Abstract for: Understanding Operating Theatre Inefficiencies Through System Dynamics Modelling for Surgical Planning in Singapore’s Public Healthcare System

Rapid population ageing, demographic shifts, evolving population health policies, technological advancements, and changing health-seeking behaviours are expected to significantly reshape healthcare demand and care delivery patterns. These developments necessitate a reassessment of the (OT) system design to ensure alignment with the long-term healthcare strategies. This study employs a system dynamics (SD) modelling approach to investigate the dynamic hypothesis (DH) that persistent OT inefficiencies (manifested as prolonged waiting times for specialist consultations and elective surgeries and suboptimal utilisation rates) are primarily driven by a delay-mediated mismatch between surgical demand and OT capacity. Such mismatches are further amplified by feedback loops involving surgery postponements, cancellations, and delayed capacity expansion. Our Causal Loop Diagram shows the systemic structure that produces patterns of behaviour in key metrics – Wait Time to Appointment (WTA), Wait Time to Surgery (WTS), Specialist Outpatient utilisation, and OT utilisation. Our preliminary stock and flow model captures how capacity adjustments react with patient flows and the performance of the system influenced by the key metrics. Through scenario analysis and the evaluation of alternative strategies, this research aims to support evidence-based strategic planning for surgical services and contribute to the development of robust and adaptive OT capacity plans that can accommodate future uncertainties in Singapore’s healthcare system.