Modeling and Simulation

of the Hospital-at-Home Service Admission Process

Ilaria Angela Amantea

, Marzia Arnone

, Antonio Di Leva

, Emilio Sulis

Dario Bianca

, Enrico Brunetti

and Renata Marinello

Computer Science Department, University of Torino, 185 Corso Svizzera, 10149, Torino, Italy

City of Health and Science, 88 corso Bramante, 10126, Torino, Italy

Keywords:

Business Process Analysis, Hospital-at-Home, Modeling and Simulation, Healthcare.

Abstract:

This article focuses on the analysis of the admissions to hospital-at-home service within the framework of

Business Process Management. While traditional process analysis deal with internal hospital services, having

a particular and speciﬁc scenario, e.g. a ward of an hospital, here we investigate a quite innovative service with

a strong socio-territorial impact based on real data. In particular, we are interested in the understanding of the

selection process in which staff discriminate cases of interest for the service. We describe here our method-

ological framework combining data and event log analysis, modeling with standard language and business

process simulation with scenario analysis.

1 INTRODUCTION

Demographic and economic modiﬁcations occurred

in last decades, together with the availability of new

technologies, pushed the research of continuous im-

provements in healthcare. In Medicine, the most

part of actual applications of artiﬁcial intelligence and

computer science concerns diagnostic processes and

performance analysis, mostly focusing on the appli-

cation of new algorithms (e.g. machine learning).

Nevertheless, an equally important aspect to investi-

gate is the organization of health processes, by con-

sidering an holistic and systemic approach. In this

direction, computer science gained a relevant role not

only for computational reasons, but also for techni-

cal hardware and information systems improvements

(Dumas et al., 2005). This is the case of Business

Process Management (BPM) (Dumas et al., 2018;

Van der Aalst, 2013), a discipline combining stud-

ies of management with data science to perform busi-

ness process improvement and computational sim-

ulation as a management instrument for decision-

making (Van der Aalst et al., 2010). A large number

of modeling techniques investigates the actual process

(As-Is) in order to propose a restructured one (To-Be)

(Di Leva and Sulis, 2017). Modeling and simula-

tion includes computer-based Discrete Event Simula-

tion (DES) (Johnson et al., 2008), probably the most

used approach to investigate the outcomes of simu-

lated scenarios, as well as to estimate the performance

of the system after introducing changes in the process

model. Moreover, modeling the actual situation easily

allows to detect the actual functioning of the work-

ﬂow by facilitating the detecting inefﬁciencies, bot-

tlenecks, constraints, and risks (Suriadi et al., 2014;

Amantea et al., 2018).

We focus on a speciﬁc department in healthcare,

one of the most relevant public service in developed

countries (Vincent et al., 2016). Our interest here is

the Hospital-at-Home Service (HHS) in Turin, one of

the largest city of Italy, within a EU co-funded project

by Regione Piemonte to investigate healthcare pro-

cesses and telemedicine (Grosso et al., 2018). This

service has a great tradition with more than thirty

years of experience. As one of the main issue con-

cerns the selection of patients, we focused the atten-

tion on the ﬁrst part of the HHS process by mod-

eling the functioning of admissions. Similar works

about business process analysis in healthcare focused

on process mining (Mans et al., 2015; Rojas et al.,

2016), also addressing the speciﬁc task to model in-

tegrated home-care services (Russo et al., 2015). Our

goal here is to investigate the organisation of HHS to

create a repeatable model, as well as to propose the

extension to other areas.

The scientiﬁc literature and the practical experi-

ences within the domiciliary cares have underlined

the particular utility and effectiveness of this type of

Amantea, I., Arnone, M., Di Leva, A., Sulis, E., Bianca, D., Brunetti, E. and Marinello, R.

Modeling and Simulation of the Hospital-at-Home Service Admission Process.

DOI: 10.5220/0007928602930300

In Proceedings of the 9th International Conference on Simulation and Modeling Methodologies, Technologies and Applications (SIMULTECH 2019), pages 293-300

ISBN: 978-989-758-381-0

293

sanitary intervention in geriatric and oncology’s ar-

eas, recognizing the function of the hospital structure

to make more ﬂexible integration between hospital

and territory. In northern Italy, the Regione Piemonte

deﬁned in 2010 the hospitalization at home as a form

of Sanitary Assistance characterized by the whole tak-

ing in charge of the patient from an hospital struc-

ture (Aimonino Ricauda et al., 2011). Such a service

relies on own personnel, formed and with expressly

and documented experience in the management of pa-

tients in acute phase directly at home.

