A Generic Simulation-based Perioperative Decision Support Tool for Tactical Decisions.

摘要

In Canada and around the world, there has been an increased focus on the efficiency, cost and access to health care services. One area of particular focus is surgical procedures, often with government funding and policies focused on reducing wait times through pay for performance and volume target initiatives. In Ontario, an expert panel was assembled to evaluate the current state of surgical processes and provide recommendations to improve access, efficiency and quality. This thesis addresses the panel's recommendation for a simulation-based decision tool to help hospitals inform decisions that can lead to improved access and efficiency.;A generalised, simulation based perioperative decision tool is presented that can be used to test a variety of tactical decisions. The generic model has been applied to six hospitals of varying sizes, ranging from large academic centres to small rural community hospitals. The model remains in use at some of the hospitals to regularly inform decisions. The model is also being applied to additional hospital sites.;During application of the generic model, challenges in design decisions and validation were encountered. As a result, a series of principles are proposed to guide future generic modelling design and achieving user acceptance. These principles add to the generic simulation modelling and healthcare modelling research fields by laying some groundwork for a formalised approach to designing effective generic simulation models and achieving confidence in results.;Finally, the research demonstrates two uses of the generic model: as decision tool and as a demonstrative tool. As a decision tool the model is used to compare numerous potential tactical decision options under consideration. As a demonstrative tool, the model is used to quantify the effect of poor practices on hospital performance. The design of the generic model only considers efficient processes and best practices. When model results are compared to historical performance, decision makers are able to quantify the effect of existing poor practices on their performance and decision making. The tool enables users to base their tactical level decisions on the assumption that good practices and procedures are followed.