ASSIGNMENT 3

HOSPITAL FLOW MANAGEMENT

BUSINESS
DYNAMICS
Submitted ByMayank Verma
(4021/21)

Questions 1-3: Discussed in class SFD for the given problem

4. Suppose now that there are two competing proposals (with the same
costs) to solve the waiting list problem:
a. An extension of the capacity of aftercare with 500 beds which
could be operational after 26 weeks;
b. An extension of the capacity of the hospital with 250 beds, which
could only be operational after 52 weeks.
Sketch the behavior of both options over time. Which of these two
measures is most suitable to reduce the waiting list?
Current behaviour Waitlist (Pre-ops Patients)

Hospital Capacity =700; Aftercare Capacity =100; The number of Pre-Ops (Waitlist)
increases with time.

Option A: Aftercare Capacity =1000+STEP(500,26)

Capacity = 700+STEP(500,52)

Option B: Hospital

Option A is not effective in reducing the waitlist whereas in Option B the waitlist starts
to decline as soon as the increased hospital capacity takes effect.
Increasing Aftercare Capcity will lead to a greater flow through aftercare. Hence the
number of people who will not recover and would be redirected back to the waitlist
will increase as the recovery percentage remains same and overall Option A has no
beneficial effect on the waitlist as shown above.
Waitlist = Patient Arrival Rate-Ops Admit Rate
Ops Admit Rate = Min("Pre-Ops Patients",Hospital Capacity/Average Admin
Proc Time before Admission - Ops Patient + Patient Discharge Rate)
The waitlist is limited by the Ops Admit Rate which in turn is limited by the hospital
capacity in our case. So with an increase in the Hospital Capacity the waitlist
decreases as shown above.
5. Choosing the best extension, how large should the most appropriate
extension be to eliminate the waiting list within 2 years?
Selecting Option B: Increasing Hospital Capacity, taking effect from 52 weeks
Hospital Capacity = 700+STEP(350,52)

If Hospital Capacity is increased by 350 beds after 52 weeks the waitlist reduces to its
steady state (minimum) value in 2 years (104 weeks).

6. Based on previous recommendations, the Board of Directors of the

hospital has decided to go for the capacity extension of the hospital
with 400 beds that will only be operational after one year. Simulate the
dynamics of this option over exactly 3 years. Sketch the effect on the
waiting list (pre--ops on the waiting list before admission).
Hospital Capacity = 700+STEP(400,52)
If the hospital capacity is increased to 400 the time taken for the waitlist to
reduce to its minimum value decreases to about 70 weeks.

7. The Board of Directors asks you to perform a number of additional

analyses to take into account some of many uncertainties. The referred
pre--ops, the fraction of recovered patients with aftercare and the
fraction of recovered patients without aftercare are according to the
Board of Directors particularly uncertain. List at least 3 other
uncertain variables.
Other Uncertain variables:
1. Average Hospital Residence Time
2. Fraction of recovered patients with aftercare
3. Fraction of recovered patients without aftercare

8. Manually and separately test the influence of following variables

within the indicated un--certainty bounds: Referred pre--ops
between 600 and 1000 patients per week Fraction of recovered
patients with aftercare between 96% and 100% Fraction of recovered
patients without aftercare between 70% and 90% Sketch the influence
on the waiting list in 3 separate graphs.
a. The follwing graphs show the effect of change in Newly referred Pre-Ops
on the waitlist:
Run #
Newly
ref. PreOps Value

600

610

620

640

700

750

800

The waitlist curve changes shape from declining to rising around Newly ref. Pre-Ops
= 620.

The graph wasnt clear when all the runs were shown together hence Runs 1-4 have
been shown separately.
b. The follwing graph show the effect of change in Fraction of recovered
patients with aftercare on the waitlist:
Run #
Fraction of
recovered
patients

96%

97%

98%

99%

100%

The wailist decreases as the Fraction of recovered patients with aftercare is

increased from 96% to 100%.
c. The follwing graph show the effect of change in Fraction of recovered
patients without aftercare on the waitlist:
Run #
Fraction of
recovered
patients

70%

75%

80%

85%

90%

The waitlist decreases as the Fraction of recovered patients without aftercare

increases from 70% to 90%.

9. Test, automatically and simultaneously, the uncertainty of these three

variables between the uncertainty bounds indicated above. Use
uniform distributions and assume the distributions are independent.
Sketch the dynamics of at least 2 uncertainty bounds (e.g. 50% and
75%) for the waiting list. What is your conclusion: is this
recommendation still acceptable considering these uncertainties?
Run1: Newly Referred Pre-Ops= 800
Run2: Modifying 3 parameters simultaneously:
"Newly Referred Pre-Ops"= 600+RANDOM UNIFORM(1,400,0)
Fraction of patients recovered without aftercare= RANDOM UNIFORM(0.1,0.3,0)
Fraction of patients recovered with aftercare= RANDOM UNIFORM(0,0.04,0)