Healthcare in the United States has evolved throughout the past decade because of an
aging population of both patients and healthcare professionals, the exacerbation of chronic
illnesses, and the Affordable Care Act, hospitals and outpatient medical organizations need to
become efficient with the limited resources for providing more personalized care to patients
while meeting the increasing demand of maximizing the number of patients seen on a daily basis
(Cho & Cattani, 2018) (Luo, Zhou, Han, & Li, 2019). There are several identifiable barriers that
interfere with the efforts for the healthcare practices goal to becoming more efficient including
patient no-shows, cancellations, and extended patient wait times. “No-shows and cancellations
account for a little more than thirty-one percent of overall scheduled appointments among
approximately forty-five thousand patient per year” accounting for three to fourteen percent of
total annual revenue deficiency (Kheirkhah, Feng, Travis, Tavakoli-Tabasi, & Sharafkhaneh,
Patient no-show is defined as the patient who does not appear for his/her scheduled
medical appointment (Kheirkhah, Feng, Travis, Tavakoli-Tabasi, & Sharafkhaneh, 2016). Patient
no-shows not only reduce the level of continuity of care, but also has the tendency to reduce
timely access to care for those patients who cannot schedule an appointment, negatively impacts
health outcomes, and wastes the provider’s time and resources (Turkcan, Toscos, & Doebbeling,
2014). Studies have shown that those patients who tend to not show-up tend to be younger, are in
a lower socioeconomic status, have a history of past no-shows, are receiving governmentprovided benefits, experience psychosocial problems, and those who just do not fully understand
the importance of keeping their appointment (Lacy, Paulman, Reuter, & Lovejoy, 2004).
There are several issues for which a patient may cancel their appointment some such
reasons could be due to a scheduling conflict, their symptoms appear to have resolved, or they
decided to visit an alternate provider (emergency department or urgent care facility) for
worsening or other symptoms (Norris, et al., 2014). Ideally, when cancelling an appointment, the
patient cancels leaving sufficient time for the healthcare professionals to schedule someone else
for that time slot.
The biggest challenge is determining the best way to schedule patients by specific time
slots based on the inevitable fluctuation in patients and actual treatment times (Chen, Robielos,
Palana, Valencia, & Chen, 2015). Patient wait times include the actual time between arrival and
the time the patient is seen by the physician, in turn this time is affected by the patient being
either too early or tardy for their scheduled appointment, and differing treatment times based on
need of patient. An example of this could be a patient finishing his/her treatment later than the
scheduled time; therefore, causing all subsequent patients’ appointments are delayed as well
(Chen, Robielos, Palana, Valencia, & Chen, 2015). Patients usually show up earlier rather than
later for scheduled medical appointment, when patients arrive late to their appointment the
clinics’ operation schedule is disrupted as a result the timely care provision is stressed (Hang,
Lich, & Kelly, 2017). In an effort to care for the late arrival causes a domino effect that
continues through the remainder of the clinic day, the medical team is thrown behind schedule in
turn increasing the patient wait time and decreasing the amount of time that the physician has to
spend with his/her patients. This results in patient dissatisfaction. Patient satisfaction seems to be
highest when they experience shorter wait times and longer time spent with the medical
professional (Hang, Lich, & Kelly, 2017). In some cases, when patients arrive late for their
appointment, they can be held responsible to financially cover those charges incurred if the
medical organization has not entered into a contract with the payor. The payers, both government
and commercial, refuse to reimburse the office for those patients who either no-show, cancel, or
are late to their medical appointments (Selesnick & Karapetyan, 2018).
Healthcare operations managers are responsible for determining an appointment schedule
that promotes satisfaction, reimbursement is heavily dependent patient satisfaction therefore it
makes up a large portion of a practice’ revenue. In order to accomplish this, practices have
implemented a variety of scheduling methods including advanced access, open access, dynamic
scheduling, and sequential scheduling. For example primary health care clinics have been tasked
with improving access, better health outcomes, and providing quality services efficiently while
managing limited resources (Turkcan, Toscos, & Doebbeling, 2014). “Cost and efficiency are
key outcomes of process improvement”, there are times when efficiency does get in the way of
quality efforts especially when it comes to patient satisfactions and the appointment scheduling
process (Langabeer II & Helton, 2016, p. 86). Quality revolves around patient outcomes, patient
safety, patient logistics flow and facilities, financial, and administrative (Langabeer II & Helton,
2016). Based on this, scheduling interventions vary based on the domain of care, for example,
same-day appointments, walk-in clinics, telemedicine, and after-hour services can be used to
improve acute care access. Chronic disease care practices can utilize a multidisciplinary care
team, disease specific clinics, group appointments, the use of registries, patient education, and
group appointments in order to improve patient satisfaction. Finally preventative care clinics
increase awareness through different community and population based programs, use reminder
systems, and support systems for compliance (Turkcan, Toscos, & Doebbeling, 2014).
