The aim of this work is to present the practical applications of an integrated use of soft and hard methodologies applied in a case study of the Surgical Centre of the University Hospital Clementino Fraga Filho, where the low volume of surgeries is of major concern. The proposed approach is particularly appropriate in situations where there is limited time, financial resources, and institutional cooperation. Cognitive maps were used to elicit the perspectives of health professionals, which supported simulation experiments and guided the model's execution. Human-resource, patient-related, room-schedule, material, and structural constraints were found to affect the number of surgeries performed. The major contribution of this paper is the proposal of a multi-methodological approach with a committed focus on problem solving that incorporates specialists' views in simulation experiments; these specialists’ collaborative work highlights actions that can lead to the resolution (or improvement) of real-world problems. 
Integrating soft and hard operational research to improve surgical centre management at a university hospital