Multi-level strategic evaluation of hospital plans and decisions

Strategic decision making in hospitals involves the assessment of linkages between decisions that are typically made in a hierarchical fashion. In hospitals, as in most large organizations, overall system performance is a function of how well the critical decisions are integrated. This paper focuses on the multi-level nature of the decisions and policies that typically need to be evaluated in hospital planning, highlighting that both optimization and simulation approaches may be required. An application involving a large general purpose urban hospital is used to illustrate the interdependency between the levels in the planning hierarchy. An optimization model is formulated to deal with facility layout and capacity allocation while a simulation model is proposed to capture the complexities of hospital operations. The linkages and information feedback between the models are shown to be critical in the design of a system that performs well and facilitates strategic hospital planning.