Altering the environment to improve appointment system performance

Abstract

Current research on clinic performance is focused primarily on appointment scheduling rather than shaping the clinical environments. The goal of this study is to investigate the impact of environmental factors on the total cost performance of a clinic, measured as a weighted sum of patients' wait times and physician's idle time and overtime. The environmental factors investigated include the variability of service times, the probabilities of no-shows and walk-ins, the number of appointments per session, and the cost ratio of physician's time to patients' time. The effects of these factors are evaluated using a near-optimal rule that already adjusts the patients' appointment times to minimize the negative effects of these factors so that their residual or true effects on total cost performance can be isolated. As a result, this study provides useful insights for healthcare practitioners in prioritizing their efforts in managing the different sources of variability to further improve the clinic performance beyond the use of an optimal or near-optimal appointment rule. Additional experiments are conducted on the effects of patient and physician unpunctuality, which have been studied to a lesser extent in prior literature.