The paper includes the following sections: we

introduce our methodological framework and data

about the admission process in section 2. Section 3

describes the model of the service, while the follow-

ing section includes simulation results. We conclude

the paper with future works in Section 5.

2 METHODOLOGY

Our methodological framework consists of three

phases:

• Context Analysis - this phase aims to ﬁx the over-

all strategic scenario of the enterprise and to de-

termine the organizational components that are re-

lated to the process under analysis.

• Process Engineering - the initial purpose of this

phase is the determination of the activities per-

formed in the functions involved in the pro-

cess and the causal relationships existing between

them. The process is then reconstructed from

facts external to the system, events and objects

in input/output: this provides the Process dia-

gram (sometimes referred to as process map or

ﬂowchart) that will be speciﬁed by adopting a

standard language.

• Data analysis - this phase aims to analyze the real

data of the past years to understand and better rep-

resent the process the most truthful and and the

more next to the reality as possible. The whole

process model must be validated with the stake-

holders involved in the process, using animation

and simulation of speciﬁcation, obtaining the so

called As-is model.

2.1 Business Process Modeling Notation

We adopt Business Process Modeling and Notation

(BPMN) (Allweyer, 2016), which is a standard mod-

eling language developed to reduce the fragmenta-

tion that was witnessed between the existing model-

ing languages. We prefer such notation as it is sufﬁ-

ciently generic to be easily extended, as well as easily

understand by stakeholders. The actual version 2.0 is

a “de facto” standard for process modeling (Allweyer,

2016). Our diagram includes the following ﬁgures:

activities, delays, exclusive gateways, start and end

events.

2.2 Business Process Simulation

Once modeled the process, we aim to simulate the

arrival of patients in the workﬂow of resources. We

adopt iGrafxProcess tool (iGrafx, 2015), used to

implement the main phases of our methodological

framework, as well as process simulation. The sim-

ulation model is driven by the arrival of patients, as

detailed in the simulation section, following the ﬂow

of activities and events.

2.3 Data Analysis

We analysed data about the arrival of patients in pre-

vious year to identify patterns and deﬁne the work-

ﬂow in the business process. As already mentioned,

new patients are admitted to the service following a

standard procedure which involves several qualitative

information. The exploration of existing ﬁle about

event and activities facilitates the preparation of the

model and the analysis of the output results. We pro-

cessed information about the arrival of patients by

using python programming language and speciﬁc li-

braries for scientiﬁc computing numpy, statistics

3 THE HOSPITAL AT HOME

SERVICE

The Hospital at Home Service is operating in the City

of Health in Turin. This is a service that provides

diagnostic and therapeutic treatments by healthcare

professionals at patient’s home, in a condition that

normally would require acute hospital in-patient care.

Transport and acceptance are free for these patients,

as part of the HHS service. In case of necessity, a

quick admission to hospital is possible for examina-

tions or interventions that cannot be carried out at

home.

The service normally operates 12 hours a day

(from 8 am to 8 pm), each day of the week. For some

patients medical staff is available 24 hours a day.

Caregivers are instructed in the emergency plan and

encouraged to telephone if any problem arise. The

multidisciplinary staff includes four geriatricians, 13

Cfr. https://www.python.org/

SIMULTECH 2019 - 9th International Conference on Simulation and Modeling Methodologies, Technologies and Applications

294

nurses, one nurse coordinator, two physiotherapists,

one social worker, one counsellor. One of the main

features of the service is that physicians and nurses

work together as a team with daily meeting to discuss

the needs of each patient and to organize individual-

ized medical care plans and day-to-day work.

The three most important aspects of the nurs-

ing activity are: home visits to outpatients to give

medical care as agreed with the doctors; daily team

meeting; secretarial work, receiving applications for

hospitalization, stocking pharmaceuticals and sani-

tary material, sending and collecting laboratory anal-

ysis, transporting patients for particular consultations

or exams which can be done only in hospital.

