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DCB Process Improvement in Health Care Questions

DCB Process Improvement in Health Care Questions

I will send you around 4-6 quastion so please read the chapters from 11-15 also i will send u the chapters from the textbook latter. keep in mind that dome snswers will be from spesfice pages.
Health Administration Press
Chapter 11
Process Improvement and
Patient Flow
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
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Process Improvement (PI)
• Measuring and improving systems
• Systems
• Processes
• Subprocesses
• Tasks
• PI tools can be used at any level
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PDCA
• Plan: Define the entire process to be improved using
process mapping. Collect and analyze appropriate data for
each of element of the process.
• Do: Use process improvement tool(s) to improve the
process.
• Check: Measure the results of the process improvement.
• Act to hold the gains: If the process improvement results
are satisfactory, hold the gains. If the results are not
satisfactory, repeat the PDCA cycle.
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PDCA Graphically
4. Act to maintain it.
1. Plan your
corrective action.
3. Check to make sure
it is working properly.
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2. Do it.
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Flow
• Theory of swift, even flow
• Process is more productive as:
• Speed of flow increases
• Variability of process decreases
• Example: advanced access
• Decreased time from request to appointment (speed)
• Decrease in no-shows (variability)
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Patient Flow
• Hospital flow is negatively affected by variability in
“scheduled” demand
• Surgical admissions (scheduled)
• Medical admissions (emergency)
• When surgical admissions have high variability, backlogs
and waiting occur
• 2013 study showed that IT investments were
positively related to smooth and even flow
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Actions to Improve Inpatient Flow
• Establish uniform discharge time
• Write discharge orders in advance
• Centralize oversight of census and patient movements
(care traffic control)
• Change physician rounding times
• Coordinate with ancillary departments on critical
testing
• Coordinate discharge with social services
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Why Use Process Mapping?
• Provides a visual representation that offers an
opportunity for process improvement through
inspection
• Allows for branching in a process
• Provides the ability to assign and measure the
resources in each task in a process
• Is the basis for process modeling via computer
simulation software
Copyright © 2017 Foundation of the American
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Process-Mapping Basics
• Assemble and train the team.
• Determine the boundaries of the process (where it starts and ends)
and the level of detail desired.
• Brainstorm the major process tasks and list them in order. (Sticky
notes are often helpful here.)
• Once an initial process map (also called a flowchart) has been
generated, the chart can be formally drawn using standard symbols
for process mapping.
• The formal flowchart should be checked for accuracy by all relevant
personnel.
• Depending on the purpose of the flowchart, data may need to be
collected or more information may need to be added.
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Intensive
ED Care
High
Patient
Arrives
at the ED
Triage Clinical
Complexity
Vincent Valley
Hospital and
Health System
Emergency
Department (ED)
Patient Flow
Process Map
Low
Waiting
Admitting
Private
Insurance
Yes
Triage Financial
Private
Insurance
Waiting
No
Admitting
Medicaid
Nurse
History/
Complaint
Waiting
Exam/
Treatment
Waiting
Discharge
End
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Process Metrics
• Capacity of a process: maximum possible amount of output (goods
or services) that a process or resource can produce or transform.
• Capacity utilization: proportion of capacity actually being used.
Measured as actual output/maximum possible output
• Throughput time: average time a unit spends in the process.
Includes both processing time and waiting time and is determined by
the critical (longest) path through the process
• Throughput rate: average number of units that can be processed per
unit of time
• Service time or cycle time: time to process one unit. Cycle time of a
process is equal to the longest task cycle time in that process
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Process Metrics (cont’d.)
• Idle or wait time: time a unit spends waiting to be processed
• Arrival rate: rate at which units arrive at the process
• Work-in-process (WIP), things-in-process (TIP), patients-in-process
(PIP), or inventory: total number of units in the process
• Setup time: amount of time spent getting ready to process the next
unit
• Value-added time: time a unit spends in the process where value is
actually being added to the unit
• Non-value-added time: time a unit spends in the process where no
value is being added. Wait time is non-value-added time
• Number of defects or errors
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Basic Process Redesign Techniques
•
•
•
•
•
•
•
Eliminate non-value-added activities
Eliminate duplicate activities
Combine related activities
Process in parallel
Balance workloads
Develop alternative process flow paths and contingency plans
Establish the critical path
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Health Administration Press
Basic Process Redesign Techniques
(cont’d.)
