SIMULATION ABOUT RESILIENCE OF THE TEAM IN THE EMERGENCY DEPARTMENT

Open Access
Author:
Wang, Jing
Graduate Program:
Industrial Engineering
Degree:
Master of Science
Document Type:
Master Thesis
Date of Defense:
November 13, 2017
Committee Members:
  • Ling Rothrock, Thesis Advisor
  • Yiqi Zhang, Committee Member
Keywords:
  • team resilience
  • efficiency of teams
  • emergency department
  • perturbation
Abstract:
Teamwork is essential in many different organizations and industries, especially in the emergency department of the hospital. Moreover, the emergency department, as one of the most important departments, is often faced with identified and potential perturbations. The identified perturbations include incidents with historical records, such as earthquakes. The potential perturbations consist of unpredictable absence of doctors and nurses. Both situations need to be solved by the team in the emergency department. The doctors, nurses and other staff members need to make decisions within a limited time. In addition, with increasing number of patients and limited resources, the emergency department should pay attention to improving the efficiency of teamwork and reducing the treatment time for patients. The limited resources and the overcrowding of patients would result in team resilience. Team resilience in the emergency department describes the ability of the system to handle all kinds of perturbation. When the system goes into a degraded or critical state, the team of the emergency department is in a resilient state. Moreover, team resilience would influence the performance of emergency departments and the waiting time of patients. In this thesis, the team resilience was analyzed with identified and potential perturbations. Several proposals were designed and investigated to relief or solve the team resilience in emergency department. A discrete event simulation model was fabricated to evaluate the performance of these proposals under varying situations. The simulation results in this thesis shows that the best solution to natural disasters or other identified perturbation is to add one nurse and one doctor. The primary waiting time for all patients can be reduced to 60 minutes. Also, the utilization of all resources could decrease by 70%. In this condition, the performance of the team in the emergency department could maintain in a normal state. The performance of teams and the utilization of resources are analyzed with respect to potential perturbations. The environment is assumed to be a normal state in the beginning, and the influence of the absence of one doctor and one nurse is simulated. The results shows that this perturbation would increase the primary waiting time and the utilization of resources. The primary waiting time for every patient is longer than that of normal state. The maximum primary waiting time is longer than 60 minutes and the acuity level of the patient is 5. It can be concluded that no resilience happens. When two doctors and two nurses are out of work all day, the primary waiting time of 1 or 2 patients can be longer than 60 minutes. The possibility of a degraded performance is 66%. When identified perturbations happen with one doctor and one nurse absent, the performance of the team would be degraded and remain critical for 24 hours. Varying time strategies of correction actions are analyzed. The earlier the corrections are made, the better team performed under perturbations. The correlation between resilience and amount of supplementary doctors and nurses is further discussed. Although there are no ways to eliminate the resilience, adding three doctors and three nurses could reduce the primary waiting time. Moreover, the coefficient of resilience would increase to 0.284. Hence, the performance of team could return to normal state after 9h 28 minutes after the occurrence of identified perturbation. As a conclusion, the performance of the investigated emergency department is simulated and discussed in terms of two types of perturbation. According to simulation results, a response strategy in terms of supplementary doctors, nurses and resources is designed to minimize the expectation of resilience time in case of perturbations.