Need my group members and I drafts combined into 1 paper - graduate level - no research required just format the paper

Anonymous

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i will attach all our parts along with the outline that tells how it should be worded and ordered and you will combine them and format accordingly(spacing etc proofread).,,

I am still working on my portion of the paper so I will upload it as soon as i finish it but you can begin working on the others parts

I will upload the remaining group member portions as well

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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, 2016). 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. References: 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. Https://doi-org.ezproxy.liberty.edu/10.1111/deci.12351. 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. https://doi.org/10.1177/0009922816672450. 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. http://www.annfammed.org/content/2/6/541.full.pdf. 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. http://dx.doi.org/10.1016/j.dss.2012.10.048. Selesnick, A., & Karapetyan, G. (2018). Missed appointments and late arrivals: Who to bill and when. Medical Economics; 95(12), 1-3. https://www.medicaleconomics.com/business/missed-appointments-and-late-arrivalswho-bill-and-when. 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/. Draft 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, 2012). 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. References 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 from https://ieeexplore-ieeeorg.ezproxy.liberty.edu/stamp/stamp.jsp?tp=&arnumber=8621008 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 d=62cf5e28 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, 2018). 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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Running head: OPERATIONS MANAGEMENT OF HEALTH ORGANIZATIONS

1

BUSI 611 Operations Management of Health Organizations

Scheduling for better provisions in healthcare with an emphasis on electronic scheduling systems
and its influence on the quality of care and patient healthcare satisfaction

Group 2
Carrie Brown, Miracle Cannon, Dina Crawford, Emily Gawlak, and Pamela Wannamaker
February 16, 2020

Respectfully submitted to: Dr. Kelly

OPERATIONS MANAGEMENT OF HEALTH ORGANIZATIONS

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Abstract
Traditionally, patient scheduling has been done through verbal communication with the patient
over the phone or face-to-face interactions. However, because these conventional scheduling
methods have the necessity of requiring the intervention of schedulers, the limited number of
appointment slots, and the time-factor of traditional scheduling, most hospitals have faced it off.
Thus, paving the way for electronic scheduling. In the end, this study reports general
improvements in both clinical and patient outcomes based on its use as well as the barriers to its
applicability. Patient scheduling in healthcare is a key component of providing patient-centered
care and this research project outline is based on the topic of “Scheduling for Better Provisions in
Healthcare”. This topic allows for the understanding of how electronic scheduling systems can
do much more than the traditional (non-automated) forms of scheduling. This is because they run
on computer platforms, they can utilize and generate data that produce better schedules in a more
flexible format, as well as link scheduling to specific health needs of patients. The thesis
statement and six research questions explain the background of the 21st-century healthcare, the
factors affecting patient scheduling, the benefits of electronic scheduling, the barriers in
electronic patient scheduling, and the role of operations managers. The research has shown how
healthcare has evolved, the affects that it has had on patient scheduling, the benefits and
limitations that electronic scheduling has brought to the healthcare industry, and finally, the role
that physicians and operations managers play in patient scheduling. Scheduling for better
provisions in healthcare has the goal of improving patient’s overall wellbeing and satisfaction
and the research paper draft for group two will provide further information pertaining to the
success or decline in the development of scheduling for better provisions in healthcare.

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Table of Contents
Abstract ........................................................................................................................................... 2
Introduction ..................................................................................................................................... 4
Background of 21st-century healthcare ........................................................................................... 5
Cost, Quality and Patient Satisfaction ......................................................................................... 5
Integration of Health Information Technology ........................................................................... 5
Improved Access to Healthcare................................................................................................... 6
Patient-Centered Care ................................................................................................................. 7
Improved Efficiency in Healthcare ............................................................................................. 7
Factors affecting patient scheduling ............................................................................................... 8
The benefits of electronic scheduling in relation to scheduling for better provisions in healthcare
....................................................................................................................................................... 12
How flexibility can benefit patient scheduling ......................................................................... 13
The benefits of work balance in relation to electronic scheduling ............................................ 13
How patient-centeredness offers benefits to electronic scheduling .......................................... 14
How electronic scheduling can benefit patient wait times ........................................................ 14
Electronic scheduling can benefit patients by helping to schedule to specific health needs ........ 15
Barriers to electronic patient scheduling....................................................................................... 15
Methods of data collection ........................................................................................................ 16
Data analysis ............................................................................................................................. 17
Results ....................................................................................................................................... 17
Discussion ................................................................................................................................. 18
Recommendation for nationwide Electronic Patient Scheduling system use ............................... 19
Conclusion and recommendation for future work ........................................................................ 19
Electronic Health System (EHR) .................................................................................................. 19
The Issue: Waiting Time Affects Patient Satisfaction .............................................................. 21
Operation Managers’ Role in Staff Scheduling ........................................................................ 22
Conclusion .................................................................................................................................... 23
References ..................................................................................................................................... 25