•
•
•
•
•
•
•
Embed information feedback and real-time control
Ensure quality at the source
Match capacity to demand
Let the patient do the work
Use technology
Apply the theory of constraints
Identify best practices and replicate
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Queuing Theory
• Queues (lines) form because of limited resources
• Queuing theory is used to determine the best balance
between customer service and economic
considerations
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Queuing Notation
A/B/c/D/E
Where:
A = Interarrival time distribution
B = Service time distribution
c = Number of servers
D = Maximum queue size
E = Size of input population
•When both queue and input population are assumed to be infinite, D and E are
typically omitted.
•M/M/1 = exponential service time distribution, single server, infinite possible
queue length, infinite input population, assumes only one queue
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Queuing Formulas
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Queuing Formulas (cont’d.)
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Little’s Law
Average throughput time =
People (or things) in the system/Arrival rate
Example
• Clinic serves 200 patients in an 8-hour day (or 25 patients per hour).
• Average number of patients in waiting room, exam rooms, etc., is 15.
15 patients/25 patients per hour = 0.6 hours in the clinic
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Discrete Event Simulation
• Built on queuing theory
• Basic simulation model
• Entities (patients)
• Queues (waiting lines)
• Resources (people, equipment, space)
• Based on states and events
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Discrete Event Simulation
Note: Created with Arena simulation software. M = exponential
distribution; MRI = magnetic resonance imaging
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Process Improvement Methods and
Tools
• Six Sigma (chapter 9)
• Seven basic tools
• Benchmarking
• Poka-yoke
• Lean (chapter 10)
• Value stream mapping
• Takt time
• Standardized work
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Health Administration Press
End of Chapter 11
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Chapter 12
Scheduling and Capacity
Management
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Scheduling and Capacity Management
• Hospital census and resource loading
• Staff scheduling
• Job/operation scheduling and sequencing rules
• Patient appointment scheduling models
• Advanced access scheduling
• Operating and market advantages
• Implementing advanced access
• Metrics for advanced access
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Typical Daily Hospital Census
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Hourly Census
Patients in the System
60
50
40
30
20
10
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Hour
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Staff Scheduling
• Optimization/mathematical programming (chapter 6)
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Riverview Clinic Urgent Care Staffing
Using Linear Programming (LP)
Objective: Minimize salary and benefit expenses while satisfying
nurses
• Five consecutive days, with two days off every seven days
• Schedules chosen by seniority
Sun
Nurses Needed/Day
Salary and
Benefits/Nurse-Day
($/day)
5
Mon Tues
4
3
320 240 240
Wed
Thurs
3
3
240
240
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Fri
Sat
4
6
240 320
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LP Problem
• There are seven possible schedules (Sunday and
Monday off, Monday and Tuesday off, and so forth).
• Objective is to minimize:
Salary and benefit expense = ($320 × Sun. # of nurses)
+ ($240 × Mon. # of nurses) + ($240 × Tues. # of
nurses) + ($240 × Wed. # of nurses) + ($240 × Thurs. #
of nurses) + ($240 × Fri. # of nurses) + ($320 × Sat. # of
nurses)
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LP Problem (cont’d.)
Subject to:
• The number of nurses scheduled each day must be
greater than the number of nurses needed each day.
• Sun. # of nurses ? 5
• Mon. # of nurses ? 4
• The number of nurses assigned to each schedule must
be greater than 0 and an integer.
• # A (B, C, D, E, F, or G) nurses ? 0
• # A (B, C, D, E, F, or G) nurses = integer
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Excel? Solver Setup
Minimize Salary and Benefit Expense
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Excel? Solver Solution: Minimize Salary and Benefit
Expense (cont’d.)
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Excel? Solver Setup
Maximize Nurse Satisfaction
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Excel? Solver Solution: Maximize Nurse
Satisfaction (cont’d.)
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Job/Operation Scheduling and
Sequencing Rules
•
•
•
•
•
First come, first served (FCFS)
Shortest processing time (SPT)
Earliest due date (EDD)
Slack time remaining
Critical ratio (CR)
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Sequencing Rule Example
Job
A
B
C
D
E
Processing
Time
50
100
20
80
60
Due
Date
Slack
100
160
50
120
80
How many possible sequences for five jobs?
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Critical
Ratio
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First Come, First Served
Sequence
A
B
C
D
E
Average
Start
Time
0
50
100
170
250
Processing
Time
50
100
20
80
60
Completion
Time
50
150
170
250
310
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Due
Date
100
160
50
120
80
Tardiness
Health Administration Press
First Come, First Served
(cont’d.)
