Article Text

Download PDFPDF

Improving patient waiting times: a simulation study of an obesity care service
  1. Antuela A Tako1,
  2. Kathy Kotiadis2,
  3. Christos Vasilakis3,
  4. Alexander Miras4,
  5. Carel W le Roux4,5
  1. 1School of Business and Economics, Loughborough University, Loughborough, UK
  2. 2Warwick Business School, University of Warwick, Coventry, UK
  3. 3UCL Clinical Operational Research Unit, University College London, London, UK
  4. 4Imperial Weight Centre, Imperial College London, London, UK
  5. 5Experimental Pathology, UCD Conway Institute, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
  1. Correspondence to Dr Antuela A Tako, School of Business and Economics, Loughborough University, Richard Morris Building, Ashby Road, Loughborough LE11 3TU, UK; a.takou{at}


Background Obesity care services are often faced with the need to adapt their resources to rising levels of demand. The main focus of this study was to help prioritise planned investments in new capacity allowing the service to improve patient experience and meet future anticipated demand.

Methods We developed computer models of patient flows in an obesity service in an Academic Health Science Centre that provides lifestyle, pharmacotherapy and surgery treatment options for the UK's National Health Service. Using these models we experiment with different scenarios to investigate the likely impact of alternative resource configurations on patient waiting times.

Results Simulation results show that the timing and combination of adding extra resources (eg, surgeons and physicians) to the service are important. For example, increasing the capacity of the pharmacotherapy clinics equivalent to adding one physician reduced the relevant waiting list size and waiting times, but it then led to increased waiting times for surgical patients. Better service levels were achieved when the service operates with the resource capacity of two physicians and three surgeons. The results obtained from this study had an impact on the planning and organisation of the obesity service.

Conclusions Resource configuration combined with demand management (reduction in referral rates) along the care service can help improve patient waiting time targets for obesity services, such as the 18 week target of UK's National Health Service. The use of simulation models can help stakeholders understand the interconnectedness of the multiple microsystems (eg, clinics) comprising a complex clinical service for the same patient population, therefore, making stakeholders aware of the likely impact of resourcing decisions on the different microsystems.

  • Simulation
  • Performance measures
  • Decision support, computerized

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles