Quality-Driven Efficiency in Healthcare

A generic simulation-based perioperative decision support tool



In Canada and around the world, there has been an increased focus on the efficiency, cost and access to health care services. One area of particular focus is surgical procedures, often with government funding and policies focused on reducing wait times through performance and volume target initiatives. In Ontario in 2007, an expert panel was assembled to evaluate the current state of surgical processes in the province and provide recommendations to improve access, efficiency and quality. One of the panel’s recommendations was for a generic simulation-based decision tool that could be used by all hospitals to inform tactical decisions that could lead to improved access and efficiency. This work was inspired by that recommendation. We have created a generalized simulation model that has helped hospitals allocate operating room time to improve efficiency and smooth the demand for resources over the week. The model has been applied at six hospitals of varying sizes, ranging from large academic centres to small community hospitals. Two case studies are discussed demonstrating the practical value and the flexibility of the model.


Michael Carter is a Professor in the Department of Mechanical and Industrial Engineering at the University of Toronto (since 1981) and Director of the Centre for Research in Healthcare Engineering. He received his doctorate in Mathematics from the University of Waterloo in 1980. Since 1989, his research focus has been in the area of health care resource modeling with a variety of projects in hospitals, home care, rehab, long term care, medical labs and mental health institutions. He has supervised more than 160 engineering students in over 100 projects with healthcare institutions. He currently has 18 students (7 doctoral, 7 masters and 4 undergrad) working in the area. He was the winner of the Annual Practice Prize from the Canadian Operational Research Society (CORS) four times (1988, 1992, 1996 and 2009). In 2000, he received the CORS Award of Merit for lifetime contributions to Canadian Operational Research. He also received an “Excellence in Teaching” Award from the University of Toronto Student Administrative Council. He is on the editorial board for the journals “Health Care Management Science” and “Operations Research for Healthcare”. He is a member of the “Nursing Effectiveness, Utilization and Outcomes Research Unit” and a mentor in the “Health Care, Technology and Place” Program at the University of Toronto. He is on the Advisory Board for the Regenstreif Centre for Healthcare Engineering at Purdue University and an Adjunct Scientist with the Institute for Clinical Evaluative Sciences in Toronto (www.ices.on.ca). He is member of the Professional Engineers of Ontario and in 2012, he was inducted as a Fellow of the Canadian Academy of Engineering.