Sequence
A
B
C
D
E
Average
Start
Time
0
50
100
170
250
Processing
Time
50
100
20
80
60
Completion
Time
50
150
170
250
310
186
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Due
Date
100
160
50
120
80
Tardiness
0
0
120
130
230
96
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Shortest Processing Time
Sequence
C
A
E
D
B
Average
Start
Time
0
20
70
130
210
Processing
Time
20
50
60
80
100
Completion
Time
20
70
130
210
310
148
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Due
Date
50
100
80
120
160
Tardiness
0
0
50
90
150
58
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Earliest Due Date
Sequence
C
E
A
D
B
Average
Start
Time
0
20
80
130
210
Processing
Time
20
60
50
80
100
Completion
Time
20
80
130
210
310
150
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Due
Date
50
80
100
120
160
Tardiness
0
0
30
90
150
54
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Sequencing Rule Example
Job
Processing
Time
Due
Date
Slack
Critical
Ratio
A
50
100
100 ? 50 = 50
100/50 = 2.00
B
C
D
E
100
20
80
60
160
50
120
80
160 ? 100 = 60
50 ? 20 = 30
120 ? 80 = 40
80 ? 60 = 20
160/100 = 1.60
50/20 = 2.50
120/80 = 1.50
80/60 = 1.25
120 possible sequences for five jobs
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Slack Time Remaining
Slack for each job: A—50, B—60, C—30, D—40, E—20
Sequence
E
C
D
A
B
Average
Start
Time
0
60
80
160
210
Processing
Time
60
20
80
50
100
Completion
Time
60
80
160
210
310
164
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Due
Date
80
50
120
100
160
Tardiness
0
30
40
110
150
66
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Critical Ratio (CR)
CR for each job: A—2.00, B—1.60, C—2.50, D—1.50, E—1.25
Sequence
E
D
B
A
C
Average
Start
Time
0
60
140
240
290
Processing
Time
60
80
100
50
20
Completion
Time
60
140
240
290
310
208
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Due
Date
80
120
160
100
50
Tardiness
0
20
80
190
260
110
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Summary
Rule
Average
Completion Time
FCFS
SPT
EDD
SLACK
CR
*Best values
186
148*
150
164
208
Average
Tardiness
No. of
Jobs Tardy
96
58*
54*
66
110
3*
3*
3*
4
4
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Maximum
Tardiness
230
150*
150*
150*
260
Health Administration Press
Guidelines for Selecting a
Sequencing Rule
1.
SPT is most useful for a very busy resource.
•
•
2.
3.
Some jobs may never be completed.
SPT often is used with another rule.
Use EDD when only small tardiness values can be tolerated.
Use FCFS when there is excess capacity.
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Appointment Scheduling Models
Purpose is to balance the competing goals of:
• Maximizing resource utilization
• Minimizing waiting time
Four types:
•
•
•
•
Block appointment
Individual appointment
Mixed block-individual appointment
Combinations
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Bailey-Welch Schedule
Bailey-Welch
Individual Appointment
Time
# Scheduled
Time
# Scheduled
0:00
1
0:00
2
0:20
1
0:20
1
0:40
1
0:40
1
1:00
1
1:00
1
1:20
1
1:20
0
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Advanced Access
• Traditional scheduling systems
• Long times until next appointment
• High no-show rates
• Double/triple booking—queues form
• Advanced access
• Patients seen same day as request
• Reduces no-show rate
• Better continuity of care
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Implementing Advanced Access
• Obtain buy-in
• Predict demand
• Predict capacity
• Little’s law (chapter 11)
• Standardize and minimize types of visit times
• Assess operations
• Work down backlog
• Go live
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Advanced Access Metrics
• PCP match: percentage of same-day patients who see their
PCP
• PCP coverage: percentage of same-day patients seen by any
physician
• Wait time for next appointment (or third next available
appointment)
• Good backlog: appointments scheduled in advance because
of patient preference
• Bad backlog: appointments waiting because of lack of slots
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End of Chapter 12
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Chapter 13
Supply Chain Management
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Supply Chain Management (SCM)
• What is supply chain management (SCM)?
•
•
•
•
•
•
•
Why is SCM important for healthcare organizations?
