Conditional Value at Risk as a Measure for Waiting Time in Simulations of Hospital Units

Abstract The utility of conditional value at risk (CVaR) of a sample of waiting times as a measure for reducing long waiting times is evaluated with special focus on patient waiting times in a hospital. CVaR is the average of the longest waiting times, i.e., a measure at the tail of the waiting time distribution. The presented results are based on a discrete event simulation (DES) model of an orthopedic surgical unit at a university hospital in Denmark. Our analysis shows that CVaR offers a highly reliable performance measure. The measure targets the longest waiting times and these are generally accepted to be the most problematic from the points of view of both the patients and the management. Moreover, CVaR can be seen as a compromise between the well known measures: average waiting time and the maximum waiting time.

[1]  D. E. Roberts,et al.  The Upper Tail Probabilities of Spearman's Rho , 1975 .

[2]  G. Bevan,et al.  "Systematic" , 1966, Comput. J..

[3]  S.C. Brailsford,et al.  Tutorial: Advances and challenges in healthcare simulation modeling , 2007, 2007 Winter Simulation Conference.

[4]  Emre A. Veral,et al.  OUTPATIENT SCHEDULING IN HEALTH CARE: A REVIEW OF LITERATURE , 2003 .

[5]  Phil Howlett,et al.  The Mekong—applications of value at risk (VaR) and conditional value at risk (CVaR) simulation to the benefits, costs and consequences of water resources development in a large river basin , 2007 .

[6]  David J. Groggel,et al.  Practical Nonparametric Statistics , 2000, Technometrics.

[7]  Marvin K. Nakayama,et al.  Output Analysis for Simulations , 2006, Proceedings of the 2006 Winter Simulation Conference.

[8]  P. Rosenbaum,et al.  Conditional Length of Stay. , 1999, Health services research.

[9]  D. Krahl,et al.  The Extend simulation environment , 2000, Proceeding of the 2001 Winter Simulation Conference (Cat. No.01CH37304).

[10]  David Krahl Extend: the Extend simulation environment , 2002, WSC '02.

[11]  Nathalie Demoulin,et al.  Waiting time influence on the satisfaction‐loyalty relationship in services , 2007 .

[12]  Sheldon Howard Jacobson,et al.  Application of discrete-event simulation in health care clinics: A survey , 1999, J. Oper. Res. Soc..

[13]  Sally C. Brailsford,et al.  Advances and challenges in healthcare simulation modeling: tutorial , 2007, WSC.

[14]  T. Coleman,et al.  Minimizing CVaR and VaR for a portfolio of derivatives , 2006 .

[15]  Jack P. C. Kleijnen,et al.  EUROPEAN JOURNAL OF OPERATIONAL , 1992 .

[16]  Loon Ching Tang,et al.  Mean residual life of lifetime distributions , 1999 .

[17]  A. I. Kibzun,et al.  Analysis of criteria VaR and CVaR , 2006 .

[18]  M. Hollander,et al.  Testing Whether New is Better Than Used , 1972 .

[19]  Philip H. Ramsey Nonparametric Statistical Methods , 1974, Technometrics.

[20]  Brian T. Denton,et al.  Simulation of a Multiple Operating Room Surgical Suite , 2006, Proceedings of the 2006 Winter Simulation Conference.

[21]  S. Sheather Density Estimation , 2004 .

[22]  David M. Ferrin,et al.  Maximizing hospital finanacial impact and emergency department throughput with simulation , 2007, 2007 Winter Simulation Conference.

[23]  Javier García-González,et al.  Risk-averse profit-based optimal scheduling of a hydro-chain in the day-ahead electricity market , 2007, Eur. J. Oper. Res..

[24]  R. Rockafellar,et al.  Conditional Value-at-Risk for General Loss Distributions , 2001 .

[25]  Andrey I. Kibzun,et al.  Comparison of VaR and CVaR Criteria , 2003 .

[26]  David M. Ferrin,et al.  Merging six emergency departments into one: A simulation approach , 2007, 2007 Winter Simulation Conference.