Improving surgery department performance via simulation and optimization

The production process inside a hospital surgery department is made up of three distinct main sub-processes: waiting list management, operating theatre planning and scheduling, stay area sizing and organization. Overall department performance depends on how these sub-processes are managed as well as they are integrated. In the literature, they are mainly treated separately recurring to two approaches: optimization or simulation. The complexity of the system often makes the optimization models intractable, whereas simulation seems to be preferred because of its ability to evaluate what if scenarios. The novelty of this paper is to propose an integrated approach to deal with the described issues. The approach is integrated under two points of view: firstly, because it concerns all the three sub-processes together, i.e. from the moment the patient enters the system to the moment it is discharged, and, secondly, because it utilizes both the methods, i.e. simulation and optimization. The proposed holistic integrated approach can be used as a decision support tool to compare alternative operative scenarios by means of a complete set of performance indexes, regarding all the different sub-processes. The framework has been applied to the analysis of a surgical department of a university public hospital sited in Genova (Italy).