Open access scheduling offers a considerably promising potential in clinics where there
seems to be a high rate of patients who end up visiting the emergency department for urgent and
non-urgent problems because they are otherwise unable to arrange a same-day appointment.
Advanced scheduling has the potential to reduce the number of no-shows, improves provider
utilization as well as patient satisfaction, and requires a careful analysis of the practice’s patient
demand and capacity (Turkcan, Toscos, & Doebbeling, 2014).
One way outpatient medical clinics strive to increase their profitability by maximizing
their resource utilization is to utilize an overbooking scheduling model Although it may be
difficult to accurately predict the number of patient arrivals, to schedule the appropriate number
of staff, and “resource utilization plans when patient no-shows and cancellations are common”
(El-Sharo, Zheng, Yoon, & Khasawneh, 2015, p. 1). Overbooking is a technique that is used to
reduce the effects of patient cancellations and no-shows. Many healthcare organizations utilize
this method in order to lessen the blow of no-shows and cancellations, this method however can
be detrimental because this practice has the potential to increase wait times.
Luke 14:28 (NIV) states “Suppose one of you wants to build a tower. Won’t you first sit
down and estimate the cost to see if you have enough money to complete it? Just as taking on the
responsibility of building a tower, a Christian leaders and managers, we must first sit down and
estimate the cost, and then ensure that we lay an adequate foundation before we start building.
One way of doing this is by examining our patient scheduling practices and rework and revise
current structures when need be.
Chen, P., Robielos, R., Palana, P., Valencia, P., & Chen, G. (2015). Scheduling patients'
appointments: Allocation of healthcare service using simulation optimization. Journal of
Healthcare Engineering, 6(2), 259-280. DOI: 10.13140/RG.2.2.28070.57926.
Cho, D., & Cattani, K. (2018). The patient patient: The performance of traditional versus open
access scheduling policies. Journal of The Decision Sciences Institute, 50(4), 756-785.
El-Sharo, M., Zheng, B., Yoon, S., & Khasawneh, M. (2015). An overbooking scheduling model
for outpatient appointments in a multi-provider clinic. Operations Research for
Healthcare, 6, 1-10. https://doi-org.ezproxy.liberty.edu/10.1016/j.orhc.2015.05.004.
Hang, S., Lich, K., & Kelly, K. (2017). Patient and visit-level variables with late arrival to
pediatric clinic appointments. Clinical Pediatrics, 56(7), 634–639.
Kheirkhah, P., Feng, Q., Travis, T., Tavakoli-Tabasi, S., & Sharafkhaneh, A. (2016). Prevalence,
predictors and economic consequences of no-shows. BMC Health Services Research;
16(13), 1-6. DOI 10.1186/s12913-015-1243-z.
Lacy, N., Paulman, A., Reuter, M., & Lovejoy, B. (2004). Why we don't come: Patient
perception on no-show. Annals of Family Medicine; 2(6), 441-445.
Langabeer II, J., & Helton, J. (2016). Health Care Operations Management A Systems
Perspective. Burlington: Jones & Bartlett Learning.
Luo, L., Zhou, Y., Han, B., & Li, J. (2019). An optimization model to determine appointment
scheduling window for an outpatient clinic with patient no-shows. Healthcare Managing
Science Journal, 22(1), 68-84. https://doi.org/10.1007/s10729-017-9421-7.
Norris, J., Kumar, C., Chand, S., Moskowitz, H., Shade, S., & Willis, D. (2014). An empirical
investigation into factors affecting patient cancellations and no-shows at outpatient
clinics. Elsevier Decision Support System; 57, 428-443.
