On the Improvement of Healthcare Management Using Simulation and Optimisation

University dissertation from Karlskrona : Blekinge Institute of Technology

Abstract: This thesis concerns healthcare management and specifically addresses the problems of operating room planning and waiting list management. The operating room department is one of the most expensive areas within the healthcare system which necessitates many expensive resources such as staff, equipment and medicine. The planning of operating rooms is a complex task involving many dependencies and conflicting factors and hence careful operating room planning is critical to attain high productivity. One part of the planning process is to determine a Master Surgery Schedule (MSS). An MSS is a cyclic timetable that specifies the allocation of the surgical groups into different blocks of operating room time. Using an optimization-based approach, this thesis investigates whether the MSS can be adapted to better meet the varying surgery demand. Secondly, an extended optimization-based approach, including post-operative beds, is presented in which different policies related to priority rules are simulated to demonstrate their affect on the average waiting time. The problem of meeting the uncertainty in demand of patient arrival, as well as surgery duration, is then incorporated. With a combination of simulation and optimization techniques, different policies in reserving operating room capacity for emergency cases together with a policy to increase staff in stand-by, are demonstrated. The results show that, by adopting a certain policy, the average patient waiting time and surgery cancellations are decreased while operating room utilization is increased. Furthermore, the thesis focuses on how different aspects of surgery pre-conditions affect different performance measures related to operating room planning. The emergency surgery cases are omitted and the studies are delimited to concern the elective healthcare process only. With a proposed simulation model, an experimental tool is offered, in which a number of analyses related to the process of elective surgeries can be conducted. The hypothesis is that, sufficiently good estimates of future surgery demand can be assessed at the referral stage. Based on this assumption, an experiment is conducted to explore how different policies of managing incoming referrals affect patient waiting times. Related to this study, possibility of using data mining techniques to find indicators that can help to estimate future surgery demand is also investigated. Finally, in parallel, an agent-based simulation approach is investigated to address these types of problems. An agent-based approach would probably be relevant to consider when multiple planners are considered. In a survey, a framework for describing applications of agent based simulation is provided.