IMPROVEMENT OF BUSINESS PROCESS SURGERY USING

SIMULATION

Nadja Damij

Faculty of Information Studies, Sevno 13, pp 299, 8000 Novo mesto, Slovenia

Talib Damij

Faculty of Economics, University of Ljubljana, Kardeljeva ploscad 17, 1000 Ljubljana, Slovenia

Keywords: Business process, Simulation, Process improvement.

Abstract: This paper discusses the possibility of finding a better solution for the problem of business process im-

provement using simulation technique. Most of problems of organisations are originated in fact that their

business processes are neither well defined nor particularly efficient. Business process modelling is done by

identifying a certain business process, defining its activities, and using a modelling technique to develop its

model. Process improvement is carried out by precise analysis of the process, suggesting changes and im-

provements, and giving solutions for existing problems. To achieve this, we concentrate our work on ana-

lysing and simulating the business process discussed. This means that the simulation results need to be ana-

lysed and understood in order that the analyst is able to suggest necessary changes. A complete

understanding of the results of process simulation is an essential precondition to move forward with busi-

ness process improvement. The problem of conducting a surgery is used as an example to carry out business

process improvement using simulation technique.

1 INTRODUCTION

The aim of this paper is to introduce the importance

of using simulation technique in the field of business

process improvement. The purpose of using simula-

tion is to analyse the current or the alternative ver-

sion of the business process discussed in order to de-

termine its behaviour and carry out further

improvements by solving problems, removing ob-

stacles and identifying bottlenecks existing in the

process.

A process model, which represents a true reflec-

tion of the business process discussed, is essential

for carrying out business process improvement and

information system development successfully. Busi-

ness process improvement became a very important

way of ensuring changes in an organisation's struc-

ture and functioning in order to create a better, more

competitive and successful enterprise.

In Section 2, different definitions and explana-

tions of business process published by well-known

authors are presented. In Section 3, business process

modelling is discussed. In Section 4, business proc-

ess simulation as a technique for business process

improvement is introduced. The last section contains

some useful remarks and conclusions. In this work,

the problem of business process Surgery is used to

illustrate the use of simulation to improve business

processes.

2 BUSINESS PROCESS

Most of problems faced by enterprises concern in-

ternal business procedures that are neither well de-

fined nor particularly efficient (Hales, 1993; Lavery,

1992; Medina-Mora et al., 1992).

Business processes come within our scope in that

they potentially add value to the organisation and as

such are attracting attention (examples given in Mar-

tinez et al. 2001; Aguilar-Saven, 2001; Chan, 2002;

Hammer, 1990; Hammer and Champy, 1993; Dav-

enport and Short, 1990 and so forth). Consequently,

business process modelling is on the increase as only

434

Damij N. and Damij T. (2009).

IMPROVEMENT OF BUSINESS PROCESS SURGERY USING SIMULATION.

In Proceedings of the International Conference on Health Informatics, pages 434-437

DOI: 10.5220/0001536604340437

 SciTePress

a thorough comprehension of the business processes

within the organisations can lead to effective, effi-

cient and value-adding systems. According to Agui-

lar-Saven and Olhager (2002), it is the business

processes that are the key element when integrating

an enterprise.

A process is defined as structured, measured sets

of activities designed to produce a specified output

for a particular customer or market (Davenport,

1993). Hence, a process converts inputs by summing

their value through various activities into outputs.

However, Aguilar-Saven (2003) stressed that a busi-

ness process is related to the enterprise, as it defines

the way in which the goals of the enterprise are

achieved.

To sufficiently define a process, firstly the proc-

ess activities need to be identified, and then the se-

quence order of the identified activities needs to be

established. Resources are origins of supply, mate-

rial assets required to activate process activities and

are consequently twofold; capital assets and labour

(Laguna and Marklund, 2005). They are exploited

within the process but not consumed.

To identify business processes, we organize in-

terviews with the management at strategic and busi-

ness levels. The purpose of the interviews with stra-

tegic management is to define the strategic goals and

objectives of the enterprise. After that, we continue

conducting interviews with the management at busi-

ness level. Actually, the results of these interviews

are valuable information, which enable us to create a

list of business processes of the organization dis-

cussed. In addition, the interviews are also useful in

discovering the organizational scheme of the enter-

prise.

