I I I I I

PROCESSFLOW ANALYSIS OF BAYLOR INSTITUTE OF REHABILITATION

OCCUPATIONAL THERAPY SCHEDULING SYSTEM

I I

Amy S. Edmiston and

Christopher C. Raps

I I

Senior Design Project May 14, 1993

I I I Dr. Richard Barr

I

I

I

TABLE OF CONTENTS

I. Management Summary

Page

II. Introduction ........................................1

Purpose ..........................................1

Problem Background .................................2

Constraints......................................... 5

Analysis of Situation .................................5

Technical Description ................................7

Conclusion ........................................9

Glossary ..........................................11

APPENDICES

Organizational Chart .................................A

Scheduling Board ....................................B

Magnet Example ....................................C

Data Record Information ..............................D

FlowChart.........................................E

Pseudo Code .......................................F

Therapy Teams .....................................G

Therapist Levels ....................................H

I I

Process Flow Analysis of Baylor Institute of Rehabilitation

Occupational Therapy Scheduling System

Amy S. Edmiston & Christopher C. Raps

Management Summary

The patient treatment schedule for the Occupational Therapy Department

I at Baylor Institute for Rehabilitation is currently displayed on a large

magnetic board. This board is sufficient to display the necessary

information, but is outdated in comparison with the rest of the

• rehabilitation facility.

Each day the program specialists of each therapy team must reschedule

the patients who are seeing therapists who are off. The rescheduling is

now done by a manual trial and error system. This process could more

quickly and efficiently be completed by a computer system.

We chose to view this situation as a process flow analysis problem. First,

we documented the current system of scheduling. This documentation

outlined how the system is currently operated, what the constraints are

governing the rescheduling, and how it could be improved. We then

developed a flow chart and pseudo code that outlines the pattern that a

computer would follow in solving this model. The model is to be used in

order to help BIR in the implementation of a effective, reliable computer

system.

I I

I As submitted to Dr. Richard Barr for CSE 4395 Senior Design project, Southern

Methodist University, May 14, 1993.

I PROCESS FLOW ANALYSIS OF BAYLOR INSTITUTE OF REHABILITATION

I OCCUPATIONAL THERAPY SCHEDULING SYSTEM

Amy S. Edmiston & Christopher C. Raps

I Introduction

In January, Mr. Tom Freeman came to our Senior Design class to discuss

Ipossible ideas for Senior Design projects at Baylor Hospital. He offered

a number of ideas, but one caught our attention. It was a scheduling task

in the Occupational Therapy Department at Baylor Institute for

Rehabilitation. This project seemed like a worthwhile effort and offered I a chance for us to use our knowledge of management science to get

Iinvolved in an application that would help the community.

I Purpose

The purpose of our study of the Baylor Institute of Rehabilitation was to

I help the Baylor Occupational Therapy Department develop a new process

Iby which to schedule the patient therapies. The current process consists

of a magnetic scheduling board which involves manually scheduling

patients for the next day. This is done by physically rearranging the

magnets that represent patient therapies. Our goal was to gather

information in order to understand the existing process, then to design a

I new, more efficient way for the Occupational Therapy Department to

schedule patients.

I I

1

I

I I By developing a new system for rescheduling patients at BIR we hope to

save the department time and money, and to make the it run more

efficiently. The program specialists are the staff members most directly

affected by the current system, because they reschedule the patients every

afternoon. However, the entire therapy staff depends on the accuracy and

clarity of the schedule board in order for the department to operate in an

orderly manner. There were many constraints that had to be brought into

consideration before an accurate and feasible solution could be attained.

Our written analysis and recommendations, as well as an oral

presentation, will be presented to Mr. Tom Freeman and Ms. Tracey

Holden of the Management Engineering Department of Baylor Health

Care System.

Problem Background

At Baylor Institute for Rehabilitation the Occupational Therapy

Department is divided into four teams, each led by a specific doctor.

There is the Traumatic Brain Injury (TBI) team lead by Dr. Thomas; the

Cerebra-Vascular Accident (CVA) team, led by Dr. Rowe; the Spinal

Cbrd Injury (SCI) team, led by Dr. Bruce; and the General team which

is led by Dr. Porter. These doctors order the patients' therapies and also

collaborate with their teams once a week to discuss their patients'

progress. The therapy teams rotate each month so that the therapists

work with all the different doctors as well as the different types of

injuries. The structure of the Occupational Therapy Department itself is

shown in Appendix A. This structural chart does not include the doctors

I2

as they are employed by the hospital and not by the Occupational

Therapy Department itself.