Tracking and managing inventory
Forecasting
Inventory models
Inventory systems
Procurement and vendor relationship management
Strategic SCM
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Supply Chain Management
(cont’d.)
• The management of all activities and processes related to
both upstream vendors and downstream customers in the
value chain
• Tracking and managing demand, inventory, and delivery
• Procurement and vendor relationship management
• Technology enabled
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SCM in Healthcare
• Potential savings of 2–8% of overall operating
costs with effective supply chain management
of tangible goods
• Procurement costs can be reduced >10%
• Quantity of items purchased can be reduced
>20%
• With $500M+ hospital budgets, savings
potential is enormous
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Inventory
• Inventory is the stock of items held by the
organization either for sale or to support the
delivery of a service
• Inventory management answers three
questions:
• How much to hold
• How much to order
• When to order
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Functions of Inventory
• To meet anticipated demand
• To level process flow
• To protect against stockouts
• To take advantage of order cycles
• To help hedge against price increases or to take advantage
of quantity discounts
• To decouple process steps
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Effective Inventory Management
• Classification system
• Inventory tracking system
• Reliable forecast of demand
• Knowledge of lead times
• Reasonable estimates of:
• Holding or carrying costs
• Ordering or setup costs
• Shortage or stockout costs
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ABC Classification System
• Classifying inventory
according to some
measure of importance
and allocating control
efforts accordingly
• Pareto Principle
– A very important
– B moderately
important
High (80%)
Annual
$ volume
of items
A
B
C
Low (5%)
Few
(20%)
– C least important
Many
(50%)
Number of Items
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Inventory Tracking
• Track additions and removals
• Bar coding
• Point of use or point of sale (POS)
• RFID
• Physical count of items
• Periodic intervals
• Cycle count
• Find and correct errors
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Forecasting
• Exercises
• Averaging methods
• Trend, seasonal, and cyclical models
• Model development and evaluation
• VVH example
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Forecasting: Exercise 1
• Identify the pattern and construct a formula that will
“predict” successive numbers in the series.
• What is the next number in the series?
(a) 3.7, 3.7, 3.7, 3.7, 3.7, 3.7, 3.7, 3.7
(b) 2.5, 4.5, 6.5, 8.5, 10.5, 12.5, 14.5, 16.5
(c) 5.0, 7.5, 6.0, 4.5, 7.0, 9.5, 8.0, 6.5
• What is the formula for the next number in the
series?
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Exercise 1: Graphs
Series b
18
16
14
12
10
Series1
8
6
Series a
Series c
4
4.4
2
10.0
4.2
0
9.0
1
2
3
4
5
6
7
8
4.0
8.0
7.0
3.8
6.0
Series1
3.6
Series1
5.0
3.4
4.0
3.2
3.0
3.0
2.0
1.0
2.8
1
2
3
4
5
6
7
8
0.0
1
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2
3
4
5
6
7
8
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Exercise 1: Solution
a.
3.7, 3.7, 3.7, 3.7, 3.7, 3.7, 3.7, 3.7
• Constant
• Next number is 3.7
b.
2.5, 4.5, 6.5, 8.5, 10.5, 12.5, 14.5, 16.5
• 0.5 + 2x, where x specifies the position (index) of the number in the series
• Next number is 18.5
c.
5.0, 7.5, 6.0, 4.5, 7.0, 9.5, 8.0, 6.5
• 4.5 + 0.5x + Cs, where x specifies the position (index) of the number in the
series
• Cs represents the seasonality factor
• C1 = 0, C2 = 2, C3 = 0, C4 = ?2
• Next numbers: 9, 11.5, 10, 8.5
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Forecasting: Exercise 2
• Identify the pattern and construct a formula that will
“predict” successive numbers in the series.
• What is the next number in the series?
(a) 4.1, 3.3, 4.0, 3.8, 3.9, 3.4, 3.5, 3.7
(b) 2.9, 4.7, 6.8, 8.2, 10.3, 12.7, 14.2, 16.3
(c) 5.3, 7.2, 6.4, 4.5, 6.8, 9.7, 8.2, 6.3
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Exercise 2: Solution
• Same as series above, but with a random component
generated from normal random number generator with
mean 0
(a) 4.1, 3.3, 4.0, 3.8, 3.9, 3.4, 3.5, 3.7
• 3.7 + ?
(b) 2.9, 4.7, 6.8, 8.2, 10.3, 12.7, 14.2, 16.3
• 0.5 + 2x + ?
