OR Insight Vol 8 Issue 2 April - June 1995

A hospital capacity planning model

Darryl Gove and David Hewett
space in the hospital, the arrival rates of patients,

Current health reforms mean that the Royal Hampshire Hospital, like many others, needs to examine
its use of resources very carefully. In particular, it
has to understand how various casemix combina-

and their lengths of stay patterns. The following outline specification for the first stage of the model was
devised by health planners at the hospital in collaboration with the modellers from the University.

tions impact on the way resources are used and

attempt to define feasible packages of care. Previously, the hospital was funded on a fixed budget and
was forced to constrain its costs within this even if
that meant slowing down or stopping elective work.
The new arrangements require the hospital to bid
competitively for agreed volumes of workload. Two
of the many issues raised by the new system are the
need for an accurate knowledge of the day to day
capacity of the hospital and the behaviour of the
hospital system under different case-mixtures. The
model described n this article attempts to address

The model is required to run under Microsoft

Windows, in order to integrate with other

systems and to take advantage of the hospital's extensive PC networks. lt must be able

to import data from prepared files and extract values for variables from this data, and

then it must be able to export results to a

spreadsheet.

The model is required to deal with up to 25

specialities. Each speciality has a number

this problem of capacity.

of beds that are available for its own patients and for loan out to other specialities.

-oo0oo-

Model specification

The patients have age characteristics and

are admitted by one of two methods: either

The model that has been developed uses information derived from the standard NHS contract minimum data set, a feature which means that the model
is capable of generalisation to any other NHS hospital. The Royal Hampshire County Hospital has a
fully developed Hospital Information Support System

planned admission or emergency admission.

(HISS). This compute rised system collects and

particular day is sampled from a probability

distribution which is sensitive to the day of

The planned admissions are assumed to

arrive at nine o'clock every morning, and the
emergency admissions are spread over the

whole day according to some probability

distribution. The number of arrivals on a

maintains data about patients automatically; something which renders data collection and maintenance
easy. However, the use of minimum datasets in the
model means that such information systems are not
a pre-requisite for the model to be applicable to a

the week, the method of arrival (either

planned or emergency), and the age group
of the patient.

hospital.

Each patient can potentially undergo up to

two transfers between specialities within the

The model was specified in a modular approach,

hospital before leaving. The available

which means that the model will be developed

through a number of discrete steps, rather than

outcomes are that the patient finally returns

home, dies, or is transferred to another NHS

attempting to produce a completed version immediately. The modular approach allows greater control
over the progress of the model that is both practical
and valued by users. The modular approach also

hospital. The duration of stay in each

speciality depends on the patient characteristics and the number of previous transfers
within the hospital.

helps the modeller since it produces a definite

Some of the patients require operations.
The probability of a patient requiring an

boundary on the area to be modelled, and therefore

directly limits the level of detail to be modelled. The
first stage (hospital beds) has just been completed

operation depends on the speciality, the age

of the patient, and whether the patient was a
planned or emergency admission. There is

and work should soon be starting on the second

stage (outpatients and theatre usage). Currently the
model is primarily concerned with the available bed

Copyright 0 1995 Operational Research Society.

a limited amount of operating theatre time

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OR Insight Vol 8 Issue 2 April - June 1995

for planned operations, and an additional

are scheduled to arrive at random over the

amount available for emergency operations.

entire day.

The model is required to run over a time

Once a particular arrival occurs, the avail-

period of a year. The year should consist of

able theatre hours are checked if the patient

tour quarters each with their own data

needs an operation, and the beds are

characteristics (for example, there might be

more elderly people requiring treatment in

checked for space. If there are no beds in

the speciality that the patient is to be admitted to, then the other specialities are examined to determine if a bed can be borrowed.
If that fails, the hospital is examined to find

winter). The model should also allow for

multiple runs in order to produce some
estimates of variance.

patients who can be discharged early to

The output of the model should be the bed
usage over time, the bed turnover interval
and occupancy, the number of cases, the

obtain a free bed. lt there is no available

operating theatre time (surgical patients

only) or bed space, then the patient is

turned away. The flow chart in Figure 1

number of people turned away, and the

length of stay by speciality. These measures reflect the actual measures used in

demonstrates this.

hospitals.

Once the patient has stayed in the speciality

and had any necessary operations, the

A brief explanation of the flow of patients in the

patient: is discharged home, dies, is transferred to another NHS medical centre, or is

transferred internally to another speciality.
Internal transfers have priority over admis-

model is as follows:

sions. Figure 2 shows the entire patient

Patient flows

stay process.
I

The number of arrivals is generated daily.