As shown in the chart, each team has a program specialist that leads the

team within the Occupational Therapy Department. The program

specialists, the OTR H's and the OTR I's are the staff who are regularly

scheduled with therapies. There is an Aquatics Program Coordinator on

board who performs therapies in the pool as they are ordered by the

doctor. There is also a Positioning Program Coordinator who performs

specialized therapies according to the patients needs. Both of these

therapists can do pick-ups as necessary. All the therapists are limited to a

certain number of therapy treatments per day. The different levels of

seniority determine the number of treatments a therapist is allowed in an

eight hour work day. The program specialists can see four patients, twice

a day; the OTR II can see five patients twice a day; and the OTR I can

see six patients twice a day. These limits are included in the constraints

over the rescheduling of patients within the department.

At Baylor Institute for Rehabilitation the scheduling is now done

manually. They have a large magnetic scheduling board along one wall.

Across the top of the schedule board are the names of the therapists,

organized by group. Down the left side of the schedule board are the

therapy times, from 8:00 a.m. to 5:00 p.m., staggered in half hour

increments. An example of what the board looks like, with sample

therapies, is found in Appendix B. The scheduling is now done by

attaching colored magnets to the scheduling board. These magnets

contain the patient's name, the therapy time, and the regular therapist. An

I 3

example of the information on the magnet is found in Appendix C. The

magnet is placed on the space on the board corresponding to the

appropriate therapist and time. The color coding specifies the team to

which the patient is assigned.

Each afternoon two of the program specialists perform the rescheduling

of patients for the next day. The program director attaches a slip of paper

to the board telling the program specialists who will be off the next day

and when. It is then the program specialists job to reschedule these

therapists' patients to other available therapists. In an ideal situation the

patients would be treated at the same time that they normally see their

therapist. At the present time the program specialists complete the

rescheduling by a manual trial and error system. They take a patient's

magnet, find another open slot in the same half hour period, check to see

if the reschedule meets the constraints, and places the magnet on the

board in the new time. The magnet is placed at an angle to signify that it

is a pick-up. They repeat this process for all the patients who normally

see therapists who are going to be gone. The next day, the program

specialists take all the angled magnets and return them to their proper

time and therapist before beginning the rescheduling task again.

This process is quite time consuming and very inefficient. It does

however get the job task done correctly. It is imperative that all the

necessary constraints be incorporated into the scheduling model in order

to assure that the output it produces is legitimate. If the schedule

produced by a computer system is erroneous, it has not saved the

program specialists any time or energy.

I

I I

Constraints

IThe constraints that direct the rescheduling of patients are as follows:

1. According to the individual therapist's training level, he/she has a limit to the number of therapies that can be performed in a given day.

2. On certain days, the therapists have hour-long team meetings and cannot see patients during these times.

3. Certain therapies require specific therapists, such as the aquatic therapy, and cannot simply be rescheduled to anyone.

4. Female therapists who are pregnant cannot see any patient who is possibly infectious.

I Analysis of Situation

During our first meeting at Baylor, we met with Tom Freeman, Director

I of the Management Engineering Department, Judy Waterston, Executive

Director of the Baylor Health Care System, Derrick Moore, Hospital

Controller, and Janna Irwin, the Director of Information Services. We

explained that we were considering BIR as the focus for our Senior

Design project. They informed us that the Occupational Therapy

Department had requested assistance in improving the department's

scheduling system. They admitted that the current system is somewhat

Iout of date and inefficient. On that note, we accompanied Tracey Holden

to the Occupational Therapy Department where we met with Julie

I Jordan, the Director of Occupational Therapy.

I5

I

I I

Julie then introduced us to the scheduling board and gave us an idea of

how it works. She also gave us all the information about the various

teams within the Occupational Therapy Department and showed us how

the department is organized. Later we sat down to determine the best

way to view the problem so that we could develop a model to improve

the situation.

On another visit to BIR we met with the program specialists who were

doing the rescheduling for the next day. We talked with them about the

current method, and then observed as they completed the rescheduling

task. We made notes on the method to make our investigation of a new

implementation more complete. We had to be sure we covered

everything that needed to be included in the model

Upon review of our notes and further investigation of Baylor's therapy

department , we came to the conclusion to view this situation as a process

flow analysis problem. We found that the best way in which we could

help the therapists was to begin by documenting the current system of

scheduling that Baylor uses. Next we developed a flow chart and pseudo

code that together with the documentation, would be the necessary

groundwork that a private software company could use to develop a

working computer system for the Occupational Therapy Department of

Baylor Institute for Rehabilitation. The flow chart for the rescheduling

process is found in Appendix D and the pseudo code is found in

Appendix E.

