BACKGROUND: Today, hospital rankings are based not only on basic clinical indicators, but even on quality service indicators such as patient waiting times. Improving these indicators is a very important issue for hospital management, so finding a solution to achieve it in a simple and effective way is one of the greatest goals. OBJECTIVES: The aim of this article is to evaluate the use of a discrete event simulation model to improve healthcare processes and reduce waiting time of patients and hospital costs. METHODS: The case study proposed in this paper is the reorganization of non-clinical front office operation for the patients (i.e. booking of exams, delivering medical reports, etc.) of the Careggi University Hospital of Florence, to optimize the utilization of the human resources and to improve performances of the process. RESULTS: The development and validation of the model was made according to an analysis of real processes and data, pre and post implementation of model outcomes. The new organization shows a decrease of waiting times from an average value of 10 minutes and 37 seconds to 5 minutes and 57 seconds (-44%). CONCLUSIONS: This paper shows that discrete event simulation could be a precise, cost-limited tool to optimize hospital processes and performance.

A clinical pathway can be defined as a macro process that includes the complete management of a health problem. It could be considered the equivalent of diagnostic and therapeutic pathway, but the word clinical includes also the person assistance to self-care and the psychological and social support. Managing and organizing a clinical pathway in order to exploit as efficiently as possible all available resources could be the aim of all hospitals.The simulation is a modern approach that allows understanding, with a logical sequence, the entire process, in order to identify, analyze and underline characteristics, advantages and problems of the specific context. Nevertheless, simulation is not effective if the process analysis and the mathematical model are overlooked.The purpose of this work is to characterize clinical pathways, and try to understand and optimize weak points. The various phases of the work allowed conducting a precise, clear and detailed analysis, in order to develop a more efficient process. Finally, the simulation model is able to consider all possible variables that could modify the efficiency of the process and also confirms that the reorganization proposal could be effective and sustainable before a real implementation.

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