HAWASSA UNIVERSITY INSTITUTE OF TECHNOLOGY SCHOOL OF

MANUFACTURING DEPARTMENT OF IELM

(MSC. WEEKEND PROGRAM)

Simulation Modeling and Analysis Term Paper on Discrete-Event Model

development At Hawassa Riferal Hospital

PREPARED BY: Sirgut Tesfaye ID- GPIELMW/0012/13

Submmitted To- Dr. Engineer Fantahun Moges

July 19, 2021

Simulation Model Analysis Semister project done on DES model development

Table of Contents
Excutive Summary........................................................................................................................ 1
1.Introduction Background ............................................................................................................ 3
1.1 Objectives.............................................................................................................................. 3
1.1 Key Components of DES....................................................................................................3
2. Queuing system of Patient Flow...............................................................................................6
2.1 Waiting time and Utilization Analysis...................................................................................7
2.1.1 Variable Arrival Rate (VAR)...............................................................................................7
2.1.2 Priority Queuing Discipline (PQD).....................................................................................8
2.2 Simulation Model.................................................................................................................... 8
3.0 Methodology........................................................................................................................... 8
4.0 Data Analysis, Simulation and Result....................................................................................9
4.1 Descriptive Data Analysis....................................................................................................... 9
4.2 ARENA Simulation Queuing Model....................................................................................11
4.2.1 Simulation Model............................................................................................................... 11
4.2.2 Simulation Results............................................................................................................. 13
4.2.2.1 Average Waiting Time in Queue....................................................................................13
4.2.2.2 Average Service Time of Patient....................................................................................13
4.2.2.3 Average Total Time in System.......................................................................................14
4.2.2.4 Total Exit of Patients....................................................................................................... 15
4.2.2.5 Server Utilization............................................................................................................ 15
4.2.2.6 Summarization of the Performance Measure..................................................................16
4.3 Discussion............................................................................................................................. 17
4.3.1 Verification and Validation................................................................................................17
4.3.2 Detail of Average Waiting Time........................................................................................17
5. Conclusion and Recommendation...........................................................................................18
5.1 Conclusion............................................................................................................................. 18
5.2 Recommendation................................................................................................................... 19
6.0 Reference............................................................................................................................... 20
Executive Summary
Long waiting time to be served at the outpatient counter is always the main problem faced by the
public Health facilities. Outpatient department at public health center had the greatest queuing
challenge compared to the other units. This situation has been a common complaint by the
patients. Therefore, the purpose of this project is to determine the waiting arrival time and
service time of patients at the outpatient counter and to model suitable queuing system by using
simulation technique. This case study was conducted at one of the Public Health Centers at
Hawassa city.
This formulated model employed descriptive analytical and simulation method to develop
suitable model. The collection of waiting time for this project is based on the arrival rate and
service rate of patients at the outpatient counter. The data calculated and analyzed using
Microsoft Excel. Based on the analyzed data, the queuing system of the patient current situation
was modeled and simulated using the ARENA software. The result obtained from the simulation
model shows that average waiting time of patients in queue is 54.295 minutes with the average
total exit patient is 327 patients. Thus, the average service time is 13.481 minutes.
The observation and analysis also addressed a few problems found during the observation and
appropriate strategies were formulated to improve the waiting time and utilization percentage were
carried out including rearrange the schedule of resources.

1. Background
Discrete-Event simulation (DES) is a model of physical system that has changes at precise points in
simulated time.
Patients arriving at an outpatient Department to be served by healthcare professionals can be taken as
DES. Alamura Health Center is one of the public health centers located at Hawassa city.

1.1 Objectives
 To develop discrete-event simulation model Hawassa Riferal hospital
Specific objective
 To determine the waiting arrival time and service time of patients at the outpatient Department of
hawassa referral hospital
 TO model suitable queuing system by using simulation technique.
 1.1 Key Components of DES
key components of Discrete-Event simulation of Public Health Center are:

No Entity Attribute Activities State Events

1. Patient Characteristics of patient serving number of arrival of

(Health status, age, (treating) a patients patients;
gender, money) patient, waiting waiting in line, departure of a
for a new Doctor/Nurse patient
patient is busy or idle