I I I I I I I I I I I I El H I1 I

[] [1

One important factor of the current scheduling board that a new system

Iwould need to match is the high visibility of it. Although to the novice

eye the board seems quite obscure and difficult to understand it does

represent the information well. Our solution to this obstacle is to display

I the daily therapy schedule on terminals around the therapy area in much

the same way that airlines display flight information in the airport. In

order to do this the database would need to sort the therapy schedule

information by therapy time and then send it to the display terminals.

This would create easy access to the necessary patient information, and

eliminate any drawbacks to implementing the new system.

Technical Description

The necessary information would be stored in a database containing the

Iinformation as described in the Data Record Information, Appendix D. I The program begins when the user inputs the therapist who is going to be

I off and for what length of time. The computer then goes to that I I

therapist's schedule and locates the first patient that needs to be

rescheduled. The computer then checks the patient's record for the team

Icode. The computer then locates the first therapist in the appropriate

team. First a check is made to see if the patient is possibly infectious,

and if so, then a second check is made to see if the therapist being I considered is pregnant. If both checks are positive then the search

continues to the next therapist.

I I I

7 1

If the first constraint is met, the computer checks the therapist's schedule

to see if they have the necessary time slot free. If the time slot is

available the computer checks to see if the therapist is at their maximum

number of treatments for the day. If not, then the computer inserts the

patient into the new time slot, and starts over with the next rescheduling.

If the therapist is at the maximum number of treatments then the

computer goes on to the next therapist in the database.

If the computer does not find a match for the patient within their team,

then it moves on to the other therapists in the department. If no match

can be made the computer returns to the patients record and finds another

time slot in which the patient is free. Then it repeats the process as

described above with the new time.

When all the patients have been rescheduled, the computer sorts the

patient record information by therapy time and sends it to the display

monitors. The updated patient schedules are then printed out and sent to

each individual patient's floor, so the staff knows where the patients will

be during the day.

TO

I I I 1 I I I I I I I I I I I I I I I

Conclusion

After working on our project, and spending a fair amount of time

postulating why this system was never revamped and updated before, we

gained a better understanding of the saying "if it ain't broke don't fix it".

For the therapy staff, their scheduling board had been a dependable

scheduling system for the last twenty years, so they saw no real reason to

change it. However as the number of patients increased, they saw that

their reliable way of scheduling was starting to show its imperfections.

The time that it took to reschedule all of the new patients, and

consequently the additional staff that would be required to handle this

increase was quickly becoming too large of a problem to ignore.

Since BIR had never documented the process, they did not have any real

Inotion of where to start the process of exploring a new way in which to

schedule the patients. With our process flow analysis, which includes the

complete documentation of how their present system works, the pseudo

code and flowchart that contains our suggestion of how to build a new

system that is very user friendly and much more efficient, they now have

the information to take to a software company for the final step of the

project to be done: the actual implementation of the new computerized

system with the display terminal readouts.

Throughout this project we never actually came across any type of

limitations that could stop BIR from implementing our suggestion for

creating a more efficient scheduling system. In the beginning Tom

Freeman related that we should not consider funding a constraint, as long

as the recommendations were reasonable. In fact, since our analysis

I I I I I I I I I

I I I U I I I I I

I I I I I I I I I I I I I I I I I I I

completes the background work that a software company would have to

assess themselves, we have made any type of financial limitation that

Baylor might encounter, much less of a problem.

The staff at Baylor was extremely helpful and friendly. They seemed

open to whatever ideas we introduced to them and were very tolerate of

our "nosing around" in the Occupational Therapy Department. Everyone

we encountered was very patient in explaining any questions we had

regarding the department and how it was run. The staff does seem to

realize that the schedule board is outdated and seemed delighted that we

were working to help them improve their work environment.

10

I I I I I I I I I I I I I I I I I I I

GLOSSARY

aide - staff member at BIR who assists with therapies as needed.

BIR - Baylor Institute for Rehabilitation.

CVA - cerebra vascular accident.

General - any therapy that does not fall under one of the other three

categories; i.e. bums, broken bones etc.

OTR I - occupational therapy resident; staff level.

OTR II - occupational therapy resident; senior therapist.

pick up - when a therapist treats a patient who is normally treated by

another therapist.

program specialist - leader of the therapy team; in charge of

rescheduling.

