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    • DSS FOR DENTAL HOSPITAL EMERGENCY SECTION SIMULATION Shamsuddin Ahmed, KIMEP, Shamnsuddin_Ahmed@Yahoo.Com Mujibul Haque, KIMEP, mmhaque@kimep.kz ABSTRACT 2.) Periodontics & Oral Implantology Diseases of the Tooth Supporting Structures & DentalThis paper presents results obtained from simulating a Implantsservice system with process oriented simulationmethodology. To make the service system responsive 3.) Prosthodontics Fixed and Removable Dentaland efficient, the SCOR modeling idea is incorporated Prostheticsto build the simulation model. Awesim is a process 4.) Oral & Maxillofacial Surgery Head and Neckoriented simulation modeling methodology and so is theSupply Chain Operations Reference (SCOR), developed Surgeryby supply chain council. A dental hospital case is taken 5.) Endodontics Root Canalsin this study to exhibit how the dental care servicesystem is simulated and design parameters are derived 6.) Orthodontics Braces and Dental Orthopaedicsusing response surface technique to configure the 7.) Head & Neck Painservice efficient and besides responsive. The paper alsoprovides detail sketch of the dental case management 8.) Diagnosis & Oral Radiology.practices. Simulation as Supply Chain Process FunctionKeywords: DSS, Hospital, Service system design, A simple supply chain (SC) can be conceptualized asSystem Time, Awesim, Simulation, Response surface an integrated network of suppliers, manufacturers and distributors that are linked logically to transform the input or raw material into goods or services to be INTRODUCTION delivered to a customer according to consumerTawam Hospital’s Dental Centre is a freestanding specification and requirements. Managing suchdental hospital close to city centre. There are 16 clinics network constitutes supply chain management (SCM)at the Centre exclusively for the general and specialty function. The flow in a supply can be characterizedtreatment. There are two clinics at Tawam itself for by material flow, information flow and cash flowOral and Maxillo Facial Surgery, and one fully (Herrmann et al. 2003). The process orientedequipped mobile dental coach. simulation model discussed resembles the concept ofTawam Hospital employs 16 general dentists and 14 the Supply Chain Operations Reference (SCOR)Consultants/Specialists, representing every clinical model, Version 4.0(Supply-Chain Council, 2000).specialty. The majority of the dentists and dental The SCOR model describes the business function tospecialists have western qualifications and/or deliver goods or services to a customer based onexperience, and some have held academic appointments demand and satisfaction. The SCOR model providesat American, Canadian, or European universities. All a common process oriented language fordental services are provided from emergency dental communicating among supply chain partners in thecare to orthogenetic surgery. The Dental Centre is following decision areas: Plan, Source, Make, anddistinguished as one of the first dental facilities in the Deliver. These building blocks belong to processGulf region to provide a complete implant dentistry categories and can describe a supply chain (Stewart,service, specializing in one- and two-stage dental 1997). Supply-Chain Council (SCC) introduced theimplant placement and reconstruction. The Dental SCOR model to assist firms in improving efficiencyCentre boasts a VIP Clinic with adjoining VIP Lounge of the supply chains. Recently, the details for thefor Royal and VIP patients, a conference room with decision area of Return have been added to the SCORmini-library and projection facilities, and a staff Version 5.0 model (Lockamy et al., 2004).cafeteria. Although the working language at the DentalCentre is English, there are 4 Dental Interpreters who In Figure 1, the flow of information and flow ofare always available to assist with the Arabic-speaking patient in a dental hospital is shown, while Figure 2patients. The divisions of Dental Department are translates the process flow as sketched in Figure 1classified as: with the simple Awesim simulation blocks connected logically from one component to another1.) Pedodontics Children’s Dentistry to construct a dental treatment model, where aVolume VIII, No. 2, 2007 406 Issues in Information Systems
