Contents

INTRODUCTION.....................................................................................................................................1
AIM....................................................................................................................................................1
OBJECTIVES.......................................................................................................................................1
KEY PERFORMANCE INDICATORS.....................................................................................................1
ASSUMPTIONS MADE FOR THE MODEL SIMULATED.......................................................................1
DEFINITION AND ANALYSIS OF THE NHS PROBLEM.........................................................................2
LOGIC IDENTIFICATION.........................................................................................................................2
FLOWCHARTING................................................................................................................................2
DISTRIBUTION FITTING.........................................................................................................................4
SIMULATION MODELLING....................................................................................................................7
AS-IS SCENARIO.................................................................................................................................7
“AS-IS” SCENARIO ANALYSIS.......................................................................................................10
EXPERIMENTAL DESIGNS....................................................................................................................14
WHAT IF SCENARIO 1 ANALYSIS.....................................................................................................14
WHAT IF SCENARIO 2 ANALYSIS.....................................................................................................18
RECOMMENDATIONS.........................................................................................................................22
REFERENCES........................................................................................................................................23

INTRODUCTION
The NHS organisations are tasked with providing quality healthcare to the British inhabitants. Over
the years, these organisations have been the most reliable for providing accurate diagnosis and
treatments for the teeming UK population at reduced costs. This have obviously attracted many
patients to the fold of NHS as people always look forward to obtaining good healthcare delivery at
minimal rates. However, the rising aging population, technological advancements and the rise in the
price of NHS services has been plaguing the efficiency and adorability status of these organisations
lately. Patients now seek for healthcare services elsewhere because of the prolonged service times
caused by increasing patient waiting times and increasing costs.

Based on the aforementioned problems, this report is focused on improving patients’ waiting time
and proper allocation of resources for optimum performance in a bid to raise the quality assurance
from NHS organisations.

AIM
This work is aimed at simulating a model which imitates the real life scenario at NHS organisations
which will aid the organisations to understand their systems, identify bottlenecks and permit for
improvements in the systems in order to reduce patients’ waiting times and optimise resource utility
for restoring their quality assurance confidence.

OBJECTIVES
1. To understand the healthcare delivery processes at NHS organisations.
2. To design a flowchart for a pictorial representation of the processes in the NHS
organisations.
3. To use distribution fitting to give the most appropriate arrival time in NHS organisations.
4. To develop a simulation model on Arena showing the “As-Is” situations of processes in the
delivery of healthcare in NHS organisations.
5. To identify bottlenecks in the model developed.
6. To explore possible means of improvement without disrupting the real life system by
running various “What-If” scenarios.
7. To provide recommendations for improvement of the system based on the results of the
“What-If” scenarios in order to reduce waiting times and optimise productivity.

KEY PERFORMANCE INDICATORS

1. Reduced overall process time.
2. Reduced queue length at each process.
3. Optimum resource utilisation.
4. Minimised average waiting time.

ASSUMPTIONS MADE FOR THE MODEL SIMULATED

In order to develop a model which is very close to the real life situation, some assumptions were
made and these are

1. All the resources (human and equipment) used in the clinic are in good shape.
2. The hospital operates 24 hours daily.
3. All events are discrete.
4. Maximum arrival of 100 entities.
5. Shift change over does not affect any functionality of the system.
DEFINITION AND ANALYSIS OF THE NHS PROBLEM
The definition and analysis of the NHS problem will be done by decomposing the system into basic
simulation components. This is shown in the table below

ENTITIES ATTRIBUTES STATE VARIABLES ACTIVITIES EVENTS

Patients New patients Queue length for appointed New Patient arrival
registration registration

Appointed Queue length for new Appointed Patient departure

patients registration registration

Queue length for laboratory Laboratory

tests testing

Queue length for Consultation

consultation inspection inspection

Queue length for payment Payment

Queue length for collecting Prescription
prescription

LOGIC IDENTIFICATION
FLOWCHARTING
A flowchart is an analytical tool which is used in showing the logical relationships between processes
in a system. It guides system developers to fully understand the logic in a system before the actual
development and implementation. In this case, it is a graphical representation that shows the logical
flow of processes that make up the daily functions of NHS organisations in the UK. The figure below
is a flowchart for the NHS organisations as described in the assignment scenario.

