A discrete-event simulation application for clinics serving the poor

Healthcare management operates in an environment of aggressive pricing, tough competition, and rapidly changing guidelines. Computer simulation models are increasingly used by large healthcare institutions to meet these challenges. However, small healthcare facilities serving the poor are equally in need of meeting these challenges but lack the finances and personnel required to develop and implement their own simulation solutions. An academic medical center, healthcare facilities that serve the poor, and the local public health department formed a unique partnership to create low-cost tools to meet these challenges. This article describes the creation of a low-cost, generic, discrete-event simulation model populated by a workflow observation Excel spreadsheet that can be completed by clinic staff themselves, thus "customizing" the simulation model for their own purposes. This initial model focuses on childhood immunization delivery services; the intent is to develop a tool flexible enough to serve other health services delivery needs as well.