Using OR to support the development of an integrated musculo-skeletal service

This paper discusses the question of how operational research in general, and discrete event simulation in particular, can help to meet management challenges in hospital-based orthopaedics medicine. It focuses on the reduction of waiting times for elective patients, both for a first outpatient appointment and for the subsequent commencement of in-patient treatment. The research is based on a series of projects carried out by students from the Department of Management Science, University Strathclyde in Stobhill Hospital and the Glasgow Royal Infirmary between 1999 and 2003. An increasingly detailed and complex simulation model was developed for the musculo-skeletal service provided by these hospitals. The paper discusses the application of a modelling methodology—based on the idea of requisite models evolving over time—that is participatory, iterative and focused on enhancing the clients' understanding of the main performance drivers of the service. It concludes that this methodology fits well with successful strategies to sustain reductions in waiting times.