A simulation model approach to decrease the length of stay of patients undergoing cataract surgery

Background: In the health systems, two issues of quality and quantity of services are extremely important. One way to improve the quality and quantity of services in health centers is to solve the patient flow problem. Disrupting the normal patient flow, increasing waiting time, reducing productivity and increasing patient dissatisfaction are only some of patient flow problems. Methods: In this research, we first reviewed the relevant literature. Then, we investigated the patient flow problem in an eye hospital. In order to evaluate the solutions, a computerized model was made and validated. The improvement scenarios were divided into policy changes and resource changes. The policy changes scenario was divided into two groups: changing scheduling rules and separating the reception and surgical wards' scheduling. In the first group, we just implemented a scheduling rule for patients’ arrivals. However, in the second group, we proposed a novel idea for implementing scheduling rules for the reception and surgical ward. The main contribution of this research includes: 1) proposing a novel scheduling rule for this problem, 2) proposing a new methodology for comparing scenarios through the simulation model and statistical tool, and 3) proposing a valuable managerial insight toward the patient flow problem through an analytic approach. Results: In the first group of scenarios, the proposed scheduling rule reduced the length of stay (LOS) by 12% and the duration of arrival until dispatch to surgery's ward (DASW) by 35%. In the second group of scenarios, the proposed scheduling rule reduced the LOS by 20% and DASW by 35%. Then, adding one staff member to the eye scan ward and one employee to the laboratory were investigated as two resource enhancement scenarios. Conclusions: The simulations showed that policy change scenarios reduced the LOS and DASW much more than what we can achieve in resource enhancement scenarios. This is a very important managerial insight because it shows that the utilization of resources in an efficient way enhances the healthcare system's efficacy more than increasing the number of resources can do.