(c) 5.3, 7.2, 6.4, 4.5, 6.8, 9.7, 8.2, 6.3
• 4.5 + 0.5x + Cs + ?
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Forecasting Methods
• Qualitative methods
• Based on expert opinion
and intuition; often used
when there are no data available
• Quantitative methods
• Time series methods, causal methods
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Demand Behavior
• Trend
• Gradual, long-term up or down movement
• Cycle
• Up and down movement repeating over long time frame
• Seasonal pattern
• Periodic, repeating oscillation in demand
• Random movements follow no pattern
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Demand
Demand
Forms of Forecast Movement
Trend
Cycle
Random
movement
Time
Seasonal
pattern
Demand
Demand
Time
Trend with
seasonal pattern
Time
Time
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Forecasting: Averaging Methods
• Simple moving average
• Weighted moving average
• Exponential smoothing
• Averaging methods all assume that the variable of
interest is relatively constant over time; no trends or
cycles
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Simple Moving Average
Average over a given number of periods that is
updated by replacing the data in the oldest period
with that in the most recent period
F
t
=D
t ?1
+ Dt ? 2 ? + Dt ? n
n
Ft = Forecasted demand for the period
Dt-1 = Actual demand in period t ? 1
n = Number of periods in the moving average
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Weighted Moving Average
Simple moving average where weights are assigned
to each period in the average. The sum of all the
weights must equal one.
Ft =w D
t ?1
t ?1
+ w t ? 2 D t ? 2 + ? + w t ? n Dt ? n
Ft = Forecasted demand for the period
Dt-1 = Actual demand in period t ? 1
wt-1 = Weight assigned to period t ? 1
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Exponential Smoothing
Times series forecasting technique that does not
require large amounts of historical data
F = (1? ? )F
t
Ft =
Ft-1 =
Dt-1 =
? =
+
?
Dt ?1
t ?1
Exponentially smoothed forecast for period t
Exponentially smoothed forecast for prior period
Actual demand in the prior period
Desired response rate, or smoothing constant
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
Forecasting: Trend, Seasonal, and
Cyclical Models
• Holt’s trend-adjusted exponential smoothing
technique
• Winter’s triple exponential smoothed model
• ARIMA models
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
Holt’s Trend-Adjusted Exponential Smoothing
Exponentially smoothed forecast that accounts for a trend in the data
FITt = Ft + Tt
and
Ft = ?Dt ?1 + ( 1 ? ?)FITt ?1
Tt = Tt ?1 + ?(Ft ?1 -FITt ?1 )
FITt = Forecast for period t including the trend
Ft = Smoothed forecast for period t
Tt = Smoothed trend for period t
Dt?1 = Value in the previous period
0? ? = smoothing constant ?1; 0? ? = smoothing constant ?1
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
Forecast Accuracy
• Error = Actual ? Forecast
• Find a method that minimizes error
• Mean absolute deviation (MAD)
• Mean squared error
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
Forecasting: Model Development
and Evaluation
• Identify purpose of forecast
• Determine time horizon of forecast
• Collect relevant data
• Plot data and identify pattern
• Select forecasting model(s)
• Make forecast
• Evaluate quality of forecast
• Adjust forecast and monitor results
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
VVH Diaper Example
Week of Period Actual
1-Jan
8-Jan
15-Jan
22-Jan
29-Jan
5-Feb
12-Feb
19-Feb
26-Feb
5-Mar
12-Mar
19-Mar
26-Mar
1
2
3
4
5
6
7
8
9
10
11
12
13
70
42
63
52
56
53
66
61
45
54
53
43
60
Weekly Demand
80
70
60
50
40
30
20
10
0
1
2
3
4
5
6
7
Period
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
8
9
10
11
12
13
Health Administration Press
VVH Simple Moving Average
F
F
=D
t ?1
t
+ Dt ?2? + Dt ?n
n
=D
13
14
+ D12 + D11 + D10 + D9
5
60 + 43 + 53 + 54 + 45
=
= 51
F 14
5
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
VVH Weighted Moving Average
F t = w D + w D +?+ w D
F 14 = w D + w D + w D
F 14 = 0.5 ? 60 + 0.3 ? 43 + 0.2 ? 53 = 53.5
t ?1
13
t ?1
13
t ?2
12
t ?2
12
t ?n
11
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
11
t ?n
Health Administration Press
VVH Exponential Smoothing
F
F
F
t
= ? Dt ?1 + (1 ? ? ) F t ?1
14
= ? D13 + (1 ? ? ) F 13
14
= (0.25 ? 60) + (0.75 ? 52) = 54
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
VVH Comparison
(from the Excel? template)
Weight 3
Weight 2
0.3
Periods
5
Least
Recent
0.2
MAD
MSE
7
86
MAD
MSE
6
75
Period Actual Forecast Error
1
70
2
42
3
63
4
52
5
56
6
53
57
4
7
66
53
13
8
61
58
3
9
45
58
13
10
54
56
2
11
53
56
3
12
43
56
13
13
60
51
9
14
51
Weight 1
Most
0.5 Recent
Period Actual Forecast Error
1
70
2
42
3
63
4
52
58
6
5
56
53
3
6
53
56
3
7
66
54
12
8
61
60
1
9
45
61
16
10
54
54
0
11
53
53
0
12
43
52
9
13
60
48
12
14
53.5
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
?