FIGURE 1. FLOWCHART FOR THE NHS ORGANISATIONS’ PROCESSES

START PATIENTS ARRIVAL

NEW APPOINTED
DECIDE APPOINTED PATIENTS
NEW PATIENTS REGISTRATION
REGISTRATION PATIENT TYPE
ARRIVAL – The process starts with the arrival of the patient to the hospital which occurs at an inter
arrival time that id determined by the probabilistic distribution function of ( ). On arrival, the
patients are categorised as new patients or appointed patients of which 85% of patients are
appointed while the rest are new.

REGISTRATION – The registration desk of the new patients is responsible for collecting their data
and fixing appointments for them at a later date after which they leave the system. Meanwhile, the
desk of appointed patients retrieves their data to know if they need laboratory test or not. 74% of
patients need laboratory tests while the rest don’t. Those that do not need testing are sent straight
to the waiting room while others are sent to the laboratory.

LABORATORY – At the laboratory, the patients are split according to the kind of test that is to be
administered on each. 30% do urine test, 50% do blood test while the rest are administered with
blood pressure test. After the test, each proceeds to the waiting room..

CONSULTATION INSPECTION – At this stage, the patients consult with the doctors on call who
diagnose and treat them according to their ailments. Also prescriptions are written here for those
that may require such. From here they proceed to the payment unit.

PAYMENT – The patients make payments for the services and prescriptions they received at the
hospital here. After payment, those that have prescriptions to collect go to the pharmacy to pick up
their drugs while those that don’t leave the hospital. 82% of the patients are prescribed while the
remainder leave the system.

PHARMACY – This is where prescriptions are picked up within a predetermined service time function
before the prescribed patients finally leave the hospital.

DISTRIBUTION FITTING

A distribution is a collection of the values of a variable which shows their observed or theoretical
rate of occurrence in any order (Al Bazi, 2015). Distribution fittings are used to estimate a real life
occurrence of an event. It entails the ways of selecting statistical distribution, which fits a set of
randomly generated processes. A common application of distribution fitting procedures can be for
verification of the assumption of normality before using some parametric test. Distribution fitting
can also be applied when trying to determine a particular distribution that best describe a
given/randomly generated set of data.

When using distribution fitting for predictive purposes, it is imperative that the shape of the
underlying distribution be properly understood. A good way to determine the underlying distribution
is by fitting the observed distribution to a theoretical distribution by matching the frequency
observed in the data to frequency expected of the theoretical distribution. A good tool that can be
used to in achieving a well-acquainted business decision is the probability distribution, which is used
for dealing with uncertainties and specific calculations.

The inappropriate use of distribution models can result to delays or inability to complete projects,
which can eventually lead to loss of time, effort, improper engineering design and money. The
proper use of distribution fitting brings about the development of effective random process models.
Distribution fittings are the functions of the variability of arrival and process times (Greasley, 2004).
The data used for simulating this model was gotten by observation and is fitted thus

Figure 2. Snapshot of bars

Data Summary

Number of Data Points = 252

Min Data Value = 2.04
Max Data Value = 20.6
Sample Mean = 11.8
Sample Std Dev = 5.7
Histogram Summary

Histogram Range = 2 to 21
Number of Intervals = 15

Figure 3. Snapshot of bars with curve

 Distribution Summary
Distribution: Beta
Expression: 2 + 19 * BETA (0.92, 0.855)
Square Error: 0.009262
Chi Square Test
Number of intervals = 15
Degrees of freedom = 12
Test Statistic = 32.8
Corresponding p-value < 0.005
Kolmogorov-Smirnov Test
Test Statistic = 0.0538
Corresponding p-value > 0.15
Data Summary
Number of Data Points = 252
Min Data Value = 2.04
Max Data Value = 20.6
Sample Mean = 11.8
Sample Std Dev = 5.7
Histogram Summary
Histogram Range = 2 to 21
Number of Intervals = 15

DISTRIBUTION COMPARISON
Fit All Summary
FUNCTION SQUARE ERROR
Beta 0.00926
Uniform 0.00945
Normal 0.021
Weibull 0.0229
Gamma 0.0248
Triangular 0.0255
Erlang 0.0265
Exponential 0.0269
Lognormal 0.0349
Table 1. Distribution Comparison
 Square Error
0.04
0.035
0.03
0.025
0.02
0.015
0.01
0.005
0
ta rm al ll a la
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Figure 4. Distribution Comparison Chart

The chart and table above compares the square error values of various possible distribution
functions that can be used for this simulation. It is clear that the beta function is the most suitable
for doing the simulation as it has the least square error which stands at 0.00926. It is closely
followed by the uniform function with 0.00945 square error. Normal, Weibull and Gamma functions
followed suit in that order while lognormal function is the least suitable with a square error of
0.0349.

