Fine-grained simulation optimization for the design and operations of a multi-activity clinic

To ensure that patients are appropriately prepared for surgical procedures in a welcoming environment, the Sir Mortimer B. Davis Jewish General Hospital, a McGill University affiliated teaching hospital located in Montreal, is redesigning and relocating its existing presurgical screening clinic so that it provides additional services and is more patient friendly. Given the services being added, limited space, and the desire of senior management to minimize overtime costs, physician idle time, and excessive patient waiting times, we apply simulation optimization to the operations of the redesigned clinic. The simulation optimization is then used to evaluate the effect of possible design decisions to be made by senior management, to ensure that the resulting clinic meets their goals. In contrast to existing research which generally limits clinic optimization to just a few facets, we simultaneously optimize the clinic’s multiple objectives at a fine-grained level with respect to individual decision variables for the start time of each physician, the appointment time of each patient, and the start, break, and lunch times of each staff member. To perform the optimization, we apply a simple heuristic to a simulation model of the clinic. We show, with this simple heuristic, that simultaneously optimizing the clinics’s multiple objectives by adjusting decision variables at this more granular level can significantly reduce physician idle time, staff overtime, and excessive patient waiting. This in turn makes it possible to evaluate design decisions in context of optimized operations. These results suggest the usefulness of this approach to other multi-activity clinics such as cancer treatment clinics.