Waleed Abo-Hamad

Simulation-based framework to improve patient experience in an emergency department

The global economic crisis has a significant impact on healthcare resource provision worldwide. The management of limited healthcare resources is further challenged by the high level of uncertainty in demand, which can lead to unbalanced utilization of the available resources and a potential deterioration of patient satisfaction in terms of longer waiting times and perceived reduced quality of services. Therefore, healthcare managers require timely and accurate tools to optimize resource utility in a complex and ever-changing patient care process. An interactive simulation-based decision support framework is presented in this paper for healthcare process improvement. Complexity and different levels of variability within the process are incorporated into the process modeling phase, followed by developing a simulation model to examine the impact of potential alternatives. As a performance management tool, balanced scorecard (BSC) is incorporated within the framework to support continual and sustainable improvement by using strategic-linked performance measures and actions. These actions are evaluated by the simulation model developed, whilst the trade-off between objectives, though somewhat conflicting, is analysed by a preference model. The preference model is designed in an interactive and iterative process considering decision makers preferences regarding the selected key performance indicators (KPIs). A detailed implementation of the framework is demonstrated on an emergency department (ED) of an adult teaching hospital in north Dublin, Ireland. The results show that the unblocking of ED outflows by in-patient bed management is more effective than increasing only the ED physical capacity or the ED workforce.

Integrating balanced scorecard and simulation modeling to improve emergency department performance in Irish hospitals

In the healthcare sector, there is a requirement for innovative solutions in managing the high levels of complexity and uncertainty within Emergency Departments (EDs). Simulation modeling is currently seen as a competent means of analyzing EDs, which allows changes effects to be understood and predicted more easily. The Balanced Scorecard (BSC), well-known performance management concept, has become a steering method in approaching new improvement cycles. This paper presents a methodology that integrates BSC and simulation modeling to improve the performance of ED in a University Hospital in North Dublin. BSC design began with understanding patients needs, ED activities, as well as training and development programs. Then a detailed simulation model was developed and integrated with the BSC to provide a comprehensive decision support system. This integrated model can be used for evaluation of various decisions in emergency area. The developed integrated model is also a tool for improvement.

A system dynamics view of the acute bed blockage problem in the Irish healthcare system

Global population ageing is creating immense pressures on hospitals and other healthcare services, compromising their abilities to meet the growing demand from elderly patients. Current demand–supply gaps result in prolonged waiting times in emergency departments (EDs), and several studies have focused on improving ED performance. However, the overcrowding in EDs generally stems from delayed patient flows to inpatient wards – which are congested with inpatients waiting for beds in post-acute facilities. This problem of bed blocking in acute hospitals causes substantial cost burdens on hospitals. This study presents a system dynamics methodology to model the dynamic flow of elderly patients in the Irish healthcare system aimed at gaining a better understanding of the dynamic complexity caused by the systems various parameters. The model evaluates the stock and flow interventions that Irish healthcare executives have proposed to address the problem of delayed discharges, and ultimately reduce costs. The anticipated growth in the nations demography is also incorporated in the model. Policy makers can also use the model to identify the potential strategic risks that might arise from the unintended consequences of new policies designed to overcome the problem of the delayed discharge of elderly patients.

Simulation Optimisation Methods in Supply Chain Applications: a Review

T competitiveness and dynamic nature of today’s marketplace is due to rapid advances in information technology, short product life cycles and the continuing trend in global outsourcing. Managing the resulting supply chain networks effectively is challenged by high levels of uncertainty in supply and demand, confl ict objectives, vagueness of information, numerous decision variables and constraints. With such levels of complexity, supply chain optimisation has the potential to make a signifi cant contribution in resolving these challenges. In this paper, a literature review – based on more than 100 peer-reviewed articles – of state-of-the-art simulation-based optimisation techniques in the context of supply chain management is presented. A classifi cation of supply chain problems that apply simulation–optimisation techniques is proposed. The main criteria for selecting supply chain optimisers are also identifi ed, which are then used to develop a map of optimisation techniques. Such a map provides guidance for researchers and practitioners for a proper selection of optimisation techniques.

Towards Leaner Healthcare Facility: Application of Simulation Modelling and Value Stream Mapping

Recently, the application of lean thinking in healthcare has grown significantly in response to rising demand caused by population growth, ageing and high expectations of service quality. However, insufficient justifications and lack of quantifiable evidence are the main obstacles to convince healthcare executives to adopt lean. Therefore, this paper presents a methodology that integrates lean tools with simulation to enhance the quality of patient care in healthcare facilities. This enables healthcare organisations to dedicate more time and effort to patient care without extra cost to the organisation or to the patient. Value stream mapping is used to identify value-added and non-value-added activities.. Then, a comprehensive simulation model is developed to account for the variability and complexity of healthcare processes and to assess the gains of proposed improvement strategies. An extensive analysis of results is provided and presented to managers to illustrate the potential benefits of adapting lean practices.

