may call in sick or become ill during the course of the day (Gabel et al. 1999).Modern operating theatre management requiresan information system that includes an effectivescheduling system. Such a system has two basic but critical functions: performing the actualscheduling of cases, which involves finding outthe time available on the schedule, whether thattime occurs in a surgeon’s specific block time,and to facilitate intelligent management of resources. It must provide data on how resourcesare being used in relation to their availability(Harris et al. 1998). Block scheduling assigns asurgeon (or a surgical group) a block of time thatis exclusively for his cases.The anaesthesia service is often a separatedepartment; in some hospitals it is a divisionunder surgery department. In contrast withsurgical sub-specialties, anaesthetists specializingin specific clinical areas such as pediatricanaesthesia, obstetric anaesthesia and cardiacanaesthesia are not typically organized intodistinct departments. The anaesthesia departmentmust be organized in such a way as to ensureavailability of a sufficient number of anaesthesia providers for elective and emergency cases,which requires 24-hour-a-day coverage (Gabel etal. 1999).
Simulation in the Health Care Industry
The health care industry is a dynamic system withcomplex interactions, in which the simulationtechnique would play an indirect but vital role toachieve the optimal result (Zhang 2001). Keltonet al. (1998) state that the real power of thesimulation technique is fully realized when it isused to study a complex system. Numeroushealthcare service providers such as D. R.Hospital in North Carolina, and St John Hospitalin Detroit, U.S.A. have successfully employed thesimulation technique to help them inunderstanding their processes and to optimizethem (ProModel Corporation 2002).
The Department of Surgery at the SingaporeHospital oversees the operations of the surgicaltheatres. The main operating theatre complex atBlock 3 of the hospital grounds is where surgicaloperations of different specialties take place. Thelocal demand for surgery services has increasedover the last two decades. The capacity of theoperating theatres at the complex has reachedhigh levels of utilization, and action is necessaryto ensure that the department is able to cope withincreasing patient load. Due to the increasingdemand by patients on the services provided bythis operating theatre complex and the acuteshortage of manpower in the local health careindustry, the Department of Surgery has toemploy reengineering practices to achieve moreefficient and effective utilization with its existingresources.There are a total of 21 operating theatres at themain OT complex at Block 3 of the hospital. Inthe year 2000, the number of surgical operationsconducted at the hospital was 59,377, of whichabout 45% were outpatient (day) surgeries. Thedaily average was 162. Out of the 21 theatres, 19are allocated for elective surgery and operate 8hours a day (from 8:30 to 17:30), and theremaining 2 are employed as emergencyoperating theatres and operate 24 hours a day.Historical data was extracted from the hospital’sscheduling database for the period January toSeptember 2001. The data includes the percentageutilization of all the operating theatres, and thesurgeons’ log of all the surgical operationsconducted within the same period.Every day, each operating theatre is reserved for aspecific clinical discipline to carry out surgicaloperations. Some of the operating theatres areexclusively reserved for a particular discipline,whereas others may be used by differentdisciplines for each day of the week.
MODELING OF THE OPERATINGTHEATRE COMPLEX
MedModel is a simulation-based powerfulsoftware tool for evaluating, planning or re-designing hospitals and other healthcare systems.It provides a basis for the comprehensiveevaluation of large and complex health caresystems. MedModel is also equipped with animpressive collection of pre-programmedconstructs. Before a model for the operatingtheatre complex can be developed, a flow chart of the operating theatre process is provided in Figure1 to illustrate the entities, resources and locationsinvolved. Figure 2 shows the layout of thecompleted simulation model. The proportion of elective surgical operations for each clinicaldiscipline varies greatly.To keep simulation as simple as possible, thismodel deals with only 8 operating theatres, each