Simulation modelling: Problem understanding in healthcare management

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.One of the main problems that face decision makers in healthcare systems is complexity and the lack of a well-defined problem. This causes a lack of understanding about the system. Another problem associated with healthcare systems is that usually there are several stakeholders involved in decision making. In such cases different stakeholders may have different views about the problem. In addition to the lack of understanding and intercommunication, there is the tendency in healthcare management to use quantitative methods for analysing the system. These methods are highly data dependant and usually based on historical data, which may not reflect the system's performance under the present circumstances, given the changing pace of healthcare services and structure. Also data may not be available in the first place. This research looks at how modelling techniques may help healthcare stakeholders to understand their system and increase their level of intercommunication (in the case of multiple stakeholders) with minimum dependency on data. Two main aspects are considered in this research: first appraising the existing modelling techniques with regard to problem understanding and intercommunication, and second, looking for an effective modelling approach for achieving such objectives. Discrete Event Simulation (DES) offers good facilities for modelling for understanding. However, DES could be used more effectively to enable viable understanding and means of communication. It is assumed that in order to enhance stakeholders' understanding and intercommunication, that it is better to involve them in the process of modelling from the beginning, using an iterative modelling process, and without being restricted to logical steps. To achieve this a case study strategy is followed in order to devise a modelling framework that helps in enhancing stakeholders' understanding and intercommunication. In this particular research Single Case approach is employed using two case studies. The first case study is used as an attempt to evaluate the hypotheses and tackle research questions which are raised based on an analysis of findings from the literature. The experimentation and analysis part are used to refine the initial hypotheses. These hypotheses are then examined using the second case study to establish a picture about how to achieve the research objectives. In both case studies simulation modelling is examined with regard to the research questions. The thesis concludes by identifying a modelling approach that has high versatility and flexibility to enhance stakeholders understanding and intercommunication. The approach is called MAPIU2, which stands for a Modelling Approach that is Iterative Participative for Understanding. From its name it can be deducted that the main factors of this approach are based on involving the stakeholders in the modelling process from the beginning in an iterative behaviour. One of the main lessons learned is that to achieve better results from the simulation modelling it is important that stakeholders should be involved with modelling process rather than just getting the final results, which helps implanting any decisions or recommendations arising from the model