Abstract
Long waiting times in emergency departments remain a critical challenge for healthcare systems. This study proposes an integrated framework combining the DMAIC (Define, Measure, Analyze, Improve, Control) methodology with simulation-based analysis to improve outpatient waiting times. In the Define phase, a SIPOC diagram was used to clarify processes and stakeholders. Key causes of delays were identified in the Measure phase using a Fishbone Diagram, while the Analysis phase applied FMEA to prioritise improvement actions. In the Improve phase, agent-based simulation was developed to model patient behaviour and process interactions, estimating patient flows across emergency department pathways. These outputs informed a discrete-event simulation model used to evaluate alternative operational scenarios for reducing waiting times. Finally, in the Control phase, statistical analysis was conducted to assess sustainability. A Wilcoxon test confirmed that the reduction in waiting times was statistically significant, demonstrating the effectiveness and stability of the proposed improvements.
| Original language | English |
|---|---|
| Number of pages | 24 |
| Journal | Journal of Simulation |
| Early online date | 19 Dec 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 19 Dec 2025 |
Bibliographical note
Copyright © 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.Keywords
- Agent-Based Simulation(ABS)
- Discrete Event Simulation (DES)
- DMAIC
- emergency room
- process improvement
- Six sigma