Services and Treatment Provided: physician and

nursing visits; standard blood tests; pulse oximetry;

electrocardiogram; spirometry; echocardiogram; in-

ternistic ecographies and Doppler ultrasonographies;

oral and intravenous medication administration, in-

cluding antimicrobials and cytotoxic drugs; oxygen

therapy; blood product transfusion; central venous ac-

cess (PICC, Midline); surgical treatment of pressure

sores; X-rays; telemonitoring; physical therapy; oc-

cupational therapy; counselling

The daily activities at home of patients are deﬁned

on the basis of different clinical necessities of the pa-

tients. The team of care (physicians and nurses) guar-

antees an answer in 20-30 minutes in case of emer-

gency. Hospital-at-home patients are considered hos-

pital patients, and all services are provided by the

hospital, which retains legal and ﬁnancial responsi-

bility for care. If the patient needs instrumental ex-

aminations or consultations that are not practicable to

the domicile the performance as hospitalized patient.

Hospital team booked and organized the move in the

hospital with the ambulances service for the necessary

time, then the patient returns to his/her own domicile.

All the medical equipment (e.g. the medicines) are

brought to the patient’s domicile during the daily vis-

its and furnished from the hospital. A documentation

exists for each patient always available at the patient’s

home, with an updated report available in the HHS of-

ﬁce.

The professional experience of the staff and im-

portant clinical studies described the advantages in

terms of clinical improvement, reduction of the com-

plications, reduction of the re-entry in the hospital,

the impact on the quality of patient’s life, as well as a

reduction of the costs (i.e., from 400 Euro/day to 155

Euro/ day on average).

3.1 The Admission Process: The

Challenge to Balance Qualitative

and Quantitative Variables in a

Diagram

The admission process have only one human re-

source, that is the Case Manager (CM), who have to

evaluate all the requests and each one case according

to some guideline to understand if the patient have

some characteristics to allow him to take in charge to

this type of hospitalization. It seams a simple process

but is full of qualitative variables, over the quantita-

tive once, which make the process very more com-

plex of that it seems. At the end of this evaluation,

for the taken in charge of a patient, a real contract of

collaboration is created. It sees on one side the hospi-

tal, and in speciﬁc the staff of the department of HHS,

and from the other side the patient with the caregiver

and the possible family, which can be coincide or not

with the ﬁgure of the caregiver in itself. Besides it

is important that this type of collaboration remains

as established to the beginning for the whole time of

the duration of the service. Otherwise, for instance

in case of caregiver missing or family exhaustion, the

patient is immediately moves to hospital and hospital-

ize classically inside the hospital wall.

Firstly, every morning the Case Manager (CM)

have to evaluate the available numbers of possible

posts (Evaluation n

◦

places available, that corre-

spond to the maximum numbers of patients that she

could accept in this day. In this evaluation the CM

spent about 45 minutes because she have to evaluate:

• The number of patient that during the day will be

probably release.

• The number of staff available: for example if we

are near Christmas or summer holiday sorely staff

are fewer, so patients must be proportionate.

• How long each patients, they already have in

charge, been: some patients have some pathology

that must imply more time then other, for exam-

ple blood transfusions are longer then bandages

that are longer then giving a medicine. First type

of patient occupy two slot, second type of patients

occupy one slot and an half and the third type oc-

cupy only one place.

This ﬁrst evaluation imply both type the variables,

qualitative and quantitative, it is based on the best ex-

perience of the Case Manager made by years of expe-

rience, and it is a very important task because it deter-

minate the future workload of all the staff involve in

the service.

At the same time requests can arrive by telephone

from the emergency department as well as from any

Modeling and Simulation of the Hospital-at-Home Service Admission Process

295

Figure 1: Process of acceptance of requests for the HHS.

other hospital departments. The requests are made by

the responsible doctors of the departments that made

a ﬁrst quick evaluation.

The arrival of a request by phone at the Hospital

at Home (HaH) (generator Request HaH) implies an

initial evaluation (gateway First evaluation?) by the

doctor and the CM or the chief nursing (Make pre-

liminary analysis). If there are really features not

complying with this type of hospitalization (gateway

Evaluation’s result?) the request is immediately re-

jected (end of the process Rejected). Otherwise, CM

moves to the department to evaluate the patient (Move

to the Dep/Emergency). At ﬁrst, the CM talks to the

requested doctor to evaluate clinical conditions (Talk

to doctor). All patients are in acute disease but they

must not be in state of bleeding or risk of reanimation.

Then the CM talks to the patient, if he is conscious

and capable of understanding and willing (Talk to pa-

tient), as well as to the family and the caregiver (Talk

to caregiver).

