Faculty Profile

Joe Viana

Postdoctoral Fellow - Department of Accounting, Auditing and Business Analytics


Viana, Joe; Simonsen, Tone Breines, Faraas, Hildegunn E., Schmidt, Nina, Dahl, Fredrik Andreas & Flo, Kari (2020)

Capacity and patient flow planning in post-term pregnancy outpatient clinics: a computer simulation modelling study

BMC Health Services Research, 20(117) Doi: 10.1186/s12913-020-4943-y

Background: The demand for a large Norwegian hospital’s post-term pregnancy outpatient clinic has increased substantially over the last 10 years due to changes in the hospital’s catchment area and to clinical guidelines. Planning the clinic is further complicated due to the high did not attend rates as a result of women giving birth. The aim of this study is to determine the maximum number of women specified clinic configurations, combination of specified clinic resources, can feasibly serve within clinic opening times. Methods: A hybrid agent based discrete event simulation model of the clinic was used to evaluate alternative configurations to gain insight into clinic planning and to support decision making. Clinic configurations consisted of six factors: X0: Arrivals. X1: Arrival pattern. X2: Order of midwife and doctor consultations. X3: Number of midwives. X4: Number of doctors. X5: Number of cardiotocography (CTGs) machines. A full factorial experimental design of the six factors generated 608 configurations. Results: Each configuration was evaluated using the following measures: Y1: Arrivals. Y2: Time last woman checks out. Y3: Women’s length of stay (LoS). Y4: Clinic overrun time. Y5: Midwife waiting time (WT). Y6: Doctor WT. Y7: CTG connection WT. Optimisation was used to maximise X0 with respect to the 32 combinations of X1-X5. Configuration 0a, the base case Y1 = 7 women and Y3 = 102.97 [0.21] mins. Changing the arrival pattern (X1) and the order of the midwife and doctor consultations (X2) configuration 0d, where X3, X4, X5 = 0a, Y1 = 8 woman and Y3 86.06 [0.10] mins. Conclusions: The simulation model identified the availability of CTG machines as a bottleneck in the clinic, indicated by the WT for CTG connection effect on LoS. One additional CTG machine improved clinic performance to the same degree as an extra midwife and an extra doctor. The simulation model demonstrated significant reductions to LoS can be achieved without additional resources, by changing the clinic pathway and scheduling of appointments. A more general finding is that a simulation model can be used to identify bottlenecks, and efficient ways of restructuring an outpatient clinic. Keywords: Simulation, Post-term pregnancies, Patient flow, Capacity planning, Optimisation, Outpatient

Rand, Kim; Dahl, Fredrik Andreas, Viana, Joe, Rønning, Ole M., Faiz, Kashif Waqar & Barra, Mathias (2019)

Fewer ischemic strokes, despite an ageing population: stroke models from observed incidence in Norway 2010–2015

BMC Health Services Research, 19(1) Doi: 10.1186/s12913-019-4538-7

Willis, Rosalind; Channon, Andrew Amos, Viana, Joe, LaValle, Maria Herica & Hutchinson, Aisha (2019)

Resurrecting the interval of need concept to improve dialogue between researchers, policymakers, and social care practitioners

Health and Social Care in the community Doi: 10.1111/hsc.12769

Barra, Mathias; Labberton, Angela Susan, Faiz, Kashif Waqar, Lindstrøm, Jonas Christoffer, Rønning, Ole M., Viana, Joe, Dahl, Fredrik Andreas & Rand, Kim (2019)

Stroke incidence in the young: evidence from a Norwegian register study

Journal of Neurology, s. 1- 17. Doi: 10.1007/s00415-018-9102-6

Viana, Joe; Simonsen, Tone Breines, Dahl, Fredrik Andreas & Flo, Kari (2018)

A hybrid discrete event agent based overdue pregnancy outpatient clinic simulation model

Winter simulation conference : proceedings, s. 1488- 1499. Doi: 10.1109/WSC.2018.8632282

Rand, Kim; Viana, Joe & Dahl, Fredrik Andreas (2017)

Combining bootstrap-based stroke incidence models with discrete event modeling of travel-time and stroke treatment: non-normal input and non-linear output

