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Similar urgent needs for improvement of health care systems exist in the developed and developing world. The culture and the organization of an emergency department in developing countries can best be described as a professional complex adaptive system, where each agent (employee) are ignorant of the behavior of the system as a whole; no one understands the entire system. Each agent's action is based on the state of the system at the moment (i.e. lack of medicine, unavailable laboratory investigation, lack of beds and lack of staff in certain functions). An important question is how one can improve the emergency service within the given constraints. The use of simulation signals is one new approach in studying issues amenable to improvement. Discrete event simulation was used to simulate part of the patient flow in an emergency department. A simple model was built using a prototyping approach. The simulation showed that a minor rotation among the nurses could reduce the mean number of visitors that had to be refereed to alternative flows within the hospital from 87 to 37 on a daily basis with a mean utilization of the staff between 95.8% (the nurses) and 87.4% (the doctors). We conclude that even faced with resource constraints and lack of accessible data discrete event simulation is a tool that can be used successfully to study the consequences of changes in very complex and self organizing professional complex adaptive systems.

Discrete event simulation as a tool in optimization of a professional complex adaptive system