Time management at the outpatient Departmentis important especially to the patient with bad
injures and diagnose with critical illness. There are two most common factors cited that impact
patient flow and department load in the public health center; (i) patient arrival rate and (ii) in-public
health center flow. These factors affect longer waiting time that will caused patients to be
dissatisfied. Although the patient has an appointment with the doctor, the long waiting time has made
the patient feel bored and depressed. Additionally, long wait times lead to patient forgoing
scheduling appointments, increase no shows, and limit access to care for patients who really need
it. Nonetheless, the most paradoxical situation emerges are; longer waiting time, yet capacity is
underutilized.
2. Queuing system of Patient Flow
A basic queuing system is a service system where “customers” arrive to a bank of “servers” and
require some service from one of them. “Customer” is referring to the entity that waiting for the
service and that entity is not necessarily human. Similarly, a "server" is the person or thing that
provides the service. In the case of public health center, a queuing system can be described as
patient’s arrival time for the service, waiting for service if it is not immediate, utilizing the service,
and leaving the system after being served. A queuing system is characterized by arrival pattern
of those requiring service, service pattern of servers, queue discipline, system capacity, number
of service channels, and number of service stages.

Queue discipline refers to the order in which customers are processed. The assumption that service
is provided on a first-come, first-served basis is the most commonly encountered rule. This
outpatient department operates with two types of patients: appointment and nonappointment
patients. Non-appointment patients include new patients who first arrive at the hospital, walk-in
patients and no-show patients who missed their appointments. All appointment patients must refer
to the reception deck to identify the appointed clinic and check if there is any laboratory test
required. Meanwhile, all non-appointment patients, need to pass registration process. After all
consultation process completed, patients may get drugs from a pharmacy before leaving the public
health center.
The process of patient flow at selected Public Health Center is recorded based on the flowchart
as illustrated in Figure 1.

Figure 1: Queuing system of patient flow

2.1 Waiting time and Utilization Analysis

Waiting time and utilization is an overview of research into using queuing theory as an analytical
tool to predict how particular health care configurations affect delay in patient service and health
care resource utilization. In a queuing system, minimizing the time that customers (in health
care, patients) have to wait and maximizing the utilization of the servers or resources (in health
care, doctors, nurses, public health center beds, for example) are conflicting goals. Lakshmi &
Appa, (2013) divided them into four categories: leaving without treatment ratio (LWTR), variable
arrival rate (VAR), priority queue discipline (PQD), and minimum waiting time (MWT). LWRT is
define as when a patient is waiting in a queue, he/she may decide to forgo the service because he/she
does not wish to wait any longer. The probability that a patient reneges usually increases with the
queue length and the patient’s estimate of how long he/she must wait to be served. It is possible
to redesign a queuing system to reduce reneging. A common approach is to separate patients by
the type of service required. For example, separate the non-acute patients with acute patients and
treat them in dedicated fast-track areas.

2.1.1 Variable Arrival Rate (VAR)

Although most analytical queuing models assume a constant customer arrival rate, many health
care systems have a variable rate. In some cases, the arrival rate may depend upon time but be
independent of the system rate. For instance, arrival rates change due to the time of day, the day
of the week, or the season of the year. In other cases, the arrival rate depends upon the state of
the system. The arrival rate may increase over time due to population growth or other factors.
Lengths of the intervals between arrivals are independently and identically distributed and
described by a continuous density function. It is assumed that inter-arrival times and service
times follow the exponential distribution or equivalently that the arrival rate and service rate
follow a Poisson distribution.
2.1.2 Priority Queuing Discipline (PQD)
In most public health care settings, unless an appointment system is in place, the queue
discipline is either first-in first-out or a set of patient classes that have different priorities as in an
emergency department, which treats patients with life-threatening injuries before other.

2.2 Simulation Model

The queuing theory and patient flow systems are often associated with simulation techniques.
Simulation is a powerful tool for the evaluation and analysis of a new system designs,
modifications to existing systems, and proposed changes to control systems and operating rules.
Simulation involves the methodology to provide the information from the model by observing
the flow of the model using a digital computer. ARENA is graphical modeling or animation
system that is based on hierarchical modeling concepts. It allows users to create new modeling
objects called modules, which are the building blocks of model creation. It also offers Application
Solution templates that can be used to tailor the software to a specific animation. Besides that,
Arena also includes the input analyzer, designed to give users the ability to read raw input data,
and output analyzer for simulation data viewing and analysis