During this meeting the Case Manager explains to

the patient, if possible, and to the family:

• The characteristics of the service.

• The organization of the service.

• The necessity that a person of the family, or some-

one else, collaborates with the hospital’s team.

Already from this phase:

• Evaluation of clinical, functional and cognitive as-

pects.

• A run of diagnosis, care and assistance are estab-

lish to optimize the existing human and material

resources, that is ﬁnalized to a held result the best

possible, reducing the days of hospitalization.

• If necessary, a solution of suitable relief is evalu-

ate.

• Since the possible taking in charge of the patient

that possible problem list are analyzed for the fu-

ture resignation.

• Predispose the applications for the supply of aids

and garrisons that can be useful to the domicile

(for instance, it is possible to require with pro-

cedure of urgency the liquid oxygen that will be

delivered in a few hours to the patient’s house).

The requisite to access the service are:

• As quantitative variable:

– Patient’s residence in the Piedmont Region.

– Patient’s domicile in the geographical area cov-

erage by the service (half city of Turin).

– Clinical characteristics to be asked for hospital-

ization without an invasive or intensive moni-

toring. Are exclusion criteria the need of me-

chanical ventilation, a monitoring more fre-

quent than every 2 hours of blood pressure or

haemogasanalysis, patients with an heart attack

or with very low levels of oxygen in the blood

or with a serious acidosis or alkalosis or with a

suspect of pulmonary embolism.

• As qualitative variable:

– Signature of the informed consent of the patient

and/or of the family, that imply the consent of

and the will to access to this service.

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– Suitable family support.

Through this structured interview of mutual

knowledge, Case Manager attentively appraises the

real availability to accept the cares to house, if it is

possible to identify a caregiver, so the avaialility of

taking in charge the patient in this type of hospitaliza-

tion.

The requests could be forward both from each de-

partments of the hospital and from the emergency

department. For both of them the activities already

shown are always the same, but after having talked to

all the interested parts, the decisional trial is different

according to where they are (gateway Where?).

If they are in the emergency department there is

an urgent need to free up beds. Any bed of the emer-

gency department can be busy for more than 24 hours.

Therefore, the evaluation result must be immediately

positive or negative (gateway Result?). If it is neg-

ative the request is deﬁnitively rejected (Rejected).

Probably the patient have not the requirement and he

is transferred in a classical departments. If the parts

(CM-patient-caregiver-patient’s family) reach the ac-

cord to hospitalize at home the CM signs the policy

of admission (Sign policy of admission), the emer-

gency department’s doctor compiles the emergency

report (Compile emergency report) and then the CM

books the ambulance for the transport to the patient’s

domicile through ambulance of the service of trans-

port settled with the hospital (Book ambulance) and

ﬁnally the CM ﬁll out the nurse form asking dates to

the patient/caregivers, collects some patient’s infor-

mation, give to the patient and to his family some in-

formation about the service including an “Informative

Card” with information on the service and about or-

ganization of the next tasks and at the end makes to

sign and pick up informed consent to the patient, or

to the caregiver if the patient is unable (Fill out the

nurse form + Pick up informed consent).

If the request came from a classical department

of the hospital the result of the evaluation (gateway

Result?) could be:

• Positive: the patient is taken in charge, so the CM

books the ambulance, give and take different in-

formation, compile the nurse form and make sign

the informed consent to the patient, like the pre-

vious process (Book ambulance and Fill out the

nurse form + Pick up informed consent).

• Really negative: CM suggest an alternative route

to the patient (gateway Make an alternative

route?) and the request for this type of hospital-

ization is deﬁnitively rejected (Rejected).

• Negative but really Suspended: often the family

need time to organize themselves or to required

medical products or it is necessary to talk also to

the ”real” caregiver that remain with the patient

or to other family members, so it is a temporary

reject (Suspended), but the CM takes another ap-

pointment.

To establish this contract of trust and collabora-

tion among patient and hospital is essential that the

CM talks to the whole family nucleus to narrow con-

tact with the patient, that must take care and divide

assignments and responsibility and ﬁnally with the

caregiver, that could be a relative or not. It is nec-

essary that all these people are informed, aware and

give the consent to the service, otherwise there could

be severe consequences in terms of collaboration that

could affect the patient’s care.

