International Journal of Engineering & Technology, 7 (4.

30) (2018) 304-307

International Journal of Engineering & Technology

Website: www.sciencepubco.com/index.php/IJET

Research paper

Review on Queueing Problem in Healthcare

Hajar Ariff1, M Ghazali Kamardan2*, Suliadi Sufahani2, Maselan Ali3
1,2,3
Department of Mathematic and Statistic, Faculty of Applied Science and Technology, Universiti Tun Hussein Onn Malaysia, Bandar
Universiti Edu Hub Pagoh, 84600 Pagoh, Johor, Malaysia.
*Corresponding author E-mail:[email protected]

Abstract

This article shows the application of queueing, simulation and scheduling used in the field of healthcare. A summary of queueing,
simulation and scheduling theory used in waiting time, appointment system and patient flow are summarised in this article. Different
departments in the healthcare system are also considered in this article such as emergency department, outpatient department and the
pharmacy. The aim is to provide the reader a general background into queueing, simulation and scheduling in the healthcare.

Keywords: Healthcare; Scheduling; Simulation; Queueing.

performance [2]. As the solution to long waiting time, an efficient

1. Introduction queuing model for proper appointment system is proposed. A
series of interviews are carried out to get the general overview on
Patients are expected to receive treatment and services from the factors affecting patients waiting time. Hence, the appointment
specialized staff and equipment from the main healthcare facility queueing system provides better utilization of resources and
centre which is the hospital. However, the queueing in many reduces patients waiting time in the outpatient department [1]. A
hospitals has been a big issue to the public. This is due to the long survey on patient’s satisfaction at the emergency department has
waiting time to receive health services. Furthermore, the very long been done which evaluated 2195 questionnaires for a period of
waiting time for treatment results in boredom and can cause a three years to plan the capacity of emergency department in Mures,
patient's health status decline and hence, reduce the treatment County, Romania to manage in optimal way to patient’s flow.
efficiency due to patients may not be attended and end up going Queueing models are used to provide reasonable accurate
home without receiving attention. evaluations for the system’s performance and as a useful tool for
The long waiting problem is caused by the increasing number of decision making [3]. In this research, queueing theory has been
visitors and patients attending to the hospital while the services used as the first tool to view patient waiting time on each server
system remains unchanged. There are lot of complain has been and the results show that the appointment system should be
reported due to queueing problem such as, lacking beds in the change for physicians. Through this research, recommendation on
hospital, long queue at the pharmacy department and reduced the best strategy to improve the appointment system and a study of
number of equipment. The seriousness of this problem is often the major causes of patients’ length of time for medical treatment
featured in the news report through the mainstream media. could be provided [4]. A descriptive analysis was conducted to
In the hospital, the nurses, trained counter personnel including the develop a suitable model for determining waiting arrival time and
IT staff and the entire equipment act as the servers in the queueing service time of patients at the outpatient counter. This study
system while clients who come to the hospital include the walk-in included the arrival rate and service rate of patients at the
patients, wait for the necessary service, obtain it and then leave outpatient counter for the analysis. The result shows that multiple
upon completion of service or walk to another department server channel model was developed for the outpatient department
expecting supplementary service [1]. with the focus on the patient waiting time to have the treatment [5].

2. Queueing 3. Simulation
A study on the application of queueing theory and modelling to A simulation study to replicate patient movement flows in an
the queueing problem at the outpatient department at a hospital in emergency department (ED) of a general hospital in north
Ghana is investigated. The method used are descriptive, Peninsular Malaysia has been conducted [6]. This study was
observational and ex-post facto case study approach. The analysis carried out to evaluate resource utilization among personnel and
came out with a result stated that optimum performance can be physical resources. Then, a hybrid simulation method combining
achieved with eight doctors compared to five doctors. Therefore, discrete event simulation and system dynamic modelling approach
applying queuing theory and modelling to queueing can enhance was proposed to better understand emergency department
decision making with regards to what will provide optimal operations from a whole system perspective [7].

