Success and Failure in the Simulation of an Accident and Emergency Department

Healthcare simulation has the potential to offer many benefits but the implementation is often problematic. This paper describes the development of a simulation of an Accident and Emergency Department in an NHS hospital. The early experience of the client provoked great enthusiasm but ultimately the simulation failed to meet all expectations. The simulation delivered a number of benefits, notably in terms of stimulating constructive debate and helping the stakeholders appreciate the complete Accident and Emergency system. The project produced a technically proficient tool that was delivered too late to have the desired impact. This mixed record of success appears typical of many simulations. Important lessons were learned, both technically and in the management of client expectations, which have contributed to subsequent successful implementation in other departments of the hospital. The experience suggests that both potential clients and analysts need to establish realistic expectations and appreciate the particular challenges of simulation in a healthcare environment

Quid pro quo:reflections on the value of problem structuring workshops

Attracting clients who are willing to invest in using a problem structuring method (PSM) can be particularly difficult for the emerging generation of modellers. There are many reasons for this, not least that the benefits of a problem structuring intervention are vague and evidence of benefits are often anecdotal for example, claims of constructing a deeper understanding of the problem or building the commitment of a group to implementing an outcome. This paper contributes to the evaluation of problem structuring methods by reflecting on the quid pro quo that a client and problem structuring modeller can enjoy from collaboration. The paper reflects on 21 cases, where Journey Making (a problem structuring method) was used with 16 organizations to help managers agree a suite of actions to tackle a complex strategic issue. The reflections are clustered around those benefits that pertain to: PSMs in general; PSMs that use computer-supported workshops; the Journey Making methodology

Application of the quick scan audit methodology in an industrial filter production process

The quick scan audit methodology (QSAM) is an established investigative tool to assess the health of business processes and supply chains within short schedules. This study extends the standard QSAM procedure to include the simulation step. It also extends the QSAM to a wider industry platform by applying it into the precision mechanical engineering industry, where managers have been under competitive pressure to reduce an industrial filter production lead time. Following a review of the relevant literature, this paper presents the research design adopted in the study. The QSAM has been conducted using various data collection techniques (such as observations, process activity mapping, interviews, questionnaires, brainstorming and access to company documents) and data analysis methods (including cause and effect analysis, Pareto analysis and time series plot). This is followed by the development of a set of improvement strategies, namely, direct information sharing, priority planning, and additional data recording and analysis. In addition to testing the potential benefits of changing scheduling approaches for the paint plant, simulation has been utilized in this study as a communication means to increase employee participation in the QSAM process and enhance the audit accuracy. It has also provided the case company with a better understanding of the behaviour and characteristics of the system under study, thus facilitating more thoughtful decisions to improve the system. The paper concludes with further research opportunities derived from this study

Soft systems methodology: a context within a 50-year retrospective of OR/MS

Soft systems methodology (SSM) has been used in the practice of operations research and management science OR/MS) since the early 1970s. In the 1990s, it emerged as a viable academic discipline. Unfortunately, its proponents consider SSM and traditional systems thinking to be mutually exclusive. Despite the differences claimed by SSM proponents between the two, they have been complementary. An extensive sampling of the OR/MS literature over its entire lifetime demonstrates the richness with which the non-SSM literature has been addressing the very same issues as does SSM

A Discrete Event Simulation model to evaluate the treatment pathways of patients with Cataract in the United Kingdom

Background The number of people affected by cataract in the United Kingdom (UK) is growing rapidly due to ageing population. As the only way to treat cataract is through surgery, there is a high demand for this type of surgery and figures indicate that it is the most performed type of surgery in the UK. The National Health Service (NHS), which provides free of charge care in the UK, is under huge financial pressure due to budget austerity in the last decade. As the number of people affected by the disease is expected to grow significantly in coming years, the aim of this study is to evaluate whether the introduction of new processes and medical technologies will enable cataract services to cope with the demand within the NHS funding constraints. Methods We developed a Discrete Event Simulation model representing the cataract services pathways at Leicester Royal Infirmary Hospital. The model was inputted with data from national and local sources as well as from a surgery demand forecasting model developed in the study. The model was verified and validated with the participation of the cataract services clinical and management teams. Results Four scenarios involving increased number of surgeries per half-day surgery theatre slot were simulated. Results indicate that the total number of surgeries per year could be increased by 40% at no extra cost. However, the rate of improvement decreases for increased number of surgeries per half-day surgery theatre slot due to a higher number of cancelled surgeries. Productivity is expected to improve as the total number of doctors and nurses hours will increase by 5 and 12% respectively. However, non-human resources such as pre-surgery rooms and post-surgery recovery chairs are under-utilized across all scenarios. Conclusions Using new processes and medical technologies for cataract surgery is a promising way to deal with the expected higher demand especially as this could be achieved with limited impact on costs. Non-human resources capacity need to be evenly levelled across the surgery pathway to improve their utilisation. The performance of cataract services could be improved by better communication with and proactive management of patients.Peer reviewedFinal Published versio

Using mixed-methods, a data model and a computational ontology in film audience research

This paper discusses a methodology that seeks to address one of the challenges in working with a range of data in mixed-methods audience research, which is how to sort, order and categorise different data so that it can be systematically combined and interrogated. The methodology was developed as part of the ‘Beyond the Multiplex: audiences for specialised films in English regions’(BtM) project . This project sought to explore the richness of audience experiences and the broad audience trends in the context of regional film policy. This required a mixed methods approach using surveys, interviews, focus groups and document analysis. The project utilised a data model approach that uses the principles of a computational ontology in order to sort, order and categorise data for systematic interrogation. The paper discusses methods, data, coding, and the use of a data model to support data analysis. We argue that this approach enables the cross referencing of data that provides a rich, multi-layered and relational understanding of film audiences but it requires time and attention to data management and coding. Although, additionally it also forms the basis of an open access data resource for future research

A generic testing framework for agent-based simulation models

International audienceAgent-based modelling and simulation (ABMS) had an increasing attention during the last decade. However, the weak validation and verification of agent-based simulation models makes ABMS hard to trust. There is no comprehensive tool set for verification and validation of agent-based simulation models, which demonstrates that inaccuracies exist and/or reveals the existing errors in the model. Moreover, on the practical side, many ABMS frameworks are in use. In this sense, we designed and developed a generic testing framework for agent-based simulation models to conduct validation and verification of models. This paper presents our testing framework in detail and demonstrates its effectiveness by showing its applicability on a realistic agent-based simulation case study

Examining the strategy development process through the lens of complex adaptive systems theory

The development of strategy remains a debate for academics and a concern for practitioners. Published research has focused on producing models for strategy development and on studying how strategy is developed in organisations. The Operational Research literature has highlighted the importance of considering complexity within strategic decision making; but little has been done to link strategy development with complexity theories, despite organisations and organisational environments becoming increasingly more complex. We review the dominant streams of strategy development and complexity theories. Our theoretical investigation results in the first conceptual framework which links an established Strategic Operational Research model, the Strategy Development Process model, with complexity via Complex Adaptive Systems theory. We present preliminary findings from the use of this conceptual framework applied to a longitudinal, in-depth case study, to demonstrate the advantages of using this integrated conceptual model. Our research shows that the conceptual model proposed provides rich data and allows for a more holistic examination of the strategy development process. © 2012 Operational Research Society Ltd. All rights reserved