In Canada and around the world, there has been an increased focus on the efficiency, cost and access to health care services. One area of particular focus is surgical procedures, often with government funding and policies focused on reducing wait times through pay for performance and volume target initiatives. In Ontario, an expert panel was assembled to evaluate the current state of surgical processes and provide recommendations to improve access, efficiency and quality. This thesis addresses the panel's recommendation for a simulation-based decision tool to help hospitals inform decisions that can lead to improved access and efficiency. A generalised, simulation based perioperative decision tool is presented that can be used to test a variety of tactical decisions. The generic model has been applied to six hospitals of varying sizes, ranging from large academic centres to small rural community hospitals. The model remains in use at some of the hospitals to regularly inform decisions. The model is also being applied to additional hospital sites. During application of the generic model, challenges in design decisions and validation were encountered. As a result, a series of principles are proposed to guide future generic modelling design and achieving user acceptance. These principles add to the generic simulation modelling and healthcare modelling research fields by laying some groundwork for a formalised approach to designing effective generic simulation models and achieving confidence in results. Finally, the research demonstrates two uses of the generic model: as decision tool and as a demonstrative tool. As a decision tool the model is used to compare numerous potential tactical decision options under consideration. As a demonstrative tool, the model is used to quantify the effect of poor practices on hospital performance. The design of the generic model only considers efficient processes and best practices. When model results are compared to historical performance, decision makers are able to quantify the effect of existing poor practices on their performance and decision making. The tool enables users to base their tactical level decisions on the assumption that good practices and procedures are followed.

In Canada and around the world, there has been an increased focus on the efficiency, cost and access to health care services. One area of particular focus is surgical procedures, often with government funding and policies focused on reducing wait times through pay for performance and volume target initiatives. In Ontario, an expert panel was assembled to evaluate the current state of surgical processes and provide recommendations to improve access, efficiency and quality. This thesis addresses the panel's recommendation for a simulation-based decision tool to help hospitals inform decisions that can lead to improved access and efficiency. A generalised, simulation based perioperative decision tool is presented that can be used to test a variety of tactical decisions. The generic model has been applied to six hospitals of varying sizes, ranging from large academic centres to small rural community hospitals. The model remains in use at some of the hospitals to regularly inform decisions. The model is also being applied to additional hospital sites. During application of the generic model, challenges in design decisions and validation were encountered. As a result, a series of principles are proposed to guide future generic modelling design and achieving user acceptance. These principles add to the generic simulation modelling and healthcare modelling research fields by laying some groundwork for a formalised approach to designing effective generic simulation models and achieving confidence in results. Finally, the research demonstrates two uses of the generic model: as decision tool and as a demonstrative tool. As a decision tool the model is used to compare numerous potential tactical decision options under consideration. As a demonstrative tool, the model is used to quantify the effect of poor practices on hospital performance. The design of the generic model only considers efficient processes and best practices. When model results are compared to historical performance, decision makers are able to quantify the effect of existing poor practices on their performance and decision making. The tool enables users to base their tactical level decisions on the assumption that good practices and procedures are followed.

Les réseaux ferroviaires sont sujets à des dégradations de leur voie qui impactent directement le service offert aux voyageurs. Des politiques de maintenance sont donc déployées pour en limiter les effets sur la qualité et la disponibilité du réseau. Ce mémoire propose une modélisation générique de ces politiques reposant sur la fiabilité, et ce à partir du seul formalisme des réseaux bayésiens (RB). La fiabilité du système est caractérisée par un RB dynamique particulier tenant compte des temps de séjour dans chacun de ses états (hypothèse semi-markovienne). Les outils de diagnostics et les actions et les actions de maintenance sont également modélisés, autorisant la description fine de stratégies complexes. La prise en compte de l'utilité de chaque attribut du modèle (disponibilité/sécurité/coût) permet l'évaluation des politiques de maintenance innovantes en particulier prévisionnelles. La méthodologie est appliquée au cas précis du réseau RER de la RATP relativement au problème du rail cassé. / Rail networks are prone to degradations of their railtrack that directly impact the commercial service. Therefore, maintenance policies are implemented in order to limit the loss of network quality and avaibility. This thesis proposes a generic modelling for these policies based on the reliability, using Bayesian Network (BN) formalism. The system reliability is captured by dedicated dynamic BN, allowing to take in account the sojorn-time in each system state (semi-markovian assumptiun). The diagnostic tools and the maintenance actions are also represented to accurately describe complex strategies. The consideration of the utility associated to each model ,attribute (availabiblity/security/cost) enables to evaluate innovative predictive maintenance policies. This methodology is applied to the RATP RER network to deal with the rail break prevention problem.