Simulation-Based Performance Scenarios for a Health House and Health Post: An Empirical Study
,
Abstract
Background: Enhancing the performance of healthcare provider units, such as Health Houses (HHs) and Health Posts (HPs), is vital for improving service delivery. We aimed to develop simulation-based scenarios to optimize performance and minimize risks associated with decision-making.
Methods: Conducted in 2021, this empirical study utilized operational research methods at one HH and one HP in southern Tehran. The operational characteristics of these units were modeled using Arena 20 simulation software. Additional performance scenarios were iteratively developed based on expert recommendations. Key performance metrics from the simulations were evaluated and ranked using the nominal group technique and Expert Choice software.
Results: Four distinct scenarios were developed for both units. The fourth scenario emerged as the optimal model, receiving the highest expert scores for both the HH (score: 349) and HP (score: 418). This scenario demonstrated significant improvements in key indicators, including the number of patients admitted (HH: 24; HP: 31), patients served (HH: 23; HP: 33), health worker productivity (HH: 95%; HP: 47%), and reduced patient waiting times (HH: 4.45 min; HP: 0 min).
Conclusion: The study recommends adopting the fourth scenario as a benchmark for HHs and HPs in suburban areas of major Iranian cities. The employed simulation methodology and evidence-based scenarios can be applied to other healthcare units, aiding in performance forecasting and system optimization.
1. Jalali Khan Abadi T, Alvani SM, et al (2020). Designing a network governance model in Iran’s health care system. Iran J Manag Sci, 15(58): 1-30.
2. Tghvaei Yazdi M (2016). The Relationship between Organizational Health and Or-ganizational Trust to Social Responsibil-ity of Teachers in Sari Education Dis-trict. J New Approaches Educ Adm, 7(27): 95-116.
3. Negarandeh R, Kamran A, Heydari H (2022). Iran’s health system performance in achieving goals based on the World Health Organization’s framework: a scoping review. J Research Health, 12(2): 65-74.
4. Askarzade E, Nabizade Z, Goharinezhad S, et al (2023). Universal health coverage in Iran: a review of strengths, weaknesses, opportunities, and threats. Med J Islam Repub Iran, 37: 6.
5. Yanful B, Kirubarajan A, Bhatia D, et al (2023). Quality of care in the context of universal health coverage: a scoping re-view. Health Res Policy Syst, 21(1): 21.
6. Obubu M, Chuku N, Ananaba A, et al (2023). Evaluation of healthcare facilities and personnel distribution in Lagos State: implications on universal health coverage. Hosp Pract(1995), 51(2): 64-75.
7. Gharaee H, Azami Aghdash S, Farahbakhsh M, et al (2023). Public–private partnership in primary health care: an experience from Iran. Prim Health Care Res Dev, 24: e5.
8. Chen M,Huang X,Cheng J, et al. (2023). Ur-banization and vulnerable employment: Empirical evidence from 163 countries in 1991–2019. Cities, 135: 104208.
9. Khoshchashm K (2016). Rapid urbanization and healthy cities and healthy villages programs in the Eastern Mediterranean. In: Transforming Distressed Global Communities. 1st ed, Routledge, London, pp.277–302.
10. Razavi Fard H (2018). Urbanization and in-formal settlement challenges: Case study Tehran metropolitan city. Open House Int, 3(2): 77-82.
11. World Health Organization (2022). Region-al review: role of the private health sec-tor in the provision of essential health services in the Eastern Mediterranean Region. Available from: https://apps.who.int/iris/handle/10665/366798
12. Moore M, Gould P, Keary B (2003). Global urbanization and impact on health. Int J Hyg Environ Health, 206(4): 269–78.
13. Li X, Song J, Lin T, et al (2016). Urbaniza-tion and health in China: thinking at the national, local and individual levels. En-viron Health, 15: 113-123.
14. Asghar Pilehvar A (2021). Spatial-geographical analysis of urbanization in Iran. Humanit Soc Sci Commun, 8(1): 1-12.
15. Marvi A, Kokabisaghi F, Tabatabaee SS, et al (2024). Evaluation of the primary health care expansion program with public-private partnership in slum areas from the perspective of stakeholders: a qualitative study. BMC Prim Care, 25(1): 67.
16. Shafiee A, Kazemian S, Jalili A, et al (2024). Epidemiology and Prevalence of Dyslipidemia Among Adult Population of Tehran: The Tehran Cohort Study. Arch Iran Med, 27(2): 51-61.
17. Najarkolaei F, Rakhshbani F, Tavafian S, et al (2018). Health Education Performance in Health Houses: A Descriptive study from Iran during April-September 2011. Shiraz E Med J, 19(4): 1-6.
18. Hosseini SH, Takian AH, Sepehri MM, et al (2020). Effects and challenges of Health Transformation Plan in public health: views of public health providers. Dilemas Contemp Educ Polit Valores, 7(2): 1-22.
19. Rahbar A, Rahi L, Ebraze A, et al (2016). Compare Client Satisfaction in the Pub-lic Health Posts and Outsourced Health Posts Affiliated to Qom University of Medical Sciences in 2014. J Arak Univ Med Sci, 19(9): 67-77.
20. Tabrizi J, Pourasghar F, Gholamzadeh Nikjoo R (2019). Governance of Iranian Primary Health Care System: Percep-tions of Experts. Iran J Public Health, 48(3): 541-548.
21. Damari B (2019). Road Map of Health Area in Iran Health System. refahj, 18(70): 9-30.
22. Cooper WW, Seiford LM, Zhu J (2011). Handbook on data envelopment analy-sis. 2nd ed. Springer Science & Business Media, pp. 1-39.
23. Dargahi H, Darrudi AR (2019). Perfor-mance Assessment of Health Care Cen-ters in South Tehran Health Network. Manag Strateg Health Syst, 3(4): 264-275.
24. Scotellaro M, Cornio AR, Borgini A, et al (2024). Standardizing Primary Health Care in Italy: Operational Guidelines for Community Health Houses. Eur J Public Health, 34(3).
25. Al-Ashbal MA, Lami F (2023). Performance evaluation of health houses in Iraq 2021–2022: A descriptive study. J Family Community Med, 30(2): 116-122.
26. Aghahasani M, Saghafipoor A, Farshid Moghadam M, et al (2019). Time meas-urement and workload of primary health care services in Qom's compre-hensive health centers based on Iran Health Transformation Plan. Iran Occup Health, 16(4): 83-95.
27. Zanganeh Bagigh M, Khammarnia M, Peavand M, et al (2019). A Review of the Timing and Performance Calibration of Health Care Workers' Activities of Health Homes. Sadra Med Sci J, 7(1): 11-22.
28. Bahadori M, Teymourzade E, Hosseini SH, et al (2017). Optimizing the Perfor-mance of Magnetic Resonance Imaging Department Using Queuing Theory and Simulation. Shiraz E Med J, 18(1): 1-9.
29. Delavari A, Vosoogh-Moghadam A, Kazemi Esfa Z, et al (2022). Comparison of the Level of Satisfaction of Service Recipients Between Government and Outsourced Health Posts Under Cover-age of South Tehran Health Center. sjsph, 20(1): 1-12.
30. Aeenparast A, Tabibi SJ, Shahanaghi K, et al (2009). Estimating outpatient waiting time: a simulation approach. Payesh, 8(4): 327-333.
31. El Khatib M, Alhosani A, Alhosani E, et al (2022). Simulation in Project and Pro-gram Management: Utilization, Chal-lenges and Opportunities. Am J Ind Bus Manag, 12(4): 731-749.
32. Atalan A (2022). A cost analysis with the discrete‐event simulation application in nurse and doctor employment man-agement. J Nurs Manag, 30(3): 733-741.
33. Castanheira-Pinto A, Gonçalves B, Lima R, et al (2021). Modeling, assessment and design of an emergency department of a public hospital through discrete-event simulation. Appl Sci, 11(2): 805.
34. Wang Z, Hu Z (2024). A discrete-event sim-ulation study for pre-hospital emergency systems. J Simul, 19(3): 1-21.
35. Lin W, Zhang L, Wu S, et al (2024). Opti-mizing the management of electrophys-iology labs in Chinese hospitals using a discrete event simulation tool. BMC Health Services Research volume, 24(1): 67.
36. Gorelova A, Meliá S, Gadzhimusieva D (2024). A Discrete Event Simulation of patient flow in an Assisted Reproduc-tion Clinic with the integration of a smart health monitoring system. IEEE Access, 12(99): 1-1.
37. Forbus J, Berleant D (2024). Using Dis-crete-Event Simulation to Balance Staff Allocation and Patient Flow Between Clinic and Surgery in a Pediatric Hospi-tal Setting. Modelling, 4(4): 567-584.
38. Lin Y, Hoyt A, Manuel V, et al (2024). Using Discrete Event Simulation to Design and Assess an AI-aided Workflow for Same-day Diagnostic Testing of Women Undergoing Breast Screening. AMIA Jt Summits Transl Sci Proc, 314-323.
39. Rodríguez A.V.B, Alfaro G.N.T, Gutiérrez J.A.T (2023). Simulation of Clinical La-boratory Process Improvement based on ISO 15189 Standard. In 2nd Australi-an International Conference on Indus-trial Engineering and Operations Man-agement.
40. Vázquez-Serrano JI, Cárdenas-Barrón LE, Vicencio-Ortiz JC, et al (2024). Hybrid optimization and discrete-event simula-tion model to reduce waiting times in a primary health center. Expert Systems with Applications, 238: 121920.
41. Shoaib M, Ramamohan V (2022). Simula-tion modeling and analysis of primary health center operations. Simul, 98(3): 183-208.
42. Aboutorabi A, Darvishi B, Rezapoor A, et al (2023). History of primary health care in Iran. J Prev Med Hyg, 64(3):E367–E374.
43. Chaman R, Amiri M, Bagheri H (2012). Cal-culation of per capita performance of employees working in health care cen-ters and health homes in Shahrood city. Knowl Health, 18(1): 75-81.
44. Moradi-Lakeh M, Vosoogh-Moghaddam A (2015). Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns. Int J Health Policy Manag, 4(10): 637-640.
45. Yazdanpanah M, Jafarzadeh S, Nkhaee N, et al (2018). Evaluation of human re-sources proportion to the volume of services provided in hospitals affiliated to Kerman University of Medical Sci-ences. Health_Based Research, 4(1): 95-108.
46. Alinejad R, Yousefi M, Ebrahimpoor H, et al (2020). Workload of Disease Control (Prevention) Section in Health Care Centers: Application of Work And Time Study Model. payavard, 14(2): 176-188.
47. Jaskiewicz W, Tulenko K (2012). Increasing community health worker productivity and effectiveness: a review of the influ-ence of the work environment. Hum Re-sour Health, 10: 38.
48. Yousefi M, Ahmadi M, Fazaeli S (2014). Staff Management Based On Perfor-mance: Application Of A Work Meas-urement Model In Hospital. Payavard Salamat, 8(1): 79-89.
49. Ajami S, Ketabi S, Bagherian MahmoodA-badi H (2013). Reducing waiting time in emergency department at Ayatollah-Kashani Hospital using simulation. jha, 16(51): 84-94.
50. Shoja N, Gholamabri A, Khalili N (2014). Performance Evaluation Health Houses of Firouzkouh City by Using Data En-velopment Analysis. Journal of Economic Modelling, 8(27): 53-69.
51. Hadipour H, Kavousi Kelashomi M, Salari A, et al (2017). Applications of Data En-velope Analysis Using Efficient or Inef-ficient Frontiers in Evaluating the Effi-ciency of Rural Healthcare Centers (Case Study: Langroud County). J Res Ru-ral Plan, 6(3): 203-216.
52. Nanakar R, Bagh Sheikhi Z, Soltanifar A (2008). Investigating the cost of health care services for the population covered by health centers in Kashan city. Homa Salamat, 6(2): 23-29.
53. Amiri M, Chamani R, Bagheri H, et al (2012). Cost Analysis and Per capita Per-formance of the Staff Working in Hy-giene Sectors of Shahroud University of Medical Sciences. Intern Med Today, 18(1): 75-81.