Sc! - spinal chord injury.

TBI - traumatic brain injury.

team - a group consisting of one program specialist and two or three

other therapists who work under one of the four doctors on

specific types of patients.

transporter - staff member at BIR who transports patients from their

rooms to the therapy area.

11

APPENDICES

Occupational Therapy Organizational Chart

I Gen. Program

I

CVA ProgramI

TBI Program SCI Program Specialist Specialist Specialist Specialist

0Th II OTR I 0Th I OTR I

0Th I LOTR I LOTR I —OTR I

OThI LOTRI

Ide

IAide _

Aide Aide _

Aquatics Positioning Program Program

Coordinator Coordinator (pick-ups) (pick-ups)

ro

— — — — — — — — — — — — — — — — — — —

SD1

TEAM 1 (General Program Specialists)

PROG SPEC OTR II OTR I OTR I TIME

8:00 Pink DHF Pink DDS Pink ALL

8:30 Scheduled Team Meeting

9:00

9:30 Pink DDF Pink DDS Pink UYH Pink LKK

10:00 Pink CKL Pink UYI-1 Pink GYI-1

10:30 Pink GYH Pink UYH

11:00 Pink JGK Pink LHD Pink GYH

11:30 Pink TTH Pink LHD Pink ZVC

12:00 Pink ZVC PinkRUl Pinc LHD

12:30 PinkRUl Pink ZVC

1:00 PInkGHT Pink 000 PinkRUl

1:30 Pink EER Pink QQO Pink OPU

2:00 Pink OPU Pink YOU Pink QQO

2:30 Pink YVW

3:00 Pink OWE Pink YVW Pink POL Pink YOU

3:30 Pink POL Pink YVW

4:00 Pink YOU Pink POL

4:30 Pink TTY Pink OPU

I I I I I I I I I I I I I I I I I II

SD1

TEAM 2 CVA Group Therapy

Proa SDec OTR I OTR I

Blue DDS Blue TUR

BLue LKK Blue RYT

Blue EYR

Blue UYH Blue FHG

Blue TUR Blue GTh Blue SHD

Blue ASD

Blue AFS Blue LHD Blue WOl

Blue P01 Blue ZVC Blue VNB

Blue EJK Blue NCB

Scheduled Team

BLue FHG Blue ONB

Blue WTY Blue YOU Blue OPW

Blue QPL Blue YVW Blue WKJ

Blue THE Blue POL Blue GGG

Blue OPU

Blue TUR

Page 2

SD1

TEAM 3 TBI Group Therapy

Pro g Spec OTR I OTR I

Green PLG Green DKJ

Green_QKL

Green_DKl

Scheduled Team Meeting

Green GSD Green QLO

Green IOJ Green TKJ

Green AKJ Green OlD

Green AHS Green HFD

Green P01 Green QKD

Green WEIR Green QHD Green OYT

Green VHF

Green FHG Green AJS Green FHS

Green YUI Green AKJ

Green OWE Green AQD

Green ASD Green GJF

Green JHS Green QKd Green JSA

Green 010 Green FHW

Page 3

SD1

TEAM 4 SCI Group Therapy

Prog Spec OTR I OTR I OTR I

Yellow 1FF Yellow HSI

Yellow WIU Yellow IUH

Yellow FHJ Yellow WSD Yellow LLL

Yellow ALA Yellow JKD

Yellow JSH Yellow AAS Yellow UHG Yellow JGH

Scheduled Team Meeting

Yellow UWE Yellow USA Yellow KKH

Yellow JAS Yellow AAS Yellow JVV Yellow CCI

Yellow KAA Yellow CCH

Yellow KSI Yellow DUF Yellow HHD

Yellow DUI Yellow VHD

Yellow KHM Yellow DWI

Yellow JDS Yellow BUI

Yellow UIH Yellow YHD Yellow PPK

Yellow HDF Yellow HKD Yellow HFG Yellow PPO

Yellow QlO Yellow VHH Yellow 110

Yellow JNM Yellow VVH 1 Yellow DDJ

I I I I I [1 F^

I I I I I I I I I UI I Page 4

I I I I I I

SD1

IAcivatics Director I

I Water TTT I I

I Water JFH I I

I Water LLL I I

I Water IF I I

I I I I I I I I I I I Page 5

I •1 I I I I I I I I I I I I I I I I I

LI1

John Kasigan Johnson

9:30 A. M.