3.0 Methodology
This case-study was carried out at one of the Public Health Center located at Hawassa city. The
method of this project was a descriptive-analytical study focused at the outpatient public health
center. Collection data are from the patients who have registered the medical checked at the
outpatient counter until the pharmacy counter. We started design the pre-planned form to collect
data of patient at the outpatient counter. Once the data collection finished, we then calculated
and analyzed the data using Microsoft Excel. Based on the calculated data, the queuing system
of current situation was modeled and simulated using the software ARENA. Descriptive analysis and
observations study were used to determine the time taken of patients from the registration until
seen by pharmacist at the outpatient clinic. In order to get better results, as this case reconfirmed
the patient’s process flow with the center management together with on-site observation few times
to get the correct flow. The collected data was the arrival time (λ) which was the number of patients
entered to the outpatient counter during standard study time (30munites intervals) and the
service time (µ) which was the time period of giving services to each patient per 30 minutes.
Data were collected randomly among the patients without any specific patient classification of
treatment. This is because the case-study focuses on determining the waiting time of patients at
outpatient counter. Data was collected via record the waiting time of patients in the pre-planned form
at the outpatient clinic. The data required to develop the patient flow as follows:
1. Patients arrival times
2. Service time at the registration counter (new patient registration counter and appointed patient
registration counter). Service time is the time taken at the beginning of the service until the end of
the service for each patient.
3. Service time at the pre-consultation room.
4. Service time at the consultation room.
5. Service time at the pharmacy counter.
6. The number of patients (at each phase).
 7. The number of doctors, staffs involved at each phase.

Lengths of the intervals between arrivals are independently and identically distributed and
described by a continuous density function. It is assumed that inter-arrival times and service
times follow the exponential distribution or equivalently that the arrival rate and service rate
follow a Poisson distribution. Description of different variables and characteristics used in these
cases are as follows:

 λ = the arrival rate (outpatient arrival rate)

 µ = the service rate
 S = the number of serves (doctor)
 n = the number of patients in system awaiting service or being served.
The collected data were entered into the ARENA Simulation software to determine the statistical
distribution of the data. Input analyzer in the ARENA allows user to enter raw data and obtain
the statistical distribution for the data as need

4.0 Data Analysis, Simulation and Result

4.1 Descriptive Data Analysis
Based on the descriptive analytical data, the total number of patients was over 200 patients per
week (Monday to Friday). However, the distribution of the patient’s attendance was busiest on
Mondays and Tuesdays.
Figure 2 is the graph of the number of patients arrived to registration counter. From the graph it
shows that on Mondays at the times between 8.00am until 10.00am which is placing the highest
number of patients arrived to the registration counter. The largest average number of patients
arrived to the registration counter from 8.00am until 10.00am is about 131 patients. Meanwhile,
on Thursday which was the lowest number of patients arrived at time between 12.00pm until
2.00pm for average number of 80 patients as shown at the lowest part of table. However, on the
lowest number of patients arrived at this time will make the utilization of nurse or doctor is low.
The Public Health Center is open from 8.00 am. The health center has no regular break time. The
medical staff will relax in turns as appropriate and depending on the number of patients waiting.
Based from the observation, the operation hours for the clinic is about 10 hours per day. However,
it is important to note that after 6.00 pm there still an emergency outpatient clinic but for the
purpose of this case-study that aspect was excluded. Based on the descriptive date, the maximum
and minimum service time of patients in registration counter are 1.25 minutes and 1.98 minutes
respectively. Figure 3 shows the graph of service time against the number of patients enter the
outpatient’s department. From the graph, it shows that consultation room which is placing the
highest service time to be served. However, pre-consultation room and pharmacy counter giving
the approximately same time.
Figure 2: The graph of the number of patients arrived to registration counter.

Figure 3: The graph of service time.

4.2 ARENA Simulation Queuing Model
4.2.1 Simulation Model
The data from the previous observation, charts, tables and graph was codded into the ARENA
software. In this queuing system at the Public Health Center process the modules, a characters of
patient flow were placed on the ARENA canvas. Figure 4 shows the simulation model of the
patients at outpatient’s department from the processes module that can be altered and coded
from the data of the observation.

Figure 4: Simulation model for the outpatient department system

From the column in basic process as shown in Figure 5 include the name, type, action, resources,
delay type, units, allocation, minimum value, average value, and maximum value of the data.
Figure 5 shows the basic process of service time value in the ARENA software. However, in this
study the row consists of four basic process as it represented the four stations in queuing theory
model that the patient would be serve from the nurse or doctor.
Figure 5: Basic process of service time value
According to this case-study, the type of basic process is based on the schedule. This is means that
the utilization of the nurse and doctor at the outpatient department are based on the times schedule.
The number of servers at the Public Health Center are shown in Table 1 below.