54. Stewart J (2022). Why was US labour productivity growth so high during the COVID-19 pandemic? The role of la-bour composition. Int Prod Monit, (42): 87-103.
55. Zeng Z, Ma X, Hu Y, et al (2012). A simula-tion study to improve quality of care in the emergency department of a com-munity hospital. J Emerg Nurs, 38(4): 322-8.
56. Noorizadeh Dehkordi S, Dadashzadeh L, Dadgoo M, et al (2014). Experience of Physiotherapists of Teamwork Results: A Qualitative Study. Phys Treat Spec Phys Ther J, 4(3): 161-168.
2. Tghvaei Yazdi M (2016). The Relationship between Organizational Health and Or-ganizational Trust to Social Responsibil-ity of Teachers in Sari Education Dis-trict. J New Approaches Educ Adm, 7(27): 95-116.
3. Negarandeh R, Kamran A, Heydari H (2022). Iran’s health system performance in achieving goals based on the World Health Organization’s framework: a scoping review. J Research Health, 12(2): 65-74.
4. Askarzade E, Nabizade Z, Goharinezhad S, et al (2023). Universal health coverage in Iran: a review of strengths, weaknesses, opportunities, and threats. Med J Islam Repub Iran, 37: 6.
5. Yanful B, Kirubarajan A, Bhatia D, et al (2023). Quality of care in the context of universal health coverage: a scoping re-view. Health Res Policy Syst, 21(1): 21.
6. Obubu M, Chuku N, Ananaba A, et al (2023). Evaluation of healthcare facilities and personnel distribution in Lagos State: implications on universal health coverage. Hosp Pract(1995), 51(2): 64-75.
7. Gharaee H, Azami Aghdash S, Farahbakhsh M, et al (2023). Public–private partnership in primary health care: an experience from Iran. Prim Health Care Res Dev, 24: e5.
8. Chen M,Huang X,Cheng J, et al. (2023). Ur-banization and vulnerable employment: Empirical evidence from 163 countries in 1991–2019. Cities, 135: 104208.
9. Khoshchashm K (2016). Rapid urbanization and healthy cities and healthy villages programs in the Eastern Mediterranean. In: Transforming Distressed Global Communities. 1st ed, Routledge, London, pp.277–302.
10. Razavi Fard H (2018). Urbanization and in-formal settlement challenges: Case study Tehran metropolitan city. Open House Int, 3(2): 77-82.
11. World Health Organization (2022). Region-al review: role of the private health sec-tor in the provision of essential health services in the Eastern Mediterranean Region. Available from: https://apps.who.int/iris/handle/10665/366798
12. Moore M, Gould P, Keary B (2003). Global urbanization and impact on health. Int J Hyg Environ Health, 206(4): 269–78.
13. Li X, Song J, Lin T, et al (2016). Urbaniza-tion and health in China: thinking at the national, local and individual levels. En-viron Health, 15: 113-123.
14. Asghar Pilehvar A (2021). Spatial-geographical analysis of urbanization in Iran. Humanit Soc Sci Commun, 8(1): 1-12.
15. Marvi A, Kokabisaghi F, Tabatabaee SS, et al (2024). Evaluation of the primary health care expansion program with public-private partnership in slum areas from the perspective of stakeholders: a qualitative study. BMC Prim Care, 25(1): 67.
16. Shafiee A, Kazemian S, Jalili A, et al (2024). Epidemiology and Prevalence of Dyslipidemia Among Adult Population of Tehran: The Tehran Cohort Study. Arch Iran Med, 27(2): 51-61.
17. Najarkolaei F, Rakhshbani F, Tavafian S, et al (2018). Health Education Performance in Health Houses: A Descriptive study from Iran during April-September 2011. Shiraz E Med J, 19(4): 1-6.
18. Hosseini SH, Takian AH, Sepehri MM, et al (2020). Effects and challenges of Health Transformation Plan in public health: views of public health providers. Dilemas Contemp Educ Polit Valores, 7(2): 1-22.
19. Rahbar A, Rahi L, Ebraze A, et al (2016). Compare Client Satisfaction in the Pub-lic Health Posts and Outsourced Health Posts Affiliated to Qom University of Medical Sciences in 2014. J Arak Univ Med Sci, 19(9): 67-77.
