No abstract

Healthcare is one of the most complex systems to manage. In recent years, the control of processes and the modelling of public administrations have been considered some of the main areas of interest in management. In particular, one of the most problematic issues is the management of waiting lists and the consequent absenteeism of patients. Patient no-shows imply a loss of time and resources, and in this paper, the strategy of overbooking is analysed as a solution. Here, a real waiting list process is simulated with discrete event simulation (DES) software, and the activities performed by hospital staff are reproduced. The methodology employed combines agile manufacturing and Six Sigma, focusing on a paediatric public hospital pavilion. Different scenarios show that the overbooking strategy is effective in ensuring fairness of access to services. Indeed, all patients respect the times dictated by the waiting list, without “favouritism”, which is guaranteed by the logic of replacement. In a comparison between a real sample of bookings and a simulated sample designed to improve no-shows, no statistically significant difference is found. This model will allow health managers to provide patients with faster service and to better manage their resources.

No abstract

The emergency department of a hospital is, among all areas in which lean policies are focused, the one that has received the most attention. The emergency room, in fact, plays a vital role in providing primary care to patients and is also recognized for the contribution it gives to society. The important results in terms of cost savings and improving the flow due to the reduction of the waiting time of the patients, obtained from major international hospitals, were crucial to assess whether it was possible and useful to implement similar improvements in Italy, certainly not without to many problems in the provision of health services. This paper explores what can be improved for the department to be more efficient, using simulation techniques based on dynamic and continuous logics (system dynamics)