Table 1: Number of Server

STATIONS NUMBER OF
SERVER
TIME 0800 - 1000 - 1200 - 1400 - 1600 - 1700 -
1000 1200 1400 1600 1700 1800
REGISTRATION 2 2 1 2 1 1
PRE- 2 2 1 2 2 1
CONSULTATION
CONSULTATION 5 4 3 5 4 3
PHARMACY 2 2 1 2 2 1

There are six doctors allocated or scheduled for outpatient’s department per week but only five
to three doctors available per day. Meanwhile, several nurses are scheduled for working at the
department, but two or one nurse allocated at the registration counter, pre-consultation room and
pharmacy counter based on the schedule in Table 1. However, the meaning number of servers at
registration counter from 4.00 pm to 5.00 pm and 5.00 pm to 6.00 pm are two and one server
respectively.
4.2.2 Simulation Results
4.2.2.1 Average Waiting Time in Queue
Waiting time is the time required for a patient to wait for the service needed. Table 2 shows the
results of simulation model obtained from SIMAN reports which indicates the existence of a long
waiting time on Monday with an average of 87.936 minutes per patient which is often a common
complaint by patients than in the other days. Whereas the lowest average waiting time is on Friday
of 5.454 minutes. Thus, the maximum average waiting time for received service is 144.4848
minutes per patient whereas the average waiting time in queue is 54.2952 minutes. Table 2:
Average waiting time in queue
Day Time (minutes) Maximum Time
(minutes)
Monday 87.936 207.624
Tuesday 81.642 197.886
Wednesday 61.236 149.79
Thursday 35.208 137.922
Friday 5.454 29.202
AVERAGE 54.2952 144.4848

4.2.2.2 Average Service Time of Patient

Table 3 shows the results indicated the average of service time per patient with an average
13.324 minutes. These results show that some patients have to wait for a long period of time to
get a treatment, which may only take an average of service time, 13.4808 minutes. Meanwhile,
the maximum average service time is 23.724 minutes per patient that is less than 30 minutes. With
this service duration resulting unsatisfied patient. They have no opportunity to ask question and
get detail information about their medical problem because there are still many patients waiting
in queue outside.
Table 3: Average Service Time
Day Time (minutes) Maximum Time (minutes)

Monday 13.506 24.636

Tuesday 13.488 23.46

Wednesday 13.5 23.7

Thursday 13.506 23.37

Friday 13.404 23.454

AVERAGE 13.4808 23.724

 Probability that a customer has to wait= 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑐𝑢𝑠𝑡𝑜𝑚𝑒𝑟 𝑤ℎ𝑜 𝑤𝑎𝑖𝑡
𝑡𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑐𝑢𝑠𝑡𝑜𝑚𝑒𝑟𝑠

∑𝑤𝑎𝑖𝑡𝑖𝑛𝑔 𝑡𝑖𝑚𝑒 𝑖𝑛 𝑄𝑢𝑒𝑢𝑒

Average waiting time=𝑡𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑐𝑢𝑠𝑡𝑜𝑚𝑒𝑟𝑠

Proportion of server idle time=∑𝐼𝑑𝑙𝑒 𝑡𝑖𝑚𝑒 𝑜𝑓 𝑠𝑒𝑟𝑣𝑒𝑟

𝑠𝑖𝑚𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑟𝑢𝑛 𝑡𝑖𝑚𝑒

∑𝑠𝑒𝑟𝑣𝑖𝑐𝑒 𝑡𝑖𝑚𝑒
Average service time=
𝑡𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑐𝑢𝑠𝑡𝑜𝑚𝑒𝑟𝑠