Judy Frangensin

Appendix C

I I DATA RECORD INFORMATION

NEEDED FOR SOFTWARE I TO GENERATE DAILY PHYSICAL THERAPY SCHEDULES

I The data below will be read in from individual records to find a successful match of patient to therapist. Once a successful match has been found, then the new record generated, which includes the patients name, therapy type, I team assigned, time assigned and the physical therapist who will administer the therapy will be sent to the output screen.

PHYSICAL THERAPIST:

1. CLASSIFICATION LEVEL

a. Program Specialist b. OTR II Senior Therapist c. OTR I Staff Therapist

2. PREGNANT THERAPIST

a. Yes b. No

3. THERAPY TEAM

a. General Group Therapy b. CVA Group Therapy c. TEl Group Therapy d. SCI Group Therapy

4. THERAPISTS NAME

5. OPEN TIME SLOTS

Appendix D

I I

I I

PATIENT

1. INJURY IS INFECTIOUS

a. Yes b. No

2. PATIENTS NAME

3. TYPE OF THERAPY NEEDED

4. WHAT TEAM THEY ARE ASSIGNED TO

a. General Group Therapy b. CVA Group Therapy c. TBI Group Therapy d. SCI Group Therapy

5. ADDITIONAL OPEN TIME SLOTS IF NO MATCH IS FOUND

I

CODE IS GENERAL

CODE IS CODE IS CVA

I I TBICODE IS

SCI

User inputs Pt's I I that are off and locate 1st I Check and store ^Check patients

rp I when I I U LIent 111 I tnerapy time i I record for code

BEGIN SEARCH FLOW CHART FOR

IN DESIGNATED

B.I.R SOFTWARE TEAM SCHEDULE ro

GO TO FIRST AVAILABLE

P..T..

IS P.T PREGNANT

no continue constraint chk

Does P.T have needed time?

yes GO TO NEXT IS PATIENT AVAIL P.T INFECTIOUS I

no TEAM

if no match anywhere

12 es

check patients sched

for next open time. if none found Drop patien I no Does this exceed therapy for day. I

maximum?I

INSERT 0 TO NEXT PATIENT IN heck P.T. rec for

NOPATIENT begin process again yes of pat. allowed

send vat & time to screen

- - - - - - - - - - - - - - - - - - -

I I PSEUDO CODE FOR BAYLOR INSTITUTE

FOR REHABILITATION

User input s the therapist that is going to be off and when.

Starting at the beginning of that therapist's schedule, locate the first patient in the database.

Check patient's record for patient's code: Team 1 = General Team 2 = CVA Team 3=TBI Team 4 = SCI

Once patient's team is determined begin search in designated team's work schedule.

Within the team's schedule go to first available therapist's schedule.

First check for infectious patient and pregnant therapist.

Check the patient's record to see if he/she is possibly infectious

If yes then check therapist's record to see if she is pregnant

IIf the therapist is pregnant then move on to

next therapist's record

Else continue constraint check

Else continue constraint check

I Appendix F

I

I I

Next check to see if therapist has time needed free and if so, check to see if the therapist has their maximum number of patients allotted for the day.

If therapist has the needed open time slot then

Read therapist's record to determine how many therapies they are allowed per day. (call this MAX)

Count number of scheduled patients therapist already has scheduled for that day.

If number >= MAX goto next therapist's schedule

Else if number < MAX insert patient into time slot.

Else goto next therapist's schedule until end of file is reached.

Search through other teams schedules.

If no match is found, repeat search through next team.

Search through specialized therapists schedules.

If no match is found within the regularly scheduled therapists check aquatics therapist and positioning program therapist's schedules.

II

I I I I I I I I I I I I I I I I I I I

Search patient's schedule for new time.

If a match is still not found then check patient's schedule for open time slot.

Repeat search through regular team therapists for new open time.

Repeat until all patients have been rescheduled.

Display of data.

When all patients have been rescheduled, sort patient record files by time and send to display monitors.

ITherapy Teams

General

• Dr. Porter

I Traumatic Brain Injury (TBI)

•

I Cerebra-Vascular Accident (CVA) Dr. Rowe

I Spinal Chord Injury (SCI) Dr. Bruce

jAppendix G

1 Therapist Levels j i Program Specialist

• 4 patients - twice a day

OTR2 - Senior Therapist 5 patients - twice a day

• OTR1 - Staff Level

• 6 patients - twice a day

j Aide Iassists with therapies as needed

I Transporter I transports patients from their rooms to the therapy area

IAppendixH