Winter simulation conference : proceedings, s. 1670- 1679. Doi: 10.1109/WSC.2017.8247906

Viana, Joe; Ziener, Vigdis Margrethe, Ponton, Irene Gynnild, Holhjem, Marita Sommer, Thøgersen, Lisa Johanne & Simonsen, Tone Breines (2017)

Optimizing home hospital health service delivery in norway using a combined geographical information system, agent based, discrete event simulation model

Winter simulation conference : proceedings, s. 1658- 1669. Doi: 10.1109/WSC.2017.8247905

Viana, Joe; Rand-Hendriksen, Kim, Simonsen, Tone Breines, Barra, Mathias & Dahl, Fredrik Andreas (2016)

Do hybrid simulation models always increase flexibility to handle parametric and structural changes?

Winter simulation conference : proceedings, s. 1439- 1450. Doi: 10.1109/WSC.2016.7822196

Rand-Hendriksen, Kim; Viana, Joe, Barra, Mathias & Dahl, Fredrik Andreas (2016)

Conflicts or synergy when combining modeling approaches - Perspectives from psychology

Winter simulation conference : proceedings Doi: 10.1109/WSC.2016.7822198

Viana, Joe; Simonsen, Tone Breines, Rand, Kim, Barra, Mathias & Dahl, Fredrik Andreas (2019)

The development of workshops to introduce computer simulation modelling health care decision-makers in familiar contexts

[Academic lecture]. Den tredje nasjonale konferansen i helsetjenesteforskning.

Title: The development of workshops to introduce computer simulation modelling health care decision-makers in familiar contexts. Authors: Joe Viana, Tone Breines Simonsen, Kim Rand, Mathias Barra and Fredrik Dahl Abstract (300 word limit) Background Computer simulation modelling (modelling) provides a virtual “safe” environment to evaluate potential changes to systems, before implemented those changes in reality. Many sectors use modelling in the decision-making process, including but not limited to finance, engineering, manufacturing, space and aviation, military and healthcare. Purpose The other industries use modelling more than healthcare. This paper presents three case studies to illustrate modelling applied to health and social care systems. Case 1: Chlamydia (UK) - a model of screening linked with an operational level model of a sexual health clinic to examine the cost effectiveness of different screening programmes. Case 2: Age Related Macular Degeneration (UK) – individual eye based physiological models of the progression of the disease, linked with models of that individual’s social care needs, and the operation of a hospital eye unit to examine how the health and social care systems interactions affect each other’s resources and the impact on the sufferers. Case 3: Post Term Pregnancy clinic (NO) – a model of the operation of a post-term pregnancy clinic, to improve the flow of women through the clinic, to make better use of resources and improve the women’s experience. Method & Results The case studies utilise three main simulation paradigms, Discrete Event Simulation (DES), Agent Based Modelling/Simulation (ABM/ABS) and System Dynamics (SD). We will summarise the method(s) and results for each case study. Utilising the authors’ experience and existing modelling and problem structuring frameworks and literature, we are developing a workshop approach to introduce modelling to potential users through eliciting a problem of particular interest to them. We will discuss the proposed workshop design. Conclusions We introduced simulation case studies that have informed health/social care decision making. To disseminate the use of modelling we present a workshop approach to engage with the healthcare sector.

Viana, Joe (2019)

Research governance and ethical challenges for simulation studies: Should we develop guidelines?

[Academic lecture]. EURO working group Operational Research Applied to Health Services (ORAHS).

This talk focuses on the Research Ethics Committee (REC), and Data Privacy and Governance (data access) challenges researchers face who apply Operational Research (OR) techniques, such as simulation, to better understand and improve Health and Social care systems. It is not uncommon for a REC to judge OR research as service improvement, quality assurance, or other research outside their mandate. Protection of data, privacy and exemption from consent are the main concerns that need to be carefully considered by researchers and Data Privacy and Governance specialists. A selection of guidelines and review papers including those from the health care economic guidelines that can support the application process will be presented and assessed e.g. ISPOR-SMDM (International Society for Pharmacoeconomics and Outcomes Research-Society for Medical Decision Making) and STRESS (Strengthening the reporting of empirical simulation studies). The author will reflect on experiences from the UK and Norway. It is hoped that the session will prompt a discussion between colleagues from different sectors in different countries about application strategies, to share guidelines, literature, and advice.