20. Tabrizi J, Pourasghar F, Gholamzadeh Nikjoo R (2019). Governance of Iranian Primary Health Care System: Percep-tions of Experts. Iran J Public Health, 48(3): 541-548.
21. Damari B (2019). Road Map of Health Area in Iran Health System. refahj, 18(70): 9-30.
22. Cooper WW, Seiford LM, Zhu J (2011). Handbook on data envelopment analy-sis. 2nd ed. Springer Science & Business Media, pp. 1-39.
23. Dargahi H, Darrudi AR (2019). Perfor-mance Assessment of Health Care Cen-ters in South Tehran Health Network. Manag Strateg Health Syst, 3(4): 264-275.
24. Scotellaro M, Cornio AR, Borgini A, et al (2024). Standardizing Primary Health Care in Italy: Operational Guidelines for Community Health Houses. Eur J Public Health, 34(3).
25. Al-Ashbal MA, Lami F (2023). Performance evaluation of health houses in Iraq 2021–2022: A descriptive study. J Family Community Med, 30(2): 116-122.
26. Aghahasani M, Saghafipoor A, Farshid Moghadam M, et al (2019). Time meas-urement and workload of primary health care services in Qom's compre-hensive health centers based on Iran Health Transformation Plan. Iran Occup Health, 16(4): 83-95.
27. Zanganeh Bagigh M, Khammarnia M, Peavand M, et al (2019). A Review of the Timing and Performance Calibration of Health Care Workers' Activities of Health Homes. Sadra Med Sci J, 7(1): 11-22.
28. Bahadori M, Teymourzade E, Hosseini SH, et al (2017). Optimizing the Perfor-mance of Magnetic Resonance Imaging Department Using Queuing Theory and Simulation. Shiraz E Med J, 18(1): 1-9.
29. Delavari A, Vosoogh-Moghadam A, Kazemi Esfa Z, et al (2022). Comparison of the Level of Satisfaction of Service Recipients Between Government and Outsourced Health Posts Under Cover-age of South Tehran Health Center. sjsph, 20(1): 1-12.
30. Aeenparast A, Tabibi SJ, Shahanaghi K, et al (2009). Estimating outpatient waiting time: a simulation approach. Payesh, 8(4): 327-333.
31. El Khatib M, Alhosani A, Alhosani E, et al (2022). Simulation in Project and Pro-gram Management: Utilization, Chal-lenges and Opportunities. Am J Ind Bus Manag, 12(4): 731-749.
32. Atalan A (2022). A cost analysis with the discrete‐event simulation application in nurse and doctor employment man-agement. J Nurs Manag, 30(3): 733-741.
33. Castanheira-Pinto A, Gonçalves B, Lima R, et al (2021). Modeling, assessment and design of an emergency department of a public hospital through discrete-event simulation. Appl Sci, 11(2): 805.
34. Wang Z, Hu Z (2024). A discrete-event sim-ulation study for pre-hospital emergency systems. J Simul, 19(3): 1-21.
35. Lin W, Zhang L, Wu S, et al (2024). Opti-mizing the management of electrophys-iology labs in Chinese hospitals using a discrete event simulation tool. BMC Health Services Research volume, 24(1): 67.
36. Gorelova A, Meliá S, Gadzhimusieva D (2024). A Discrete Event Simulation of patient flow in an Assisted Reproduc-tion Clinic with the integration of a smart health monitoring system. IEEE Access, 12(99): 1-1.
37. Forbus J, Berleant D (2024). Using Dis-crete-Event Simulation to Balance Staff Allocation and Patient Flow Between Clinic and Surgery in a Pediatric Hospi-tal Setting. Modelling, 4(4): 567-584.
38. Lin Y, Hoyt A, Manuel V, et al (2024). Using Discrete Event Simulation to Design and Assess an AI-aided Workflow for Same-day Diagnostic Testing of Women Undergoing Breast Screening. AMIA Jt Summits Transl Sci Proc, 314-323.
