title: Applying the variety reduction principle to management of ancillary services.
abstract: BACKGROUND
  As central diagnostic facilities, computer tomography (CT) scans appear to be bottlenecks in many patient-care processes. This study describes a case study concerning redesign of a CT scan department in the Academic Medical Center in Amsterdam, the Netherlands.
  
  
  OBJECTIVE
  The aim was to decrease access time for the CT-scan and simultaneously increase utilization level.
  
  
  METHODS
  An important cause of relatively low-capacity utilization is variability in the time needed for the scanning process. We performed a qualitative and quantitative analysis of current processes; identified bottlenecks and selected interventions with the greatest expected reduction of variability in flow time.
  
  
  RESULTS
  The most promising and most feasible opportunity appeared to be to reallocate the insertion of intravenous access lines to a preparation room. The time needed for this activity was very hard to predict and needed a lot of slack in the lead time for appointments. By removing it from the CT room, lead time could be reduced by 5 minutes. The intervention resulted in a decrease of access time from 21 days to less than 5 days, and an increase of the utilization rate from 44% to 51%. This contributed directly to patient service and indirectly to cost reduction.
  
  
  CONCLUSIONS
  Our strategy is applicable in every appointment-based hospital facility with variation in the length of time of the process. It allows to simultaneously reduce costs and improve service for the patient.
authors.affiliation: Academic Medical Center/University of Amsterdam, Department of Innovation and Process Management, Amsterdam, the Netherlands. s.g.elkhuizen@amc.uva.nl
authors.forename: Sylvia G
authors.initials: SG
authors.lastname: Elkhuizen
authors.forename: Jasper R C
authors.initials: JR
authors.lastname: van Sambeek
authors.forename: Erwin W
authors.initials: EW
authors.lastname: Hans
authors.forename: Koos J J
authors.initials: KJ
authors.lastname: Krabbendam
authors.forename: Piet J M
authors.initials: PJ
authors.lastname: Bakker
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D017598:Efficiency, Organizational; D006801:Humans; D009313:National Health Programs; D009426:Netherlands; D013996:Time and Motion Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*