Two facilities. Two engagements. Real operational data modeled, analyzed, and translated into a prioritized improvement roadmap by a Certified Lean Six Sigma Master Black Belt. The findings are clear. The path forward is defined.
Average queue wait per stage. Red = critical bottleneck. Amber = elevated. Green = acceptable.
With only 6.03% idle time, any volume surge causes immediate cascade failure. Average time in bed: 157 min. This is the root cause of the 92.9-min waiting room average and the 157 LWBS patients.
1-in-5 patients leaves before care. National benchmark is under 2%. At ~$800/visit this equals ~$125K in lost revenue per simulation period — and represents a direct Joint Commission safety indicator.
The Enter Patient Info queue is occupied 91.51% of the time. This single-point-of-failure delays every downstream activity. A second Tech (~$55K/yr) eliminates this bottleneck entirely.
This paradox confirms the bottleneck is upstream (beds, registration), not provider supply. Adding MDs will not improve performance. Fixing beds and registration will.
| Activity | Entries | Type | Total VA Min | Total NVA Min | % of Total Time | NVA % |
|---|---|---|---|---|---|---|
| Waiting Room | 965 | NVA | 0 | 89,688 | 37.4% | 100% |
| Enter Patient Info (+ Queue) | 628 | Mixed | 4,598 | 26,180 | 12.8% | 85% |
| Combine for MD (results wait) | 652 | VA | 19,581 | 0 | 8.2% | 0% |
| ER Treatment | 648 | VA | 12,137 | 731 | 5.4% | 6% |
| Initial Assessment | 625 | VA | 9,326 | 654 | 4.2% | 7% |
| Lab Work | 308 | VA | 9,132 | 0 | 3.8% | 0% |
| CT Scan | 75 | VA | 6,336 | 16 | 2.6% | 0% |
| MD Assessment | 648 | VA | 6,570 | 324 | 2.9% | 5% |
| Triage (incl. queue) | 1,072 | VA | 5,030 | 2,413 | 3.1% | 32% |
| Develop Discharge Plan | 581 | VA | 3,527 | 792 | 1.8% | 18% |
MD2 patients wait 15.6 min to be seen — 3× longer than MD1 (5.7 min). 75% of their 3-hour visit is non-value-added time. Redistributing 3–4 patients per session to MD1 or Mid-Level is projected to cut this pathway to under 110 minutes.
18 patients per session wait nearly an hour just to schedule follow-up appointments. This is the largest single NVA time block and can be eliminated entirely through patient portal self-scheduling or pre-populated orders during the visit.
Physical space is not the constraint. Rooms are idle 79.3% of scheduled time. A phased scheduling density increase of 60–80% captures significant new revenue with zero capital investment required.
This resource is idle 98.75% of scheduled time. Immediate redeployment to a shared-resource model or telehealth conversion is recommended to align cost with actual demand.
| Activity | Entries | Avg Min / Entry | Total VA Min | Total NVA Min | % of Total |
|---|---|---|---|---|---|
| Schedule Ancillary Appts (+ 51.9-min queue) | 18 | 21.9 + 51.9 Q | 394 | 935 | 21.4% |
| Get Test Results | 19 | 51.0 | 970 | 0 | 15.6% |
| Hearing Test (Walk-in) | 17 | 40.3 | 685 | 75 | 12.3% |
| Checkin (+ 7.7-min queue) | 57 | 5.2 + 7.7 Q | 293 | 439 | 11.8% |
| Preliminary Exam | 53 | 8.7 | 460 | 0 | 7.4% |
| See MD1 (+ 5.7-min queue) | 25 | 8.7 + 5.7 Q | 218 | 143 | 5.8% |
| See MD2 (+ 15.6-min queue) | 10 | 14.1 + 15.6 Q | 141 | 156 | 4.8% |
| Hearing Test (Scheduled) | 4 | 61.0 | 244 | 0 | 3.9% |
| See Resident 1 | 13 | 12.2 | 159 | 0 | 2.6% |
| See Mid-Level (+ 8.9-min queue) | 14 | 11.4 + 8.9 Q | 160 | 125 | 4.6% |
| Speech Pathologist | 2 | 15.0 | 30 | 0 | 0.5% |
Every recommendation below is directly derived from the simulation output. Priority is ranked by projected impact and ease of implementation. Audience tags show which leader owns execution.
The data entry queue runs at 91.51% occupancy — occupied nearly the entire day. A single Tech at 85.57% utilization is the first-order constraint for every patient. Adding a second Tech (~$55K/year) cuts this queue from 41.6 minutes to under 5 minutes and is the fastest, cheapest intervention available.
Fast Track beds are running at 57.5% utilization while ER beds are at 93.97%. The simulation shows clear acuity routing opportunities. Shifting 15–20% of full-ER patients to Fast Track is projected to reduce ER bed utilization to ~78% and cut the LWBS rate by 40–60%.