39. Rodríguez A.V.B, Alfaro G.N.T, Gutiérrez J.A.T (2023). Simulation of Clinical La-boratory Process Improvement based on ISO 15189 Standard. In 2nd Australi-an International Conference on Indus-trial Engineering and Operations Man-agement.
40. Vázquez-Serrano JI, Cárdenas-Barrón LE, Vicencio-Ortiz JC, et al (2024). Hybrid optimization and discrete-event simula-tion model to reduce waiting times in a primary health center. Expert Systems with Applications, 238: 121920.
41. Shoaib M, Ramamohan V (2022). Simula-tion modeling and analysis of primary health center operations. Simul, 98(3): 183-208.
42. Aboutorabi A, Darvishi B, Rezapoor A, et al (2023). History of primary health care in Iran. J Prev Med Hyg, 64(3):E367–E374.
43. Chaman R, Amiri M, Bagheri H (2012). Cal-culation of per capita performance of employees working in health care cen-ters and health homes in Shahrood city. Knowl Health, 18(1): 75-81.
44. Moradi-Lakeh M, Vosoogh-Moghaddam A (2015). Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns. Int J Health Policy Manag, 4(10): 637-640.
45. Yazdanpanah M, Jafarzadeh S, Nkhaee N, et al (2018). Evaluation of human re-sources proportion to the volume of services provided in hospitals affiliated to Kerman University of Medical Sci-ences. Health_Based Research, 4(1): 95-108.
46. Alinejad R, Yousefi M, Ebrahimpoor H, et al (2020). Workload of Disease Control (Prevention) Section in Health Care Centers: Application of Work And Time Study Model. payavard, 14(2): 176-188.
47. Jaskiewicz W, Tulenko K (2012). Increasing community health worker productivity and effectiveness: a review of the influ-ence of the work environment. Hum Re-sour Health, 10: 38.
48. Yousefi M, Ahmadi M, Fazaeli S (2014). Staff Management Based On Perfor-mance: Application Of A Work Meas-urement Model In Hospital. Payavard Salamat, 8(1): 79-89.
49. Ajami S, Ketabi S, Bagherian MahmoodA-badi H (2013). Reducing waiting time in emergency department at Ayatollah-Kashani Hospital using simulation. jha, 16(51): 84-94.
50. Shoja N, Gholamabri A, Khalili N (2014). Performance Evaluation Health Houses of Firouzkouh City by Using Data En-velopment Analysis. Journal of Economic Modelling, 8(27): 53-69.
51. Hadipour H, Kavousi Kelashomi M, Salari A, et al (2017). Applications of Data En-velope Analysis Using Efficient or Inef-ficient Frontiers in Evaluating the Effi-ciency of Rural Healthcare Centers (Case Study: Langroud County). J Res Ru-ral Plan, 6(3): 203-216.
52. Nanakar R, Bagh Sheikhi Z, Soltanifar A (2008). Investigating the cost of health care services for the population covered by health centers in Kashan city. Homa Salamat, 6(2): 23-29.
53. Amiri M, Chamani R, Bagheri H, et al (2012). Cost Analysis and Per capita Per-formance of the Staff Working in Hy-giene Sectors of Shahroud University of Medical Sciences. Intern Med Today, 18(1): 75-81.
54. Stewart J (2022). Why was US labour productivity growth so high during the COVID-19 pandemic? The role of la-bour composition. Int Prod Monit, (42): 87-103.
55. Zeng Z, Ma X, Hu Y, et al (2012). A simula-tion study to improve quality of care in the emergency department of a com-munity hospital. J Emerg Nurs, 38(4): 322-8.
56. Noorizadeh Dehkordi S, Dadashzadeh L, Dadgoo M, et al (2014). Experience of Physiotherapists of Teamwork Results: A Qualitative Study. Phys Treat Spec Phys Ther J, 4(3): 161-168.
| Files | ||
| Issue | Vol 54 No 8 (2025) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i8.19584 | |
| Keywords | ||
| Health House Health post Simulation-based scenario Performance scenario | ||
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How to Cite
1.
Hosseini SH, Takian A, Amerzadeh M, Poormoosa Y. Simulation-Based Performance Scenarios for a Health House and Health Post: An Empirical Study. Iran J Public Health. 2025;54(8):1754-1764.