SIMULATION MODELLING
AS-IS SCENARIO
The simulation model will show what happens in the NHS organisations without actually hindering
the activities of the hospitals/clinics in real life. This method is normally utilised because it is cheaper
than running a real life test but produces results that are quite close to the real life scenario. Also, it
will be used to identify the bottlenecks within the healthcare delivery system in order to resolve
them. This will help the organisations to forecast what will happen in their clinics in the near future
by exposing what needs to be done in order to curtail those drawbacks that will hinder the
performance of the healthcare delivery systems. In doing this, NHS expects to remain relevant in the
healthcare industry through optimal utilisation of resources to enhance both productivity and
profits. The model facilitates the analyses of the “as-is” scenario in the hospitals and promotes
comparisons with other scenarios. Below is a snapshot of the whole processes in the clinics
 Figure 5. Snapshot of the hospital’s conceptual model

Detailed snapshots of each stage of the model are shown below

Figure 6. Arrival and Registration stage

At this stage, the patients arrive at the hospital at a distribution function interval of 2+19*BETA
(0.92, 0.855). They are then categorised into new and appointed patients by the decision box. 85% of
the patients who are appointed go to the registration desk where they are served by a nurse at the
rate of 2+LOGN (2.02, 3.82) before admission. The remainder go to the new patients’ registration
desk where they are served by another nurse at the rate of 5.5+LOGN (8.18, 4.37). They leave the
hospital after this registration.

Figure 7. Laboratory Testing Stage

At this stage, the admitted patients are split into two (those that require tests and those that do
not). The 26% of patients that do not require testing move straight to the waiting room for
consultation while the rest go for tests in the laboratory. The patients that require tests are further
split into 3 groups according to the test type. 30% go for urine tests which is conducted at the rate of
U(2, 4), 50% go for blood tests done at the rate of U(1, 3) while the rest have blood pressure tests
done at the rate of U(2, 4). All the tests here are done by one nurse. After the tests, they all go to the
waiting room for consultation inspection.
 Figure 8. Consultations and prescriptions stage

Consultation inspection is done by two doctors and a nurse at the rate of 10+LOGN (0.875, 0.599).
From here, the patients proceed to the payment section where they are attended to by a nurse at
the speed rate of 1+ LOGN (0.622, 0.221). From here 82% of the patients who have prescriptions
move towards the pharmacy while the rest depart. At the pharmacy, a pharmacist and a nurse
attend to the patients at the rate of 15+LOGN (0.712, 0.312). They depart from the hospital from this
stage.

Figure 9. Departure

“AS-IS” SCENARIO ANALYSIS

KEY PERFORMANCE INDICATOR 1 – TOTAL SIMULATION TIME

MINIMUM MAXIMUM
TIME AVERAGE HALF WIDTH AVERAGE AVERAGE
OVERALL SIMULATION TIME 50.33 8.11 40.71 58.36

Table 2. Total Simulation Time

 OVERALL SIMULATION TIME
70

60

50

40

30

20

10

0
AVERAGE HALFWIDTH MIN AVERAGE MAX AVERAGE

Figure 10. Total Simulation Time

From the figure and table above, it can be seen that the average total time for the simulation run is
50.37 hours. It also has a maximum value of 40.71 hours and minimum value of 58.36 hours.

KEY PERFORMANCE INDICATOR 2 – WAITING TIME

Waiting Time Average Half Width Min Average Max Average

Appointed Patients Registration 0.485 0.53 0.042 0.983

Blood Pressure Test 0.228 0.04 0.069 0.342

Blood Test 0.009 0.01 0 0.045

Consultation Inspection 6.222 3.03 3.7839 9.3362

New Patients Registration 1.116 1.0 0 2.258

Payment 0 0 0 0

Pharmacy 22.13 6.04 15.508 28.792

Urine Test 0.09 0.04 0 0.258

Table 3. Waiting times at each process

 Waiting Times
Urine Test

Pharmacy
Payment
New Patients Registration

Consultation Inspection
Blood Test

Blood Pressure Test

Appointed Patients Registration
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 2

Max Average Min Average Half Width Average

Figure 11. Waiting times at each process

The chart above shows that the payment process has negligible waiting time while the
process of picking up prescriptions has by a distance, the highest waiting time of 22.13
hours. This is followed by that of the consultation inspection which shows 6.222 hours of
average waiting time. These large differences can be attributed to the time it takes to serve
one patient in these processes as well as the number of staffs rendering the services at such
processes.

