SIMULATION WITH ARENA

TERM PROJECT (CLINIC)

Names: IDs:
Abdullah Majali 0169393
Ahmad Dawood 0164156
Ayman Jabr 0167432
Course: Simulation with ARENA Assignment: Term Project

Pledge: On our honor as students at The University of Jordan, we have abided by the School of
Engineering’s Code of Ethics on this work. In addition, each of us participated, read, approves, and
understands our work.

Signatures: Date: 26/12/19

Executive Summary:
In this project, we studied the performance of a clinic. ARENA Software, was used in order to
simulate the project objectives. Required data was given and assumed valid and accurate. We
started by simulating the current model as in the Arena model, and then changing the
resources one by one, to see which resource was the most efficient to increase. We concluded
that the best option is to add a new Physician, as this increases the number of patients by 15,
and decreases the average time in the system by about 57 minutes.

Problem description:

Performance of a clinic will be investigated. The clinic open 8-hour, 5 days a week. The clinic has
four different stations (like nodes in a network), and 3 exam-rooms, where patient might be
directed for service before leaving at the Check-Out Station.

The patient starts by checking into the clinic, from which they are directed into one of three
departments: the nurse station, the examination station, or the lab and X-rays station. The
patient might then be sent from one of these 3 stations to another one, until he finally leaves
the system, by going to the check-out station, and finally leaving the system.

We will simulate the clinic by taking replications length of 56 hours (7 working days) and 100
replications, in order to achieve a higher statistical accuracy, and verify that our system is
working correctly with the provided data, the implementation of this is shown in the figure
below:
The time distributions that a patient takes at each station as well as the probability of a patient
going from one station to the next is given in the table below:

The travelling times distributions from one station to the next station have been given to use in
the table below:

We assume that the data given to us in these 2 tables, has been validate, and is consistant with
the real model, to a sufficient degree that allows using simulation techniques on it.
Clinic Conceptual Model:
We assume that the working day in the clinic starts from 8am, the following are the resources
used for the clinic:

Where the Physicians are based on a schedule as shown below:

We assume that all the patients are of the same homogeneous group, although this might not
actually be the case, as more senior citizens might tend to come more often in the morning, or
children might tend to come more often during Fridays, which would greatly impact the
availabe data on those days or times, however as we assume that all patients are from the
same group, we rapresent them with the same picture as shown below:
We assumed that all queues were based on a first-in-first-out scenario, except for the exam
rooms, this might not be always the case, as more sick or older patients might get preferential
treatment. For the exam room, we made it depend on the attribut PriorityOfExamRoom, and
we gave the people that are coming from the waiting room of the exam rooms higher priority
than the other customers, again this might not be the case in the real clinic, as patients might
get angry at the physicians for giving another patient preferential treatment, our model for the
queues is shown below:

We assume that the movement of patients from one station to the next is a fixed distribuition,
which again, might not be the case, and instead might actually depend on the time of day that
the patients visit the clinic, these movements have been modelled as routes, as shown below:
Below is a flowchart diagram, summarizing the data above:
Arena Implementation:
We start with the patients arriving in the clinic, at which point they are put in the
WaitingRoomStation, after wich they wait in the sign-in queue, after that they are given the
attibute PriorityOfExamRoom at a value of 1, which will later be used to given them a lower
preference in the exam room queue, after that the patients can go to the nurse station or the
exam room station, this is implemented with a decide module and 2 route modules

The Patients arrive at the nurse station, where they wait to take the service, a decide module
and 2 routes is then used to either send them to the Exam Room Station, or to The lab and X-
ray Station, as shown below:

Similarly, the patients that arrive the lab and X-ray station, wait in a queue for the service, and
then are sorted by chance to those that are going to nurse station, and those that are going to
the checkout, as shown below:
The patients entering the exam rooms might come from other stations, or from the Waiting
Room of the Exam room, in which case their value of PriorityOfExamRoom is set to 0, and thus
are given priority in the Exam room queue. The patients exiting from the exam room, might go
to the nurse station, to the lab and X-ray station, to the waiting room of the exam room, or to
the checkout by change, the modules for this are shown below:

Patients that have to re-enter the exam room, are sent to the station of delay, we are they
enter the waiting room storage, where they are shown in the animation while they are in the
delay module, and then taken out of the waiting room storage, and then resent to the exam
room with a route, this is shown below:

Finally the patients go to the station of checkout, where they wait for the checkout resources,
and then they are removed from the system by a dispose module, this is shown below:
 Below is a frame of the animation that we used to convey this model, paused at around the
2295 minute, the stations and the waiting rooms are labelled, we cam see that all 3 physicians
are busy, as is the nurse, the receptionist and the the check-out counter, but not the Lab and X-
rays room.
Answers to the questions:

1) Observe the average and maximum length of each queue; the average and maximum
time in each queue.
The maximum and average values can be found in the second and fifth coloumns of the
report below, given to us by arena, for each Queue.

2) Average total time in system

The average Total time in system for the 100 replications is 142.73 minutes, as shown in
the snippet of the report below.

3) Average number of patients in clinic

The Average number of patients in the clinic, or Work In Process(WIP), is 24.0532 over
the 100 replications, as shown in the snippet of the report below.
 4) Throughput(Number of patients that have completed service)
The number of that have successfully entered and left the clinic is on average 537 over
the 100 replications, as shown in the snippet of the report below.

5) Test different scenarios for adding one unit for each resource (one at a time on each
scenario) in terms of total time in system and number out as responses. Which
scenario is the best?

We carried this experiment by adding, in turn, one unit to each resource, and the re-
running the simulation for a 100 times, below is a table comparing the results of the
average total number of patients that exited the system, and the average total time that
a patient would spend in the system.

For the Physicians, we assummed that the new fourth physician would take his brake
from 12:30 – 1 pm, with the other 2 physicians.

Resources added Total number out Average total time

One unit (patients) in system (min)
Nurse 535 131.40
Lab & X-rays 540 139.73
Physician 551 85.424
Checkout 538 119.36
Receptionist 538 136.99
None 536 142.73

As we can see the best option is to add a new Physician, as this increases the number of
patients that could by checked on by 15, but more importantly it decreases average time in the
system of any one patient by about 57 minutes, this is to be expected, as we can see from
question 1, that the average waiting time in the queue of the exam rooms, is vastly higher than
the other queues.

However, we cannot conclude that adding a Physician would be a wise investment for the clinic,
as it only adds on average 15 patients per week, the extra cost of hiring a full-time physician
could be higher than the profit, however the much lower total time in system might result in an
increase in the number of patients that wish to attend this clinic.

Furthermore, they might not be enough space in the clinic to open another exam room, and the
cost of adding another one would entail renting a more expensive office, however, if possible
we recommend hiring a new physician.

*The rest of the questions are shown directly in the arena file.