    • Dss for dental hospital emergency section simulationcustomer request a services. The customer undergoes The Clinic Staffingset of transformation in dental clinic as if an inventory The Dental Services department has a total staff ofgradually transforms from raw material to semi finished around 120, including 6 Consultants, 8 Specialists,product and eventually a final product to be used by a and 16 General Dentists. In addition there are 34customer. In this case the customer consumes the Dental Assistants and 4 Dental Hygienists. The full-services while remain fixed inside the facility and the service Dental Laboratory staffs 9 Dentalcustomer is less mobile. All related facilities moves Technicians with a capacity to construct the wholecloser to the customer to provide a customized service. range of Dental Prostheses from simple AcrylicThe simulation model interconnects process blocks that dentures to complex Implant superstructures. Indescribe the functions of the dental hospital patient care addition, the Dental Centre has a Radiographyservices. This is equivalent to SC operation in a department, Central Sterilization department,network mode. Medical Records department, Pharmacy, Biomedical Technicians, Stores, and Reception and appointmentsConfiguring SCM from planning view point one can staffs. The staff works on a weekly rotating shiftgain competitive advantage (Vickery et al., 1999; basis, five days per week.Childerhouse and Towill, 2000; Reutterer and Kotzab,2000; Stock et al., 2000; Korpela et al., 2001a,b;Harland et al., 2001). In this study process orientedAwesim simulation methodology is applied to developdental hospital service performance.West et al. (2000) suggests simple and easy to constructsimulation model are convenient to implement, changeand allow to measure conveniently system performanceto augment efficiency and quality. Figure 2: Awesim simulation model customer in a dental hospital PATIENT ADMISSION MANAGEEMENT For dental treatment at the Dental Centre, a patient must be a UAE national or a dependent. To register as a new patient, a copy of a valid UAE passport and photographs must be submitted. A non-national dependent must produce a government certificate verifying the relationship to the UAE national. The Dental Centre Administration has adopted a comprehensive dental care system for its patients. Newly registering patients have screening X-rays taken at the time of registration and given an appointment with a designated Screening doctor. There is one Emergency doctor on each shift who is in control for all emergency patients who report to the Centre. At the Screening appointment, the medical and dental history is reviewed, and the patient is given a thorough oral examination, including charting of existing and required dental work on a priority basis. A comprehensive treatment plan is formulated and presented to the patient. Once the patient has accepted the treatment plan, appointments are made according to this plan. AllFigure 1: Customer case in a dental hospital dental specialties are represented at the Centre exceptVolume VIII, No. 2, 2007 407 Issues in Information Systems
    • Dss for dental hospital emergency section simulationOral & Maxillofacial Surgery, which is housed at the with additional 31 dental clinics, including 3 Royalcentral Tawam Hospital. The specialists and consultants suites. The new faculty would accommodate aare immediately available whenever a dentist would multimedia and closed circuit projection lecture hall,require any assistance or consultation. library with Internet access computer stations, full cafeteria services, and administrative offices.There are emergency and walk-in patients. The Dental Patient Relations DepartmentCentre on an average processes 45 emergency patientsper day over two shifts. Walk-in patients are Tawam Hospital, accommodate the most advancedaccommodated as extras when clinics are available due and state of the art equipment, which are, parallel toto cancelled or failed appointments. if not exceed those available in the advanced countries. Among its well-developed support servicesThe Oral & Maxillofacial Unit is based at central departments, which are staffed with highly qualifiedTawam Hospital. The clinics specialize in the surgical administrative staff, is the patient relationstreatment of patients with cranio/maxillofacial defects, department. It is headed by director of patientespecially orthognathic surgery, temporomandibular relations department, and is assisted by a deputyjoint disorders, cleft lip and palate defects, and facial director of patient relations department and a numbertrauma. Oral surgery sessions are scheduled in every of administrative officers. This department plays aother week at the central hospital. The