In order to provide “what if” evaluations of clinical pathways in hospitals, the authors built a discrete event simulation using Arena version 8.0.

The content of the model is described in terms of doctors, patients, consultations, and surgeries. The results of several “what if” evaluations are given for a case study involving a single orthopedic doctor and eight clinical pathways--for example, an evaluation of 13 consultation sequencing rules is provided. Scheduling patients with large service time standard deviations last helps with the optimization of two performance indicators. However, the authors suggest caution when interpreting this result, as not all alternatives and performance indicators have been fully investigated.

Most readers will be convinced that this is a credible model, but little is reported about the validation of the model’s output. Experienced simulation modelers will want to know what is meant exactly by saying that “medical experts and managers ... confirm the match between the reality and simulated results.” The results section will convince readers that valuable “what if” evaluations are possible, but the scope of the investigation is clearly limited. In their conclusions, the authors emphasize the need for a more user-friendly interface for their tool, to facilitate data importation. The unstated goal here must surely be a dashboard-style interface that allows both managers and physicians to interact with the model unaided, when performing “what if” evaluations of their own choosing.

Despite the above criticisms, I strongly recommend this paper to those who are interested in digital hospital management information systems.