Modeling emergency departments using discrete event simulation techniques

This paper discusses the application of Discrete Event Simulation (DES) for modeling the operations of an Emer-gency Department (ED). The model was developed to help the ED managers understand the behavior of the system with regards to the hidden causes of excessive waiting times. It served as a tool for assessing the impact of major departmental resources on Key Performance Indicators (KPIs), and was also used as a cost effective method for testing various what-if scenarios for possible system im-provement. The study greatly enhanced managers’ under-standing of the system and how patient flow is influenced by process changes and resource availability. The results of this work also helped managers to either reverse or modify some proposed changes to the system that were previously being considered. The results also show a possible reduc-tion of more than 20% in patients waiting times

A review of historical developments of quality assessment in industry and healthcare

Purpose: This study reviewed the literature on the historical development of quality assessment methods in industry and in healthcare. A comparative analysis of quality methods in industry and healthcare was conducted to examine the gap between methods in the two sectors. An attempt was then made to examine the latest approaches to quality assessment in healthcare and finally a proposal has been offered for a more effective approach to tackling the problem of quality in healthcare. Design/methodology/approach: Firstly, a review of the evolution of quality assessment in industry and healthcare was conducted. This was based on books written by prominent experts in the field of quality. secondly, a study of the current approaches in healthcare was undertaken. Publications from varied sources were selected and reviewed. The literature consulted includes worldwide operations research and healthcare sources including dissertations, the internet and reference lists of relevant articles. The journal papers and conference proceedings were selected according to the following criteria: Objective: the study must be aimed at measuring or improving quality both. It could also be aimed at developing new ways of measuring the quality of health care; Method: observational studies, experimental trials or systematic reviews; Setting: study should be in a hospital setting and not narrowed to quality of clinical cares. Findings: This study showed that the concept of quality management and its control in healthcare is not as advanced as it is in industry. Moreover, it seemed that most researchers, who set out to assess quality of care in one way or the other, have had differing views of quality and the factors that contribute to its assessment. It was also deduced that the way forward in healthcare quality is the development of systems that give staff ownership and pride in a way that is akin to the era of the craftsmen

Using discrete event simulation (DES) to manage theatre operations in healthcare: An audit-based case study

This paper discusses the application of Discrete Event Simulation (DES) in modelling the complex relationship between patient types, case-mix and operating theatre allocation in a large National Health Service (NHS) Trust in London. The simulation model that was constructed described the main features of nine theatres, focusing on operational processes and patient throughput times. The model was used to test three scenarios of case-mix and to demonstrate the potential of using simulation modelling as a cost effective method for understanding the issues of healthcare operations management and the role of simulation techniques in problem solving. The results indicated that removing all day cases will reduce patient throughput by 23.3% and the utilization of the orthopaedic theatre in particular by 6.5%. This represents a case example of how DES can be used by healthcare managers to inform decision making

Flexible data input layer architecture (FDILA) for quick-response decision making tools in volatile manufacturing systems

This paper proposes the foundation for a flexible data input management system as a vital part of a generic solution for quick-response decision making. Lack of a comprehensive data input layer between data acquisition and processing systems has been realized and thought of. The proposed FDILA is applicable to a wide variety of volatile manufacturing environments. It provides a generic platform that enables systems designers to define any number of data entry points and types regardless of their make and specifications in a standard fashion. This is achieved by providing a variable definition layer immediately on top of the data acquisition layer and before data pre-processing layer. For proof of concept, National Instruments’ Labview data acquisition software is used to simulate a typical shop floor data acquisition system. The extracted data can then be fed into a data mining module that builds cost modeling functions involving the plant’s Key Performance Factors

Information-theoretic and stochastic methods for managing the quality of service and satisfaction in healthcare systems

This research investigates and develops a new approach to the management of service quality with the emphasis on patient and staff satisfaction in the healthcare sector. The challenge of measuring the quality of service in healthcare requires us to view the problem from multiple perspectives. At the philosophical level, the true nature of quality is still debated; at the psychological level, an accurate conceptual representation is problematic; whilst at the physical level, an accurate measurement of the concept still remains elusive to practitioners and academics. This research focuses on the problem of quality measurement in the healthcare sector. The contributions of this research are fourfold: Firstly, it argues that from the technological point of view the research to date into quality of service in healthcare has not considered methods of real-time measurement and monitoring. This research identifies the key elements that are necessary for developing a real-time quality monitoring system for the healthcare environment.Secondly, a unique index is proposed for the monitoring and improvement of healthcare performance using information-theoretic entropy formalism. The index is formulated based on five key performance indicators and was tested as a Healthcare Quality Index (HQI) based on three key quality indicators of dignity, confidence and communication in an Accident and Emergency department. Thirdly, using an M/G/1 queuing model and its underlying Little’s Law, the concept of Effective Satisfaction in healthcare has been proposed. The concept is based on a Staff-Patient Satisfaction Relation Model (S-PSRM) developed using a patient satisfaction model and an empirically tested model developed for measuring staff satisfaction with workload (service time). The argument is presented that a synergy between patient satisfaction and staff satisfaction is the key to sustainable improvement in healthcare quality. The final contribution is the proposal of a Discrete Event Simulation (DES) modelling platform as a descriptive model that captures the random and stochastic nature of healthcare service provision process to prove the applicability of the proposed quality measurement models.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

REQUIREMENTS for DIAGRAMING in the DESIGN of MENTAL HEALTH DELIVERY SERVICES

Delivering good quality mental health services remains a top priority in the English National Health Service (NHS). An approach to designing better delivery systems that takes into account the complexities of mental health services is highly desirable. This paper follows previous work that have sought to identify the key components of mental health delivery systems and explored the nature of the relationships between them. The paper presents the results of a qualitative thematic analysis of the requirements for diagrams as tools for describing and representing delivery systems in mental health