dental services major and vital role in the development of health caredepartment facilitates comprehensive general and services being delivered at Tawam hospital. Itspecialty dental treatment under general anesthesia for provides social and counseling services to thepediatric patients who have mental or physical patients including translation of various documents,handicaps, who possesses significant medical arranging for patients escort to travel with patientscomplications, or who demonstrate obstinate behavior. requiring treatment abroad, regulating the visiting hours, organizing the treatment process and otherQuality management services. The Patient Relations DepartmentAs part of the Administration’s effort to upgrade the encompasses the Admissions & Communications department. Admissions department houses a numberclinical skills and enhance the dental knowledge of itsstaff, the Dental Services department has established a of clerks assigned in various areas identified as:Continuing Dental Education Program where lectures, 1.) Front desk Female Registration areaseminars, and workshops are scheduled several times ayear on current dental topics. The staff is also 2.) Rear desk Male Registration areaencouraged to participate by delivering in-service 3.) Information appointments Specialtylectures during "Luncheons for Learning". The hospitalhas seminar series that are associated with medical 4.) Clinics Mail room Switchboardemergencies and medical complications. RegistrationDatabase maintenance and information processing The Department of Patient Relation functionsFor the purpose of record keeping, patient attendance improve the channel of communication between theand clinic statistics are maintained as routine staff and patients. The Patient Relations Departmentadministrative procedures. Each clinic keeps a daily is responsible for regulation the treatment process atelectronic treatment log in order to track procedures Tawam Hospital that provides all forms of treatmentcompleted, patient attendance, emergency and walk-in to all of its customers, and is registered with thepatients, and failed appointments. The statistics are medical record. Upon presentation of an acceptedcompiled from database and a monthly summary report identification, the patient is issued with the medicalis created. The report is dispatched to the hospital record and a prefix 800 is issued. If the requiredcentral administration for hospital as well as national identification is not immediately available, a patientstatistics. registers with the authorization of the director of patient relations or an appropriate designee. TheHealthcare strategic plan patient is informed that he /she must provide proof ofTawam Hospital in conjunction with the government identity on their next visit to the hospital. The othergeneral hospital collaborates strategically to study patients are registered with the medical record prefixprojected patient demand up to year 2010. Major 700. Patient Relations Director or his designeecapacity expansion is envisaged to accommodate the authorizes such patients for availing treatment in thisgrowing patient population. The new expansion is hospital. The employees at the hospital are eligibleexpected to house the state-of-the-art dental facility for all forms of treatment. They are registered with the medical record prefix 50. The patients who areVolume VIII, No. 2, 2007 408 Issues in Information Systems
    • Dss for dental hospital emergency section simulationspouses and children of the hospital employees are release. When a patient appears at the patienteligible for treatment. They are registered with medical relations department requesting the medical report forrecord prefix 54. The eligibility are to be proven with the appointed doctor, the administrative officer afterdocuments and approval of the director of patient consulting the concerned doctor dispatched therelations. records to the concerned doctor along with a form completed by the patient. The hospital has imposedEmergency patients and all other patients arriving for 50 Dh. fees as charge to issue medical report ifemergency treatments are treated without regard to their requested by a patient.eligibility status should the patient’s condition beconsidered life threatening by the ER physician. In-patient treatment will be provided if required. These The director of the hospital is a link between thepatients are registered with medical record tag 90. Once hospital administrations and the community it serves.the patient is discharged or