A theoretical framework for hybrid simulation in modelling complex patient pathways

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Providing care services across several departments and care givers creates the complexity of the patient pathways, as it deals with different departments, policies, professionals, regulations and many more. One example of complex patient pathways (CPP) is one that exists in integrated care, which most literature relates to health and social care integration. The world population and demand for care services have increased. Therefore, necessary actions need to be taken in order to improve the services given to patients in maintaining their quality of life. As the complexity arises due to different needs of stakeholders, it creates many problems especially when it involves complex patient pathways (CPP). To reduce the problems, many researchers tried using several decision tools such as Discrete Event Simulation (DES), System Dynamic (SD), Markov Model and Tree Diagram. This also includes Direct Experimentation, one of techniques in Lean Thinking/Techniques, in their efforts to help simplify the system complexity and provide decision support tools. However, the CPP models were developed using a single tools which makes the models have some limitations and not capable in covering the entire needs and features of the CPP system. For example, lack of individual analysis, feedback loop as well as lack of experimentation prior to the real implementation. As a result, ineffective and inefficient decision making was made. The researcher also argues that by combining the DES and SD techniques, named the hybrid simulation, the CPP model would be enhanced and in turn will help to provide decision support tools and consequently, will reduce the problems in CPP to the minimum level. As there is no standard framework, a framework of a hybrid simulation for modelling the CPP system is proposed in this research. The researcher is much concerned with the framework development rather than the CPP model itself, as there is no standard model that can represent any type of CPP since it is different in term of its regulations, policies, governance and many more. The framework is developed based on several literatures, selected among developed framework/models that have used combinations of DES and SD techniques simultaneously, applied in a large system or in healthcare sectors. This is due to the condition of the CPP system which is a large healthcare system. The proposed framework is divided into three phases, which are Conceptual, Modelling and Models Communication Phase, and each phase is decomposed into several steps. To validate the suitability of the proposed framework that provides guidance in developing CPP models using hybrid simulation, the inductive research methodology will be used with the help of case studies as a research strategy. Two approaches are used to test the suitability of the framework – practical and theoretical. The practical approach involves developing a CPP model (within health and social care settings) assisted by the SD and DES simulation software which was based on several case studies in health and social care systems that used single modelling techniques. The theoretical approach involves applying several case studies within different care settings without developing the model. Four case studies with different areas and care settings have been selected and applied towards the framework. Based on suitability tests, the framework will be modified accordingly. As this framework provides guidance on how to develop CPP models using hybrid simulation, it is argued that it will be a benchmark to researchers and academicians, as well as decision and policy makers to develop a CPP model using hybrid simulation

A theoretical framework for hybrid simulation in modelling complex patient pathways

Providing care services across several departments and care givers creates the complexity of the patient pathways, as it deals with different departments, policies, professionals, regulations and many more. One example of complex patient pathways (CPP) is one that exists in integrated care, which most literature relates to health and social care integration. The world population and demand for care services have increased. Therefore, necessary actions need to be taken in order to improve the services given to patients in maintaining their quality of life. As the complexity arises due to different needs of stakeholders, it creates many problems especially when it involves complex patient pathways (CPP). To reduce the problems, many researchers tried using several decision tools such as Discrete Event Simulation (DES), System Dynamic (SD), Markov Model and Tree Diagram. This also includes Direct Experimentation, one of techniques in Lean Thinking/Techniques, in their efforts to help simplify the system complexity and provide decision support tools. However, the CPP models were developed using a single tools which makes the models have some limitations and not capable in covering the entire needs and features of the CPP system. For example, lack of individual analysis, feedback loop as well as lack of experimentation prior to the real implementation. As a result, ineffective and inefficient decision making was made. The researcher also argues that by combining the DES and SD techniques, named the hybrid simulation, the CPP model would be enhanced and in turn will help to provide decision support tools and consequently, will reduce the problems in CPP to the minimum level. As there is no standard framework, a framework of a hybrid simulation for modelling the CPP system is proposed in this research. The researcher is much concerned with the framework development rather than the CPP model itself, as there is no standard model that can represent any type of CPP since it is different in term of its regulations, policies, governance and many more. The framework is developed based on several literatures, selected among developed framework/models that have used combinations of DES and SD techniques simultaneously, applied in a large system or in healthcare sectors. This is due to the condition of the CPP system which is a large healthcare system. The proposed framework is divided into three phases, which are Conceptual, Modelling and Models Communication Phase, and each phase is decomposed into several steps. To validate the suitability of the proposed framework that provides guidance in developing CPP models using hybrid simulation, the inductive research methodology will be used with the help of case studies as a research strategy. Two approaches are used to test the suitability of the framework – practical and theoretical. The practical approach involves developing a CPP model (within health and social care settings) assisted by the SD and DES simulation software which was based on several case studies in health and social care systems that used single modelling techniques. The theoretical approach involves applying several case studies within different care settings without developing the model. Four case studies with different areas and care settings have been selected and applied towards the framework. Based on suitability tests, the framework will be modified accordingly. As this framework provides guidance on how to develop CPP models using hybrid simulation, it is argued that it will be a benchmark to researchers and academicians, as well as decision and policy makers to develop a CPP model using hybrid simulation.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Optimizing University Shuttle Buses to Reduce Students’ Waiting Time Using a Discrete Event Simulation Technique

