ESTIMATING SERVICE LEVEL AND IMPROVING EFFICIENCY OF

PHARMACY IN PSG HOSPITAL

Report submitted to

PSG Institute of Management

for

Trimester 4

under

the Faculty of Operations Modelling and Simulations

by

Sanjeev M (14AB30)

Radhika Nair(14AA26)

David Livingstone (14AD04)

Vignesh C (14AD39)

Under the guidance of

Dr. J. Sekkizhar

PSG Institute of Management

Coimbatore

October 2015
 PSG Institute of Management
Coimbatore
Dr. J. Sekkizhar Phone:(+919842246452)
Reader
Certificate

This is to certify that the report entitled :Estimating and improving service level
at PSG Hospital Pharmacy” is a record of bonafide research work done by Sanjeev
M, Radhika Nair,David and Vignesh C under my supervision and guidance.
The report is the outcome of their original work and has not formed the basis for
the award of any degree, diploma, associateship, fellowship or any other similar
title.
 Dr. J. Sekkizhar
(Research Guide)
Declaration

We hereby declare that the dissertation entitled “IMPROVING EFFICIENCY IN

PSG HOSPITAL PHARMACY” is a record of the bonafide research work done by us
and that it has not previously formed the basis for the award of any degree,
diploma, associateship, fellowship or any other title of recognition.
 Acknowledgement

Many hands and minds were instrumental in contributing, their expertise in

helping us complete our research study. We will be failing in our endeavour if we
do not thank all these contributors who have rendered their services towards
completing our research work.
We thank with gratitude and courtesy, Prof. (Dr.) R.Nandagopal, Director, PSG
Institute of Management, Coimbatore for being very supportive all the time.
We offer our sincere gratitude to our guide and mentor, Dr. J. Sekkizhar, Assistant
Professor, Decision Sciences, PSG Institute of Management, Coimbatore, who has
supported us throughout our research with his patience and knowledge whilst
allowing us the room to work in our own way.

Finally still closer to our heart, our family, friends and well-wishers, without
whose support, love and tolerance this work would not have been possible.
1 )Introduction
When there is uncertainty present, such as uncertainty in the amount of time
necessary
to complete an assignment, decisions become more complex. No longer can we
rely on fixed values.We must be willing to consider variation in estimates. For
example,
you might estimate that an assignment will take between two and four hours. If
you do this for several assignments, the key question is how long it will take to
complete
all assignments. Simulation is a tool that can directly take into account the
uncertainty
in a situation, incorporating the uncertainties from multiple sources. It has
become one of the most useful analytical techniques in operations management
for
analyzing facility layouts, testing scheduling methods, and other important
questions

A computer simulation is a model that mimics what might happen in reality. In the
broadest sense, every mathematical model is really a simulation. However, in this
supplement we restrict ourselves to situations in which there is some uncertainty
or
randomness about some aspect of the system under consideration and we want
to
model that uncertainty directly. For example, future demand is uncertain in most
business planning situations. Customers arrive to a restaurant drive-through
window
according to some random process rather than being equally spaced in time.
Simula- tion allows us to model this random behavior and compute system
performance
measures, providing valuable information for decision makers. Simulation is one
of
the most commonly used analytical tools for complex systems.
This supplement focuses on spreadsheet-based simulation models. Spreadsheet
simulation is well suited to analyze many operational problems.We will apply
Monte-
Carlo Simulation, which repeatedly takes samples from known probability
distributions
for the random parameters in a problem and computes the resulting output
measures. Examples of decision situations amenable to Monte-Carlo Simulation
include
location and expansion decisions, inventory analyses, project planning, and
relatively
simple waiting line (queuing) systems. All of these situations typically involve
uncertainty. In this supplement we will develop, run, and analyze these simulation
models using only built-in Excel functionality. However, you should be aware that
there are Excel add-ins available for simulation that provide more functions for
probability
distributions and analysis of the simulation results and eliminate some of the
routine tasks involved in running the simulation model. Two leading Excel add-ins
are
Crystal Ball (http://www.decisioneering.com) and @Risk
(http://www.palisade.com). Although relatively complex systems can be analyzed
in spreadsheets, there are
many software products available that are better able to handle large, complex
systems.
Many of these products employ what is known as discrete-event simulation,
which is a methodology for modeling how the state of the system under
investigation
changes as different events (such as customer arrivals or departures) occur. For
example,
if you were planning the layout and operation of an entire new production or
service
facility, modeling the supply chain of a company, or reengineering complex
business processes, a stand-alone simulation product using discrete-event
simulation
would be a better choice than a spreadsheet model. Products more suitable for
complex systems modeling include ProModel (http://www.promodel.com),
Extend
(http://www.imaginethatinc.com), and ProcessModel
(http://www.processmodel.com).
OR/MS Today (http://www.lionhrtpub.com/ORMS.shtml), a publication of the
Institute
for Operations Research and Management Science (INFORMS), periodically
publishes simulation software surveys.

