An investigation of the current advancement of discrete event simulation in healthcare management and future development with consideration of environmental sustainability

Abstract

In view of the versatility of and growing attention paid to discrete event simulations (DES) in the healthcare sector, this dissertation is intended to investigate the current application and future implication of discrete event simulations in support of evidenced-based healthcare decision-making. To do this, three pieces of scientific writing are prepared as three main lenses used to approach different aspects relating to DES applications in healthcare. A systematic review was carried out in module 1 to provide an up-to-date overview of the current development and newly emerging trends of healthcare-related DES models. Given few reviews critically assessing the reporting quality of these modeling studies and a lack of suitable appraisal instruments available, an 18-item appraisal checklist was developed in module 2 covering model conceptualization, parameterization and uncertainty assessment, validation, generalizability, and stakeholder involvement, and applied to the total of 211 DES studies included in module 1. Given that environmental factors are rarely touched on by DES studies, a novel framework applying German diagnosis-related-group cost data to estimating carbon footprints of hospital care pathways was developed in module 3 and could serve as a preparatory work for the integration of environmental impacts into the future development of healthcare-related DES models. Overall, this dissertation presents the current advancement, new trends and reporting quality of DES as a decision-analytic model in healthcare, and formulates an estimation framework for hospital care carbon footprinting which facilitates integrating environmental performance into DES modeling studies.