Shuttle buses replacing private transports have long been used to reduce traffic congestion in a university campus. However, to estimate the optimal number of buses taking into account human behaviour using a manual method to provide a better service is very difficult. This is especially true when the shuttle buses have multiple routes and are significantly affected by unpredictable human behaviour such as their stochastic arrival at the available bus stops. This paper thus employs modelling and simulation methodologies specifically a Discrete Event Simulation (DES) technique to observe the effects of various configuration of bus number to student waiting time. For this, a DES model for bus transportation in a university using various available modules in Arena software was first developed. The simulation model was then fed with relevant data; e.g., the total number of students having classes at certain time periods, the current allocation of the buses for each bus stop, etc. The model was later used as a test bed for various configurations and analysis of the number of buses and their effects on students waiting time including their optimal number. The simulation results show that the current number of used buses can be reduced to its optimal number while maintaining student waiting time. This simulation model employs a new approach of using a transport module to transport a huge amount of entities to multiple stations as opposed to its traditional usage to only transport a single entity to a particular station

Penyeimbangan beban kerja di kalangan pemandu lori tangki: Satu kajian kes

Kajian ini membincangkan masalah beban keja seimbang bagi pemandu lori tangki disebuah syarikat pengangkutan yang berpangkalan di Pelabuhan Kelang. Bagi menyeimbangkan jumlah muatan yang perlu dibawa oleh setiap pemandu agar beban kerja adalah sama, satu model pengaturcaraan integer telah dibangunkan dengan mengambilkira beberapa kekangan yang telah dikenal pasti. Antara kekangan tersebut ialah jumlah trip yang dibawa setiap pemandu tidak boleh melebihi jumlah hari bekeja dalam sebulan. Model ini dibangunkan bertujuan menyeimbangkan beban keja dengan memfokuskan kepada jumlah kapasiti yang dibawa bagi setiap pekerja supaya setiap pekerja akan membawa jumlah kapasiti yang seimbang. Model tersebut diselesaikan dengan menggunkan perisian LOG. Kajian ini juga turut memuatkan analisis sensitiviti (what - if scenario) bagi melihat berapakah jumlah pekerja sebenar yang diperlukan bagi mengangkut muatan tersebut. Hasilnya, setiap pemandu lori akan membawa antara 354 - 408 tan setiap bulan dengan bilangan trip setiap pekerja sebanyak 11 - 13 trip. Dapatan kajian ini berguna kepada pihak pengurusan syarikat dalam mnjanakan pengagihan tugasan bulanan yang lebih berkesan

A comparative study of work values between US and Malaysia marketing students

This paper aims to identify the ranking of importance of work values as perceived by marketing students, and to explore the underlying dimensions of work values in the Malaysian context.It also aims to determine whether there are differences of work values between marketing students in Malaysia and US.Previously validated Super’s Work Values Inventory (SWVI) containing 15 dimensions was completed by business students undertaking Marketing and other majors in Malaysia and USA. Factor analysis is employed to examine the underlying structure of work values.The study confirms the two-factor structure (intrinsic and extrinsic) of work values and shows that marketing students value the work that allows them to fulfill their potential in terms of creativity (M = 4.23) and intellectual stimulation (M = 3.99) in Malaysia. Moreover, the results showed that significant differences in work values exist between Malaysia and US students with respect to economic return, way of life, altruism, prestige, management and variety.This article contributes to the worldwide knowledge on work values by highlighting the importance of understanding potential marketing professionals’ work values in the two different countries. Respondents selected from two countries will limit the generalizability of the study

