Document Type

Theses, Ph.D


Available under a Creative Commons Attribution Non-Commercial Share Alike 4.0 International Licence


Health care sciences and services, Business and Management.

Publication Details

Successfully submitted for the award of Doctor of Philosophy (Ph.D) to the Technological University Dublin, September, 2011.


Emergency departments (EDs) are a crucial access point to the healthcare system in Ireland. High patient demand and limited resources have resulted in long waiting times and long lengths of stay in EDs. Some of this pressure on EDs could be ameliorated by more streamlined hospital processes particularly in managing discharges and managing the volume of work. This research sought to develop a simulation-based Decision Support System (DSS) to enable an accelerated development of a simulation based solution to improve quality and care at Irish hospitals.

In order to investigate causes of bottlenecks and insufficient distribution of resources, a novel process modelling approach is developed, where patient pathways are investigated in relation to the work flow of medical staff with the consideration of the dependence on limited resources. This approach is included in the simulation based DSS which aids to consult managers of EDs by providing a comprehensive perspective onto the crucial factors affecting their services and processes. To prove this novel concept of Multiple Participants Pathway Modelling (MPPM) with regard to Flexible Resource Allocation (FRA), a simulation study is applied to the ED of an academic teaching hospital in Dublin. This research is divided into primary and secondary research phases, in which the secondary – the applied field work – is guided by a combination of qualitative and quantitative research methodologies. EDs are an ideal test environment as they represent a dynamic working environment where the allocation of medical staff is flexible and tailored to current patient demand. However, exact medical procedures must still be followed. These factors are considered by the application of MPPM with regard to FRA. These complex process interactions form a holistic simulation process flow network allowing application of scenarios that impact both process flow pathways: those of patients and of medical staff.

This research makes a contribution to both theory and practice: the theory is covered by the framework which outlines the simulation based DSS, while the practical objectives are delivered by its application in the ED. The investigated scenarios offer a higher degree of confidence in the interpretation of the simulation results and provide a clearer picture of the resulting consequences of the potential introduction of certain policies.


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