transferred to another The director of the hospital monitors the healthhospital eligibility to readmit is withdrawn. The patient services being delivered at the Tawam hospital torelations director or his designee will review all records improve the channel of communication betweenof 90 categories patient the following day. The citizens patients and staff. In addition, the functional headof other countries are not eligible for free treatment also receives patient complaints and regulate theunless they fall into the following categories: treatment process for non-national patients. The following figure shows the process of admitting1.) Patients referred to Tawam hospital from ministry patient at the hospital. of health hospitals by means of an official letter classifying the eligibility. The director of patient The flow chart describes the patient system relations department or his designee, however, processing in the dental center with patient visiting reviews the eligibility for treatment every 2 in: Pedodontics Children’s Dentistry, Periodontics months. & Oral Implantology Diseases of the Tooth2.) All UAE University students who hold passports Supporting Structures and Dental Implants, from GCC countries may receive treatment at Prosthodontics Fixed and Removable Dental Tawam hospital following authorization from the Prosthetics, Oral and Maxillofacial patient relations director or his designee. Surgery, Head and Neck Surgery, Endodontics Root Canals, Orthodontics Braces and Dental3.) Patients referred to Tawam hospital with a Orthopaedics, Head & Neck Pain and Diagnosis diagnosis of cancer for investigations and treatment & Oral Radiology. Also the dental have specialist is accommodated. Treatment for cancer patient is dentists. The treatment system processing is confined to the disease and its sequel. characterized as:4.) All non-national patients are registered with a a.) The patient report at the hospital and an medical record having prefix 80 identification number is given for record5.) The only recognized authority for granting keeping. permission for treatment at the hospital are the b.) The patient registers in the dental center assistant undersecretary for Al Ain Medical reception District or Director of Al Ain Medical District or Director of patient Relation or the Deputy Director c.) Patient waits in a room a time to visit the dentist of patient relations. d.) A medical team does a preliminary diagnose onAll the new patients seeking treatment at the hospital the patient and decides the treatment needs. Theare required to show sufficient identification of a UAE team decides if the patient needs furthernational status. The primary acceptable identifications appointment or notare: e.) If the patient doesn’t require appointment, thena.) UAE passport the patient receives a medical prescription finishes the dental center visitb.) UAE Citizenship identity card f.) If the patient is recommended an appointment,c.) Birth Certificate and parents passport the receptionist at the appointment centre fixes ad.) Family Census records time slot to visit a dentist g.) At the end of consultation, the patient is eitherThe department of patient relations is in command to gets a further appointment for follow up or thestreamline the processing of medical reports and it’s patient is declared fit. The patient in either caseVolume VIII, No. 2, 2007 409 Issues in Information Systems
    • Dss for dental hospital emergency section simulation reports to the appointment desk. The appointed Figures 3, 4 and 6 show the time distribution for patient continues treatment either same time or in arrival time of patient in hospital. In simulation the future, while the fit patient is fee to leave the clinic arrival is reconstituted from the inter-arrival time with necessary records and prescriptions distribution as shown in Figure 3. the service and waiting distribution is shown in Figure 4 and Figure 5 Int erarrival Time Distribution respectively. The simulation model uses the observed time distribution to replicate the actual environment 20 120. 00% 18 with the iconic model as developed in Figure 2. 100. 00% 16 14 80. 00% 12 10 60. 00% RESULTS 8 6 40. 00% The simulation model is simulated for 100 days. The 4 20. 00% average time a patient remains in hospital is found to 2 0 . 