WAITING TIME AND PATIENTS’ SATISFACTION

In line with Vision 2021, the UAE’s National Agenda has six pillars: providing world-class healthcare is one of them. It is hence not surprising that the UAE healthcare industry is allocating substantial weight to the element of quality. Patient-centered care is internationally becoming part of the quality domain. Patient-centered quality may be defined as “providing the care that the patient needs in the manner the patient desires at the time the patient desires”. This requires substantially more attention to learning about patients’ preferences. One of the main dimensions of patient-centered quality is timely access to care, which includes shorter waiting times and efficient use of physicians’ time. Long waiting time is a globally challenging phenomenon that most healthcare systems face; it is the main topic of this thesis. The thesis consists of two main studies. The first empirical study was conducted by interviewing a sample of 552 patients to assess their satisfaction with their waiting experience in UAE hospitals. The collected data allowed us to test several hypotheses that were formulated based on an extensive literature study to better understand the relationship between waiting time and certain variables. In the second study, a simulation model for a typical clinic was built from real data obtained from a public hospital in Abu Dhabi emirate, considering two types of patients’ arrival; by appointment and walk-in, to test the effect of delayed arrivals and number of resources on the waiting time. The objective of the simulation study was to determine effective strategies for reducing the patients’ waiting time. The results of both studies are presented and discussed, with some recommendations, managerial implications, and conclusions

Effect of Appointment Schedules on the Operational Performance of a University Medical Clinic

Healthcare costs in the United States are one of the highest in the world. The healthcare expenditure alone accounted for 17.9% of the Gross Domestic Product of US in 2011. The National Healthcare Expenditure (NHE) is expected to increase at an annual rate of 6.6% from $2.6 Trillion in 2010 to$ 4.5 Trillion in 2019. The per capita expenditure for hospital outpatients and physicians has been the highest among other hospital expenses. This escalation in expenses created a need for productivity improvements in the healthcare industry to control costs. Some of the common problems encountered in outpatient clinics are high patient wait times, physician idle times, physician overtimes and high patient congestion. These problems not only lead to the inefficient operation of a clinic but also cause frustration and dissatisfaction to the physicians and patients. A well designed appointment system is very critical for the effective operation of outpatient clinics by minimizing these problems. The objective of this research was to study the effect of different appointment systems on the operational performance of a university medical clinic. The process at the medical clinic in the LSU Student Health Center (SHC) was modeled using the Rockwell Arena® simulation software. Four scheduling rules: Individual block rule, Bailey rule, 3-Bailey rule, and the Two-at-a-time rule, were studied to understand their effect on the performance parameters of the SHC. The performance parameters considered were the provider measures (provider idle time, startup idle time, provider overtime, provider utilization) and patient measures (patient wait time and patient throughput time). The individual block rule was the most patient friendly with shortest patient measures (patient throughput time - 39.6 min and patient wait time - 15.5 min); however it had the highest provider measures (Idle time – 50.5 min, Startup idle time – 10.4 min, Overtime – 16.2 min). The 3-Bailey rule was the most provider friendly rule with the least provider times (Idle time – 17 min, Startup idle time – 4.6 min, Overtime – 5.6 min) and best provider utilization (95%), but had high patient times (throughput time – 48.1 min and wait time – 24.1 minute). To aid the decision making process of the schedule selection for the SHC, a KT analysis was performed by weighing the performance parameters. The Bailey rule was observed to be the most suitable rule for the SHC as it had a good trade-off between the patient times and provider times compared to the other rules. The Bailey rule had better provider times (Idle time – 31.8 min, Startup idle time – 6.5 min, Overtime – 6.9 min) and better provider utilization rate (92%) when compared to the individual block rule and had marginally higher patient times (throughput time – 41.4 min and wait time – 17.3 min). A test run of the Bailey rule with one provider for ten days also confirmed this behavior of the rule

Online Clinic Appointment Scheduling

Health care is a fast growing industry in the United States. Appointment scheduling is one of the key processes in this industry. This thesis focused on on-line appointment system for clinics. The objective of this thesis is to maximize patients\u27 preferences and the number of patients seen during normal business hours. This is a multi-objective problem to balance the trade-off between overtime and patients\u27 preferences.To achieve the objective, a simulation model was built to compare four policies proposed. Based on simulation results, it was found that most of non-dominated solutions were close both minimum objective values, so policies proposed were helpful for the clinics to balance overtime and patients\u27 preferences

