improving patient waiting time in the emergency department using system dynamics modeling (case study: kosar hospital, semnan)

The emergency department, as one of the most critical components of the healthcare system, constantly faces challenges such as crowding and prolonged patient waiting times. these issues not only increase staff workload but can also reduce the quality of care and patient satisfaction. given the necessity of improving emergency department performance, system dynamics modeling serves as an effective tool to understand system behavior under varying conditions and to evaluate the impact of managerial and operational interventions. the aim of focuses on policy-based improvement rather than formal mathematical optimization, using system dynamics simulation to evaluate alternative intervention scenarios.the study began with a systematic review of scientific literature and prior experience related to emergency department management and patient waiting time reduction. subsequently, semi-structured interviews were conducted with key experts—including physicians, nurses, and hospital managers—to identify the factors influencing patient flow and waiting time. based on these findings, a system dynamics model was developed and simulated in vensim. three managerial and operational scenarios were designed: controlling patient arrival rates and increasing triage capacity, improving workforce effectiveness by enhancing physician-to-patient and nurse-to-patient ratios, and a combined scenario involving the simultaneous implementation of all interventions. the results revealed that the combined scenario produced the greatest improvement, leading to a substantial reduction in the overall average waiting time.overall, the findings indicate that the simultaneous implementation of managerial and operational interventions yields the greatest synergistic effect and can serve as an effective strategy to optimize emergency department performance, reduce congestion, and enhance the quality of hospital services.