## 5 Simulations
### Real Case Study  
Figure 4a shows the _expected occupation rate_ in each time block. The average value obtained using CIPLAN (77.44%) is greater than using the manual method (75%). Moreover, in the scheduling obtained using CIPLAN, the values of the expected occupation rate in each time block are more concentrated around the average value (\(\sigma=3.61\)) than using the manual scheduling (\(\sigma=7.42\)). Figure 4: Comparison of manual and CIPLAN scheduling. A set of 24 time blocks has been scheduled manually and using CIPLAN. The following values are shown: (**a**) expected occupation rate; (**b**) real occupation rate; (**c**) confidence level of not exceeded the available time; (**d**) ending time. In Figure 4b, the _real occupation rate_ obtained in each time block is shown. Again, the average value obtained using CIPLAN (77.86%) is greater than the average value using the manual method (75.03%). Using CIPLAN, the improvement in the occupation rate with respect to use the manual method is 2.83%. In Figure 4b, it is also possible to see that using CIPLAN there are some time blocks (1, 2, 23, and 24) with occupation rates too high (about 90%) and could lead to exceeding the available time. This does not happen in manual scheduling. Analyzing the results, it has been observed that it happens because the scheduler (in the manual method) knows the surgery skill of the surgeon and can estimate better the expected duration of the surgery depending on the surgeon. However, the CIPLAN scheduling algorithm initially uses the average duration of the surgeries. These average durations are computed considering historical data, independently from the surgeon. As the tool is used, the time spent in each surgery as well as the surgeon who performs it will be registered in CIPLAN. Thus, the surgery duration will be more and more customized depending on the surgeon and better results will be obtained. In Figure 4c, the confidence level of not exceeding the available time is shown. The corresponding values are computed by considering the average duration and the standard deviation of each surgery. It can be seen that using CIPLAN does not exist time blocks with a confidence level lower than 69%. However, using the manual method, there are several time blocks with a really low confidence level. For example, in time block 4, the confidence level of not exceeding the available time is only 23.3%. Again, these low values are obtained since the scheduler knows the surgery skills of the surgeon. Particularly, in time block 4, three knee arthroplasties have been scheduled. Considering the average duration and the standard deviation based on historical data, the expected occupation rate is 94.8% and the confidence level that will not exceed the available time is 23.3%. However, the scheduler knows that the surgeon who has to perform the knee arthroplasties needs 25 min less than the average duration of the team. Consequently, the real occupation rate obtained is 73.3% and the time block ends at 13:52. Figure 4d shows the ending time of each block. It can be observed that, using CIPLAN, there are four time blocks (1, 2, 13, and 24) ending around 3:00 p.m. and the time block 23 exceeding the available time 30 min (ending 15:30). This situation does not happen in manual scheduling. According to the results obtained in the case study, the quality of the service decreases, because some blocks exceed the available time. However, this situation will be solved when the average duration and standard deviation of the surgeries will be customized depending on the surgeon. This customization will allow that the real occupation rate will be more similar to the expected one and, consequently, not only the number of blocks exceeding the available time will decrease, but also the total exceeding time. In Figure 5, the time execution of the manual (a) and automatic (b) scheduling are shown by two bar-graphs. Each row is composed by boxes that represent different actions in one surgical time block.