MeritCare Health System
uses simulation to optimize integration
of service areas into new Day Unit

by ProModel Healthcare Solutions Staff

Simulation shows potential to increase patient throughput by up to 40%
and demonstrates capacity for 30% more volume

Visualizing the Problem

MeritCare Health System in Fargo, ND was in the process of preparing for the consolidation of several service lines into a new Day Unit. The new facility will house Interventional Radiology, Cath Lab/Heart Services, and AM admissions for Surgical Services.

With architectural and building plans complete and construction slated to be finished in approximately two years, MeritCare was faced with the complicated task of integrating three different services, each with their own unique operational practices, into one shared space. Recognizing that the related departments may not initially yield optimal performance in their new environment, and the undertaking would require considerable planning, team building and coordination, MeritCare retained ProModel Healthcare Solutions.

Analyzing the Situation

In order to provide the highest confidence level in the new facility design, it was critical that patient care processes, projected staff and resource allocations, and case volume projections were clearly defined, analyzed and tested to identify realistic performance expectations. MeritCare selected and worked with ProModel Healthcare Solutions to create a dynamic simulation of the new facility for the purpose of projecting how the new Day Unit would operate upon opening, and to define areas for process improvement and ensure optimal patient care.

ProModel helped MeritCare achieve its design and planning objectives using their proprietary VAO (Visualize. Analyze. Optimize.) methodology and simulation software technology.

Key metrics used to measure and compare (optional) operational scenarios, for the purpose of identifying the most effective solution:

  • Length of Stay (micro and macro)
  • Cost/Revenue
  • Patient Throughput
  • Staff Utilization (patient transport, room-prep)
  • Day Unit Close Time
  • Patient Wait Times

Optimizing the Solution

Working with MeritCare colleagues, the ProModel Healthcare Solutions' Team recognized the newly designed Day Unit had the potential to accommodate a substantial increase in patient volume over current levels. This was well-received news, given many in administration and operations feared the new facility might not be able to handle the projected volumes.

Additionally, the department's design allowed for the implementation of recommended changes, based upon the strength of the simulation model which included: modified staff and space deployments, changes to processes and policies; utilization of cross-trained staff, centralized records, standardized patient transport, and multi-use rooms.

Sue Fridgen, MeritCare Quality Management Coordinator, commented, "One of the greatest benefits from the project was the capability to communicate effectively with internal team members and management to gain consensus on issues of critical importance." The following specific results will be achieved upon final implementation of the project recommendations:

  • Reduction of 3 RN's through cross training, resulting in savings of $191,478 per year.
  • Reduction in transporters resulting in savings of $30,377 per year.
  • Deployment of non-dedicated patient rooms, improving operational flexibility and resulting in a potential for up to 40% greater patient throughput.
  • Facility's design supported staff-efficient growth, e.g. ability to manage a 30% increase in patient volume, with only 16% increase to staff allocation.
  • Determining the New Day Unit can support a substantial increase in Cath Lab patients. Cath Lab will open two additional rooms to support projected volumes and meet performance requirements.
  • Minimizing room holds for patients exiting and then returning to the Day Unit, after identifying that the system bogs down when the volume increases and the hold time exceeds 30 minutes.
  • The model is being used by MeritCare staff and will serve as an excellent long-term tool in evaluating future opportunities for care process improvement and change.

Fig. 1. Promodel simulation screen shot MeritCare new day unit.

About MeritCare

MeritCare Medical Group is the largest group practice in North Dakota. It has 11 locations in Fargo/Moorhead/West Fargo; 8 regional locations in North Dakota, and 14 regional locations in Minnesota. MeritCare includes one hospital with two locations: MeritCare Medical Center and MeritCare South University. MeritCare has been recognized as one of the "100 Most Wired Hospitals in the United States" (1999, 2000, 2001, 2002, 2003 Hospitals and Health Networks magazine). MeritCare Health System, P.O. Box MC, Fargo, ND 58122. For more information check

About ProModel Solutions

ProModel Solutions was formed in January 2000 as a result of the merger between ProModel Corporation and QuestOne Decision Sciences. ProModel Corporation, founded in 1988 in Orem, UT, was a leader in advanced simulation technology. QuestOne Decision Sciences, founded in 1987 in Bethlehem, PA, provided decision support solutions. Today ProModel Solutions combines professional services and innovative technology to deliver business process optimization and decision support solutions to the pharmaceutical, healthcare, and manufacturing and logistics industries. There are over 4,000 users of ProModelís VAO Technology.

About ProModel Healthcare Solutions

ProModel Healthcare Solutions is a performance optimization and decision support organization serving hospitals and healthcare organizations seeking to improve patient care productivity. They provide a healthcare VAO (Visualize, Analyze and Optimize) methodology, simulation technology and industry expertise to clients, enabling them to redesign procedures, patient flow, resource and space allocations, and processes under present and future conditions, to predict performance and assess changes. Check

Some Questions for Further Analysis and Discussion

  1. Is this application a model-driven Decision Support System OR is it an example of using simulation for a special decision support study?
  2. What decision support technologies were used?
  3. What is the purpose of the simulation software?
  4. How can the model serve as a "tool in evaluating future opportunities for care process improvement and change"? If it serves this function, then is it a DSS?
  5. What are the major benefits of this type of analysis?
  6. What problems or difficulties do you anticipate with use of this type of decision support solution?

Please cite as:

ProModel Staff, "MeritCare Health System uses simulation to optimize integration of service areas into new day unit", 2004, at URL DSSResources.COM.

Steve Haekler provided permission to use this case study on Tuesday, November 18, 2003. Haekler's email address is Sue Fridgen (, MeritCare Quality Management Coordinator, confirmed the information in the case prior to posting. This case study was posted at DSSResources.COM on Friday, January 09, 2004.

This case study is provided for informational purposes only. DSSResources.COM makes no warranties, express or implied, about this case summary.