Copyright © 2018 Authors. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.
International Journal of Engineering & Technology 305

In this study, an improvement of discrete event simulation model be achieved through classification and sequencing of patients [25-
for modelling outpatient pharmacy workflow queueing system has 27].
been done in an outpatient pharmacy in Riyadh. The intention of A research was developed to schedule the working shift of the
this study was to explore the possible options in designing nurses so that the availability and equality of the nurses were
efficient queueing system. The data were collected using ensured. This research used goal programming method to develop
stopwatch. Based on the analysis of the data which involved the work shift schedule. The results show that the hard constraints
various scenarios, the result found from the simulation model were satisfied compared to the current scheduling work shift for
shows that long waiting time exist in the system and simulation the nurses in the hospital [14]. A real scheduling problem was
model basically helps to reduce the patients’ waiting time and used in this study to develop a mathematical model to schedule the
improve the service quality [8]. A suitable queueing theory and operation theatre during peak and off-peak time. Integer Linear
simulation technique has been developed in this study to optimize Programming and Linear Programming techniques were used for
the management of studied outpatient pharmacy. the analysis of this study. The results show that linear
A descriptive analytical study was conducted with a sample of 220 programming technique able to obtain optimal schedule which
patients involves in this study. The simulation results showed that meet the aim to develop a mathematical model for the operation
reducing staff in the morning would not change the performance theatre scheduling and the related constraints [15]. A model was
but increasing one staff may change the queue performance. proposed for the scheduling entry of the non-critical patients into
Hence, by using queueing theory and simulation techniques, the the Emergency Department which may be helpful for the
patients’ waiting time and number of waiting patients could be management service. The data were extracted from the hospital
reduced [9]. In this research, a queueing model is developed using historical data and the model was based on the patient scheduling
discrete event simulation where the healthcare centre at algorithm. The results show that overall mean of 31 % of the
Mississippi State University (MSU) is selected as case example. patient waiting time able to be reduced and proved that the model
The aim is to reduce patient waiting time and improve throughput is efficient for the application within the service provided in the
the system. The results suggest that 50% of patients should follow emergency department [16]. A mathematical programming model
normal route in the blood lab and another 50% should reroute to was proposed to generate physician schedules which satisfy
other lab [10]. In reducing average waiting time for outpatient physicians’ preferences and their duty requirements. The
section, a simulation for number of patients attending the constraints were collected and included into the analysis which
outpatient section was simulated. Patient’s arrival time, service results in the automated schedule provide fairness and more
time and average waiting time were calculated by simulating the effective among the physicians [17].
number of patients. The results show that the average waiting time In the research of [18], a stochastic integer programming was
can be reduced by 40.97% if another doctor allocated to provide developed for multiple operating room to minimize the costs from
the services and the extra doctor must be present at least in the both health care providers and patients. Synthetic data was used to
peak hours between 9 a.m. to 12 noon [11]. test the performance of the proposed model and experiments were
This study of [12] had proposed a new method for surgical conducted to show the effectiveness of the proposed model. The
scheduling which based on duration groups and level of variability results show that approximately 27% of the cost can be reduced by
for scheduled procedures in the operating theatres. A discrete using the proposed stochastic integer programming model. The
event simulation was used to model and validate the daily surgical variables and constraints are introduced as follow:
schedules. Based on the analysis, the result shows that how a can a
method improves the surgery scheduling but additional factors
such as considering accurate estimations for variability of y
tT
it  1 i  I , yit  xt i  I , t  T (1)
surgeons and system for managing emergency should be included
into the analysis [19-24]. yit 0,1, i  I , t  T , representing patient i is assigned to the
th
t OR. The basic model includes:
4. Scheduling Min
 
In the research of [13] modelled the patients’ flow using discrete  ct xt + di  1 −

yit 

event simulation where many appointment scheduling is analysed tT tT  tT 
and evaluated with an attempt to address the appointment  
scheduling problem for appointment systems which involved
multiple classes of patients having different mean service times,
+  p q  W W
I k i i
k ,l
+ Ot O t
k ,l 