Simonsen, Tone Breines; Viana, Joe, Faraas, Hildegunn E., Schmidt, Nina, Dahl, Fredrik Andreas & Flo, Kari (2019)

Driftsplanlegging i en kvinneklinikk ved hjelp av simuleringsmodellering

[Academic lecture]. Jordmordagene 2019.

Barra, Mathias; Labberton, Angela Susan, Faiz, Kashif Waqar, Lindstrøm, Jonas Christoffer, Rønning, Ole M., Viana, Joe, Dahl, Fredrik Andreas, Rand, Kim & Næss, Halvor (2019)

Slaginsidens i alle aldre – tidstrender og fremskrivninger

[Academic lecture]. Hjerte- og karregisterseminaret 2019.

Vogt, Yngve; Häikiö, Kristin, Rand, Kim, Labberton, Angela Susan, Cheng, Socheat, Nyttingnes, Olav, Saddiqui, Tahreem, Kristvik, Ellen Elisabeth, Beddari, Henriette Høyer, Viana, Joe, Bråten, Beret, Barra, Mathias, Lindstrøm, Jonas Christoffer, Kakad, Meetali & Menichetti, Julia (2019)

Helse-Norge kan spare mye penger - se de 15 ideene

[Popular scientific article]. Apollon : Forskningsmagasin for Universitetet i Oslo

Viana, Joe; Rødøy, Lise Raanes, Rojahn, Tone, Simonsen, Tone Breines & Dahl, Fredrik Andreas (2018)

Improving chemotherapy drug production at Radium Hopsital Oslo

[Academic lecture]. Helstejenesteforskningskonferansen.

The preparation of drugs is a crucial logistical challenge for health services. Each drug has its own recipe, requiring different raw ingredients, each with potentially different shelf lives. Patients require different drug courses which follow specific protocols in terms of when the drugs are required, how much is required and how frequently. The drug preparation facility at the Radium Hospital produces primarily chemotherapy drugs for the Radium hospital and other public and private hospitals in Oslo. The facility has invested in a robot to prepare drugs alongside pharmacists. The pharmacy is interested in exploring the best way to allocate requests to the pharmacists and the robot given their constraints and operating procedures, subject to the following: the urgency of request, e.g. children and other more vulnerable patients such as urgent requests from outpatients, allocation of drug requests between different pharmacists and to the robot, the pick-up schedule for completed drugs, the number of hospitals they produce drugs for, the pharmacy opening hours, the procedures and pathways, staff schedules and the robot’s maintenance schedule. A Discrete Event Simulation model has been combined with an Agent Based Model to evaluate suggested quality improvements, and evaluate specific research questions defined by the model stakeholders. Data was collected from January 2016 to May 2017. The data collected was a mixture of manually collected observations and data available from various hospital systems. The model will be validated against historical data and used to evaluate the effectiveness of alternative procedures, prior to implementation, to predict what affect these proposed changes would have on operations. The model will project forward over a 3-year time horizon. Three scenarios of interest to model stakeholders are evaluated in the model, with the data currently available. The modelling work identified several areas where better data could be collected and/or estimated.

Rand, Kim; Dahl, Fredrik Andreas, Barra, Mathias, Viana, Joe & Faiz, Kashif Waqar (2018)

Fremskrivinger av forekomst av hjerneslag i Norge

[Academic lecture]. Helsetjenesteforskningskonferansen 2018.

Simonsen, Tone Breines; Faraas, Hildegunn E., Schmidt, Nina, Viana, Joe, Flo, Kari & Dahl, Fredrik Andreas (2018)

Driftsplanlegging i en kvinneklinikk ved hjelp av simuleringsmodellering

[Academic lecture]. Helsetjenesteforskningskonferansen 2018.

Rand, Kim; Viana, Joe, Barra, Mathias & Dahl, Fredrik Andreas (2017)

Using bootstrapping to reflect variance in resource demand in simulation modeling of patient flow; the case of stroke treatment in Norway

[Academic lecture]. Operational Research Applied to Health Services 2017.