A. SIMULATION:

Simulation is the imitation of the operation of a real-world process or

system over time. The act of simulating something first requires that a model be
developed; this model represents the key characteristics or behaviors/functions
of the selected physical or abstract system or process. The model represents the
system itself, whereas the simulation represents the operation of the system over
time.

Simulation is used in many contexts, such as simulation of technology for

performance optimization, safety engineering, testing, training, education, and
video games. Often, computer experiments are used to study simulation models.
Simulation is also used with scientific modelling of natural systems or human
systems to gain insight into their functioning. Simulation can be used to show the
eventual real effects of alternative conditions and courses of action. Simulation is
also used when the real system cannot be engaged, because it may not be
accessible, or it may be dangerous or unacceptable to engage, or it is being
designed but not yet built, or it may simply not exist.

Key issues in simulation include acquisition of valid source information

about the relevant selection of key characteristics and behaviours, the use of
simplifying approximations and assumptions within the simulation, and fidelity
and validity of the simulation outcomes.

Historically, simulations used in different fields developed largely

independently, but 20th century studies of systems theory and cybernetics
combined with spreading use of computers across all those fields have led to
some unification and a more systematic view of the concept.
 Physical simulation refers to simulation in which physical objects are
substituted for the real thing. These physical objects are often chosen because
they are smaller or cheaper than the actual object or system.

Interactive simulation is a special kind of physical simulation, often referred

to as a human in the loop simulation, in which physical simulations include human
operators, such as in a flight simulator or a driving simulator.Human in the loop
simulations can include a computer simulation as a so-called synthetic
environment.

Simulation in failure analysis refers to simulation in which we create

environment/conditions to identify the cause of equipment failure. This was the
best and fastest method to identify the failure cause.

A computer simulation (or "sim") is an attempt to model a real-life or

hypothetical situation on a computer so that it can be studied to see how the
system works. By changing variables in the simulation, predictions may be made
about the behaviour of the system. It is a tool to virtually investigate the
behaviour of the system under study.

Computer simulation has become a useful part of modeling many natural

systems in physics, chemistry and biology, and human systems in economics and
social science (e.g., computational sociology) as well as in engineering to gain
insight into the operation of those systems. A good example of the usefulness of
using computers to simulate can be found in the field of network traffic
simulation. In such simulations, the model behaviour will change each simulation
according to the set of initial parameters assumed for the environment.

Traditionally, the formal modeling of systems has been via a mathematical

model, which attempts to find analytical solutions enabling the prediction of the
behaviour of the system from a set of parameters and initial conditions.
Computer simulation is often used as an adjunct to, or substitution for, modeling
systems for which simple closed form analytic solutions are not possible. There
are many different types of computer simulation; the common feature they all
share is the attempt to generate a sample of representative scenarios for a model
in which a complete enumeration of all possible states would be prohibitive or
impossible.
 Several software packages exist for running computer-based simulation
modeling (e.g. Monte Carlo simulation, stochastic modeling, and multimethod
modeling) that makes all the modeling almost effortless.

Modern usage of the term "computer simulation" may encompass virtually

any computer-based representation.

B. SIM QUICK:

SimQuick is an Excel spreadsheet (with some macros) developed by David

Hartvigsen that allows the user to model and simulates simple processes:
 Waiting lines (e.g., banks, fast-food restaurants, call centers).
 Inventory and supply chains (e.g., stores, warehouses, and simple
combinations of these).
 Manufacturing (e.g., assembly lines, batch processes, simple job shops)
 Projects with uncertain task times.