(2)
kK T L  tT tT 
punctualities, no-show probabilities and service time variability.
Thus, it is found that significant performance improvements may

Table 1: Summary of Previous Study

Author Year Title Research Problem
Nor Aziati & Nur 2018 Application of Queueing Theory To determine the waiting arrival time & service time of patients at the outpatient
Salsabilah Model and Simulation to Patient counter also to model suitable queueing system using simulation.
Flow at The Outpatient Department Arena student version unable to develop more than 150 entities waiting & simulate
complex model. Only simple flow can be developed.
Afrane & Appah 2014 Queueing Theory and The To investigate the application of queueing theory and modelling to the queueing
Management of Waiting-time in problem at the outpatient department at Anglogold Ashanti hospital in Obuasi,
Hospitals: The Case of Anglo Gold Ghana.
Ashanti Hospital in Ghana This study however did not consider costs and it would be interesting to include the
cost dimension in another study in future.
Obulor & Eke 2016 Outpatient Queueing Model To propose and efficient queueing model for proper appointment system as the
Development for Hospital solution to the long waiting times.
Appointment System Queueing model seems difficult to implement due to the increase in the calling
population.
Lade, Chowriwar 2013 Simulation of Queueing Analysis in To reduce the average waiting time of patients for OPD section.
& Sawaitul Hospital There would be more profits made and more time to carry out business to improve
306 International Journal of Engineering & Technology

the queues.
Vass & Szabo 2015 Application of Queueing Model to To plan the capacity of ED situated in Mures County, Romania, to manage in
Patient Flow in Emergency optimal way the patients flow using queueing model.
Department: Case Study Models can be invaluable in providing decision support in complex environments
as the ED.
Hossain, 2017 Reducing Patient Waiting Time in To reduce patient waiting time and improve the overall throughput of the system.
Khasawneh & Outpatient Clinic: A Discrete Event Increasing rerouting of patients to lab technician may decrease the waiting time.
Jaradat Simulation (DES) Based Approach
Bahadori et al 2014 Using Queuing Theory and To optimize the management of studied outpatient pharmacy by developing
Simulation Model to Optimize suitable queueing theory and simulation technique.
Hospital Pharmacy Performance The study has limitation where the over-the-counter drugs and patients requesting
such drugs were not considered in the evaluation of scenarios.
Alhaag, Aziz & 2015 A Queueing Model for HealthCare To improve and build a discrete event simulation model for modelling outpatient
Alharkan Pharmacy Using Software Arena pharmacy workflow queueing system with the intent of exploring options for
designing an efficient the queueing system of KKUH outpatient pharmacy Riyadh
KSA.
A flexible simulation model that can be applied into different type of systems and
able to give more accurate result should be developed.
Mardiah & Basri 2013 The Analysis of Appointment System To provide a study of the major causes of patients’ length of time for medical
to Reduce Outpatient Waiting Time treatment in an outpatient clinic at one of Indonesian public hospital and provide
at Indonesia’s Public Hospital recommendation on the best strategy to improve the appointment system so that
can maximize the effectiveness and efficiency of resource and capacity.
A simulation of all variable that affects bottleneck should be made to make the
clinic performance more effective and efficient.
Suliadi & 2014 A Real Scheduling Problem for To develop a mathematical model for scheduling the operating theatre during peak
Zuhaimy Hospital Operation Room and off-peak time.
Different approach can be used such as heuristic algorithm technique which able to
solve NP-hard scheduling problem for other related areas.
Nainggolan & 2017 Scheduling Nurses’ Shifts at PGI To identify nurse scheduling criteria and find the best schedule that can meet the
Kusumastuti Cikini Hospital criteria.
Nurses should not be assumed to have similar level of skill and different nurses’
skills may be required in each shift.
Bruballa, Wong 2017 Scheduling Model for Non-Critical To improve the quality of service in a ED, trying to reduce length of stay patients
& Epelde Patients Admission into a Hospital in the service (LoS) through a model for scheduling the entry of non-critical
Emergency Department patients into the service.
Implementation of the proposed model in the real system should be noted to ensure
the effectiveness on the entry of patients, depends on the decision of the patients.
Shamia, 2015 Physician On Call Scheduling: Case To generate physician schedules that satisfy as may physicians’ preferences and
Aboushaqrah & of a Qatari Hospital duty requirements.
Bayoumy Both view from schedule maker and physician where hospital’s policies, safety
regulations and high level of physician work life satisfaction should be included in
the schedule.
Pang et al. 2018 Surgery Scheduling under Case To minimize the costs from the perspective of both health care providers and
Cancellation and Surgery Duration patients by developing a stochastic integer programming model for multiple ORs
Uncertainty simultaneously considers the uncertainties of case cancellation and surgery
duration.
The model should be extended to a comprehensive scheduling system with both
elective and emergency surgeries included.
Schultz & 2014 Variability Based Surgical To propose a new methodology for surgical scheduling which sequences
Claudio Scheduling: A Simulation Approach procedures based on duration groups and their level of variability.
The model should consider the procedure variability to the scheduling problem for
the completion of more complex procedures.