In this case, the Case Manager will have other tour

(gateway First evaluation arrow 2

◦

visit). These oth-

ers visit are in average 1, 2, 3 or at most 4 in particular

cases, maybe if there is the need to wait some medical

products that have to be order. These other visit are

not made by the different doctor with other requests,

but the Case Manager take the appointment on a case-

by-case bases directly with the patients. The activ-

ities remain the same but need to less time then the

ﬁrsts. This second evaluation could be exist only in

the department (gateway Where, 2

◦

visit), for reasons

already explained. In all these visits is possible both

taken in charge the patient, or a rejected the request

or a suspended it for another visit and the trial can be

repeated until the patient will be taken in charge, or

the service will be refused, or the patient will die or

will be discharge.

In all cases in which the patent go at home in a

different day from the request of the HHS, the Case

Manager autonomously goes to the patient before he

goes away, with the purpose to make sure that all the

information are clear. It imply the remake of the three

activities already explain but in less time.

At the end of this trial with the patient the Case

Manager came back to her department’s ofﬁce and

make the administrative tasks for the patients just

taken in charge. On the hospital’s computer system

the CM has to make the prescription of the Hospital-

ization at Home (Make HaH prescription) and the

formal taking in charge in the department of the Hos-

pitalization at Home (Make taking in charge). In

the meantime, as soon as the doctors and the nurses

arrive the CM informs them about the new patients

(Transfer of power). At this time the request is also

formally accepted and the patient is deﬁnitively in the

workload of the department of the Hospital at Home

(Accepted).

Modeling and Simulation of the Hospital-at-Home Service Admission Process

297

4 SIMULATING BUSINESS

PROCESSES

4.1 Analysis of Input Requests

We analyze and simulate the real date of the hospital

in the years 2017 and 2018.

The arrival of patients follows a not uniform dis-

tribution and this is because activation of the service

can happen:

• On direct application of the physician of general

medicine in alternative to the dispatch of the pa-

tient in Emergency Department.

• On application of the physicians of the depart-

ments of hospitalization of the hospital.

• Directly from the Emergency Department for pa-

tients transferred home within few times (in av-

erage 7-8 hours), after the necessary diagnostic

checks.

Doctors makes requests for this type of hospital-

ization mainly in three occasions:

• When the patients request this service because he

already use it and the conditions of the pathology

are conform to this type of hospitalization.

• When doctor is enough convinced that the patient

would have great beneﬁts with this type of hospi-

talization.

• When there are few department’s beds and some

patients could proﬁt of this type of hospitalization

freeing beds, especially in the emergency depart-

ment.

Today, approximately 60% of the HHS depart-

ment’s patients are referred by the Emergency De-

partment (ED), 25% by hospital wards and 15% by

specialist or general physicians in the community.

Table 1: Daily distribution of the arrival request.

R + CM visit R rej. by phone Total

2017 468 96 558

2018 516 103 619

Total 994 199 1,193

Analyzing hospital data base, it is shown, in Table

1, the number of the requests that have wanted at least

one CM visit (R + CM visit) and the number in av-

erage of the request that are immediately rejected by

phone, without a CM visit (R rejected by phone), in

years 2017 and 2018. The number of request imme-

diately rejected are an average number because they

don’t report this call in the data base. This value has

been arranged with the CM.

4.2 Case Manager Workload: Data

Analysis

The workload of the Case Manager depend not only

by the real number or the request made by the differ-

ent doctors, but also, as shown in the process (Figure

1), by the other appointment on a case-by-case basis

that the CM autonomously take with the patient.

Starting to the Table 1 and according to the data

base analysis we can estimate about that the workload

of the Case Manager is incremented of the 57% by the

visits after the ﬁrst.

Table 2: Increasing of the CM’s workload by the seconds

visits, in 2017-2018.

Tot.R+CM visits Tot.CM visits Diff.(%)

994 1,742 43%

Table 2 considers the sum (Total) of the column

R + CM visit of Table 1 comparing the results of the

Case Manager database of the HHS.

The increasing of the workload of the CM, al-

most 50%, shows how much balancing all these vari-

ables, above the qualitative once, increase the work-

load. This is made with the purpose to create a clear

collaboration, stable in time that will lead advantages

in the workload of the team that will go home and to

the patient’s care.

Figure 2: Arrivals of patients at the HaH service in 2017

and 2018 in the different months.

