Skip to main navigationSkip to main content
The University of Southampton
CORMSIS Centre for Operational Research, Management Sciences and Information Systems

CORMSIS Seminar Event

16:00 - 17:00
16 October 2014
Building 02 Room 3041

For more information regarding this event, please telephone Sally Brailsford on +23567 or email .

Event details

Health System Patient Flow Simulation Model

Our cross-sector patient flow model is a system dynamics simulation focused on the flow rates of patients between health system sectors, and the feedback structures around them. It takes a whole-system, strategic perspective, and is designed to produce output that captures the direction and magnitude resulting from policy changes around patient pathways and service levels.

The model was developed within a geographically large health region of around one million people. It was constructed based on consultations with four expert panels: health policy leaders, acute, institutional and home and community care. The first panel identified the policy levers targeting flows of patients between healthcare sectors, while the other three panels were engaged to develop causal loop diagrams (CSD) that explained admission and discharge flows of their respective sectors. Qualitative input from these panels was merged with health system data to develop a stock-and-flow structure of the health region. Patients are grouped into cohorts by age, sex, clinical condition, referral source and discharge destination. The model output was validated against admission and discharge data collected over a four year period.

The model has been applied to both qualitative (CSD) and quantitative (stock and flow) decision problems. The CSD model was used by the Ontario Ministry of Health and Long Term Care to test a new slow stream rehab option for complex patients. The model demonstrated several negative unintended consequences and led the policy team to revise their recommendations. The quantitative model has been used to validate the Ontario Stroke Strategy to estimate length of stay improvements. We are currently working with the Ministry to make the tool more widely accessible.

Speaker information

Michael W.Carter,University of Toronto,Michael Carter is a Professor in the Department of Mechanical and Industrial Engineering at the University of Toronto and Director of the Centre for Research in Healthcare Engineering. He received his doctorate in Mathematics from the University of Waterloo in 1980. Since 1989, his research focus has been in the area of health care resource modelling with a variety of projects in hospitals, home care, rehab, long term care, medical labs and mental health institutions. He has supervised more than 160 engineering students in over 100 projects with healthcare institutions. He currently has 18 students (7 doctoral, 5 masters and 6 undergrad) working in the area. He was the winner of the Annual Practice Prize from the Canadian Operational Research Society (CORS) four times (1988, 1992, 1996 and 2009). In 2000, he received the CORS Award of Merit for lifetime contributions to Canadian Operational Research. He also received an Excellence in Teaching Award from the University of Toronto Student Administrative Council. He is on the editorial board for the Journal of Scheduling and the journal Health Care Management Science. Professor Carter is co-editor of an issue of Interfaces on Healthcare Applications. He is a member of the Nursing Effectiveness, Utilization and Outcomes Research Unit and a mentor in the Health Care, Technology and Place Program at the University of Toronto. He was a lecturer with the Project H.O.P.E. international program in Healthcare Quality in Central and Eastern Europe in 2002 (Estonia & Latvia) and 2003 (Hungary & the Czech Republic). He is on the Advisory Board for the Regenstreif Centre for Healthcare Engineering at Purdue University. He is an Adjunct Scientist with the Institute for Clinical Evaluative Sciences in Toronto (

Privacy Settings