5. Discussion 6. Conclusion
Table 1 shows the summary of previous study on the application Queueing, simulation and scheduling are combinations of
of queueing, simulation and scheduling in healthcare. However, powerful management tool which often applied in many different
there is a few parts that need to be improved. Further contributions areas which now has been applied in the medical sector. Proper
are listed in Table 2. Both scheduling and simulation can be implementation of these powerful management tool may lead to
implemented in queueing system. Scheduling helps in arranging an effective and efficient management system.
and optimizing processes while simulation is an innovative
approach to imitate the real-world operation process and improve
system performance. Therefore, both scheduling and simulation
Acknowledgement
are important to ensure queueing problem can be overcome based
on what is the problem circumstances. Funding from U904 Tier 1.

Table 2: Recommendations of the Research References

Contributions
i. To analyse the current queuing problem in the healthcare. [1] Obulor R & BO Eke (2016), Outpatient Queueing Model
ii. To study the waiting times for the health services. Development for Hospital Appointment System. International Journal of
iii. To simulate the healthcare system. Scientific Engineering and Applied Science (IJSEAS) 2(4), 15-22.
iv. To validate the best decisions for the healthcare system. [2] Afrane S & Appah A (2014), Queueing Theory and The
v. To reduce the waiting time during peak hour. Management of Waiting-time in Hospitals: The Case of Anglo
International Journal of Engineering & Technology 307