Combating obesity through healthy eating behavior: A call for system dynamics optimization

Poor eating behavior has been identified as one of the core contributory factors of the childhood obesity epidemic.The consequences of obesity on numerous aspects of life are thoroughly explored in the existing literature.For instance, evidence shows that obesity is linked to incidences of diseases such as heart disease, type-2 diabetes, and some cancers, as well as psycho social problems.To respond to the increasing trends in the UK, in 2008 the government set a target to reverse the prevalence of obesity (POB) back to 2000 levels by 2020. This paper will outline the application of system dynamics (SD) optimization to simulate the effect of changes in the eating behavior of British children (aged 2 to 15 years) on weight and obesity. This study also will identify how long it will take to achieve the government’s target. This paper proposed a simulation model called Intervention Childhood Obesity Dynamics (ICOD) by focusing the interrelations between various strands of knowledge in one complex human weight regulation system. The model offers distinct insights into the dynamics by capturing the complex inter dependencies from the causal loop and feedback structure, with the intention to better understand how eating behaviors influence children’s weight, body mass index (BMI), and POB measurement. This study proposed a set of equations that are revised from the original (baseline) equations. The new functions are constructed using a RAMP function of linear decrements in portion size and number of meal variables from 2013 until 2020 in order to achieve the 2020 desired target. Findings from the optimization analysis revealed that the 2020 target won’t be achieved until 2026 at the earliest, six years late.Thus, the model suggested that a longer period may be needed to significantly reduce obesity in this population

A Circularity-based Planning Approach for Construction and Demolition (C&D) Waste Management: A Case Study of Malaysia

In recent years, Malaysia has faced an intense demand for infrastructure development and the construction industry has become an integral part of transforming the country into a developed nation. Large numbers of development works are perturbing and they are subject to the improper management of construction and demolition (C&D) wastes. Lacking in methods for managing C&D wastes throughout the construction cycle has jeopardized the effort to preserve the environment. Circular economy (CE) was used as a basis to improve the C&D waste management system in Malaysia. We have developed a circularity-based planning approach to managing the wastes with an idea to maximize the resources. We collected the feedback from the construction actors in Malaysia to identify the suitable 3R principles of reduce, reuse and recycle and waste minimization strategies to be adopted throughout the construction cycle. Based on the feedbacks, we introduced a circularity-oriented framework of C&D waste management that could be applied throughout the construction cycle. Then, we tested the effectiveness of the framework by conducting a simulation process using system dynamics modelling. The results revealed that the waste generation could be significantly reduced – that indirectly mitigate the environmental impacts

Evaluation on absenteeism effect in production line at Aircraft Composite Manufacturer

This paper studies the effect of absenteeism in production line.The analysis shows that the number of absentees at production line increases the workload to the available worker and gives effect to the production.Thus, it gives a major potential for generating bottlenecks.To mitigate this problem and ensure that the workload of workers is at optimum level, an appropriate number of production plans need to be investigated.This paper demonstrates the integration of Discrete Event Simulation (DES) and System Dynamics (SD) in simulating the effect of absenteeism in production flow at an aircraft composite manufacturing factory.Based on the preliminary result, the effect of the absenteeism is found to influence the amount of throughput, waiting and cycle time

A Non-Standard Optimal Control Problem Using Hyperbolic Tangent

A current ideal control issue in the region of financial aspects has numerical properties that do not fall into the standard optimal control problem detailing. In our concern the state an incentive at the final time, y(T ) = z, is free and obscure, and furthermore the integrand is a piecewise consistent capacity of the obscure esteem y(T ). This is not a standard optimal control problem and cannot be settled utilizing Pontryagin’s Minimum Principle with the standard limit conditions at the final time. In the standard issue a free final state y(T ) yields an important limit condition p(T ) = 0, where p(t) is the costate. Since the integrand is a component of y(T ), the new fundamental condition is that y(T ) yield to be equivalent to a specific necessary that is a consistent capacity of z. We present a continuous estimation of the piecewise consistent integrand function through hyperbolic tangent approach and tackle a case utilizing a C++ shooting method with Newton emphasis for tackling the two point boundary value problem (TPBVP). The limiting free y(T ) value is computed in an external circle emphasis through the Golden Section metho