Evaluating policy interventions for delayed discharge: a system dynamics approach

Global population ageing is creating an immense pressure on hospitals to meet the growing demand for elderly healthcare services. Current demand-supply gaps results in prolonged waiting times for patients and substantial costs for hospitals due to delay in discharges. This paper uses System Dynamics (SD) methodology to map the dynamic flow of elderly patients in the Irish healthcare system. The developed system dynamic model helped decision makers to envisage the complexity resulted in the system due to the infringing parameters. Stock and flow intervention policies are proposed and evaluated subject to the projected future demographic changes. The model enables policy makers to identify potential strategic policies that will contribute significantly to overcome the delayed discharge for elderly patients. Future work will focus on using a modified model of the developed national model in order to assist local communities in Ireland in their long-term planning for non-acute service sector for elderly.

Multi-criteria approach using simulation-based balanced scorecard for supporting decisions in health-care facilities: an emergency department case study

Health research is a priority in every economy, and this research – set in the context of building a more sustainable and efficient health-care system – examines how operations management practices can be translated to clinical applications. Health-care systems in general (and emergency departments (EDs) in particular) around the world are facing enormous challenges in meeting the increasingly conflicting objectives of providing wide accessibility and delivering high-quality services efficiently and promptly. The framework proposed in this study integrates simulation modelling, the Balanced Scorecard, and multi-criteria decision analysis with the aim of providing a decision support system for health-care managers. Using the Analytic Hierarchy Process, simulation results are aggregated to achieve defined strategic as well as tactical and operational objectives. Communicating the significance of investigated strategies can encourage managers to implement the framework’s recommendations in the ED within the partner hospital.

Multi-criteria framework for emergency department in Irish hospital

Health research is one of these priorities in every economy and through this research an emphasis will be put on translational research in the context of more sustainable and efficient healthcare system (translation of operations management practices to clinical applications). Healthcare systems in general and Emergency Departments in particular around the world are facing enormous challenges in meeting the increasingly conflicting objectives of providing wide accessibility and efficiency while delivering high quality and prompt services. The proposed framework integrates simulation modeling, balanced scorecard, and multi-criteria decision analysis aiming to provide a decision support system to emergency department managers. Simulation outputs are aggregated using analytic hierarchy process (AHP) to provide marginal performance regarding the achievement of the defined strategic as well as tactical and operational objectives. Communicating the significance of investigated strategies has encouraged managers to implement the framework recommendations in the emergency department within the hospital partner.

Towards Operations Excellence: Optimising Staff Scheduling For New Emergency Department

This paper presents a case study of an Emergency Department of a public hospital in Dublin, and uses an integrated approach to determine optimal staffing levels to meet the challenges of its dynamic patient demand levels. A comprehensive stochastic model is developed to incorporate patients care pathways and the resources required along their treatment journeys. Analytical Hierarchical Process is utilised to enable decision makers to set their preferences for the facility’s strategic objectives. Evolutionary algorithms are applied to optimise staff schedules. The resulted optimized schedules maintains continuity of care delivery for patients while ensuring a balanced equilibrium among available staff.

Using Modelling and Simulation to Improve Elderly Care in Ireland: A Case Study

Health care services both globally and domestically are encountering critical issues due to the increasing demand for services at the time of economic recession. Hospital performance is subject to many constraints, and planning is made more difficult by the complexity and uncertainty of demand. Population ageing is creating immense pressures on healthcare facilities across the world, leaving them struggling to cope with the growing demand for elderly healthcare services. Current demand-supply gaps result in prolonged waiting times for patients and substantial cost burdens for healthcare systems due to delayed discharges. This paper reports on a project that uses modelling and simulation to address elderly care pathways in the Irish healthcare sector. The faster management of frail patients admitted to acute hospitals and the introduction of new intermediate care beds are alternative interventions that healthcare executives are interested in simulating to examine their impact on the performance of the elderly care system. The simulation model developed, along with the statistical analysis, enabled hospital services managers to assess the critical performance and financial issues of the current system, and highlighted the decision variables that could significantly improve the flow of elderly patients. Keywords—Population Ageing, Elderly Care, Discrete Event Simulation, Discharge Planning.