KEY PERFORMANCE INDICATOR 3 – QUEUE LENGTH

Queue Length Average Half Width Max Average Min Average

Appointed Patients Registration 0.035 0.04 0.003 0.072

Blood Pressure Test 0.002 0 0.0006 0.0003

Blood Test 0.0003 0 0 0.001

Consultation Inspection 0.448 0.24 0.261 0.682

New Patients Registration 0.014 0.01 0 0.025

Payment 0 0 0 0

Pharmacy 1.315 0.4 0.887 1.78

Urine Test 0.002 0 0 0.005

Table 4. Queue Length at each process

 Queue Length
Urine Test
Pharmacy
Payment
New Patients Registration
Consultation Inspection
Blood Test
Blood Pressure Test
Appointed Patients Registration
0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8

Max Average Min Average Half Width Average

Figure 12. Queue Length at the processes

Just as expected due to the high waiting times, the processes for collecting prescriptions at the
pharmacy and the one at the consultation inspection came up with the highest and second highest
queue length averages respectively. This is connected to the enormous amount of time it takes to
serve a patient in these processes. However, the payment process showed the lowest queue length
average of 0 which reflects the waiting time it displayed in the previous KPI.

KEY PERFORMANCE INDICATOR 4 – RESOURCE UTILISATION

Resource Utilisation Average Half Width Min Average Max Average

Doctor 0.774 0.04 0.74 0.819

Nurse 1 0.17 0.06 0.108 0.23

Nurse 2 0.267 0.04 0.222 0.297

Nurse 3 0.384 0.02 0.312 0.421

Nurse 4 0.774 0.04 0.740 0.819

Nurse 5 0.119 0.01 0.115 0.128

Nurse 6 0.929 0.04 0.898 0.971

Pharmacist 0.929 0.04 0.898 0.971

Specialist 0.774 0.04 0.740 0.819

Table 5. Resource Utilisation

 Resource Utilisation
1.2

0.8

0.6

0.4

0.2

0
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Average Half Width Min Average Max Average

Figure 13. Resource Utilisation

From the table and chart shown above, it is clear that the pharmacist and nurse involved in the
dispensation of prescription to the patients are the busiest with the highest average resource
utilisation of 0.929 each. They are closely followed by the doctors and nurse involved in the
consultation inspection process who are at 0.774 average resource utilisation. However, the nurse at
the payment process, had been consistently the least busy resource and as such, has the lowest
resource utilisation average which stands at 0.119.

EXPERIMENTAL DESIGNS
WHAT IF SCENARIO 1 ANALYSIS
In this scenario, the capacity of the pharmacist and nurse 6 working in the pharmacy were doubled
respectively. On running the simulation, the results obtained are analysed below

KEY PERFORMANCE INDICATOR 1 – TOTAL SIMULATION TIME

MINIMUM MAXIMUM
TIME AVERAGE HALF WIDTH AVERAGE AVERAGE
OVERALL SIMULATION TIME 35.89 5.25 31.61 41.67

Table 6. Total Simulation Time (What If Scenario 1)

 OVERALL SIMULATION TIME
45
40
35
30
25
20
15
10
5
0
AVERAGE HALFWIDTH MIN AVERAGE MAX AVERAGE

Figure 14. Total Simulation Time (What if Scenario 1)

The chart above shows that there was a noticeable decrease (about 14.48 hours difference)
in the average overall simulation time when the capacity of the hospital’s personnel working
in the pharmacy was doubled. This indicates that the bottleneck present in the hospital’s
pharmacy is partially responsible for the excess time consumed within the system.

KEY PERFORMANCE INDICATOR 2 – WAITING TIME

Waiting Time Average Half Width Min Average Max Average

Appointed Patients Registration 1.05 1.78 0.06 3.32

Blood Pressure Test 0.045 0.04 0 0.23

Blood Test 0.07 0.03 0 0.15

Consultation Inspection 7.33 3.60 3.80 10.43

New Patients Registration 0.044 0.12 0 0.22

Payment 0 0 0 0

Pharmacy 0 0 0 0

Urine Test 0.07 0.03 0 0.21

Table 7. Waiting times at each process (What If Scenario 1)

 Waiting Times
Urine Test
Pharmacy

Payment
New Patients Registration

Consultation Inspection

Blood Test
Blood Pressure Test

Appointed Patients Registration

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8

Max Average Min Average Half Width Average

Figure 15. Waiting times at each process (What if scenario 1)

The chart above shows that the waiting time at the pharmacy after the staff strength was doubled
has disappeared. This is due to the fact that prescribed patients are being attended to at a much
faster rate than they are being discharged from the consultation room. Furthermore, it can be seen
that the increased efficiency of the pharmacy section has increased the pressure on the appointed
patients’ registration and consultation inspection processes.

