Simulation of Maternity Ward Operations

Problem:




This model simulates the maternity ward in a hospital currently under construction. Since the new hospital building will replace an existing ward and since the new maternity ward will be staffed by current personnel, the model also simulates current facilities.


The purpose of the model is to support discussions related to which resources, capacity, and work methods are required on the new ward. One relevant discussion is whether to apply an “integrated philosophy” - where the mother and child stay in the same room during their entire stay - or whether dedicated rooms for antenatal care, delivery and postnatal care are preferred, as used in the current system.


The project was carried out for Karolinska University Hospital in the Stockholm County, Sweden.

Solution:




Since this problem is on a micro and operative level of abstraction, Discrete Event Modeling is naturally the preferred modeling choice. This enables the handling of resources, processes, patients, etc. in the best way. Further, since this issue requires the comparison of a two distinctive alternatives, it is advantageous to run these scenarios/alternatives in parallel, instead of in sequence. In this way it is possible to pinpoint differences in performance given the same demand. From a modeling perspective, the mother-to-be is “cloned” and sent (and her clone) simultaneously to the two different process alternatives. This method was also chosen especially in this case to support the discussions during two workshops.

Hospital Ward Simulation

Model of the current ward

Hospital Model

Model of the projected ward

This process model focuses on the physical resources. A number of variable parameters enabled the users to experiment with relevant scenarios. The parameters include yearly demand, number of rooms of different categories for the existing ward and future ward, relevant patient categories and their traits (such as minimum, maximum, and average time for delivery, postnatal care, etc.), proportions/probabilities for forms of care, and prioritization (when several resource types can be used for the same care process).


The process description excludes human resources. To do so the staff schedules, personnel categories, skill levels, planning strategy, etc. should be included. Given that the purpose of the model was to focus on physical resources and investments and support the discussion process, this was unnecessary. The model therefore assumes that there are always enough personnel. The caregivers are animated but are never limiting.


Outcome:




The primary purpose of this model was to stimulate and support the discussions and conclusions in a workshop format. The simulation “provoked” participants into better insights into their situation. From a clearly skeptical outset, the model enabled participants to see that the future scenario was in fact realizable and envisage how they could start to prepare for this.


The outcome can also be seen in the light of that fundamentals from operations management and healthcare management engineering are much easier to understand for those lacking a strong background in these fields if communicated and presented with the help of a visual simulation model. Examples of such fundamentals include:

  • Dividing a total need over several dedicated resources will always cost something in terms of effective capacity compared to having the same number of resources but fully flexible. 
  • A need evaluation must always be made per resource type – and the amount of resources per type should roughly have the same relationship as the relative needs. 
  • Historical output, result and production figures can seldom be used to take decisions for systems in the future (with different traits and circumstances).

The output and results from the simulations were summarized in a result window. Indicators were presented for the existing ward and the future ward both numerically and graphically. This enabled the evaluation of the strengths and weaknesses of each simulated scenario.

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