Managing Operational Efficiency And Health Outcomes At Outpatient Clinics Through Effective Scheduling

A variety of studies have documented the substantial deficiencies in the quality of health care delivered across the United States. Attempts to reform the United States health care system in the 1980s and 1990s were inspired by the system\u27s inability to adequately provide access, ensure quality, and restrain costs, but these efforts had limited success. In the era of managed care, access, quality, and costs are still challenges, and medical professionals are increasingly dissatisfied. In recent years, appointment scheduling in outpatient clinics has attracted much attention in health care delivery systems. Increase in demand for health care services as well as health care costs are the most important reasons and motivations for health care decision makers to improve health care systems. The goals of health care systems include patient satisfaction as well as system utilization. Historically, less attention was given to patient satisfaction compared to system utilization and conveniences of care providers. Recently, health care systems have started setting goals regarding patient satisfaction and improving the performance of the health system by providing timely and appropriate health care delivery. In this study we discuss methods for improving patient flow through outpatient clinics considering effective appointment scheduling policies by applying two-stage Stochastic Mixed-Integer Linear Program Model (two-stage SMILP) approaches. Goal is to improve the following patient flow metrics: direct wait time (clinic wait time) and indirect wait time considering patient’s no-show behavior, stochastic server, follow-up surgery appointments, and overbooking. The research seeks to develop two models: 1) a method to optimize the (weekly) scheduling pattern for individual providers that would be updated at regular intervals (e.g., quarterly or annually) based on the type and mix of services rendered and 2) a method for dynamically scheduling patients using the weekly scheduling pattern. Scheduling templates will entertain the possibility of arranging multiple appointments at once. The aim is to increase throughput per session while providing timely care, continuity of care, and overall patient satisfaction as well as equity of resource utilization. First, we use risk-neutral two-stage stochastic programming model where the objective function considers the expected value as a performance criterion in the selection of random variables like total waiting times and next, we expand the model formulation to mean-risk two-stage stochastic programming in which we investigate the effect of considering a risk measure in the model. We apply Conditional-Value-at-Risk (CVaR) as a risk measure for the two-stage stochastic programming model. Results from testing our models using data inspired by real-world OBGYN clinics suggest that the proposed formulations can improve patient satisfaction through reduced direct and indirect waiting times without compromising provider utilization

Do Consumers Care about How Prices Are Set?

Using a survey approach, we ask consumers to reveal their preferences over pricing schemes that may differ in terms of the average price of consumption, the amount of price variation, and the probability of being rationed. We find that consumers dislike pricing schemes that vary prices more but that they are willing to trade off price variation and rationing. Surprisingly, they are not willing to trade off an increase in price variation for a decrease in expected prices. We discuss the implications of these findings for firm pricing policies.Consumer demand, rationing, demand fluctuation, antagonism, fairness

A review of revenue management : recent generalizations and advances in industry applications

Originating from passenger air transport, revenue management has evolved into a general and indispensable methodological framework over the last decades, comprising techniques to manage demand actively and to further improve companies’ profits in many different industries. This article is the second and final part of a paper series surveying the scientific developments and achievements in revenue management over the past 15 years. The first part focused on the general methodological advances regarding choice-based theory and methods of availability control over time. In this second part, we discuss some of the most important generalizations of the standard revenue management setting: product innovations (opaque products and flexible products), upgrading, overbooking, personalization, and risk-aversion. Furthermore, to demonstrate the broad use of revenue management, we survey important industry applications beyond passenger air transportation that have received scientific attention over the years, covering air cargo, hotel, car rental, attended home delivery, and manufacturing. We work out the specific revenue management-related challenges of each industry and portray the key contributions from the literature. We conclude the paper with some directions for future research

Operational decision making for medical clinics through the use of simulation and multi-attribute utility theory.