00% be 70 minutes. This implies from the response 10 15 20 5 0 25 M or e surface that if one to two nurses are deployed, the patient processing rate is approximately 2 to 3 Figure 3: Reception area inter-arrival time distribution corresponding to system time 70 minutes. The figure clearly suggests how to deploy the resources to Service Time maximize the patient processing rate. For example, if 25 120.00% it is necessary to process more patient, say 8, due to 20 100.00% unexpected future demand, without expanding the 80.00% capacity of the hospital with physical infrastructure, Frequency 15 60.00% would require at least 5 nurses and the time in system 10 40.00% is expected to be about 50 minutes. Observe the 5 20.00% system time as 50 minutes approximately that comply 0 .00% 10 15 20 5 25 0 More with the x and y coordinate resources as nurse and number in systems respectively. Similarly, the Figure 4: Dental care service time distribution number of doctors, paramedics and other resources can be matched to make the service systems Waiting Time responsive in SCM context. 25 120.00% CONCLUSION 100.00% 20 80.00% It is shown in this study how Awesim, a simulation Frequency 15 60.00% modeling technique, can capture the process 10 40.00% modeling concept as of SCOR. Dental care service 5 20.00% system in a hospital is simulated with Awesim model 0 .00% to identify the decision parameters to improve the 2 4 0 6 8 More service system. The SCOR is based on process modeling philosophy, while Awesim also steams Figure 5: Patient waiting time distribution from process modeling viewpoint and it hence conveniently assemble SCOR service system model. Further, it is demonstrated that the simulation results conveniently augment the decision support system with response surface methodology. The response surface maps and calibrates the expensive recourses conveniently in a service system to improve the performance of a SC that is either responsive or efficient. A service system SC is responsive if it reduces the systems time, while it is efficient it economizes in resource utilization. Awesim generates detail level of recourse utilization report. However it is not discussed in detail using simulation results due to space limitations. Figure 6: Response surface for Decision SupportVolume VIII, No. 2, 2007 410 Issues in Information Systems
    • Dss for dental hospital emergency section simulation 6. Vickery, S., Calantone, R. and Droge, C. (1999), REFERENCES “Supply chain flexibility: an empirical study”, Journal of Supply Chain Management, Vol. 351. West, A.A., Rahimifard, S., Harrison, R. and No. 3, pp. 16-24. Williams, D.J. (2000), “The development of a 7. Childerhouse, P. and Towill, D. (2000), visual interactive simulation of packaging flow “Engineering supply chains to match customer lines”, International Journal on Production requirements”, Logistics Information Research, Vol. 38 No. 1, pp. 4717-41. Management, Vol. 13 No. 6, pp. 337-45.2. Stewart, G. (1997), “Supply-chain operations 8. Reutterer, T. and Kotzab, H.W. (2000), “The use reference model (SCOR): the first cross-industry of conjoint-analysis for measuring preferences in framework for integrated supply-chain supply chain design”, Industrial Marketing management”, Logistics Information Management, Management, Vol. 29 No. 1, pp. 27-35. Vol. 10 No. 2, pp. 62-70. 9. Stock, G., Greis, N.P. and Kasarda, J.D. (2000),3. Supply-Chain Council, 2000, Supply-Chain “Enterprise logistics and supply chain structure: Operations Reference-model, Version 4.0, the role of fit”, Journal of Operations Pittsburgh, Pennsylvania. Management, Vol. 18 No. 5, pp. 531-47.4. Herrmann, Jeffrey W., Lin, Edward., Pundoor, 10. Korpela, J., Lehmusvaara, A. and Tuominen, M. Guruprasad. (2003). SUPPLY CHAIN (2001a), “Customer service based design of the SIMULATION MODELING USING THE supply chain”, International Journal of SUPPLY CHAIN OPERATIONS REFERENCE Production Economics, Vol. 69 No. 2, pp. 193- MODEL, Proceedings of DETC’03, ASME 2003 204. Design Engineering Technical Conferences and 11. Korpela, J., Lehmusvaara, A. and Tuominen, M. Computers and Information in Engineering (2001b), “An analytic approach to supply chain ConferenceChicago, Illinois USA, September 2-6, development”, International Journal of pp. 1-9. Production Economics, Vol. 71 Nos 1-3, pp.5. Lockamy III, Archie., McCormack, Kevin. (2004). 145-55. Linking SCOR planning practices to supply chain 12. Harland, C.M., Lamming, R.C., Zheng, J. and performance: An exploratory study, International Johnsen, T.E. (2001), “A taxonomy of supply Journal of Operations & Production Management, networks”, Journal of Supply Chain Vol. 24 No. 12, pp. 1192-1218. Management, Vol. 37 No. 4, pp. 20-7.Volume VIII, No. 2, 2007 411 Issues in Information Systems