title: Use of discrete event simulation to improve a mental health clinic.
abstract: OBJECTIVE
  To improve clinic design, trial-and-error is commonly used to discover strategies that lead to improvement. Our goal was to predict the effects of various changes before undertaking them.
  
  
  METHODS
  Systems engineers collaborated with staff at an integrated primary care-mental health care clinic to create a computer simulation that mirrored how the clinic currently operates. We then simulated hypothetical changes to the staffing to understand their effects on percentage of patients seen outside scheduled clinic hours and service completion time.
  
  
  RESULTS
  We found that, out of the change options being considered by the clinic, extending daily clinic hours by two and including an additional psychiatrist are likely to result in the greatest incremental decreases in patients seen outside clinic hours and in service time.
  
  
  CONCLUSIONS
  Simulation in partnership with engineers can be an attractive tool for improving mental health clinics, particularly when changes are costly and thus trial-and-error is not desirable.
authors.affiliation: New England Veterans Engineering Resource Center, Boston MA, USA. Electronic address: bo.kim@va.gov.
authors.forename: Bo
authors.initials: B
authors.lastname: Kim
authors.forename: Yisraela
authors.initials: Y
authors.lastname: Elstein
authors.forename: Brian
authors.initials: B
authors.lastname: Shiner
authors.forename: Renata
authors.initials: R
authors.lastname: Konrad
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Pomerantz
authors.forename: Bradley V
authors.initials: BV
authors.lastname: Watts
mesh_terms: D001071:Appointments and Schedules; D003198:Computer Simulation; D003695:Delivery of Health Care / Q000379:methods*; D017598:Efficiency, Organizational; D006801:Humans; D008503:Medical Staff / Q000600:supply & distribution; D008605:Mental Health Services / Q000592:standards*; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement
keywords: Computer technology; Outpatient clinics; Quality improvement; Risk–benefit analysis; Service delivery systems