Surgery: The management of a Clinic of ab-

dominal surgery wished to improve this process of

conducting a surgery by making it more efficient

and less time consuming. As a result of conducting

interview with the management, one business proc-

ess was identified called Surgery, which covers the

whole problem discussed.

3 PROCESS MODELLING

Conceptual modelling of business processes is de-

ployed on a large scale to facilitate the development

of software that supports the business processes, and

to permit the analysis and re-engineering or im-

provement of them (Aguilar-Saven, 2003).

The business process modelling system is a

computer-based, potential solution to these prob-

lems. It is a system for managing a series of tasks

(actions) defined for one or more procedures

(Scholz-Reiter and Sticker, 1996). Business process

modelling generates a model to describe a certain

business process in an enterprise using different

techniques. A model is a representation of a business

process, which reflects its reality by capturing all the

necessary information on process behaviour. The

modelled process is then analysed and improved in-

stead of the real business process.

To model a business process, we continue with

organizing interviews with the employees of de-

partments corresponding to the plan of interviews

developed earlier. The aim of these interviews is to

define in detail the work processes of the process

identified and their activities.

Work processes are the sets of procedures or ac-

tivities, tasks, and steps where the real work of the

organization is accomplished to produce the eco-

nomic output that generates the profitable return on

the capital employed (Watson, 1994). There are

many methods and techniques used in the field of

business process modelling. In the framework of this

paper the flowchart technique was chosen to model

business process Surgery. A flowchart is a simple

diagram, which is used to model business processes

in software packages such as iGrafx. In addition to

process modelling, iGrafx also enables us to perform

simulation of the modelled processes. The paper

does not discuss simulation; as such a discussion

would exceed the scope of this paper.

The flowchart technique defines a flowchart as a

formalised graphical representation of a program

logic sequence, work or manufacturing process, or-

ganisation chart, or similar formalised structure

(Lakin et al., 1996). A flowchart is commonly used

to show the flow of a process from its start to its end.

It usually consists of different symbols connected by

lines, arranged in such a way to lead us through a se-

ries of steps in the correct sequence order.

Process flow is traced by following the connect-

ing lines between the symbols drawn. These sym-

bols include: start and end, activity, input and out-

put, decision, and department. A flowchart begins

with a starting point and finishes with an ending

point. The terminus symbol is commonly used in

flowcharting to designate the beginning and the end.

An activity is represented by a rectangle and

means an elementary task. An input is indicated by

an arrow, which enters an activity. An output is

shown by an arrow, which leaves an activity. An ar-

row connects one activity to another, showing the

movement of the diagram. A decision specifies al-

ternative paths based on some Boolean expression

and is shown by a diamond. There can be only one

IMPROVEMENT OF BUSINESS PROCESS SURGERY USING SIMULATION

435

path to a decision, but there can be many output

paths (Arlow, Neustadt, 2002).

According to Aguilar-Saven (2003) flowcharts

are built to offer an enhanced comprehension of the

processes, which is a requirement for process im-

provement. By grouping tasks into logical areas of

activity (processes) and drawing flowcharts of the

events which occur, it is possible to get a concise

picture of the way particular processes are com-

pleted within the organisation

. The flexibility of the

flowchart technique is argued by many to be its ad-

vantage as it allows each modeller to unite various

pieces of the process together to gain the overall pic-

ture as he/she feels they fit best. On the other hand,

some argue that the technique is too flexible, de-

scribing large models without illustrating the hierar-

chy of different layers.

4 PROCESS SIMULATION

Business processes are modelled with the aim of

analysing their current states within the organization,

as well as improving them through the execution of

potential “what-if” simulation scenarios (Aguilar-

Saven and Olhager, 2002). Simulation modelling ac-

cording to Pidd (1998) is based on very simple prin-

ciples: the analyst builds a model of the system of

interest, writes a computer program which embodies

the model and uses a computer to initiate the sys-

tem’s behaviour when subject to a variety of operat-

ing policies. Simulation is the imitation of the opera-

tion of a real-world process or system over time

(Banks et al., 2001). A simulation model enables the

analyst to observe and study the system’s behaviour

as it advances through time.

The aim of using simulation is to analyse the cur-

rent or the alternative version of the business process

discussed in order to determine its behaviour and

carry out further improvements by solving problems,

removing obstacles and identifying bottlenecks ex-

isting in the process.

