Operations and Facility Management
This domain tests patient flow, capacity, scheduling, supply reliability, and physical-environment safety. Items often require a flow calculation or a judgment about whether high utilization is helping or harming access.
Core rules and concepts
- Little's Law: work-in-process equals arrival rate times time in system (L = λW). Use it to estimate queue size, wait time, or required capacity.
- Capacity is the maximum sustainable throughput; demand is what arrives. Utilization = demand ÷ capacity. Near 100% utilization, queue times rise sharply because variation has no slack.
- Identify the bottleneck: the step with the least capacity constrains the whole process. Improving a non-bottleneck does not improve throughput.
- Facility safety includes preventive maintenance, life-safety systems, utility management, emergency preparedness with a hazard vulnerability analysis, and supply-chain contingency plans.
Worked example
A clinic has 10 operating hours and 60 scheduled patients, so demand is 6 patients per hour. Average time from arrival to departure is 0.75 hours. By Little's Law, average patients in the system = 6 × 0.75 = 4.5. If capacity is 8 patients per hour, utilization is 75%. Adding a provider raises capacity to 10 per hour, but utilization falls to 60% unless demand grows or scheduling is tightened. Reasoning: capacity decisions must consider demand, variation, and the cost of idle capacity, not utilization alone.
Traps that cost marks
Treating 100% utilization as the goal; ignoring arrival variation; expanding a non-bottleneck; deferring preventive maintenance to save budget; assuming a backup generator eliminates emergency planning; confusing scheduled slots with completed visits.