Management Engineering

257

Chapter 31

Simulation in Healthcare

Tarun Mohan Lal and Thomas Roh

Introduction

As healthcare costs continue to rise and providers move toward optimizing the care delivery pro-

cesses with the Institute for Healthcare Improvement (IHI)’s triple aim of improving patient expe-

rience, improving health of populations, and reducing costs as the eventual goal, the ability to

assess trade-os among resource utilization, service, and operating costs is becoming more and

more important. Simulation, successfully applied in other industries, is an industrial engineer-

ing methodology that provides the ability to assess such trade-os and is now gaining traction

in healthcare. is chapter discusses the use of simulation modeling in studying and improving

health systems. e chapter will cover the basics of discrete event simulation model development,

and its common applications in healthcare.

Contents

Introduction .............................................................................................................................257

Denition of Simulation and Its Importance and Growth ........................................................258

Example: Major Applications in Healthcare .............................................................................258

Steps in a Simulation Study ......................................................................................................259

Example Project ...................................................................................................................... 260

Situation ............................................................................................................................. 260

Objective ............................................................................................................................ 260

Analysis .............................................................................................................................. 260

Results .................................................................................................................................261

Advantages and Disadvantages of Simulation .......................................................................... 262

Software Decision ................................................................................................................... 262

Future of Simulation in Healthcare ......................................................................................... 263

Bibliography ............................................................................................................................ 263

258 ◾ Tarun Mohan Lal and Thomas Roh

Denition of Simulation and Its Importance and Growth

e term simulation refers to imitationorenactmentofa future event. Simulation in healthcare

sometimes refers to physical simulation in which education centers are set up for training care

providers to practice real patient care in an articial environment. In a medical context, the words

model and simulation can have several meanings and are beyond the scope of this chapter. e

focus of this chapter will be on an analytical computer simulation technique known as discrete

event simulation that is often used by management engineers or operations research experts to

evaluate, optimize, and improve care delivery processes. In this technique, historical data are used

to imitate or simulate the operations of various kinds of healthcare systems to provide an approxi-

mation of future outcomes. As an example of simulation, consider a hospital that is contemplating

a decision to add beds in the intensive care unit to reduce the time that a patient must wait to

be moved into an inpatient unit. It is not certain that adding more beds would truly reduce the

congestion in the system, and even if it does, the number of additional beds required to make this

a nancially viable option is unknown.

A healthcare system is often referred to as a system of systems due to multiple components that

are both operationally and managerially dependent. ere is also a high level of variability, mak-

ing them stochastic in nature. When the relationships that compose the system are simple, it is

possible to use simple mathematical methods to obtain exact information on questions of interest

and provide an analytical solution. However, for complex systems such as most healthcare pro-

cesses, with multiple moving parts, deterministic methodologies do not give the desired accuracy.

e use of simulation is crucial in order to estimate the desired characteristics.

Simulation is used when the proposed change cannot be implemented without a signicant

change in practice that might be too disruptive or too expensive. It can be used to justify improve-

ments or to nd the bottlenecks in a system without a huge investment. Going back to the exam-

ple of additional beds in the ICU, for example, it would certainly not be cost eective to add beds

and then remove them later if it does not work. However, discrete event simulation could throw

light on the question by simulating the operations of the hospital as they are currently and as they

would be if the number of beds were increased.

Example: Major Applications in Healthcare

Application areas for simulation in healthcare are numerous and diverse. e following is a list

of some of the problems in healthcare for which simulation has been found to be a useful and

powerful tool.

◾ Hospital operations

− Bed occupancy and utilization

− Stang analysis

− Operating room scheduling

− Patient ow analysis

◾ Emergency department

− Patient triage and its impact on resource needs

− Number of beds needed

− Patient ow from emergency department to hospital inpatient units

− Stang analysis