To run the simulation, we have to transform the

content of the activity table into a flowchart or other

diagram depending on the simulation software used.

In our example, we used the flowchart diagram be-

cause iGrafx software was used to run the simulation

of the process. Furthermore, the information stored

about the activities of the business process was used

to define the characteristics of the activities and de-

velop the process model as is required by iGrafx

http://www.hci.com.au/hcisite2/toolkit/flowchar.htm

software. The step of process simulation could be

summarized by using the following algorithm:

a. create the process diagram (flowchart);

b. develop the process model by defining the

properties of each activity;

c. define process simulation parameters and run

the simulation;

d. analyse carefully the simulation results;

e. make changes to improve the process if pos-

sible; and

f. return to c if changes have been made.

Surgery: To carry out simulation of the business

process “Surgery”, the process model was built by

using the information stored about the process and

its activities to define the model’s characteristics.

The simulation of the process “Surgery” was run

taking into consideration a Clinic for abdominal sur-

gery with a capacity of 30 beds; 20 patients were al-

ready in the Clinic in different phases of the process,

and 30 patients were scheduled for different forms

surgeryIn addition to this, we postulated that 3 pa-

tients from the planned 30 patients were hospitalized

every day. To do that, a standard calendar was used,

that is, 8 hours/day, 5 days/week and 22 days/month.

And the following resources were defined: 1 Nurse

and 1 Doctor in the Reception Office, 4 Nurses and

4 Surgeons in the Clinic, 1 Nurse in the Laboratory,

1 Nurse and 1 Doctor in the X-Ray unit, 1 Nurse and

1 Doctor in Anaesthesia, 2 Anaesthetists and 2

Nurses for performing anaesthesia in the Surgery

block, 2 Anaesthetists and 2 Nurses for waking up

patients and post-surgery recovery in the Surgery

block, and 2 Nurses working with the Surgeons to

carry out operations in the Surgery Block.

The results of running the simulation of the busi-

ness process “Surgery” were as follows:

• Average cycle time for one patient is 14.68 days;

• Elapsed time for carrying out surgery for 30 pa-

tients is 25.57 days. This is understandable be-

cause the software needed 10 days to enter 30

patients into the Clinic (3 patients per day);

• Average time for performing different activities

before surgery is 2.94 days. This is 1.43 days for

performing various medical examinations in the

Reception Office and Clinic, and 1.51 days wait-

ing for surgery;

• Average time for performing anaesthesia, sur-

gery and post-surgery recovery in the Surgery

block is 7.1 hours;

HEALTHINF 2009 - International Conference on Health Informatics

436

• Average time for recovery in Intensive care is

4.26 days;

• Average time for recovery in the Clinic is 6.39

days;

• Average time for creating a release form is 0.78

hour.

These results show that the process “Surgery”

could be improved by considering the following

suggestions:

• The time for performing different activities be-

fore surgery (average is 2.94 days) could be

shortened by carrying out most of these activities

before the patient’s hospitalization or organizing

them better;

• The recovery time in Intensive care (average is

4.26 days) should be reduced when possible;

• The recovery time in Clinic (average is 6.39

days) should be shortened when possible.

5 CONCLUSION

Developing a visible and comprehensible model,

which represents a true reflection of the real busi-

ness process, is essential in making the task of proc-

ess analysis and identification of the necessary

changes possible. The aim of this work was to study

the possibility of using simulation technique for car-

rying out business process improvement.

To carry out the improvement of the business

process “Surgery”, process model was developed as

a flowchart diagram of iGrafx software to run a

simulation of the process. The results of the process

simulation are very encouraging and show that the

process “Surgery” is well planned and does not have

major problems. Nevertheless, the process could be

improved by shortening the time of 2.94 days spent

before surgery; this is 1.43 days for performing dif-

ferent medical examinations in the Reception Office

and Clinic and 1.51 days waiting for surgery. Some

of the medical examinations could be done before

hospitalization and also the time of waiting for sur-

gery could be shortened. Furthermore, the recovery

time in Intensive care (4.26 days) and the Clinic

(6.39 days) could be reconsidered.

We are aware that these suggestions cannot be

generalized for all patients, but they are good points

for the medical staff to rethink. This fact proves that

using simulation in the field of business process im-

provement could be very important.

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