Integration of simulation modelling and lean management to improve patient flow at outpatient clinics

The outpatient clinics suffer from various inefficiencies such as long queues, long waiting times and low utilisation of medical resources. Simulation modelling and process improvement techniques have been applied separately to tackle such inefficiencies. This paper demonstrates how simulation modelling and lean management can be integrated to improve the patient flow and performance of outpatient clinics. The proposed framework for integrating lean and simulation consists of three main phases where the first phase includes the system description, data collection and analysis, and simulation model development and validation. In the second phase, the value stream mapping (VSM) is used to determine possible improvement scenarios while simulation modelling is employed in the third phase to evaluate the selected improvement scenarios. This framework has been applied to characterise and improve the patient flow in an Internal Medicine Outpatient Clinic (IMOC) in Egypt. The simulation of some improvement scenarios shows that the average patient time in system and average patient waiting time at clinic queue can be decreased by 64.20% and 71.65%, respectively; without the need for additional resources. Accordingly, the presented framework is a useful quantitative decision-making tool that can be adopted to investigate and improve the operating characteristics of outpatient clinics.