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The Good and the Bad of Visit per Room per Day

In graduate school, I noticed that the vast majority of theories in industrial and systems engineering led back to efficiency, on top of which is a series of “metrics of success” to indicate how “good” or “bad” a system is performing operationally. Two years as a member of the operations design team has allowed me to observe how our healthcare clients are scratching their heads every day to design the “best” dashboard metric as an indicator of operational efficiency across the board, regardless of specialty or provider.

Visit per Room per Day has gained lots of popularity from intelligent C-suit decision makers, physicians and administrators. Of course, seeing quantitative metrics being calculated and referenced before making major decisions yields a proud feeling for a data geek/guru/specialist/fanatic like me. It is also confirmation of the progress we have made as a society to spend taxpayer money wisely. However, like selecting the right spice to cook your dinner, we need to ask ourselves: Is Visit per Room per Day the “correct” metric to meet our clients' design goals?

The Good

As straightforward as it sounds, Visit per Room per Day indicates, on average, how many visits occur in each exam room on a daily basis. This is exactly why the metric has been selected as the representative of exam room productivity. Without massive data analysis or analytical modeling, anyone with basic data literacy can calculate this metric with the function below:

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Not only is Visit per Room per Day easy to calculate, but it is also one of the simplest metrics to explain and implement in a medical environment without extensive definitions and data training for medical staff. Because this metric offers the maximum convenience to both decision makers and clinic managers, it has become increasingly popular when it comes to space productivity and operational efficiency.

The Bad

However, as Lean Six Sigma Black Belts and operational experts, we know that a system cannot be measured purely by throughput. Merely pursuing a high Visit per Room per Day metric may drive up other resource needs and, in turn, raise operational costs. For example, with a fixed number of exam rooms, by extending operational hours, a clinic will most likely see more patients each day, resulting in a higher Visit per Room per Day. But maintaining longer operational hours will require appropriate staffing and scheduling, and ROI analysis may not favor the decision to extend working hours to support a limited increase in volume.

Often, Visit per Room per Day is referenced by C-suit decision makers to compare different specialties. Knowing that visit durations and operation hours can vary widely across clinics, this metric can be unfair and misleading. For instance, assuming two clinics — cancer and women’s — operate with the same clinic hours, cancer patients are scheduled for 60 minutes on average while primary care patients are scheduled for 30 min on average. When comparing Visit per Room per Day, women’s is most likely going to have a “better” performance by having a quicker cadence of seeing patients. Without addressing the difference in visit durations, decision makers may be misled by this comparison and decide to implement a similar operational model between women’s and other specialties.

When to use or not use Visit per Room per Day?

Knowing Visit per Room per Day can be both “good” and “bad”, it is important for decision makers to use it properly and at the right time. It is especially important to avoid using it as an across the board metric for operational and space productivity and comparing different specialties.

Nevertheless, Visit per Room per Day can still be adopted for internal performance evaluation within a clinic. For instance, weekly or monthly or event annual average Visit per Room per Day can be calculated to depict an increase or decrease of each clinic’s performance chronically.

A fair metric needs to be clearly defined in order to compare across the board. With HDR’s data-driven design, percent room utilization across any timeframe can be obtained through simulation modeling with appropriate data inputs and assumptions from the client, and can clearly describe how long the space is occupied by value-adding activities and non-value-adding activities. This can be easily translated by Visit per Room per Day in combination with visit durations and operation hours with function below, which makes it easier for our clients to accept and implement this metric gradually and enhance their decision making processes.

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Thinking back on my time working in operations design, it has been our job to find solutions and increase operational efficiency for our clients with quantifiable metrics. Understanding the “good” and “bad” of existing solutions has been challenging, but it has also allowed the team to continuously learn, test and inspire.

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