Average bed time is 157 minutes per patient. Discharge Order and Discharge Patient steps each take only 1 minute — indicating the delay is in planning and plan review, not execution. Beginning the discharge plan at MD decision point (concurrent with orders) reduces bed occupancy by 20–30 min per patient.
With MDs idle 47% of scheduled time yet door-to-doctor averaging 151.8 minutes, adding more providers will achieve nothing. The constraint is beds and registration. Two MDs shifted to a dedicated discharge/disposition role focus on freeing beds faster, breaking the upstream backup that creates LWBS.
The simulation strongly suggests bed expansion should be deferred until process interventions (Fixes 01–04) are implemented and measured. If bed utilization remains above 85% after those changes, a 4-bed expansion to 24 total is modeled to reduce utilization to ~78%. Do not approve capital before running this scenario in simulation.
The simulation shows the waiting room averages 16.7 patients (max: 59). LWBS incidence rises sharply above 25. A real-time operational dashboard with a threshold alert at 25 patients in the waiting room enables surge protocols before the crisis point — preventing the worst LWBS episodes without structural changes.
MD2's queue wait (15.6 min) is 3× MD1's (5.7 min) and their patient visit efficiency is only 24.6% vs. 51.2% for MD1. Redistributing 3–4 MD2 patients per session to MD1 or Mid-Level is projected to reduce the MD2 pathway from 182 minutes to under 110 minutes and bring overall clinic efficiency above 60%.
18 patients per session wait an average of 51.9 minutes in queue just to schedule follow-up appointments — this is the single largest NVA activity in the clinic at 21.4% of total time. Implementing patient portal self-scheduling or pre-populating follow-up orders during the visit eliminates this queue at minimal cost. Payback is projected in under 90 days.
Exam rooms are idle 79.3% of scheduled time at only 20.7% utilization. The simulation confirms physical space is not the bottleneck — scheduling is. A phased density increase of 60–80% over 6 months can be absorbed without adding rooms, staff, or capital. This is the highest-revenue opportunity in the ENT engagement.
Get_Test_Results averages 51 minutes per encounter and accounts for 15.6% of all clinic time. Root cause is manual transcription or retrieval during the visit. Routing results automatically to the provider workstation before the results review visit reduces this step by 36 minutes per patient without any clinical change.
At 1.25% utilization across only 2 encounters in the simulation period, the Speech Pathologist represents a fully-loaded cost for minimal demand. A shared-resource model across 2–3 clinic lines or a telehealth conversion aligns cost to actual demand and recovers an estimated $110K annually in labor efficiency.
4 of 61 patients (6.6%) were no-shows. Combined with the low provider utilization rates (MD1: 22.7%, MD2: 27.5%), predictive overbooking based on historical no-show patterns can recover 1–2 slots per provider per day without over-booking risk. Analytics-driven scheduling tools can implement this in 90 days.
| Fix | Facility | Action | Timeline | Effort | Projected Impact | Annual Value |
|---|---|---|---|---|---|---|
| ED-01 | ED | Add 2nd Registration Tech | Immediate (2–4 wks) | Low | −30–40 min LOS per patient | $380K |
| ED-02 | ED | Redirect low-acuity to Fast Track | Immediate (2–4 wks) | Low | −40% LWBS rate | $1.02M |
| ENT-01 | ENT | Rebalance MD2 patient load | Immediate (1–2 wks) | Low | −70 min MD2 visit time | $195K |
| ENT-02 | ENT | Eliminate ancillary scheduling queue | Short-term (4–8 wks) | Medium | −52 min per affected patient | $80K |
| ED-03 | ED | Concurrent discharge protocol | Short-term (4–8 wks) | Medium | −25 min bed time per patient | $680K |
| ED-04 | ED | Realign 2 MDs to discharge role | Short-term (4–8 wks) | Medium | −30 min door-to-doctor | $240K |
| ENT-03 | ENT | Increase scheduling density +60% | Short-term (6–10 wks) | Medium | +60% patient volume capacity | $820K |
| ENT-04 | ENT | Automate test results delivery | Short-term (6–10 wks) | Medium | −36 min results step | $110K |
| ED-05 | ED | Evaluate bed expansion (post-fixes) | Medium-term (3–6 mo) | High | −residual LWBS / surge capacity | $2.8M avoided |
| ENT-05 | ENT | Speech Path shared/telehealth model | Medium-term (2–3 mo) | Low | Labor cost realignment | $110K |
| Total Projected Year-1 Value | $6.43M | |||||
All simulations are personally conducted by a Certified Lean Six Sigma Master Black Belt. A 45-minute executive briefing will map the specific opportunity in your environment and provide a preliminary ROI estimate based on your actual volume and staffing data — at no cost.
Request Executive Briefing +1 (555) 555-0100Typical engagement: 6–10 weeks from data collection to board-ready recommendations · $120K–$220K depending on scope