Using simulation to test ideas for improving speech language pathology services

Speech language programs aim to prevent and correct disorders of language, speech, voice and fluency. Speech problems in children can adversely affect emotional, educational and occupational development. In the past several years, a particular health region in Saskatchewan, Canada has experienced an increase in the number of preschool children referred for speech language therapy. Indeed, current wait times from referral to first appointment are well in excess of one year and one-tenth of patients do not receive any service before entering school. In an effort to demonstrate successful operational research (OR) practice through improving patient flow, we developed a discrete-event simulation model to test change ideas proposed by speech language therapists. These change ideas involved increasing the percentage of group treatments (rather than having a majority of patients treated individually), using a paraprofessional to complete many of the routine tasks currently covered by the therapists, standardizing appointment durations, hiring additional therapists and incorporating block treatment scheduling. We also tested combinations of the above strategies in order to determine the impact of simultaneously adopting different change ideas. Some strategies showed considerable promise for improving patient flow and are now being used in actual practice.