With an expanding number of healthcare clinics and a growing trend of consolidation, the possibility of a centralized location performing admission for multiple clinics has been presented as a possible method to save on operational costs. This centralized approach would cause significant changes in the admission process for decentralized clinics that have their own admission processes, and the effect on quality of care cannot be ignored when deciding which method to use. To determine the characteristics under which a centralized or decentralized admission system would be better, a discrete event simulation methodology is designed and utilized to compare the alternative approaches. Using the model and real-world data, a better understanding of the criteria that works best for each system can be gained and used as a guide for clinical organizations considering this choice. An experimental performance evaluation investigates factors including arrival rate per day, the mixture of patients for each clinic, the percentage of patients who have multiple appointments, the travel time to clinics, and the number of clinics in each system. Overall these experiments reveal that a centralized system can obtain the same or faster wait times than the decentralized system with less staffing in certain scenarios such as an increase in the number of clinics and number of multiple appointment patients. However, the centralized system with fewer staff can result in slightly higher maximum wait times than the decentralized model. A validation case study, supports the results and demonstrates the usefulness of the simulation methodology.
Industrial and Systems Engineering (MS)
Department, Program, or Center
Industrial and Systems Engineering (KGCOE)
Michael E. Kuhl
Nazibeh Azadeh Fard
Smyth, Jacob, "A Simulation Study of Centralized versus Decentralized Healthcare Admission Processes" (2020). Thesis. Rochester Institute of Technology. Accessed from
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