Chapter 14. Queuing Models and Capacity Planning Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 1 Outline Queuing System Characteristics – – – – Population Source Servers Arrival Patterns Service Patterns Specific Queue Characteristics Measures of Queuing System Performance Infinite Source-Models Model Formulations – Single Server (M/M/1) – Multi Server (M/M/s>1) Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 2 Figure 14.1 Queue Phenomenon Location: Hospital Outpatient Pharmacy Day & Time: Monday, 11:00 AM Average number in line: 20 Idle servers: 0 Average wait time: 15 minutes Chapter 14: Quantitatve Methods in Health Care Management Location: Hospital Outpatient Pharmacy Day & Time: Monday, 3:30 PM Average number in line: 0 Idle servers: 3 Average wait time: 0 minutes Hourly wage per idle pharmacist: $40 Yasar A. Ozcan 3 Queuing Models A mathematical approach to the analysis of waiting lines Weighs the cost of providing a given level of service capacity (i.e., shortening wait times) against the potential costs of having customers wait Reduce Wait Times Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan Minimizing costs 4 Why Must We Wait In Lines? RANDOMNESS ARRIVALS SERVICE TIMES Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 5 OUR GOAL? TO REDUCE COSTS – Waiting Costs – Capacity Costs Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 6 To Summarize: Waiting Costs – Salaries paid to employees while they wait for service (e.g., physicians waiting for an x-ray or test result) – Cost of waiting space – Loss of business due to wait (balking customers) Capacity Costs-- the cost of maintaining the ability to provide service Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 7 Figure 14.2 Healthcare Service Capacity and Costs Cost Total cost Cost of service capacity Waiting line cost Optimum capacity Health care service capacity (servers) Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 8 Before getting to the complicated part. . . Let’s Examine the Main Characteristics of any queuing model: The population Source The number of servers (channels) Arrival and service patterns Queue discipline (order of service) Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 9 The Population Source Infinite – Customer arrivals are unrestricted – Customer arrivals exceed system capacity – Exists where service is unrestricted Finite source – Customer population where potential number of customers is limited Can you think of examples for each source? Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 10 Figure 14.3 Queuing Conceptualization of Flu Inoculations Population (Patient Source) Facility Queue (Waiting Line) Arrivals Chapter 14: Quantitatve Methods in Health Care Management Service Server Yasar A. Ozcan Exit 11 The Number of Servers Capacity is a function of the capacity of each server and the number of servers being used Servers are also called channels Systems can be single or multiple channel, and consist of phases Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 12 Figure 14.4 Conceptualization of a Single-line, Multi-phase System Phase -1 Phase -2 Phase -3 Population Queue-1 Receptionist (server) Queue-2 Nurse (server) Arrivals Chapter 14: Quantitatve Methods in Health Care Management Queue-3 Physician (server) Exit Yasar A. Ozcan 13 Figure 14.5 Multi-Line Queuing Systems Nurses Providing Inoculations Line-1 Queue Patients Line-2 Line-3 Emergency Room Phase-2 Phase-1 Diagnostic Testing PhysiciansInitial Evaluation Queue-1 Chapter 14: Quantitatve Methods in Health Care Management Phase-3 Queue-2 PhysiciansInterventions Queue-3 Yasar A. Ozcan 14 Arrival and Service Patterns Remember-- both arrival and service patterns are random, thus causing waiting lines Models assume that: – Customer arrival rate can be described Poisson distribution – Service time can be described by a negative exponential distribution Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 15 Figure 14.6 Emergency Room Arrival Patterns Monday Tuesday Wednesday Thursday Friday Saturday Sunday 7:00am Chapter 14: Quantitatve Methods in Health Care Management 3:00pm Time Yasar A. Ozcan 7:00pm 16 Figure 14.7 Measures of Arrival Patterns Inter-arrival time 9:00pm Chapter 14: Quantitatve Methods in Health Care Management 10:00pm Yasar A. Ozcan 17 Figure 14.8 Poisson Distribution .20 .15 Probability .10 .05 0 1 Chapter 14: Quantitatve Methods in Health Care Management 2 3 4 5 6 7 8 9 10 Patient arrivals per hour Yasar A. Ozcan 18 Figure 14.9 Service Time for ER Patients Time (minutes) 90 60 30 0 A B C D E F Patients Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 19 Exponential or Poisson? If service time is exponential, then the service rate is Poisson. Further, if the customer arrival rate is Poisson, then the inter-arrival time (i.e., the time between arrivals) is exponential. For instance: If a lab processes 10 customers per hour (rate), the average service time is 6 minutes. If the arrival rate is 12 per hour, then the average time between arrivals is 5 minutes. Thus, service and arrival rates are described by the Poisson distribution and inter-arrival times and service times are described by a negative exponential distribution. Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 20 Queue Characteristics Patients who arrive and see big lines (the flu shot example) may change their minds and not join the queue, but go elsewhere to obtain service; this is called balking. If they do join the queue and are dissatisfied with the waiting time, they may leave the queue; this is called reneging. Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 21 Queue Discipline Refers to the order in which patients are processed, for instance: First Come First Served Most Serious First Served Highest Costs (waiting) First Served Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 22 How do we judge ours systems performance? Average number of customers waiting (in line or in system) Average time customers wait (in line or in system) System utilization (% of capacity utilized) Implied costs of a given level of capacity and its related waiting line Probability that an arrival will have to wait for service Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 23 How do we judge ours systems performance? Realize that increases in system utilization are achieved at the expense of increases in both the length of the waiting line and the average waiting time. Most models assume that the system is in a steady state where average arrival and service rates are stable. Chapter 14: Quantitatve Methods in Health Care Management 0 System Utilization Yasar A. Ozcan 100% 24 Exhibit 14.1 Queuing Model Classification A: specification of arrival process, measured by inter-arrival time or arrival rate. M: negative exponential or Poisson distribution D: constant value K: Erlang distribution G: a general distribution with known mean and variance B: specification of service process, measured by inter-service time or service rate M: negative exponential or Poisson distribution D: constant value K: Erlang distribution G: a general distribution with known mean and variance C: specification of number of servers -- “s” D: specification of queue or the maximum numbers allowed in a queuing system E: specification of customer population Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 25 Typical Infinite-Source Models Single channel, M/M/s Multiple channel, M/M/s>1, where “s” designates the number of channels (servers). These models assume steady state conditions and a Poisson arrival rate. Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 26 Infinite source models Single channel, exponential service time Single channel, constant service time Multiple channel, exponential service time Multiple priority service Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 27 Exhibit 14.2 Queuing Model Notation Lq L Wq W 1/ Po Pn arrival rate service rate average number of customers waiting for service average number of customers in the system (waiting or being served) average time customers wait in line average time customers spend in the system system utilization service time probability of zero units in system probability of n units in system Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 28 Infinite Source Models: Model Formulations Five key relationships that provide basis for queuing formulations and are common for all infinite-source models: 1.The average number of patients being served is the ratio of arrival to service rate. r 2.The average number of patients in the system is the average number in line plus the average number being served. L Lq r 3. The average time in line is the average number in line divided by the arrival rate. L Wq q 4. The average time in the system is the sum of the time in line plus the service time. W Wq 1 5. System utilization is the ratio of arrival rate to service capacity. Chapter 14: Quantitatve Methods in Health Care Management s Yasar A. Ozcan 29 Single Channel, Poisson Arrival and Exponential Service Time (M/M/1). 2 Lq ( ) P0 1 Pn P0 Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan n 30 Single Channel, Poisson Arrival and Exponential Service Time (M/M/1). Example 14.1 A hospital is exploring the level of staffing needed for a booth in the local mall where they would test and provide information on diabetes. Previous experience has shown that on average, every 15 minutes a new person approaches the booth. A nurse can complete testing and answering questions, on average, in 12 minutes. If there is a single nurse at the booth, calculate system performance measures including the probability of idle time and of 1 or 2 persons waiting in the queue. What happens to the utilization rate if another workstation and nurse are added to the unit? Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 31 Solution: Arrival rate: λ = 1(hour) ÷ 15 = 60(minutes) ÷ 15 = 4 persons per hour. Service rate: μ = 1(hour) ÷ 12 = 60(minutes) ÷ 12 = 5 persons per hour. Average persons served at any given time r 42 Lq 3.2 5(5 4) Persons waiting in the queue Number of persons in the system L Lq 3.2 .8 4 persons. Minutes of waiting time in the queue Wq Minutes in the system (waiting and service) 1 Chapter 14: Quantitatve Methods in Health Care Management 4 .8 5 W Wq Yasar A. Ozcan Lq 6.4 3.2 0.1067 6.4 4 60 6.4 12 18.4 5 32 Solution: Calculate queue lengths of 0, 1, and 2 persons 4 P0 1 1 1 .8 .2 5 1 4 P1 P0 (.2) (.2)(.8)1 (.2)(.8) .16 5 2 1 4 P2 P0 (.2) (.2)(.8) 2 (.2)(.64) .128 5 Chapter 14: Quantitatve Methods in Health Care Management 2 Yasar A. Ozcan 33 Solution: Utilization of servers Current system utilization (s=1) 4 80%. s 1 * 5 System utilization with an additional nurse (s=2) 4 40%. s 2 * 5 System utilization decreases as we add more resources to it. Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 34 Multi-Channel, Poisson Arrival and Exponential Service Time (M/M/s>1) Expanding on Example 14.1: The hospital found that among the elderly, this free service had gained popularity, and now, during week-day afternoons, arrivals occur on average every 6 minutes 40 seconds (or 6.67 minutes), making the effective arrival rate 9 per hour. To accommodate the demand, the booth is staffed with two nurses working during weekday afternoons at the same average service rate. What are the system performance measures for this situation? Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 35 Multi-Channel, Poisson Arrival and Exponential Service Time (M/M/s>1) Solution: This is an M/M/2 queuing problem. The WinQSB solution provided in Exhibit 14.5 shows the 90% utilization. It is noteworthy that now each person has to wait on average one hour before they can be served by any of the nurses. On the basis of these results, the healthcare manager may consider expanding the booth further during those hours. Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 36 Figure 14.12 System Performance for Expanded Diabetes Information Booth Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 37 Figure 14.13 System Performance Summary for Expanded Diabetes Information Booth with M/M/3 Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 38 Figure 14.14 Capacity Analysis Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 39 Multi-Channel, Poisson Arrival and Exponential Service Time (M/M/s>1) Table 14.1 Summary Analysis for M/M/s Queue for Diabetes Information Booth 2 Stations 3 Stations 4 Stations Patient arrival rate 9 9 9 Service rate 5 5 5 Overall system utilization 90% 60% 45% L (system) 9.5 2.3 1.9 Lq 7.7 0.5 0.1 W (system) – in hours 1.05 .26 0.21 Wq – in hours 0.85 .06 0.01 Po (idle) 5.3% 14.6% 16.2% Pw (busy) 85.3% 35.5% 12.8% 0 0 0 790.53 294.91 302.89 Performance Measure Average number of patients balked Total system cost in $ per hour Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 40 Assumptions and Limitations Steady state of arrival and service process Independence of arrival and service is assumed The number of servers is assumed fixed Little ability to incorporate important exceptions to the general flow Difficult to model all but simple processes Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 41 The End Chapter 14: Quantitatve Methods in Health Care Management Yasar A. Ozcan 42
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