The planned arrivals are scheduled to arrive
at nine o'clock, and the emergency arrivals

Type of model
The hospital system is a complex network involving
queues, constraints, and use of resources. Flows in
the network involve variability and uncertainty. The
dynamics of the system are important for many of
the decisions that have to be made with the help of
the model. lt was clear to us that a deterministic
model using average values was quite inappropriate,

No free time
Check theatre time

No free bed

Check bed space

Available bed

Yes

and that an appropriate stochastic model was

needed. Further, the complexity of the hospital

Available borrowed bed

system is such that it would not be possible to solve

No

Yes

the model analytically. Simulation was chosen as

Another patient can leave

early and free bed

the solution method.

The model was constructed using Borland Pascal

7.0 and the TOCHSIM for Windows shell (Hawkins

Patient admitted

Figure 1:

et al, 1992) developed by members of the OR Group

Patient arrival decision flow

in the Faculty of Mathematical Studies, at the University of Southampton, and named after Professor
Tocher, who was one of the pioneers of simulation,
see Tocher (1963) The advantages of using Pascal

ist stay

are that:

tome
Other NHS

the model can be expanded and changed

easily;

Death

the model can cope with integration with

other packages easily;

FIgure 2
Entire hospital stay process

the model will run quickly;

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OR Insight Vol 8 Issue 2 April - June 1995

there is unlikely to be a requirement of the

system that is too complex to code in PasOie

cal;

568

the modelling does not require the acquisition of an expensive simulation package.

426

The simulation shell provides routines which can

handle the scheduling of events, creation and destruction of entities, the processing of queues, and

noval Ilollipsitre County IloslIllal Capacity Pu runny ocal - IBe(iosalei

ylmulatlon raphICs

Spieduitle

Help

AseSad

Bedeee --Sl)
-

the display of results.

42

The main disadvantage of the TOCHSIM shell is, of

course, the need for programming.

tn-

4
ShuoI)doo Asue (Dye)

Model validation
The model was validated using a number of ap-

Figure 3

proaches designed to highlight the internal workings

of the model (for example tracing of entities, examination of variables during the run, and step by step
execution), as advised by Sargent (1992).

A typical output graph from the model

showing the total bed use over time

orman

Since the model calculates the values for its own

internal parameters from data downloaded from the

Hospital Information System it was necessary to

validate these routines carefully to ensure that the
parameters that the model calculated matched those
that the data suggested.

The results from the model were reviewed by experts at the Royal Hampshire County Hospital and
the results seemed to fit the actual data and experi-

L6]2 -74-7- 8Q-(

oofGeperal Med e

ence.

Bids::

hroughput (Left Hand Y Axis)

%Qccupan(Rigtnd-s,
V0 of cases discharged ar

Illustrative results
Figure 3 shows the results of running the model on
illustrative data. The graph shows the total number
of beds in use in the hospital over the entire simulations run. The thick line is the mean value, and the
dotted lines about the mean give an estimate of the
95% confidence limits. The model produces results

Figure 4
Effects of bed numbers on general medicine performance

tables can be displayed on the screen or sent to a

the throughput as measured by finished consultant

episodes (FCEs) increases, and the bed occupancy
decreases. The number of patients forced to leave

printer, or exported to a spreadsheet for further

early decreases slightly as the number of beds

analysis.

increases.

as either graphs or as tables. The graphs and

Figure 4 shows a graph of the relationship between

the number of beds available to General Medicine,
and a number of measures of productivity. lt is

Concluding remarks
Although the model is only in its early stages, it has
already proved to be a potentially useful management tool. lt has been used at the hospital to evaluate the effects of increases in the number of avail-

demonstrative that, even in its current form, the

model can provide insight into the value of additional

bed space being allocated to the specialty. The

graph shows results from a number of simulation

able beds, and changes in the way in which bed

runs which have been exported to a spreadsheet. lt

demonstrates that as the number of beds increases,

sharing between specialities is implemented.

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OR Insight Vol 8 Issue 2 April - June 1995

Acknowledgements
This work is a collaboration between a large number of people
who put their time and experience into the model. At the Royal
Hampshire County Hospital we would like to thank Alan Bancroft,
David Cornforth and Colin Weston, and at the University, Arjan
Shahani and Andy Reynolds.

For the interested reader

Hawkins J D, Shahani A K, van der Hoorn H H J, Green L, Gove

D J, Brailsford SC (1992) TOCHSIM manual, Southampton

Centre for Operational Research.

Sargent R G (1991) Simulation model verification and validation,

in Nelson B L, Kelton W D, Clark G M, ads, Proceedings of the
1991 Winter Simulation Conference, pp 37-47.
Tocher K D (1963) The art of simulation, London: English Universities Press.

DARRYL COVE s a Research Assistant at the University of

Southampton, and is currently completing his PhD on the modell-

ing of infectious disease using simulation; using the infectious

diseases Trachoma and Chlamydia as particular examples.
DAVID HEWETT
Royal Hampshire County Hospital, Romsey Road, Winchester.

Copyright D 1995 Operational Research Society.

Previous to that he studied for an MSc in Operational Research

and a BSc n Mathematics, both also at Southampton.

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