Average time between arrivals=∑𝑡𝑖𝑚𝑒𝑠 𝑏𝑒𝑡𝑤𝑒𝑒𝑛 𝑎𝑟𝑟𝑖𝑣𝑎𝑙𝑠

𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑎𝑟𝑟𝑖𝑣𝑎𝑙𝑠−1

Average waiting time of those who wait= ∑𝑤𝑎𝑖𝑡𝑖𝑛𝑔 𝑡𝑖𝑚𝑒 𝑖𝑛 𝑄𝑢𝑒𝑢𝑒

𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑐𝑢𝑠𝑡𝑜𝑚𝑒𝑟𝑠 𝑡ℎ𝑎𝑡 𝑤𝑎𝑖𝑡

Average time customer spends in the system=∑𝑡𝑖𝑚𝑒 𝑐𝑢𝑠𝑡𝑜𝑚𝑒𝑟𝑠 𝑠𝑝𝑒𝑛𝑑 𝑖𝑛 𝑠𝑦𝑠𝑡𝑒𝑚

𝑡𝑜𝑡𝑎𝑙 𝑛𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑐𝑢𝑠𝑡𝑜𝑚𝑒𝑟𝑠
4.2.2.3 Average Total Time in System
Table 4 shows the result indicated the average of total time per patient with an average of 68.3148
minutes. These results stated that patient have to spend the time in outpatient department from
the registration until dispose. The maximum average total time in system is 156.7176 minutes
(more than two hours) per patient. But based on total time in system on Monday is the highest
average total time and maximum time. With this unbalanced treatment duration resulting unsatisfied
patient in hurry to get treatment.
Table 4: Average Total Time in System
Day Time Maximum Time
(minutes) (minutes)

Monday 117.642 223.812

Tuesday 81.642 197.886

Wednesday 74.736 165.45

Thursday 48.696 152.694

Friday 18.858 43.746

AVERAGE 68.3148 156.7176

4.2.2.4 Total Exit of Patients
Table 5 shows that the result between ten replications of the total exit of patients at Millennium
Health Center based on the difference day. The average number of patients arrived for one week
is 348 patients and the average number of patients that were serviced is 327 patients, the rest
remained in the system at average 21 patients. The highest arrival patient is on Monday and
Tuesday with assuming the patients have an appointment at outpatient Health Clinic. Table 5:
Total exit of patients
Day T otal exit of Patient

In Out In System

Monday 373 356 17

Tuesday 435 359 76

Wednesday 344 341 3

Thursday 345 339 6

Friday 244 241 3

AVERAGE 348 327 21

4.2.2.5 Server Utilization

Based on the table below shows the utilization percentage. Table 6 exhibits the utilization for
real situation of the working process at the Public Health Center. Based from the analysis, the
largest utilization is shown at the consultation room is about 88.7% whereas the lowest at
registration counter with the percentage of 59.7%. The utilization of server at pre-consultation
room and pharmacy counter are almost significant about 84% and 83% respectively. Therefore,
it is clear that utilization for registration counter is not reaching to 70%. If the utilization for
every process reach 90%, that means that the number of patients enter to the Public Health
Center increase from current situation. However, for current situation, the number of servers for
registration counter is one and two servers based on schedule. If the scenario of the server at
registration counter change to one server all the way, outpatient department cannot cope up the
increasing number of patient and that impossible to give the best service to the patient.
Table 6: Server utilization at outpatient department
Stations Percentages of server utilization AVERAGE

DAY Mon Tue Wed Thu Fri

Registration 64.0 74.7 58.9 59.2 41.9 59.7

Pre-consultation 90.9 99.5 84.5 85.0 60.1 84.0

Consultation 97.7 98.1 91.8 91.9 64.0 88.7

Pharmacy 89.3 91.6 87.3 85.5 61.1 83.0

4.2.2.6 Summarization of the Performance Measure

The Table 7 below summarizes all the final output measures between ten replications together with
their average and maximum time after run the simulation model. All the performance measures
statistical results are got from ARENA simulation based on the schedule of server at Table 1 for
registration counter, pre-consultation room, consultation room, and pharmacy counter at
consultation room at the Public Health Center.
Table 7: Final output performance measure development

The results obtained from the ARENA simulation stated that the average waiting time of patient
have to wait before get the treatment is 54.295 minutes whereas the maximum waiting time is
144.48 minutes. Then, the average service time for patient get the treatment is 13.48 minutes
whereas the maximum service time for several patients is 23.724 minutes. Therefore, the average
total time spend by patients in outpatient department is 68.315 minutes and maximum total time
in system is 156.718 minutes. Total average number of patients arrived at outpatient counter is 327
patients per day. Thus, based on the result average total number of patients gives the utilization
of server at outpatient department is 78.84%.
4.3 Discussion
4.3.1 Verification and Validation
After analyzed the simulation result, the average waiting time and service time for simulated output
is compared to the historical data output obtained from outpatient department clinic records. The
process is known as verification and validation process. This process needs to be done to ensure
the simulation model developed is valid and acceptable before proceed to the next steps.
Verification seeks to show that the computer program performs as expected and intended.
Validation on the other hand, questions whether the model behavior validly represents that of the
real-world system being simulated. A commonly used validation tolerance is 10% which means
that the output obtained from simulation model must not exceeds 10% of the real system output.
If the differences are less than 10%, which is within the standard total differences that can be
allowed, a simulation model is considered as acceptable and valid. Therefore, the comparison on
this case is valid and acceptable with the total arrival of patients are not less than 10%.

