An Optimisation-based Framework for Complex Business Process: Healthcare Application

The Irish healthcare system is currently facing major pressures due to rising demand, caused by population growth, ageing and high expectations of service quality. This pressure on the Irish healthcare system creates a need for support from research institutions in dealing with decision areas such as resource allocation and performance measurement. While approaches such as modelling, simulation, multi-criteria decision analysis, performance management, and optimisation can – when applied skilfully – improve healthcare performance, they represent just one part of the solution. Accordingly, to achieve significant and sustainable performance, this research aims to develop a practical, yet effective, optimisation-based framework for managing complex processes in the healthcare domain. Through an extensive review of the literature on the aforementioned solution techniques, limitations of using each technique on its own are identified in order to define a practical integrated approach toward developing the proposed framework. During the framework validation phase, real-time strategies have to be optimised to solve Emergency Department performance issues in a major hospital. Results show a potential of significant reduction in patients average length of stay (i.e. 48% of average patient throughput time) whilst reducing the over-reliance on overstretched nursing resources, that resulted in an increase of staff utilisation between 7% and 10%. Given the high uncertainty in healthcare service demand, using the integrated framework allows decision makers to find optimal staff schedules that improve emergency department performance. The proposed optimum staff schedule reduces the average waiting time of patients by 57% and also contributes to reduce number of patients left without treatment to 8% instead of 17%. The developed framework has been implemented by the hospital partner with a high level of success

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 utilisation 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 optimise 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 modelling 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 Modelling 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 patient\u27s 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

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

Virtual ED: Utilisation of a Discrete Event Simulation-Based Framework in Identifying Real-Time’ Strategies to Improve Patient Experience Times in an Emergency Department

Objectives and Backgrounds Emergency Department (ED) overcrowding and associated excessive Patient Experience Times (PETs) have proven deleterious impacts on patient mortality, morbidity and overall length of hospital stay. Health systems constantly seek cost-effective organisational strategies to reduce ED crowding and improve patient outcomes, but complex change implementation is constrained by the necessity of maintaining concurrent safe patient-care. Computer modelling in a “virtual reality” has been successfully utilised in industries outside medicine, in providing innovative “real-time” solutions to outdated practices. Therefore a bespoke “Virtual ED” computer model, based on a Discrete Event Simulation (DES) -Based Framework was constructed to determine the best simulation scenarios needed for effective “real-time” strategies to improve PETs in a Dublin teaching hospital ED. The three simulation scenarios tested were: (1) Increasing medical staffing. (2) Increasing assessment space. (3) Enforcing the national 6-h boarding limit. Methods A collaborative interactive decision support model was constructed to analyse patient flow through the ED, considering the variability in patients\u27 arrival rate, the complexity levels of patients\u27 acuity, and the dynamic interactions between key resources (eg, clinical staffing, physical capacity, and spatial relationships). ED Process Mapping utilised IDEF0, for modelling complex systems in a hierarchical form and Extend Suite V.7 software was used to develop the DES—based framework model. Historical, anonymised ED patient data of 59 986 patient episodes (tracking times, indirect acuity and clinical resource utilisation) was analysed from the “real-time” ED Information System. Baseline ED Key Performance Indicators (KPIs), PETS and resource utilisation was determined for comparison with the DES model. Distinct study scenario variables (Abstract 007 table 1) were added to the DES model and run for 3 month continuous blocks to eliminate confounders. Continuous verification and validation of the ED simulation model was ensured by using Kolmogorov–Smirnov goodness of fit test with a 5% significance level. The ultimate results of the simulation model were validated using three techniques; face validation, comparison testing, and hypothesis testing, with the deviation between actual and simulated results ranging from 1% to 9% with an average of only 5% deviation

A hybrid process-mining approach for simulation modeling

This paper presents a hybrid Modeling and Simulation framework to address business process challenges. The framework has integrated process mining techniques in the conceptual modeling phase to support developing simulation models that are unbiased and close reflection of reality in a timely manner. The hybrid approach overcomes the pitfalls of traditional conceptual modeling by using process mining techniques to discover valuable process knowledge from the analysis of event logs. The proposed hybrid framework has been applied to an Emergency Department (ED) in order to identify performance bottlenecks and explore improvement strategies in an attempt to meet national performance targets. A large number of unique process flows (i.e. patient pathways) within the ED were uncovered and deviations from process guidelines were accurately identified. Results show that unblocking of ED outflows have a significant impact on patients length of stay (over 80% improvement) rather than increasing the ED physical capacity

A Hybrid Process Mining Framework for Automated Simulation Modelling for Healthcare

Advances in data and process mining algorithms combined with the availability of sophisticated information systems have created an encouraging environment for innovations in simulation modelling. Researchers have investigated the integration between such algorithms and business process modelling to facilitate the automation of building simulation models. These endeavors have resulted in a prototype termed Auto Simulation Model Builder (ASMB) for DES models. However, this prototype has limitations that undermine applying it on complex systems. This paper presents an extension of the ASMB framework previously developed by authors adopted for healthcare systems. The proposed framework offers a comprehensive solution for resources handling to support complex decision-making processes around hospital staff planning. The framework also introduces a machine learning real-time data-driven prediction approach for system performance using advanced activity blocks for the auto-generated model, based on live-streams of patient data. This prediction can be useful for both single and multiple healthcare units management

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 system\u27s 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 nation\u27s 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

Optimization of Resources to Improve Patient Experience in the New Emergency Department of Mater Hospital Dublin

Healthcare systems globally are facing capacity issues due to the increased demand of health services, the high cost of resources and the level of quality anticipated of service providers. Emergency Departments (ED) are the most pressurized unit in healthcare systems due to uncertainty in demand and limited resources allocated. Mater Hospital (one of leading hospitals) in Dublin has built a new (state-of-the-art) unit for ED yet faced an issue in resourcing the unit to optimize performance. This paper presents an integrated solution to optimize the capacity of the new ED before opening to public and examine improvement interventions in the ED area. This solution provides ED management with a tool that can contribute significantly in enhancing patient experience by reducing the waiting time from 21 hours to 6 hours while achieving utilization below the 80% burn-out threshold. The model is recommended by Health Service Executives to be used national wide