Selesnick, A., & Karapetyan, G. (2018). Missed appointments and late arrivals: Who to bill and
when. Medical Economics; 95(12), 1-3.
Turkcan, A., Toscos, T., & Doebbeling, B. (2014). Patient-centered appointment scheduling
using agent-based simulation. AMIA Annual Symposium Proccedings Archive , 11251133. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419932/.
Operation Managers’ Role in Staff Scheduling
Operations managers play a big role in scheduling within medical departments. Staffing
manager’s responsibilities include having the ability and flexibility to assign different medical
staff to each team/department for each scheduling planning period. Areas staffing managers
focus on are hospital policy, staff allocation, and scheduling (Chen, Lin, & Peng, 2015). Medical
demand as a whole has increased throughout the years, yet medical staff shortages are not
uncommon; the workload has become more overwhelming. Staff members typically work
overtime. Unfortunately, overwork can lead to malpractice lawsuits and high turnover. It is
predicted that by 2020, there will be a 36% shortage of nurses in the American healthcare sector.
It is vital for staffing managers to allocate medical staff appropriately, as it is a critical issue for
hospitals (Chen, Lin, & Peng, 2015). Operations managers need to first decide which
departments are to be included in the schedule. Secondly, managers should also determine how
many medical staff members are to be assigned or are needed in each department. Lastly,
operations managers should as well determine which medical staff member is going to work
which shift; staff scheduling issues can come up (Chen, Lin, & Peng, 2015).
A schedule needs to comply with government regulations, hospital policies, and the
medical staff’s preferences; schedulers need to negotiate with the staff. Creating a monthly
schedule takes time. As the size of the medical staff and fluctuations increase, so does the
amount of time required to generate a monthly schedule (Chen, Lin, & Peng, 2015). Because
operations managers and department chairs already have too much to do, they need a tool to help
them design a better schedule; using electronic health records (EHRs) is a solution.
Proverbs 11:14 in the Bible states, “where there is no guidance, a people falls, but in an
abundance of counselors there is safety”. Operations managers are important for staff scheduling
because they are looked up to decreasing uncertainty in medical staff shortages.
What is an Electronic Health System (EHR)?
The keys to good scheduling in healthcare are data, analytics, systems, software, culture,
and management. Electronic health records (EHRs) can be used as a uncostly, scheduling
software that the government incentivizes for providers to use; EHRs aims to pull the healthcare
industry into the 21st century in its use of computers to improve the delivery of care. Data
captured within the software and applied analytics can track historical trends of past wait times
and patient demands to help forecast the future and create solutions to decrease long wait times
(Hall & Partyka, 2012). The software provides interfaces to schedulers and presents it to the
scheduler in a user-friendly graphical display. The software can be used as a tool of
communication between different departments, so the arrival of patients and allocation of
resources can be anticipated with greater accuracy (Hall & Partyka, 2012). A typical approach
for deriving the optimized schedules is to perform experiments using discrete event simulation.
This can be accomplished through using the collected data from electronic records systems. This
requires a series of processes to acquire simulation parameters from the raw data. The goal is for
the derived simulation model to fully reflect the reality. Three main elements for building a
healthcare simulation model are a process of medical activities, service times, and arrival dates
(Cho, Song, Yoo, & Reijer, 2019). As data capture becomes more automatic and systems
become more integrated, operations research has the potential to make EHRs even more effective
and provide even more immediate patient access at lower costs (Hall & Partyka, 2012).
One strategy using EHR that has become very effective is block scheduling. Patients’
appointments can be scheduled according to anticipated clinical length time. Shortest
appointments can be scheduled in the morning, with the longest appointments near the end of the
clinic to minimize patient wait time. To access the performance of any new scheduling template,
patient wait time and clinic length are two main metrics. Patient wait time can be calculated by
using EHR timestamps and data about the appointment. Exam lengths can be determined by
EHR audit log timestamps recorded between each appointment’s check in and check out times
(Hribar, Read-Brown, Reznick, & Chiang, 2017).
1 Corinthians 14:40 in the Bible states, “but all things should be done decently and in
order”. Electronic Health Systems can positively impact the organization and provider workflow
to ensure all patients’ needs, such as shorter wait times, are met.