SimQuick requires no “installation.” It’s just an Excel file. If you have a PC

(stand-alone or networked) with Excel 2003 or later (under any version of
Windows), or a recent Mac version of Excel, then you can immediately use
SimQuick. SimQuick is designed to be easy to learn and use: A wide variety of
processes can be modeled after an hour of class time or independent reading.
SimQuick has been used by a number of companies and by at least 40 colleges
and universities, typically as a supplement to an Operations Management or
Decision Science course.

2. COMPANY
 On 25th January 1926, a Trust under the name of 'P.S.GOVINDASWAMY
NAIDU & SONS'; came into being to cater to the growing needs of education and
industry. Coimbatore opened a new chapter in its history.

To understand the genesis, growth and objectives of the trust, it is necessary to

travel back in time and visualize the social, educational and economic scenario of
India in general and city of Coimbatore in particular.

 PSG Hospitals, established by the PSG & Sons Charities, is a symbol of relentless
pursuance towards rendering sophisticated high quality care, at an affordable
cost, to the sick and needy. Here, we believe in offering comprehensive care
under a single roof, setting the best practice standards in health care services,
continually improving our performance and exceeding the expectations of
patients and their families.
Quality Management Department

Quality Management Department focuses on the Quality Policy of the institution

which is also based on the institution's Mission & Vision statements as well as the
Quality Policy.

The department focuses broadly on the four core principles for quality assurance
in the institution. They are as follows:

1. Patient (customer)

2. Hospital delivery systems (systems and processes)

3 .Analysis and problem identification (performance measurement)

4. Team work

Quality Policy
PSG Hospitals provides total health care to its patients, with the highest levels of
skill, professionalism and ethical practice, leading to their effective care and
treatment at affordable costs. PSG Hospitals facilitates medical education and
research, and is committed to continued quality improvement.
OUR MISSION
SCIENTIFIC,ETHICAL AND QUALITY HEALTH CARE

OUR VISION
• To be a dynamic, growth oriented organization where individuals synergize to
meet the challenges and to achieve excellence in all spheres.

• To provide quality health care to the patients, conforming to scientific and

ethical standards.

• To constantly upgrade the quality of medical practice and education in the

hospital

• To be a teaching hospital of distinction, setting the highest standards in patient

care, medical education, training and research.

• To provide an ideal environment for medical education and research.

METHOD
A. DATA COLLECTION

Observation can be made of many aspects of change in learning and

teaching. e.g of learning and teaching activities (lectures, seminars, and Lab
classes), documents and other teaching material presented to students, learning
resources learning environments, interaction between participants.

Highly structured observation will consist of checklist of e.g. the incidents,

OR frequency of pre-determined evidence to be observed in the situation.
 Semi structured and Unstructured evidence allow issues to emerge from
the observation, although may be semi structured around issues considered to be
relevant to the evaluation.
The data used in this project was collected from PSG Hospital Pharmacy
which consist of details such as
 Arrival Rate
 Waiting time for billing
 Waiting time in buffer
 Service level and waitimg time at counter

B. RANDOMNESS OF DATA

A numeric sequence is said to be statistically random when it contains no

recognizable patterns or regularities; sequences such as the results of an ideal
dice roll, or the digits of exhibit statistical randomness. Statistical randomness
does not necessarily imply "true" randomness.

3)Process Flow
4) DATA COLLECTION

DATA COLLECTION FOR PHARMACY ON

26/09/2015
 Servicing Servicing
Billing Billing Servicing Time Time
Arriving Counter Counter Time Counter Counter
S.No Time 1 Time 2 Time Counter 1 2 3