KEY PERFORMANCE INDICATOR 3 – QUEUE LENGTH

Queue Length Average Half Width Min Average Max Average

Appointed Patients Registration 0.07 0.12 0.004 0.22

Blood Pressure Test 0.0003 0 0 0.002

Blood Test 0.002 0 0 0.005

Consultation Inspection 0.51 0.26 0.27 0.75

New Patients Registration 0.0006 0 0 0.003

Payment 0 0 0 0

Pharmacy 0 0 0 0

Urine Test 0.001 0 0 0.003

Table 8. Queue Length at each process (What if scenario 1)

 Queue Length
0.8
0.6
0.4
0.2
0
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Average Half Width Min Average Max Average

Figure 16. Queue Length at each process (What if scenario 1)

The chart above indicates that the waiting time difference noticed in the previous chart is reflected
in the queue length. The disappearance of the waiting time in the pharmacy process also reflects in
the queue length. More so, the work pressure which increased the waiting time for appointed
patients’ registration and that of the consultation inspection also increased the queue lengths for
each process respectively.

KEY PERFORMANCE INDICATOR 4 – RESOURCE UTILISATION

Resource Utilisation Average Half Width Min Average Max Average

Doctor 0.753 0.05 0.71 0.787

Nurse 1 0.156 0.03 0.132 0.187

Nurse 2 0.275 0.09 0.211 0.384

Nurse 3 0.38 0.01 0.36 0.41

Nurse 4 0.753 0.05 0.71 0.787

Nurse 5 0.114 0.01 0.11 0.12

Nurse 6 0.454 0.05 0.40 0.495

Pharmacist 0.454 0.05 0.40 0.495

Specialist 0.753 0.05 0.71 0.787

Table 9. Resource Utilisation (What if scenario 1)

 Resource Utilisation
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
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Average Half Width Min Average Max Average

Figure 17. Resource Utilisation (What If Scenario 1)

The pharmacist and Nurse 6 had their resource utilisation halved due to the increase in capacity of
the workers in the pharmacy section. However, the pressure on the workers in the consultation
section means that there is a negligible difference in the resource utilisation of the doctor, specialist
and nurse 4. Also, there is a marginal increase in the resource utilisation of the nurse in the
appointed patients’ registration. This can be attributed to the faster rate at which all the
organisation’s processes are executed in this scenario.

WHAT IF SCENARIO 2 ANALYSIS

In this scenario, the capacity of the medical staff working in the consultation inspection were equally
doubled as those working in the pharmacy section. On running the simulation, the results obtained
are analysed below

KEY PERFORMANCE INDICATOR 1 – TOTAL SIMULATION TIME

MINIMUM MAXIMUM
TIME AVERAGE HALF WIDTH AVERAGE AVERAGE
OVERALL SIMULATION TIME 29.48 1.82 27.61 31.61

Table 10. Total Simulation Time (What If Scenario 2)

 OVERALL SIMULATION TIME
35

30

25

20

15

10

0
AVERAGE HALFWIDTH MIN AVERAGE MAX AVERAGE

Figure 18. Total Simulation Time (What If Scenario 2)

The chart and table above shows that there was an additional decrease (about 6 hours) in the total
simulation time from what was noticed in the first “What-if” scenario. This is as a result of the
increased speed of service in the consultation inspection process owing to the increased workforce
capacity there in this scenario. This implies that the average waiting time at the system is now
reduced and indicates that the initial consultation inspection process contributed to the bottleneck
that made the system slow and unappealing to patients.

