A Markov chain model for analysis of physician workflow in primary care clinics

Improving Patient Flow in a Primary Care Clinic

When patients visit primary care clinics, they can be subject to long wait times due to operational inefficiencies and bottlenecks, decreasing patient satisfaction and sometimes leading to worse health outcomes. The existing literature models primary care clinics primarily as agent-based models, which are excellent at tracking individual patients and their movements in a model of a clinic. While agent-based models can detect bottlenecks, a network flow model better detects bottlenecks in the model by correlating changes in patient flow and wait times in the healthcare network. In this paper, a network flow model is constructed, where patients flow along the capacitated edges of a network while receiving treatment at the nodes. This configuration easily identifies bottlenecks by analyzing the flow in and flow out of nodes through metrics such as efficiency and patient wait times. The capacities of the edges for this model are taken from an agent-based model of a case study of a primary care clinic and sampled as random variables. Ensemble runs of the network flow model are created to account for uncertainty in the synthetic data. By changing the topology of the network flow model, bottlenecks are removed, increasing the model efficiency and decreasing patient wait times. Finally, the model is subjected to a sensitivity analysis. The focus in this work is on the method rather than the results per se.

A Novel Analytical Modeling Approach for Quality Propagation of Transient Analysis of Serial Production Systems

Production system modeling (PSM) for quality propagation involves mapping the principles between components and systems. While most existing studies focus on the steady-state analysis, the transient quality analysis remains largely unexplored. It is of significance to fully understand quality propagation, especially during transients, to shorten product changeover time, decrease quality loss, and improve quality. In this paper, a novel analytical PSM approach is established based on the Markov model, to explore product quality propagation for transient analysis of serial multi-stage production systems. The cascade property for quality propagation among correlated sequential stages was investigated, taking into account both the status of the current stage and the quality of the outputs from upstream stages. Closed-form formulae to evaluate transient quality performances of multi-stage systems were formulated, including the dynamics of system quality, settling time, and quality loss. An iterative procedure utilizing the aggregation technique is presented to approximate transient quality performance with computational efficiency and high accuracy. Moreover, system theoretic properties of quality measures were analyzed and the quality bottleneck identification method was investigated. In the case study, the modeling error was 0.36% and the calculation could clearly track system dynamics; quality bottleneck was identified to decrease the quality loss and facilitate continuous improvement. The experimental results illustrate the applicability of the proposed PSM approach.