Enhancing outpatient appointment scheduling system performance when patient no-show percent and lateness rates are high

Int J Health Care Qual Assur. 2018 May 14;31(4):309-326. doi: 10.1108/IJHCQA-06-2015-0072.


Purpose High lateness and no-show percentages pose great challenges on the patient scheduling process. Usually this is addressed by optimizing the time between patients in the scheduling process and the percent of extra patients scheduled to account for absent patients. However, since the patient no-show and lateness is highly stochastic we might end up with many patients showing up on time which leads to crowded clinics and high waiting times. The clinic might end up as well with low utilization of the doctor time. The purpose of this paper is to study the effect of scheduled overload percentages and the patient interval on the waiting time, overtime, and the utilization. Design/methodology/approach Actual data collection and statistical modeling are used to model the distribution for common dentist procedures. Simulation and validation are used to model the treatment process. Then algorithm development is used to model and generate the patient arrival process. The simulation is run for various values of basic interval scheduled time between arrivals for the patients. Further, 3D graphical illustration for the objectives is prepared for the analysis. Findings This work initially reports on the statistical distribution for the common procedures in dentist clinics. This can be used for developing a scheduling system and for validating the scheduling algorithms developed. This work also suggest a model for generating patient arrivals in simulation. It was found that the overtime increases excessively when coupling both high basic interval and high overloading percentage. It was also found that: to obtain low overtime we must reduce the basic interval. Waiting time increases when reducing the basic scheduled appointment interval and increase the scheduled overload percentage. Also doctors' utilization is increased when the basic interval is reduced. Research limitations/implications This work was done at a local clinic and this might limit the value of the modeled procedure times. Practical implications This work presents a statistical model for the various procedures and a detailed technique to model the operations of the clinics and the patient arrival time which might assist researches and developers in developing their own model. This work presents a procedure for troubleshooting scheduling problems in outpatient clinics. For example, a clinic suffering from high patient waiting time is directly instructed to slightly increase their basic scheduled interval between patients or slightly reduce the overloading percentage. Social implications This work is targeting an extremely important constituent of the health-care system which is the outpatient clinics. It is also targeting multiple objectives namely waiting times, utilization overtime, which in turn is related to the economics and doctor utilization. Originality/value This work presents a detailed modeling procedure for the outpatient clinics under high lateness and no-show and addresses the modeling procedure for the patient arrivals. This 3D graphical charting for the objectives includes a study of the multiple objectives that are of high concern to outpatient clinic scheduling interested parties in one paper.

Keywords: Analysis; Capacity management; Clinical effectiveness; Decision making; Patient satisfaction.

MeSH terms

  • Algorithms
  • Appointments and Schedules*
  • Computer Simulation*
  • Dental Care / organization & administration*
  • Humans
  • Models, Statistical*
  • No-Show Patients*
  • Quality Improvement / organization & administration
  • Time Factors
  • Waiting Lists