Dahl, Fredrik Andreas; Rand, Kim, Viana, Joe, Barra, Mathias & Simonsen, Tone Breines (2017)

Effects of stroke on labour force participation for patients and family caregivers

[Academic lecture]. Operational Research Applied to Health Services.

Viana, Joe; Rødøy, Lise Raanes, Rojahn, Tone, Simonsen, Tone Breines & Dahl, Fredrik Andreas (2017)

Using a combined discrete event simulation agent based model to improve drug production at the Radium Hospital, Norway

[Academic lecture]. Operational Research Applied to Health Services.

Viana, Joe; Simonsen, Tone Breines, Schmidt, Nina, Rand, Kim & Dahl, Fredrik Andreas (2017)

Simulation modelling of patient flow in the Obstetrics department at Akershus Universitetssykehus.

[Academic lecture]. Nasjonal forskningskonferanse i helsetjenesteforskning.

Barra, Mathias; Rand, Kim, Faiz, Kashif Waqar, Viana, Joe & Dahl, Fredrik Andreas (2017)

Survival of the fittest? Frailty modelling of stroke incidence.

[Academic lecture]. ORAHS2017.

Viana, Joe; Rand-Hendriksen, Kim, Simonsen, Tone Breines, Dahl, Fredrik Andreas & Barra, Mathias (2016)

Flexible healthcare hybrid simulation modeling

[Academic lecture]. Operational Research Applied to Health Services 2016.

Dahl, Fredrik Andreas; Viana, Joe & Rand-Hendriksen, Kim (2016)

Association between hospital occupancy and mortality

[Academic lecture]. Operational Research Applied to Health Services 2016.

Rand-Hendriksen, Kim; Viana, Joe & Dahl, Fredrik Andreas (2016)

Too obvious to mention? Some simple ways in which running empirical data directly through simulation models can be used to identify flaws in models and data

[Academic lecture]. Operational Research Applied to Health Services 2016.

Simulation models of hospital activities have often required manual data collection, observation, and other forms of activity sampling. Due to the increasingly pervasive automatic and semi-automatic data collection in electronic journals and other computer systems, many model parameters (arrival times, transition probabilities, lengths of stay, patient characteristics) can now be estimated based on complete empirical records. Interestingly, while the literature on simulation modeling has much to say about how such models can be validated and compared to empirical data, there is a curious lack of mention of a verification procedure that should be obvious: models built to reflect and represent a reality in the form of a complete empirical record should be able to run the empirical records in question without encountering problems. Consider a maternity ward with delivery rooms, regular patient rooms, and a patient hotel (hotel-like rooms with nursing staff for low-risk patients). Most women arrive shortly before birth, and move to the patient hotel quickly after. Other patients move between rooms several times, and some occupy regular hospital both prior to and after delivery. Our aim is to model the impact of expected changes in the demographic makeup within the catchment area, and investigate the possible benefits of altering the schedules for when patients are discharged, and how empty rooms are made ready for new patients. We create a simulation model with rooms, beds, and staff based on information from the ward administration. Distributions for patient admission, length of stay, and transition between rooms are all estimated based on complete empirical records from the electronic journal system. Before going any further, we alter the model in such a way as to allow the generation of agents (patients) directly based on the electronic record. That is, each patient in the electronic record is set to appear in the model at a time matching the record, and is set to move around and occupy resources exactly as recorded. This procedure is deterministic. If contradictions occur, such as the occupancy reaching levels beyond what is available, we need to look for problems in the model or in the data. If the model behaves well, we can sequentially «turn on» assumed model parameters one at a time, for example enforcing the restriction on number of beds, in order to verify that all assumed parameters are able to accommodate the real record. This procedure rests on the availability of full empirical records, and on the model in question being built to accommodate those records. We assume that the lack of mention of these kinds of verification procedure in the literature is caused by the historic rarity of models in which this is possible have been relatively rare, and that procedure has been considered too obvious to mention. We present a real-world example based on models of the maternity ward in a university hospital in Norway, and show how procedures such as these have been surprisingly useful in identifying flaws in the model and errors in the empirical records.

Academic Degrees
Year Academic Department Degree
2011 University of Southampton, UK PhD