Therefore, Figure 2 describes how the CM’s work-

load changed monthly in last two years. For example,

in January or autumn there were some peaks, mostly

related to periods of ﬂu. On the contrary, near (Ital-

ian) festivity days (i.e. April 2017) there were less

requests, maybe because people are less available to

move out from the city.

Another analysis that we made concerns the dif-

ference of the CM’s workload made by the Emer-

gency department and the other classical department.

This analysis is shown in Figure 3.

It is notable the difference as the requests by the

Emergency department imply only one visit, a more

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298

Figure 3: Worlkoad of the Case Manager of HHS in

2017 and 2018 from Hospital Departments (DEP) and from

Emergency Department (ED).

quickly decision and two more documents for each

patients. The request provided by the different de-

partment, in addition to the fact that the departments

are more then one, there is some more time and the

visits are frequently more then one.

We also computed the average daily arrival of pa-

tients by day, which is about 3.5 with a standard devi-

ation of about 2. Interestingly, the distribution varies

across days with a peak in the ﬁrst part of the week.

Table 3 describes the average value of patients the

modal value and the standard deviation for each day

by considering the period between 2017 and 2018.

Table 3: Daily distribution of the CS’s workload: average

(Avg), modal value (Mode) and standard deviation (StDev).

Mon Tue Wed Thu Fri

Avg 4.05 4.05 4.09 3.35 2.56

Mode 4.00 4.00 3.00 3.00 2.00

StDev 2.04 2.04 2.03 1.72 1.62

The actual process has been validated by managers of

the hospital department as well as accurately veriﬁed

in actual and future simulation results. In particular,

besides changes related to the arrival of patients, we

investigate variations in the execution times of work-

ers and organizational changes.

4.3 Output with Different Arrivals

The output of the Case Manager evaluation directly

affect on the workload of the HHS department, so on

the job of the team doctor+nurse that day by day have

to go to the different patient’s home.

The team looks after 25 patients per day and 500

patients per year, on average. Figure 4 show the ac-

cepted requests, so the patients taken in charge in

2017 and 2018, from Hospital Departments (DEP)

and from Emergency Department (ED). Curiously,

the accepted requests by the Emergency Department

follow a similar trend of the provided requests. This

Figure 4: Patients taken in charge in the HHS in 2017 and

2018, from Hospital Departments (DEP) and from Emer-

gency Department (ED).

is because, if it is possible, it is easier to free a bed of

the Emergency Department avoiding simply to move

the patient to another bed of a classical department.

The number of patient in charge each day has to be

balanced with the patients that leave the service, in

order to guarantee an adequate workload for the team

and an adequate level of care, according to the ﬁrst

evaluation activity explained in Figure 1 (Evaluate

◦

place available).

Table 4: Description of the requests accepted and rejected

in 2017 and 2018.

2017 2018

Patients taken in charge 468 489

Patient rejected from DEP 10 22

Patient rejected from ED 2 5

Request rejected by phone 96 103

Table 4 describes the number of patients taken in

charge in two last years. The fact that the rejected

patients are very few is also thanks to an adequate

information and collaboration between the doctor of

the Emergency and other classical departments and

the staff of the HHS.

4.4 Scenario Analysis

Beside scenario As-Is, we plan to modify some fea-

tures of the organisation as the introduction of dif-

ferent execution time of workers (i.e. stagiest ver-

sus expert workers) in expert-stagiest scenario, the re-

structuring of the whole process with different activi-

ties in re-engineering scenario, or the working shift of

staff in part-time scenario. The interest of managers

in considering the introduction of different execution

time of workers concerns the ability to produce more

realistic scenario including young specialist nurses

and doctors besides actual experienced workers. In

other analysis some tasks in the ﬂow can be slightly

modiﬁed, to investigate the outcome on the whole

Modeling and Simulation of the Hospital-at-Home Service Admission Process

299

time execution of the process. Finally, by introduc-

ing part-time worker shift some considerations can be

added with respect to different organisation planning,

i.e. obeying to some special request from workers.

5 CONCLUSIONS

This research describes a methodological framework

to model and simulate an hospital admission process.