The Issue: Waiting Time Affects Patient Satisfaction
In healthcare management, waiting time for consultation with a healthcare professional is an
important measure that has strong associations with patient’s satisfaction; the longer patients
have to wait before being treated by a medical staff member, the less satisfied they are, which
could lead to decreasing profits. It is required to optimize scheduling for clinicians (Cho, Song,
Yoo, & Reijer, 2019). A confounding factor is that there are significant differences with respect
to quality delivery and efficiency among clinicians. In order to handle this problem, it seems
worthwhile to consider how the personal appointment schedules of clinicians can be optimized
as to improve the overall efficiency of patient management (Cho, Song, Yoo, & Reijer, 2019).
Scheduling aims to improve the match between healthcare resources, such as medical
staff, and patient needs. A good scheduling system reduces waits for patients while also
improving the utilization of critical resources. Unfortunately, many caregivers lack the skills to
systematically improve service by creating schedules that better match resources to patient
needs (Hall & Partyka, 2012). Patients usually cannot leave until the job is done, making waiting
much more costly. Patients may experience pain and conditions may worsen as the long wait
time continues. In emergency rooms, complications may occur when patients become frustrated
and leave without being seen and against medical advice. In workforce scheduling, the challenge
is ensuring that staffing levels track needs, as predicted from patient census (Hall & Partyka,
Galatians 6:9 in the Bible states, “and let us not grow weary of doing good, for in due
season we will reap, if we do not give up”. Organization and rearranging systems to decrease
patient wait times is no easy feat, however it is definitely worth it to improve patient conditions
and lower costs.
Chen, P.-S., Lin, Y.-J., & Peng, N.-C. (2015). A two-stage method to determine the
allocation and scheduling of medical staff in uncertain environments. Computers and
Industrial Engineering, 99, 174-188. doi:https://doi.org/10.1016/j.cie.2016.07.018
Cho, M., Song, M., Yoo, S., & Reijer, H. A. (2019). An evidence-based decision
support framework for clinician medical scheduling. IEEE, 15239-15249. Retrieved
Hall, R., & Partyka, J. (2012). Scheduling for better healthcare: how analytics-and
O.R.-driven tools help healthcare organizations move from "tracking" mentality to
"delivery and logistics." OR/MS Today, 39(3), 22+. Retrieved from https://link-galecom.ezproxy.liberty.edu/apps/doc/A295420724/ITOF?u=vic_liberty&sid=ITOF&xi
Hribar, M. R., Read-Brown, S., Reznick, L., & Chiang, M. F. (2017). Evaluating and
improving an outpatient clinic scheduling template using secondary electronic
health record data. AMIA Annual Symposium Proceedings Archive, 921-929.
Retrieved from https://www-ncbi-nlm-nihgov.ezproxy.liberty.edu/pmc/articles/PMC5977636/
What are the benefits of electronic scheduling in relation to scheduling for better
provisions in healthcare?
When it comes to determining what the benefits of electronic scheduling in relation to
scheduling for better provisions in healthcare are, first, one must figure out what the benefits of
electronic scheduling how they relate to scheduling for better provision in healthcare.
Scheduling for better provisions in healthcare works on the idea of scheduling healthcare
appointments in a way that allows for patients to keep their scheduled appointment times, to help
meet the needs of their treatment plan (Burdett & Kozan, 2018). There are many benefits of
electronic scheduling, though some of the most important include providing opportunities for
flexibility, work balance, improved patient-centeredness, reduced wait times, and the option to
schedule to specific health needs. In relation to scheduling for better provision in healthcare, the
benefits provide opportunities to deliver better healthcare options for patients by being able to
meet the criteria laid out in their treatment plans, thus, improving healthcare processes
(Langabeer & Helton, 2016). This is achieved by reducing wait times, office set up times,
transfer times, and any deviations that might lead to scheduling conflicts (Burdett & Kozan,
How flexibility can benefit patient scheduling
Flexibility can benefit electronic scheduling in many ways. For instance, flexibility can
benefit electronic scheduling by allowing physicians and healthcare providers to schedule
patient’s appointments in ways that allow them to receive appointments that benefit their
schedules (Marynissen & Demeulemeester, 2019). With this, the main goal is to be able to
schedule appointments in a timely manner that allows for quick diagnostic testi ...
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