Currently, health care is a large industry that concerns everyone. Outpatient health care is an important part of the American health care system and is one of the strongest growth areas in the health care system. Many people pay attention to how to keep basic health care available to as many people as possible. A large health care system is usually evaluated by many performance measures. For example, the managers of a medical clinic are concerned about increasing staff utilization; both managers and patients are concerned about patient waiting time. In this dissertation, we study decision making for clinics in determining operational policies to achieve multiple goals (e.g. increasing staff utilization，reducing patient waiting time, reducing overtime). Multi-attribute utility function and discrete even simulation are used for the study. The proposed decision making framework using simulation is applied to two case studies, i.e., two clinics associated with University of Louisville in Louisville, Kentucky. In the first case, we constructed of a long period simulation model for a multi-resource medical clinic. We investigated changes to the interarrival times for each type of patient, assigned patients to see different staff in different visits (e.g., visit #2, visit #5) and assigned medical resources accordingly. Two performance measures were considered: waiting time for patients, and utilization of clinic staff. The second case involved the construction of a one-morning simulation model for an ambulatory internal medicine clinic. Although all the resident doctors perform the same task, their service times are different due to their varying levels of experience. We investigated the assignment of examination rooms based on residents’ varying service times. For this model, we also investigated the effect of changing the interarrival times for patients. Four performance measures were considered: waiting time for patients, overtime for the clinic staff, utilization of examination rooms and utilization of clinic staff. We developed a ranking and selection procedure to compare the various policies, each based on a multiple attribute performance. This procedure combines the use of multi-attribute utility functions with statistical ranking and selection in order to choose the best results from a set of possible outputs using an indifferent-zone approach. We applied this procedure to the outputs from “Healthy for Life” clinic and “AIM” clinic simulation models in selecting alternative operational policies. Lastly, we performed sensitivity analyses with respect to the weights of the attributes in the multi-attribute utility function. The results will help decision makers to understand the effects of various factors in the system. The clinic managers can choose a best scheduling method based on the highest expected utility value with different levels of weight on each attribute. The contribution of this dissertation is two-fold. First, we developed a long term simulation model for a multi-resource clinic consisting of providers with diverse areas of expertise and thus vastly different no-show rate and service times. Particularly, we modeled the details on assigning patients to providers when they come to the clinic in their different visits. The other contribution was the development of a special ranking and selection procedure for comparing performances on multiple attributes for alternative policies in the outpatient healthcare modeling area. This procedure combined a multiple attribute utility function with statistical ranking and selection in determining the best result from a set of possible outputs using the indifferent-zone approach

An investigation into customer perception and behaviour through social media research – an empirical study of the United Airline overbooking crisis

Airlines have been adopting yield management to optimise the perishable seat control problem and overbooking is a common strategy. This study outlines the connections between yield management, crises, and crisis communication. Using big data captured on a social media platform, this study aims to combine traditional yield management with emerging social big data analytics. As part of this, we use the twitter data on the 2017 United Airline (UA) to analyse the overbooking crisis. Our findings shed light on the importance of a more effective orchestration of yield management to avoid the escalation of crises during crisis communication phases

INVESTIGATION ON SPOT BOOKING AND DYNAMIC OCEAN FREIGHT MODELLING FOR HIGHER SPACE UTILISATION ON ULTRA LARGE CONTAINER VESSELS

The article deals with the very topical issues of the use of spot ship’s space booking and the dynamic adjustment of ocean freight, according to the demand and availability of cargo space on container ships. Container lines are facing the challenges of filling the growing container ships, which also raises the difficulty of managing the overbooking. Two research hypothesis; that (H1) freight forwarders have concerns about a new spot booking mode and a dynamic way of formulating ocean rates; and that (H2) freight forwarders feel threatened by Container Lines (CL) to some extent to phase them out from the organization of intermodal transport chains due to the introduction of larger ships and the risk of low space occupation, are followed by the research. A survey between freight forwarders and NVOCCs (Non-Vessel Operating Common Carrier) on a global scale provides guidelines for the further development of CL model for the booking process and the formation of ocean rates because the results expose how new ways of working have a greater impact on the operational and commercial work between CL, freight forwarders and NVOCCs. According to the obtained result, the article proposes a three-step approach to be developed by CL that would bring freight forwarders and NVOCCs closer to a new way of working, reduce business risks, and, as a result, provide leverage to achieve ship space optimization and lower space pressure on container terminals. The study provides new understandings in building new operational models for efficient maritime logistics and brings novelty to the scientific community by defining descriptive gaps in changing strategic and operational approach for ship’s cargo space optimization

Equilibrium and Learning in Queues with Advance Reservations

Consider a multi-class preemptive-resume $M/D/1$ queueing system that supports advance reservations (AR). In this system, strategic customers must decide whether to reserve a server in advance (thereby gaining higher priority) or avoid AR. Reserving a server in advance bears a cost. In this paper, we conduct a game-theoretic analysis of this system, characterizing the equilibrium strategies. Specifically, we show that the game has two types of equilibria. In one type, none of the customers makes reservation. In the other type, only customers that realize early enough that they will need service make reservations. We show that the types and number of equilibria depend on the parameters of the queue and on the reservation cost. Specifically, we prove that the equilibrium is unique if the server utilization is below 1/2. Otherwise, there may be multiple equilibria depending on the reservation cost. Next, we assume that the reservation cost is a fee set by the provider. In that case, we show that the revenue maximizing fee leads to a unique equilibrium if the utilization is below 2/3, but multiple equilibria if the utilization exceeds 2/3. Finally, we study a dynamic version of the game, where users learn and adapt their strategies based on observations of past actions or strategies of other users. Depending on the type of learning (i.e., action learning vs.\ strategy learning), we show that the game converges to an equilibrium in some cases, while it cycles in other cases