KEY PERFORMANCE INDICATOR 2 – WAITING TIME

Waiting Time Average Half Width Min Average Max Average

Appointed Patients Registration 0.42 0.36 0.088 0.86

Blood Pressure Test 0.045 0.04 0 0.23

Blood Test 0.04 0.03 0 0.15

Consultation Inspection 0.24 0.19 0.07 0.50

New Patients Registration 0.31 0.38 0 0.79

Payment 0.014 0.03 0 0.057

Pharmacy 0.4 0.31 0.22 0.82

Urine Test 0.15 0.12 0 0.64

Table 11. Waiting times at each process (What If Scenario 2)

 Waiting Time
Urine Test
Pharmacy

Payment
New Patients Registration

Consultation Inspection

Blood Test
Blood Pressure Test

Appointed Patients Registration

0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1

Max Average Min Average Half Width Average

Figure 19. Waiting times at each process (What If Scenario 2)

From the chart and table above, it can be seen that the average waiting time has reappeared in the
payment and pharmacy sections of the process (0.014 and 0.4 respectively) when compared with
the data from scenario 1. This trend can be attributed to the reduced average waiting time noticed in
the consultation inspection process which dropped heavily to 0.24. However, the appointed
patients’ registration process is now busier than before due to the high speed at which the whole
process currently operates.

KEY PERFORMANCE INDICATOR 3 – QUEUE LENGTH

Queue Length Average Half Width Min Average Max Average

Appointed Patients Registration 0.03 0.03 0.005 0.06

Blood Pressure Test 0.0003 0 0 0.002

Blood Test 0.001 0 0 0.004

Consultation Inspection 0.02 0.01 0.005 0.04

New Patients Registration 0.004 0.01 0 0.012

Payment 0.001 0 0 0.004

Pharmacy 0.023 0.02 0.011 0.049

Urine Test 0.002 0 0 0.007

Table 12. Queue Length at each process (What if scenario 2)

 Queue Length
Urine Test
Pharmacy

Payment
New Patients Registration

Consultation Inspection

Blood Test
Blood Pressure Test

Appointed Patients Registration

0 0.01 0.02 0.03 0.04 0.05 0.06 0.07

Max Average Min Average Half Width Average

Figure 20. Queue Length at each process (What if scenario 2)

The table and chart above shows that the reduced waiting time in the consultation inspection
process also reduced the average queue length at the process. More so, the payment and pharmacy
processes had their queue lengths increased marginally. The consultation inspection process which
had the capacity of its workforce increased is mainly responsible for this change. This is because
patients now leave the consultation process faster than before thereby putting more work load on
the pharmacy and payment processes.

KEY PERFORMANCE INDICATOR 4 – RESOURCE UTILISATION

Resource Utilisation Average Half Width Min Average Max Average

Doctor 0.37 0.04 0.333 0.40

Nurse 1 0.17 0.06 0.12 0.233

Nurse 2 0.27 0.06 0.22 0.323

Nurse 3 0.36 0.01 0.33 0.42

Nurse 4 0.37 0.04 0.333 0.40

Nurse 5 0.112 0.01 0.1 0.123

Nurse 6 0.44 0.04 0.41 0.48

Pharmacist 0.44 0.04 0.41 0.48

Specialist 0.37 0.04 0.333 0.40

Table 13. Resource Utilisation (What if scenario 2)

 Resource Utilisation
0.5
0.45
0.4
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
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Average Half Width Min Average Max Average

Figure 21. Resource Utilisation (What if scenario 2)

Here, it can be seen that the average utilisation of the workers in the consultation inspection process
has dropped to 0.37 from 0.753 in the previous scenarios. This is largely due to the increased
capacity of the staffs in the process which had impacted on the system by reducing the overall
simulation time. This goes to show that the bottlenecks in the system emanates from the
consultation inspection and pharmacy processes. A reduction in their respective resource utilisation
and waiting times have decreased the queue length and overall process time for good.

RECOMMENDATIONS
Based on the findings made from analysing the simulation model of the processes in the hospital,
the following recommendations are proffered to the management of NHS organisations

 The majority of the bottleneck experienced in their operational processes is largely

contributed by the consultation inspection and pharmacy processes.
 The hospital’s productivity is heavily dependent on the outcome of these two processes.
 The staff capacities at both processes should be increased in order to alleviate the
bottlenecks and greatly reduce the overall average waiting time for all the processes within
the hospital’s system.
 Increment in the staff capacities of both processes should be handled with care so that the
resources will not become idler thereby leading to waste.
 The workers at new patients’ registration and payment are the two most underutilised and
idlest resources in the hospital and as such, it is recommended that both functionalities
should be handled by one person to prevent resource wastage and possibly increase
profitability.
REFERENCES

 Al Bazi, A. (2015) Lecture Notes on Business Simulation. Coventry University:

Unpublished Lecture Notes
 Greasley, A. (2004) Simulation Modelling For Business. Aldershot: Ashgate
 www.arenasimulation.com