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Journal of the Operational Research Society

, Volume 61, Issue 11, pp 1572–1581 | Cite as

An evaluation of the applicability of system dynamics to patient flow modelling

  • S Vanderby
  • M W Carter
Case-oriented Paper

Abstract

The objective of this research is to determine whether Systems Dynamics (SD) is a beneficial method for modelling hospital patient flow from a strategic planning perspective. While discrete event simulation has frequently been used as a tool for analysing and improving patient flow in health care settings, the desire to assess and understand patient flow and resource demand from a more strategic, and therefore aggregate, perspective led to the use of SD. To evaluate the suitability of such an approach, a model was developed in collaboration with the General Campus at The Ottawa Hospital with particular attention paid to the delays experienced by patients in the emergency department. The modelling techniques used, model validation and scenarios tested with the model are discussed, accompanied by comments regarding the appropriateness of SD for such a model.

Keywords

health service hospitals simulation strategic planning system dynamics 

Notes

Acknowledgements

This work would not have been possible without the assistance of many people, at The Ottawa Hospital, but, in particular, we thank Cal Martell, Paula Doering and Wendy Fortier. We also thank Dr. Daniel Frances, Dr. Michael Schull and Dr. Dionne Aleman for their guidance and advice. Finally, we would like to acknowledge the Ontario Change Foundation for the funding they provided.

References

  1. Brailsford SC, Churilov L and Liew SK (2003). Treating ailing emergency departments with simulation: An integrated perspective. In: Anderson J and Katz E (eds). Health Sciences Simulation 2003. Society for Modelling and Computer Simulation: San Diego, pp 25–30.Google Scholar
  2. Brailsford SC, Lattimer VA, Tarnaras P and Turnbull JC (2004). Emergency and on-demand health care: Modelling a large complex system . J Opl Res Soc 55: 34–42.CrossRefGoogle Scholar
  3. Coats TJ and Michalis S (2001). Mathematical modelling of patient flow through an accident and emergency department . Emerg Med J 18: 190–192.CrossRefGoogle Scholar
  4. Côté MJ (1999). Patient flow and resource utilization in an outpatient clinic . Socioecon Plann Sci 33: 231–245.CrossRefGoogle Scholar
  5. Duguay C and Chetouane F (2007). Modeling and improving emergency department systems using discrete event simulation . SIM 83: 311–320.CrossRefGoogle Scholar
  6. Eldabi T, Paul RJ and Young T (2007). Simulation modelling in healthcare: Reviewing legacies and investigating futures . J Opl Res Soc 58: 262–270.CrossRefGoogle Scholar
  7. Forrester JW (1961). Industrial Dynamics . MIT Press: Cambridge, MA.Google Scholar
  8. Groothuis S, Godefridus G, van Merode G and Hasman A (2001). Simulation as decision tool for capacity planning . Comput Methods Programs Biomed 66: 139–151.CrossRefGoogle Scholar
  9. Hung G, Whitehouse SR, O'Neill C, Gray AP and Kissoon N (2007). Computer modeling of patient flow in a pediatric emergency department using discrete event simulation . Pediatr Emerg Care 23: 5–10.CrossRefGoogle Scholar
  10. Jun JB, Jacobson SH and Swisher JR (1999). Application of discrete-event simulation in health care clinics: A survey . J Opl Res Soc 50: 109–123.CrossRefGoogle Scholar
  11. Lane DC and Husemann E (2008). System dynamics mapping of acute patient flows . J Opl Res Soc 59: 213–224.CrossRefGoogle Scholar
  12. Lane C, Monefeldt C and Rosenhead JV (2000). Looking in the wrong place for healthcare improvements: A system dynamics study of an accident and emergency department . J Opl Res Soc 51: 518–531.CrossRefGoogle Scholar
  13. McCarthy ML, Zeger SL, Ding R, Aronsky D, Hoot NR and Kelen GD (2008). The challenge of predicting demand for emergency department services . Acad Emerg Med 15: 337–346.CrossRefGoogle Scholar
  14. Royston G, Dost A, Townshend J and Turner H (1999). Using system dynamics to help develop and implement policies and programmes in health care in England . Syst Dyn Rev 15: 293–313.CrossRefGoogle Scholar
  15. Samaha S, Armel WS and Starks DW (2003). The use of simulation to reduce the length of stay in an emergency department. In: Chick S, Sanchez PJ, Ferrin D and Morrice DJ (eds). Proceedings of the 2003 Winter Simulation Conference. Institute of Electrical and Electronics Engineers: Piscataway, New Jersey, pp 1907–1911.Google Scholar
  16. Sterman JD (2000). Business Dynamics: Systems Thinking and Modelling for a Complex World . Irwin McGraw-Hill: Boston, MA.Google Scholar
  17. Wolstenholme E (1999). A patient flow perspective of UK health services: Exploring the case for new ‘intermediate care' initiatives . Syst Dyn Rev 15: 253–271.CrossRefGoogle Scholar
  18. Wolstenholme E (2005). The potential of systems dynamics: A new era of strategic planning? The NHS Confederation Future Health Network Leading Edge. November.Google Scholar
  19. Wolstenholme E, Monk D, McKelvie D and Smith G (2008). Influencing and interpreting health and social care policy in the UK. In: Oudrat-Ullah H, Spector JM and Davidsen PI (eds). Complex Decision Making: Theory and Practice. Springer: Berlin, pp 155–183.Google Scholar

Copyright information

© Operational Research Society 2009

Authors and Affiliations

  • S Vanderby
    • 1
  • M W Carter
    • 1
  1. 1.Department of Mechanical and Industrial EngineeringUniversity of TorontoCanada

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