Tactical Versus Operational Discrete Event Simulation: A Breast Screening Case Study

The Regional Agency for Health and Social Care, (ASSR) of Emilia Romagna, a regional research center for innovation and improvement, is trying to understand how Discrete Event Simulation (DES) technique can be incorporated to support decision making in the field of health services. Most of decision support systems used by regional and local health planners face problems from the epidemiological point of view whereas few studies are focused on dynamic capacity planning. The aim of this work is to study how two different DES software packages can be effectively applied to support tactical and operational decision-making processes. In order to validate our DES model we built a breastscreening pathway and we showed how this model could predict lead time performances with different capacity settings. We focused our work on the inclusion in 2010 breast screening program of 45-49 and 70-74 women age bands, by showing how simulation can help to understand resource re-sizing needs as a consequence of an increase in the demand of services. We analyzed the breast program with two DES software packages in order to show how different tools can help stakeholders that operate at different decision levels (local vs regional). Both simulation models were tested over a one year time horizon, we distinguish the operational from the tactical level as a consequence of the different potential degree of detail that we can reach in the care pathway modeling.