Purpose ‐ The purpose of this paper is to carry out the business process re-engineering (BPR) of a surgical ward in a hospital in order to improve the efficiency of the ward. Design/methodology/approach ‐ This work was developed using a case study on a surgical ward. In this type of ward, in which scheduled and unscheduled operations often have to coexist and be managed, ways to minimise patient inconvenience need to be studied. A framework based on event-driven process chains (EPCs) methodology, the entity-relationship model and discrete event simulation is presented to define and analyse the current state of a surgical ward and design a future system. The modelling of the processes, activities and sub-activities, which took up a great amount of ward resources, allowed a what-if analysis to be developed which simulates various scenarios and assesses their performance. Findings ‐ Using Delphi methodology, it was possible to identify a number of areas for improvement: number of operating sessions, preparation of the operating rooms for each operation, availability of specific surgical instruments. Moreover, the discrete event simulation approach led to an understanding of the most efficient management choices. Originality/value ‐ The decision to use Delphi methodology for the information collection stage before starting the BPR process is not found in other studies in the literature. Moreover, the use of models based on EPCs methodology allowed the panel of experts to develop models to examine and understand the resource requirements of medical assessment units and to provide a framework or develop standards that hospital developers and clinical managers can consult.