We applied the standard language modeling BPMN

to introduce a simulation effort based on real data. In

future works, we consider to investigate the remain-

der of the process, as well as the trajectories of the

operators on the territory towards the patients’ home

with social network analysis by combining geograph-

ical information systems and agent-based modeling to

improve the analysis and simulation of the HHS pro-

cess (Sulis and Di Leva, 2017). Moreover, we plan

to investigate several scenarios to provide some sug-

gestions to managers by offering insights on organ-

isational aspects, also including an increment of pa-

tients as in the case of an extension with respect to

the actual service. In addition, we aim to explore dif-

ferent options concerning the arrivals of patients by

investigating the extension of the service to another

area of the same city. As the HHS actually involves

only the southern part of Turin, we plan to investigate

the extension to the northern area: that would mean

mostly doubling the arrivals of patients. In particu-

lar, we afford this research question to manage such

increment of patients by planning different conﬁgu-

ration settings, also involving the staff dimension, in

order to produce optimal results for decision-makers.

ACKNOWLEDGEMENTS

This research was conducted in the project “CANP

- CAsa Nel Parco” of Regione Piemonte funded by

POR FESR PIEMONTE 2014-2020. We are grateful

for the collaboration of the “City of Health and Sci-

ence” of Torino (Italy).

REFERENCES

Aimonino Ricauda, N., Tibaldi, V., Bertone, P., Chiusano,

V., Piano, S., Grillo, S., Rocco, M., Marinello, R.,

and Isaia, G. (2011). L’ospedalizzazione a domicilio.

Proceedings of SIGOT - Italian society of geriatrics,

Suppl.Vol.XXIII(1):53–62.

Allweyer, T. (2016). BPMN 2.0: introduction to the stan-

dard for business process modeling. Books on De-

mand.

Amantea, I. A., Leva, A. D., and Sulis, E. (2018). A

simulation-driven approach in risk-aware business

process management: A case study in healthcare. In

Proceedings of 8th International Conference on Sim-

ulation and Modeling Methodologies, Technologies

and Applications - Volume 1: SIMULTECH,, pages

98–105. INSTICC, SciTePress.

Di Leva, A. and Sulis, E. (2017). Process analysis for a

hospital emergency department. International Journal

of Economics and Management Systems, 2(1):34–41.

Dumas, M., La Rosa, M., Mendling, J., and Reijers, H.

(2018). Fundamentals of business process manage-

ment, volume 1. Springer, 2nd edition.

Dumas, M., van der Aalst, W. M., and ter Hofstede, A. H.

(2005). Process-aware Information Systems: Bridg-

ing People and Software Through Process Technology.

John Wiley & Sons, Inc., New York, NY, USA.

Grosso, M., Scardino, M., Cerutti, S., Guida, A., Tibaldi,

S., Sardo, P., Davini, O., and Marinello, R. (2018).

Telemedicina e fragilita’ clinica: il progetto la casa nel

parco. eHealth. Innovazione e tecnologia in ospedale,

65.

iGrafx (2015). iGrafxProcess 2015. http://www.igrafx.com.

Johnson, M. W., Christensen, C. M., and Kagermann, H.

(2008). Reinventing your business model. Harvard

business review, 86(12):57–68.

Mans, R., Van der Aalst, W., and Vanwersch, R. (2015).

Process mining in healthcare: evaluating and exploit-

ing operational healthcare processes. Springer.

Rojas, E., Munoz-Gama, J., Sep

ulveda, M., and Capurro,

D. (2016). Process mining in healthcare: A literature

review. Journal of Biomedical Informatics, 61:224 –

236.

Russo, V., Ciampi, M., and Esposito, M. (2015). A busi-

ness process model for integrated home care. In EU-

SPN/ICTH.

Sulis, E. and Di Leva, A. (2017). An agent-based model

of a business process: The use case of a hospital

emergency department. In International Conference

on Business Process Management, pages 124–132.

Springer.

Suriadi, S., Weiß, B., Winkelmann, A., ter Hofstede, A. H.,

Adams, M., Conforti, R., Fidge, C., La Rosa, M.,

Ouyang, C., Rosemann, M., et al. (2014). Current

research in risk-aware business process management:

overview, comparison, and gap analysis. Communica-

tions of the AIS, 34(1):933–984.

Van der Aalst, W. M. (2013). Business process manage-

ment: a comprehensive survey. ISRN Software Engi-

neering, 2013.

Van der Aalst, W. M., Nakatumba, J., Rozinat, A., and Rus-

sell, N. (2010). Business process simulation. In Hand-

book on BPM 1, pages 313–338. Springer.

Vincent, C., Amalberti, R., et al. (2016). Safer healthcare.

Cham: Springer International Publishing.

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