A hybrid simulation framework to evaluate the patient access to public health in Brazil

Healthcare has been one of the domains which have benefited from the exponential growth of academic literature on Hybrid Simulation (HS). HS is defined as the approach which combines two or more simulation methods, and System Dynamics (SD), Discrete Event Simulation (DES) and Agent-Based Simulation (ABS) are the three most frequent mixed methods. HS publications frequently focus on System Dynamics (SD) and Discrete Event Simulation (DES) hybrid models. Hybrid Discrete Event Simulation and Agent-Based Simulation (ABS) models, especially studies with stakeholder involvement over the simulation life cycle, are still unexplored in literature. The involvement of stakeholders shown to be useful in stand-alone simulation studies. In those cases, stakeholder involvement throughout the simulation lifecycle increases the participant commitment and enhances the quality of the outcomes. Additionally, those simulation studies are keener to implement their findings. Therefore, this research aims to propose a DES-ABS hybrid model framework, with active stakeholder participation, applied to public health in Brazil for evaluating the use of telehealth in delivering primary care. This framework is based on the PartiSim methodology (Tako and Kotiadis 2015) and consists of six main stages: study initiation, finding out about the problem, defining conceptual model, model coding, experimentation, and implementation. For all stages, stakeholders participate actively in the development of the DES-ABS hybrid model.