Gold Ashanti Hospital in Ghana. International Journal of Academic Development for the Lateral Collapse of Octagonal Tubes. Journal
Research in Business and Social Sciences 4 (2), 34-44. of Physics: Conference Series 995(1).
[3] Vass H & Szabo ZK (2015), Application of Queuing Model to [26] Sufahani S, Kamardan MG, Rusiman MS, Mohamad M, Othman
Patient Flow in Emergency Department: Case Study. Procedia MZM, Khalid K, Ali M & Nawawi MKM (2018), A Mathematical
Economics and Finance 32, 479-487. Study on additive Technique Versus branch and Bound Technique
[4] Mardiah FP & Basri MH (2013), The Analysis of Appointment for Solving Binary Programming Problem. Journal of Physics:
System to Reduce Outpatient Waiting Time at Indonesia’s Public Conference Series 995(1).
Hospital. Human Resource Management Research 3(1), 27-33. [27] Kamardan MG, Aminudin N, Che-Him N, Sufahani S, Khalid K &
[5] Aziati AHN & Salsabilah HN (2018), Application of Queueing Roslan R (2018) Modified Multi Prime RSA Cryptosystem.
Theory Model and Simulation to Patient Flow at The Outpatient Journal of Physics: Conference Series 995(1).
Department. Proceedings of The International Conference on
Industrial Engineering and Operations Management, 3016-3028.
[6] Ahmad N, Ghani NA, Kamil AA, Tahar RM (2015), Modelling the
complexity of emergency department operations using hybrid
simulation. Internat J. Simul. Process Model 10(4), 360-371.
[7] Laguna M & Marklund J (2005), Business Process Modeling,
Simulation and Design. Pearson Prentice Hall.
[8] Alhaag MH, Aziz T & Alharkan IM (2015). A Queueing Model for
Health Care Pharmacy using Software Arena. Proceedings of the
2015 International Conference on Industrial Engineering and
Operations Management Dubai, United Arab Emirates (UAE).
[9] Bahadori M, Mohammadnejhad SM, Ravangard R &
E.Teymourzadeh (2014), Using Queueing Theory and Simulation
Model to Optimize Hospital Pharmacy Performance. Iran Red
Crescent Med J. 16(3), 1-7.
[10] Hossain NU, Khasawneh M & Jaradat R (2017), Reducing Patient
Waiting Time in an Outpatient Clinic: A Discrete Event Simulation
(DES) Based Approach. Proceedings of the 2017 Industrial and
Systems Engineering Conference.
[11] Lade IP, Chowriwar SA & Sawaitul PB (2013), Simulation of
Queueing Analysis in Hospital. International Journal of
Mechanical Engineering and Robotics Research 2(3),122-128.
[12] Schultz J & Claudio D (2014), Variability Based Surgical
Scheduling: A Simulation Approach. Proceedings of The 2014
Winter Simulation Conference, 1353-1364.
[13] Bhattacharjee P & Ray PK (2016), Simulation Modelling and
Analysis of Appointment System Performance for Multiple Classes
of Patients in a Hospital: A Case Study (8),71-84.
[14] Nainggolan JCT & Kusumastuti RD (2018), Scheduling Nurses’
Shifts at PGI Cikini Hospital. IOP Conf. Series: Materials Science
and Engineering 332, 1-7.
[15] Sufahani S & Ismail Z (2014), A Real Scheduling Problem for
Hospital Operation Room. Applied Mathematical Sciences 8(114),
5681-5688.
[16] Bruballa E, Wong A & Epelde F (2017), Scheduling Model for
Non-Critical Patients Admission into A Hospital Emergency
Department. Proceedings of The 2017 Winter Simulation
Conference, 2919-2928.
[17] Shamia O, Aboushaqrah N & Bayoumy N (2015), Physician On
Call Scheduling: Case of a Qatari Hospital. IEEE.
[18] Pang B, Xie X, Song Y & Luo L (2018), Surgery Scheduling Under
Case Cancellation and Surgery Duration Uncertainty. IEEE:
Transactions on Automation Science and Engineering, 1-13.
[19] Jayeola D, Ismail Z, Sufahani SF & Manliura DP (2017), Optimal
method for investing on assets using black litterman model. Far
East Journal of Mathematical Sciences 101(5), 1123-1131.
[20] Sufahani SF & Ismail Z (2014), The statistical analysis of the
prevalence of pneumonia for children age 12 in west Malaysian
hospital. Applied Mathematical Sciences 8(113-116), 5673-5680.
[21] Sufahani SF, Che-Him N, Khamis A, Rusiman MS, Arbin NA C. K.
Yee, I. N. Ramli, N. A. Suhaimi, S. S. Jing & Z. A. Azmi, (2017),
Descriptive statistics with box-jenkins and marketing research for
jewellery company in Malaysia. Far East Journal of Mathematical
Sciences 101(10), 2151-2161.
[22] Sufahani SF & Ahmad A (2012), A comparison between normal
and non-normal data in bootstrap. Applied Mathematical Sciences
6(89-92), 4547-4560.
[23] Rusiman MS, Hou OC, Abdullah AW, Sufahani SF & Azmi NA
(2017). An analysis of time series for the prediction of barramundi
(Ikan Siakap) price in Malaysia. Far East Journal of Mathematical
Sciences 102(9), 2081-2093.
[24] Ismail Z, Abu N & Sufahani S (2016), “New product forecasting
with limited or no data”, AIP Conference Proceedings 1782
(050009).
[25] Kamardan MG, Sufahani S, Othman MZM, Che-Him N, Khalid K,
Roslan R, Ali M & Zaidi AMA (2018), A Mathematical Model