Appointment planning and scheduling in primary care

The Affordable Care Act (ACA) puts greater emphasis on disease prevention and better quality of care; as a result, primary care is becoming a vital component in the health care system. However, long waits for the next available appointments and delays in doctors offices combined with no-shows and late cancellations have resulted in low efficiency and high costs. This dissertation develops an innovative stochastic model for patient planning and scheduling in order to reduce patients’ waiting time and optimize primary care providers’ utility. In order to facilitate access to patients who request a same-day appointment, a new appointment system is presented in which a proportion of capacity is reserved for urgent patients while the rest of the capacity is allocated to routine patients in advance. After the examination of the impact of no-shows on scheduling, a practical double-booking strategy is proposed to mitigate negative impacts of the no-show. Furthermore, proposed model demonstrates the specific circumstances under which each type of scheduling should be adopted by providers to reach higher utilization. Moreover, this dissertation extends the single physician’s model to a joint panel scheduling and investigates the efficiency of such systems on the urgent patients’ accessibility, the physicians’ utilization, and the patients’ waiting time. Incorporating the newsvendor approach and stochastic optimization, these models are robust and practical for planning and scheduling in primary care settings. All the analytical results are supported with numerical examples in order to provide better managerial insights for primary care providers

A flexible and optimal approach for appointment scheduling in healthcare

Appointment scheduling is generally applied in outpatient clinics and other healthcare services. The challenge in scheduling is to find a strategy for dealing with variability and unpredictability in service duration and patient arrivals. The consequences of an ineffective strategy include long waiting times for patients and idle time for the healthcare provider. In turn, these have implications for the perceived quality, cost-efficiency, and capacity of healthcare services. The generation of optimal schedules is a notoriously intractable problem, and earlier attempts at designing effective strategies for appointment scheduling were based on approximation, simulation, or simplification. We propose a novel strategy for scheduling that exploits three tactical ideas to make the problem manageable. We compare the proposed strategy to other approaches, and show that it matches or outperforms competing methods in terms of flexibility, ease of use, and speed. More importantly, it outperforms competing approaches nearly uniformly in approaching the desired balance between waiting and idle times as specified in a chosen objective function. Therefore, the strategy is a good basis for further enrichments

A SIMULATION-BASED DEA FRAMEWORK TO IMPROVE CUSTOMER'S WAITING TIME AT VEHICLE INSPECTION CENTRE

A long queue and waiting time have become the most common issue that usually happened at service industry. Similarly, in a vehicle inspection centre (VIC), a higher quality of service is measured by a short and acceptable waiting time. Typically, the long waiting time among customers is resulted by some factors, which are customer arrivals, human factors, and maintenance strategy. However, this study only focuses on customer arrival factor that contributed to this problem. This paper is a review of work based on a study conducted at VIC in Selangor, Malaysia. A framework of simulation-based DEA model is proposed to determine the most efficient strategy to reduce the problem of customer waiting time at VIC. The developed framework aims to help the management in decision making to improve the operation of the VIC current system in future

Performance modelling of applications in a smart environment

PhD ThesisIn today’s world, advanced computing technology has been widely used to improve our living conditions and facilitate people’s daily activities. Smart environment technology, including kinds of smart devices and intelligent systems, is now being researched to provide an advanced intelligent life, easy, comfortable environment. This thesis is aimed to investigate several related technologies corresponding to the design of a smart environment. Meanwhile, this thesis also explores different modelling approaches including formal methods and discrete event simulation. The core contents of the thesis include performance evaluation of scheduling policies and capacity planning strategies. The main contribution is in developing a modelling approach for smart hospital environments. This thesis also provides valuable experience in the formal modelling and the simulation of large scale systems. The chief findings are that the dynamic scheduling policy is proved to be the most efficient approach in the scheduling process; and a capacity scheme is also verified as the optimal scheme to obtain the high work efficiency under the condition of limited human resource. The main methods used for the performance modelling are Performance Evaluation Process Algebra (PEPA) and discrete event simulation. A great deal of modelling tasks was completed with these methods. For the analysis, we adopt both numerical analysis based on PEPA models and statistical measurements in the simulation

The Role of Operations Research in a University Hospital: A Review and Bibliography

In the 1968 Annual Report of the Medical College of Virginia (Bulletin, 1968, pp8,18) the shortage of trained medical personnel is stressed as a serious problem in the care of the sick. As a result of this personnel shortage, approximately 100 beds have recently been closed in the University Hospital. This underlies the need for large medical centers to use O.R. techniques in developing more efficient use of existing medical personnel and in seeking cost reductions while increasing the quality and coverage of medical care. When the medical center is a component of an urban university, both urban and medical problems amenable to the O.R. approach are best tackled by an academic department of the university