1 9:09 62 99

2 9:16 69 98

3 9:26 59 153

4 9:54 94 233

5 9:56 87 305

6 10:02 66 360

7 10:18 55 330

8 10:29 87 650

9 10:48 98 300

10 10:59 54 206

11 11:15 65 492

12 11:22 66 565

13 11:26 48 433

14 11:34 63 331

15 11:49 102 165

16 1:00 160 264

17 1:15 68 538
18 1:25 46 544

19 1:36 59 416

20 1:42 110 640

21 2:09 64 146

22 2:17 66 98

23 2:22 55 694

24 2:38 76 316

25 2:55 69 499

26 3:06 82 163

27 3:39 123 493

28 3:45 94 352

29 3:57 106 94

30 3:59 93 229

31 4:03 49 266

32 4:17 40 142

33 4:24 75 199

34 4:46 59 149

35 4:58 88 731

36 5:03 47 322

37 5:19 83 661

38 5:21 165 166

39 5:51 61 672
 40 5:59 32 94

Total   20 20 13 14 13

Average 73.80 78.45 334.54 303.07 385.85

Standard Deviation 20.85 35.07 225.38 173.20 196.42

DATA COLLECTION FOR PHARMACY

Billing Billing Servicing Servicing Servicing

Arrival counter counter 2 time time time
time 1 time time counter 1 counter 2 counter 3
9:03 57 86
9:17 52 129
9:29 61 210
9:45 54 347
9:54 72 446
10:03 55 389
10:17 62 456
10:32 54 657
10:42 77 645
10:53 88 710
11:06 66       545
11:17 86 612
11:27 74     743  
11:47 77 654
11:52 76   665    
 13:03 79 425
13:12 84       725
13:26 64 555
13:39 69     630  
13:47 72 535
14:06 52   356    
14:24 67 725
14:36 79       365
14:49 58 425
14:58 75     646  
15:09 72 405
15:19 78   380    
15:26 69 585
15:38 87       445
15:51 85 460
16:09 72     350  
16:17 85 685
16:28 82   540    
16:41 70 627
16:53 76       595
17:11 88 720
17:24 69     559  
17:33 84 645
17:44 77   429    
17:57 67 375
           

Mean 72.25 71.30 472.07 529.00 538.83

Std Dev 9.03 12.38 165.81 173.94 154.56
 Chart Title
50
45
40
35
30
25
20
15
10
5
0
9 - 10 10 - 11 11 - 12 1-2 2-3 3-4 4-5 5-6

S.no Time No of people Arriving

9/8/2015 9/26/2015
1 9 - 10 12 17
2 10 - 11 17 27
3 11 - 12 20 42
4 1-2 22 35
5 2-3 31 27
6 3-4 38 32
7 4-5 39 41
8 5-6 44 39
SUGGESTIONS

A design of experiments was conducted and analyzed in order to evaluate the

average waiting time at check-in, average number of patients waiting in queue,
average waiting time for phone call answering, and average number of dropped
phone calls. Several suggestions and implications evolve from this simulation
study:
1. There should be a balance in the schedule of new and existing patients
throughout the day. Since it takes a longer time to check-in a new patient, having
multiple new patients arriving at the same time increases the waiting times at the
front desk. Also, the extra time involved in checking-in new patients would be
obstacle for answering calls.
2. The use of automated services should allow staff members to be better utilized.
For example, an user-friendly automated attendant service (i.e. switchboard)
should be implemented for answering incoming calls. In our study, most of the
patients calling the front desk needed assistance on nurse-related issues, and
therefore the switchboard would direct these calls directly to the nurse’s desk.
3. Simulation modeling and analysis enables quantitative decision making for
managing health care clinics. In our simulated system study, we observed that
there would be no need for an additional staff member at the front desk. In
addition, the results can be used as guidelines for deciding when will be
appropriate to operate with only three staff members.

CONCLUSION
In small-size outpatient clinics, several important metrics measure the quality of
customer service at patients’ admissions, such as the waiting time that patients
wait while scheduling appointments or while checking-in at the clinic.
Management of the clinics controls these quality metrics by providing an
adequate number of staff members at the front desk. In this paper, a simulation
model was developed in order to analyze the patient admission process, which
includes: setting up appointments by phone, insurance verification, and patient
check in and check out at the clinic. Factors affecting these services were
identified as the number of staff members at the front desk, number of phone
calls received, number of patients’ arrivals, and percentage of new patients during
arrivals, percentage of phone calls requesting new appointments.