ACT Kids Health Fair (Observation and Analysis)

The annual ACT Kids Health Fair serves at-risk children who are eligible for  metropolitan Phoenix Head Start programs, but lack appropriate medical clearances. This all-volunteer event addresses the full spectrum of health requirements: transportation To and from the children's neighborhoods, all appropriate medical screenings and immunizations, Establishing and updating Medical records, and arranging emergency or continuing care as needed. Over 20,000 children have been screened to date.¹

2013 was the first year that the ACT Children Health Fair used technology to track patients and families as they flowed through the fair.  Learning from using this technology, how to implement it, and the information it gives will help the navigation of families through future ACT Kids Health Fairs more efficient.

Anonymous wrist bands to track flow

An anonymous wrist band with a unique ID was given to fair participants as they entered the fair.  A hand-held scanner (used by volunteers) was then used to scan the wristband as they entered the fair.  Scanning also took place at various points inside the fair and then one last time as they exited the fair. This scan documented a “time-stamp” of the exact time the wristband was scanned. The time stamp information was then put into a database with the ID number being the unique key.

I performed time studies and observations during the ACT Kids Health Fair on September 28, 2013 and analysis of the time stamp data.

Analysis of Time-Stamp data

 

Figure #1



An analysis (Figure 1) of the white-band  time stamps, which inlcuded Children and Parents revealed that wrist band scanning was inconsistent (as evidenced by missing Check-in and Check-out times.)  For example, you can see (Figure 1) that only 63% of white bands had an associated check-in time documented. For stations inside of the fair with very low percentage of scanning (i.e. Dental, Hearing, etc) it is also likely not every child visited every station.

Data that connects a wristband to any particular screening or a simple count of how many children visited each station could be used to confirm this.  




Figure 2

The number of Patients and Family arriving by hour (Figure 2) was determined by using the “check-in” time stamp to determine the distribution pattern of the number of people that checked in by hour.  Due to the fact that we now know many check-in times did not get captured, I used this pattern of “check-ins” to distribute all of the 2083 white bands into their respective hour. It was later determined that the wristband tracking had some glitches in the beginning of the day. Despite the fact that patients and family were participating in the fair prior to 9:00am, wristband tracking data starts at 9:00am.  It is interesting to note that there exists a steady decrease in families arriving until about 2:00pm (one hour before the fair ends) where it increases again. Leaders of the fair in previous years suspected this was the case and can now confirm this increase at the end of the day every year and have already incorporated this into their resource planning for the day of the event. This also served to help further demonstrate that my analysis of the data was indeed valid.







Figure 3

How long patients and families stayed in the fair (Figure 3) was determined by subtracting the check-out time from the check-in time of white bands. The sample only included white bands that had both check-in and check-out data (Sample size was 734, which gives approx +/-  3%.)





Figure 4

Using the wristband data to determine volumes of patients (Figure 4) that arrived in each hour and how long patients stayed in the fair,  5 discrete event computer simulations were performed to determine the approximate number of patients and family members physically in the fair in 15 minute intervals.  This graph represents the averages of the 5 simulation runs.  The Maximum number of people during any of the simulation runs was 753 people.  Recall: Patients were in the fair before 9:00am, however, the tracking did not start until 9:00.  This would have the affect of elongating the shape of figure 4 to the left and slightly reducing the number of people in the fair at any one time (because the number of people in the fair can now be spread out over more time) without dramatically changing the overall distribution of the graph.

Direct Observations

I also made random observations of every area in the ACT Kids Health Fair over the course of the day where I documented (69 observations) how long each station took to see a child (also known as cycle time.) Most stations had 2 or more observations (with different Clinicians being observed) except for Lead Screening which only had 1 observation. Also, families were observed:  Approx 56.25% of white bands were children. Using this assumption: 56.25% of the 2083 white bands (1172) were children participating in the ACT Kids Health Fair.

 TAKT Time and work balance was determined.



Figure 5



TAKT time is the time a patient needs to spend at any one station (includes the area’s check-in and check-out stations for areas such as dental, vision, etc)  for the fair to complete 1172 patients in 7 ½ hours*. 420 minutes to see 1172 children is approx a child every 23 seconds (27000 seconds / 1172 people) ~ 23 seconds. Figure 5 shows each station on the horizontal axis with the dark bars demonstrating how long each station takes to process one patient. The red line, which is at 23 seconds, shows how fast each process must be to keep the TAKT time. The idea is that you can add more stations until you reach a point where someone in your area is leaving every 23 seconds.

Knowing the TAKT time can help determine how many stations we may need to meet demand. For example:  If we want all 1172 Children to get dental screenings ( a dental screen takes approx 250 seconds) in a 7 ½ hour period. We know from our TAKT time that a child must be screened every 23 seconds. To accommodate this demand, we would need approx 11 dental screeners to meet this demand (i.e.  11 screeners x 23 seconds =  253 seconds)

I put this together with information that I thought may be interesting and helpful. It was a pleasure to be able to have the opportunity to help make future ACT Kids Health Fair Events more successful.

¹ACT Kids Health Fair - Saturday, September 27, 2014. (n.d.). Retrieved January 7, 2014, from www.actkidshealthfair.org: http://www.actkidshealthfair.org/cAbout.php?cid=9

*7 ½ hours = 450 minutes = 27,000 seconds