MAD
MSE
0.25
8
135
Period Actual Forecast Error
1
70
2
42
70
28
3
63
63
0
4
52
63
11
5
56
60
4
6
53
59
6
7
66
58
8
8
61
60
1
9
45
60
15
10
54
56
2
11
53
56
3
12
43
55
12
13
60
52
8
14
54
Health Administration Press
Realities of Forecasting
• Forecasts are seldom perfect.
• Most forecasting methods assume
that there is some underlying
stability in the system.
• Service family and aggregated
service forecasts are more accurate
than individual service
forecasts.
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
I see that you will
get an A this
semester.
Health Administration Press
Order Amount and Timing
How much to hold
How much to order
When to order
• Basic economic order quantity (EOQ)
• Fixed order quantity with safety stock
• More models
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
Definitions
Lead time—time between placing an order and receiving the
order
Holding (or carrying) costs—costs associated with keeping goods
in storage
Ordering (or setup) costs—costs of ordering and receiving goods
Shortage costs—costs of not having something in inventory
when it is needed
Back orders—unfilled orders
Stockouts—occur when the desired good is not available
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
Definitions
Independent demand is demand that is
generated by the customer and is not a
result of demand for another good or
service.
Dependent demand is demand that results
from another demand. Demand for tires and
steering wheels (dependent) is related to
the demand for cars (independent).
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
Assumptions of the Basic EOQ Model
• Demand for the item in question is independent.
• Demand is known and constant.
• Lead time is known and constant.
• Ordering costs are known and constant.
• Back orders, stockouts, and quantity discounts are not
allowed.
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
Inventory Order Cycle
Demand
rate
Order
quantity, Q
Average
amount of
inventory
held = Q/2
Inventory
Level
Reorder
point, R
0
Time
Lead
Lead
time
time
Order Order
Order Order
Placed Received Placed Received
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
Reorder Point
The point in time by which stock must be ordered to
replenish inventory before a stockout occurs
R = dL
R = Reorder point
d = Average demand per period
L = Lead time (in the same units as above)
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
EOQ Model Cost Curves
Minimum
Total Cost
Annual
cost ($)
Total Cost
Holding Cost = h*Q/2
Ordering Cost = o*D/Q
Optimal
Order Quantity
Q OPT =
2Do
2(Annual Demand)(Or der or Setup Cost)
=
h
Annual Holding Cost
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Order
Quantity, Q
Health Administration Press
EOQ Model Insights
• As holding costs increase, the optimal order quantity
decreases. (Order smaller amounts more often
because inventory is expensive to hold.)
• As ordering costs increase, the optimal order quantity
increases. (Order larger amounts less often because it
is expensive to order.)
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
EOQ Model Implications
Total Cost
Annual
Cost ($)
Holding Cost
Ordering Cost
Q*
Q*
Order Quantity
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
EOQ Model Implications
Total Cost
Annual
Cost ($)
Holding Cost
Ordering Cost
Q*
Q*
Order Quantity
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
Health Administration Press
VVH Diaper Example
• Cost $5/case
•
•
•
•
Holding costs 33% or $1.67/case-year
Ordering costs $100
Lead time 1 week
Annual demand calculated as:
D = d ? period
= 53.5 cases of diapers
= 2,782 cases
week
? 52 weeks
year
Copyright © 2017 Foundation of the American
College of Healthcare Executives.
year
Health Administration Press
VVH Diaper E

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