Marion Health Clinic sees patients on a walk?in basis only. On average, 10 patients per hour enter the clinic. All patients register at the registration window with a registration clerk (RC), which takes 3 minutes. After registration, but before being seen by a nurse practitioner (NP), the registration records clerk (RRC) pulls the patient's records from the records room, which takes 6 minutes. At his or her turn, each patient then sees a NP, who checks weight, temperature, and blood pressure. This work activity takes 5 minutes. The NP determines if the patient must see a doctor (MD) or can be handled by a Physician's Assistant (PA). There is one MD, one PA, one NP, one RRC, one BC, and one RC in the system at the current time.

The NP sends 40 percent of the patients to the PA and 60 percent to the MD. The PA takes on average 6 minutes per patient whereas the MD takes 15 minutes. After the patient sees the PA and/or MD, the patient pays the bill or processes insurance information with the billing clerk (BC), which takes 5 minutes per patient. Then the patient exits the process.

a. Draw a process flow diagram, label everything, and place the times and percentages given in the problem on the diagram.

b. What is the throughput in patients per hour of each stage in the process?

c. What are the labor utilization rates for the MD, NP, PA, BC, RRC, and RC? Are these values appropriate? If not, how might you redesign the process? Where is the bottleneck?

d. The PA often discovers the patient should see a MD so the patient is sent to the MD after seeing the PA 50% of the time. How does this change affect your answers to the questions above?