of specific objectives that might be defined for a
simulation study.
1. How many operating personnel are needed to meet required production or service
levels?
2. What level of automation is the most cost-effective?
3. How many machines, tools, fixtures, or containers are needed to meet throughput
requirements?
4. What is the least-cost method of material handling or transportation that meets pro-
cessing requirements?
5. What are the optimum number and size of waiting areas, storage areas, queues, and
buffers?
6. Where are the bottlenecks in the system, and how can they be eliminated?
7. What is the best way to route material, customers, or calls through the system?
8. What is the best way to allocate personnel to specific tasks?
9. How much raw material and work-in-process inventory should be maintained?
10. What is the best production control method (Kanban, JIT, Lean, etc.)?
When the goal is to analyze some aspect of system performance, the tendency is to think
in terms of the mean or expected value of the performance metric. For example, we are
Once these issues have been settled, a project schedule can be developed showing each
of the tasks to be performed and the time to complete each task. Remember to include
sufficient time for documenting the model and adding any final touches to the animation for
presentation purposes. Any additional resources, activities (travel, etc.) and their associated
costs should also be identified for budgeting purposes.
System cost
simulation
simulation can compare with
the cost of designing and oper- Cost with
simulation
ating systems without the use
of simulation. Note that while
the short-term cost may be
slightly higher due to the added
labor and software costs asso- Design Implementation Operation
phase phase phase
ciated with simulation, the
long-term costs associated Figure 1.5 Comparison of cumulative system costs with and
with capital investments and without simulation.
system operation are consid-
erably lower due to better
efficiencies realized through simulation. Dismissing the use of simulation based on sticker price
is myopic and shows a lack of understanding of the long-term savings that come from having
well-designed, efficiently operating systems.
Many examples can be cited to show how simulation has been used to avoid costly errors in
the startup of a new system. Simulation prevented an unnecessary expenditure when a Fortune
500 company was designing a facility for producing and storing subassemblies and needed
to determine the number of containers required for holding the subassemblies. It was initially
felt that 3,000 containers were needed until a simulation study showed that throughput did
not improve significantly when the number of containers was increased from 2,250 to 3,000.
By purchasing 2,250 containers instead of 3,000, a savings of $528,375 was expected in the
first year, with annual savings thereafter of over $200,000 due to the savings in floor space
and storage resulting from having 750 fewer containers (Law and McComas 1988).
Even if dramatic savings are not realized each time a model is built, simulation at least
inspires confidence that a particular system design is capable of meeting required performance
objectives and thus minimizes the risk often associated with new startups. The economic
benefit associated with instilling confidence was evidenced when an entrepreneur, who was
attempting to secure bank financing to start a blanket factory, used a simulation model to show
the feasibility of the proposed factory. Based on the processing times and equipment lists
supplied by industry experts, the model showed that the output projections in the business
plan were well within the capability of the proposed facility. Although unfamiliar with the
blanket business, bank officials felt more secure in agreeing to support the venture (Bateman
et al. 1997).
Often simulation can help improve productivity by exposing ways of making better use of
existing assets. By looking at a system holistically, long-standing problems such as bottlenecks,
• GE Nuclear Energy was seeking ways to improve productivity without investing large
amounts of capital. Using simulation, the company was able to increase the output of
highly specialized reactor parts by 80 percent. The cycle time required for production
of each part was reduced by an average of 50 percent. These results were obtained by
running a series of models, each one solving production problems highlighted by the
previous model (Bateman et al. 1997).
• A large manufacturing company with stamping plants located throughout the world
produced stamped aluminum and brass parts on order according to customer specifica-
tions. Each plant had from 20 to 50 stamping presses that were utilized anywhere from
20 to 85 percent. A simulation study was conducted to experiment with possible ways
of increasing capacity utilization. As a result of the study, machine utilization improved
from an average of 37 to 60 percent (Hancock, Dissen, and Merten 1977).
• A diagnostic radiology department in a community hospital was modeled to evaluate
patient and staff scheduling, and to assist in expansion planning over the next five years.
Analysis using the simulation model enabled improvements to be discovered in operating
procedures that precluded the necessity for any major expansions in department size
(Perry and Baum 1976).
In each of these examples, significant productivity improvements were realized without the
need for making major investments. The improvements came through finding ways to operate
more efficiently and utilize existing resources more effectively. These capacity improvement
opportunities were brought to light using simulation.
1.12 SUMMARY
Businesses today face the challenge of quickly designing and implementing complex produc-
tion and service systems that are capable of meeting growing demands for quality, delivery,
affordability, and service. With recent advances in computing and software technology, simu-
lation tools are now available to help meet this challenge. Simulation is a powerful technology
that is being used with increasing frequency to improve system performance by providing a
way to make better design and management decisions. When used properly, simulation can
reduce the risks associated with starting up a new operation or making improvements to
existing operations.