4.3.2 Detail of Average Waiting Time

Table 8 shows the detail of average waiting time of patients in queue at every station. The highest
average waiting time is 28.096 minutes at pre-consultation room with the percentage of utilization
is 84%. This result means that the patients have to wait for a long time at this station before to
see the doctor. Based on the observation, the cause of long waiting time at this station is the
clinic using the old system for getting the blood pressure. Therefore, the suggestion at
preconsultation room need to change the new technology to get the blood pressure of patient.
Then, the lowest average waiting time of patients in queue is 4.031 minutes at registration
counter with the percentage of utilization is 59.7%. Meanwhile the average waiting time at
consultation room is
18.324 minutes with the highest percentage of utilization is 88.7%. The pharmacy counter has
the average waiting time of 4.196 minutes while the percentages of utilization is 83%.
There were several problems identified from this study that need to be rectified. A low
percentage of registration utilization an unnecessarily long time to be registered and to see the
doctor. Registration should be a quick and simple process. This study identified that the long
waiting time is due to low server utilization caused by the registration counter being manned.
Lack of staffing utilization is a known contributor to lengthy waiting time in Public Health
Centers. A recommendation need to increase the number of staff at outpatient department to reduce
the waiting time of patient. But this recommendation cannot to be accept if it increases the cost
of adding server.
Table 8: The detail of average waiting time
Days Average waiting time

Mon Tue Wed Thu Fri AVERAGE

Registration 10.92 2.562 5.322 1.056 0.294 4.031
Pre- 45.348 50.214 26.634 16.284 1.998 28.096
Consultation
Consultation 26.706 26.562 22.602 13.986 1.764 18.324
Pharmacy 3.906 5.688 6.402 3.612 1.374 4.196
5. Conclusion and Recommendation
5.1 Conclusion
In this case-study, a multiple server channel model was developed for the outpatient department at
the Public Health Center with a focus on the patient waiting time for having a treatment. The main
objective of this project is to determine waiting time of patient’s flow which can be used to improve
the operating performance and also improving the quality of the services provided to the
patients. The first objective to this case-study to determine the waiting arrival time and service
time of patients at outpatient department. This result is shown at the Table 2, 3 and 4. The result
stated that the average waiting time of patients in queue is 54.295 minutes with the average total
exit patient is 327 patients. Thus, the average service time is 13.481 minutes.
Therefore, suggested improvement need to make to this station with a view to reduce the waiting
time and increase the utilization of server. This is to ensure the high quality of services is delivered.
The outcome of this case-study is the better understanding of queuing theory and management
service. In addition, the health care providers can make decision that increase the satisfaction of
all relevant group besides optimizing the resources. This case-study further established that
queuing theory and modelling is an effective tool that can be used to make decisions on staffing
needs for optimal performance with regards to queuing challenges in clinics. This project therefore
is replicated in other Health facilities.
5.2 Recommendation
The number of population and community at selected population will be increased every year in
the next few years. Thus, the case-study recommends the management should invest in using the
new technologies or system that can be implementing at the Public Health Center especially in
outpatient department. For example, establishing a special counter for acute case and the elderly.
Besides that, the number of servers also should be rescheduled in 10 hours working by which the
capacity of server need to rearrange.
This schedule are known as the relocation of server at outpatient department even though the
reducing number of server at registration counter will affect the waiting time of patients but still
achieved with the patient charter. So that, the waiting time spend by patients at specific station
will be reduce, will not affect the cost of utilization. This is because, if the number of waiting time
of patients increase, the authorities of clinic should provide adequate waiting space for patients.
6. Reference
 Afrane, S., & Appah, A. (2014). Queuing theory and the management of Waiting-time in
Hospitals: The case of Anglo Gold Ashanti Hospital in Ghana. International Journal of
Academic Research in Business and Social Sciences, 4(2), 33–44.

 Abdul Manaf, N. H. (2006). "Patient Satisfaction as an Indicator of Service

Quality" in, 9(4), 689–704.
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