1.13 REVIEW QUESTIONS
1. Define simulation.
2. What reasons are there for the increased popularity of computer simulation?
3. What are two specific questions that simulation might help answer in a bank? In a
manufacturing facility? In a dental office?
4. What are three advantages that simulation has over alternative approaches to systems
design?
5. Does simulation itself optimize a system design? Explain.
6. How does simulation follow the scientific method?
7. A restaurant gets extremely busy during lunch (11:00 A.M. to 2:00 P.M.) and manage-
ment is trying to decide whether it should increase the number of servers from two to
three. What considerations would you look at to determine whether simulation should
be used to make this decision?
8. How would you develop an economic justification for using simulation?
9. Is a simulation exercise wasted if it exposes no problems in a system design? Explain.
10. A simulation run was made showing that a modeled factory could produce 130 parts
per hour. What information would you want to know about the simulation study
before placing any confidence in the results?
11. A PC board manufacturer has high work-in-process (WIP) inventories, yet machines
and equipment seem underutilized. How could simulation help solve this problem?
12. How important is a statistical background for doing simulation?
13. How can a programming background be useful in doing simulation?
14. Why are good project management and communication skills important in simulation?
15. Why should the process owner be heavily involved in a simulation project?
Objectives:
• Predict the potential impact of thruster motor supplies on the shuttle flight manifest.
• Reduce the probability of a shuttle launch delay by improving the supply of thruster
motors.
Figure 1.6 Simulation model of space shuttle thruster motor supply chain.
Figure 1.7 illustrates the nose cap of the space shuttle Atlantis OV-104 showing one F3
thruster motor failed inspection (in red) following a mission during the model run. The three
surrounding thrusters in yellow must also be removed since all four thrusters are serviced
from the same manifold. Figures 1.8 and 1.9 provide additional details on thrusters. Shuttles
Atlantis and Discovery are shown in Figures 1.10 and 1.11.
Figure 1.8 Thruster motor locations within the Figure 1.9 A Vernier thruster
sides and top of a shuttle orbiter nose cap. motor removed from a shuttle
orbiter.
To keep up with the growing demand for healthcare and meet the requirements of the Afford-
able Care Act, AltaMed decided to examine facility expansions, as well as the addition of
numerous new clinics to its network. It also needed to make sure that its proposed layouts
would fully support the added growth expected. However, it first wanted to determine if it
could increase its current facility capacity by better understanding patient flow. In the past,
it was common for AltaMed to simply convert existing administration space into exam rooms
Objectives
1. Simulate approximately thirty different clinics by using 1 easily configurable model
template.
2. Create suitable data sets for each clinic so a reasonable representation of each clinic
could be tested.
3. Analyze room utilization rates under various potential policy changes.
4. Increase efficiencies by identifying and eliminating waste.
5. Optimize provider/patient interaction.
Solution
The AltaMed team chose its Garden Grove clinic to begin the examination of patient flow
before expanding research across the whole system. Garden Grove was in the process of
requesting the construction of additional exams rooms to relieve current patient flow bottle-
necks and future demand. AltaMed wanted to contrast the current seventeen exams rooms
versus the requested twenty-four rooms to better understand effect on patient flow and
justification for expansion.
60%
50%
40%
30%
20%
10%
0%
2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44
Average
Room number
Figure 1.12 Baseline average room utilization for each of the seventeen exam rooms at the Garden
Grove clinic.
Results
Figure 1.14 shows the result of a scenario in which the seventeen exam rooms were unas-
signed as opposed to the company’s normal policy of preassigning exam rooms to specific
physicians. Point 1 on the chart represents the baseline situation of 60 percent room utili-
zation, allowing them to treat about 2,418 patients during the course of a year, with each
patient spending about 1.23 hours in the clinic. Point 2 on the chart shows that they could
see about 40 percent more patients (3,448) before patient length-of-stay began to increase.
4,500 80%
Room utilization
3,969 4,076
4,000 75%
Patients
3,809
3,926 4,011
3,624
3,711
3,500 3,448 70%
3,287
3,088
3,000 65%
2,880
2,652
2,500 2,418
60%
0 55%
0.50 1.00 1.50 2.00 2.50
Patient time in system (hr)
Figure 1.14 Scenario results from Garden Grove facility simulation model.
Conclusions
The simulation model allowed the AltaMed team to see inefficiencies in its system and to work
on standardizing spaces to improve workflow. These system reconfigurations would also help
improve patient flow and overall patient satisfaction and create a more cost-efficient system
design.
AltaMed was able to save $250,000 at the Garden Grove facility by increasing room utili-
zation and eliminating the need for additional exam rooms. With this result, all other facilities
within the AltaMed system were to be tested in the same manner, creating a potential savings
of millions of dollars.
Questions
Auden, Wystan Hugh, and L. Kronenberger. The Faber Book of Aphorisms. London: Faber and
Faber, 1964.
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Add subhead C:
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