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Introduction

Scheduling for better provisions in healthcare revolves around the idea that electronic
scheduling is better than traditional (non-automated) forms of healthcare scheduling. Regarding
scheduling for better healthcare provisions, healthcare in the 21st century has evolved to allow
for improvements across the board. These improvements include cost-cutting, quality
improvement efforts, increased access to healthcare options, and increased patient satisfaction.
Though, it is important to note that there are factors that can affect the impact of patient
scheduling. Which includes patients that cancel their appointments, fail to keep appointments,
and those who are late to their scheduled appointments. On the other side, there are many
benefits that are brought out by the creation of electronic scheduling.
The benefits work based on improving flexibility, work balance, improved patientcenteredness, reduced wait times, and the option to schedule based on specific health needs.
Additionally, there are factors that can be barriers to the use of electronic scheduling. In order to
understand what the key barriers are, one must understand the characteristics of the respondents,
the classification of and non-use of electronic patient scheduling during visits, the characteristics
of those who do not use electronic scheduling and those who use it intensely. Without this, key
barriers cannot be understood. Furthermore, physicians play a vital role in scheduling for better
healthcare provisions. This can be seen through the fact that physicians are pressured into
spending less time with their patients in order to help shorten the length of their appointments.
Operations managers also play a vital role in the use of electronic health records. Operations
managers work to provide physicians and facilities with the best options possible for decisions
regarding patient care options, with the main goal of improving patient satisfaction (Langabeer &
Helton, 2016).

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Background of 21st-century healthcare
Cost, Quality and Patient Satisfaction

Improving cost, quality, access and patient satisfaction are continuous efforts that drive
the provision of 21st-century healthcare. As healthcare costs continue to risk in the United States
(U.S.), efforts to reduced costs while still maintaining quality within the healthcare setting can be
challenging (Langabeer II & Helton, 2016, p. 13). According to Langabeer II and Helton (2016),
quality refers to “high standards, excellence, and the ability to meet and exceed customer’s
expectations” (p. 86). These quality principles focus on categories that are impacted at the
service-level and include patient outcomes, patient safety, financial, administrative, and patient
logistics flow, and facilities (Langabeer II & Helton, 2016, p. 86-87). Improving efficiency and
effectiveness is central to improving cost, quality, and patient satisfaction in 21st-century
healthcare (Langabeer II & Helton, 2016, p. 159). Therefore, the need for operations
management is more evident than ever as some of the primary roles of operations managers are
to reduce costs and improve the quality of customer services (Langabeer II & Helton, 2016, p. 9,
11).
Integration of Health Information Technology

In 2009, the Health Information and Technology for Economic and Clinical Health
(HITECH) Act was enacted with the intention of producing greater efficiencies in healthcare
(Langabeer II & Helton, 2016, p. 43). The integration of health information technology has had a
significant impact on the provision of care in the 21st-century healthcare setting (Langabeer II &
Helton, 2016, p. 43). According to Wong, Nohr, Kuziemsky, Leung, and Chen (2017), the use of
health informatics serves as a cornerstone for improving the quality and efficiency of healthcare
delivery. The use of health information technology (HIT) for electronic patient scheduling drives

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a paradigm shift from traditional healthcare delivery to a digital transformation that supports
value-based healthcare in the 21st-century healthcare setting (Williams, Lovelock, Cabarrus, &
Harvey, 2019). Additionally, the use of electronic patient appointment scheduling increases
communication between patients and clinical staff as well as provides efficient, high-quality
service (Zhang & Kulkarni, 2017). Fetherall, et al. (2018), stated that consumer health
information technology is seen as a promising solution to reducing pressure to improve outcomes
and decrease cost. HIT infrastructure, such as electronic health records and electronic patient
scheduling allows for data to be collected and analyzed to support operational decisions by
developing solutions for controlling costs and reducing errors (Williams, Lovelock, Cabarrus, &
Harvey, 2019).
Improved Access to Healthcare

Timely access to care is a primary concern in U.S. healthcare (Anhalt, Kharoufeh, &
Bhattacharya, 2017). The introduction of the Affordable Care Act of 2010 resulted in a
significant increase in Americans with insurance coverage thus increasing demand for access to
healthcare services (Srinivas & Ravindran, 2018). According to Srinivas and Ravindran (2018),
it is expected that the demand for outpatient services will rise while the number of available
physicians needed to provide care is anticipated to decline. An estimated 65 percent of hospital
revenue is expected to be received from outpatient care (Srinivas & Ravindran, 2018). Therefore,
it is essential that interventions be implemented to improve access and increase efficiency in the
delivery of healthcare. Implementation of interventions, such as electronic patient scheduling, to
meet the supply and demand have ensured utilization efficiency as well as patient satisfaction
(Srinivas & Ravindran, 2018). According to Anhalt, Kharoufeh, and Bhattacharya (2017), access
to care can be improved when appointment slots are effectively allocated and utilized for

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individual providers. Managing supply and demand in the outpatient setting can be optimized
through the use of electronic patient scheduling systems that are equipped with predictive
analytics to assist with distributing workload throughout the day (Srinivas & Ravindran, 2018).
Patient-Centered Care
In 21st-century healthcare, a key healthcare service deliverable is patient-centered care
(Wong, Nohr, Kuziemsky, Leung, & Chen, 2017). Patient-centered care refers to establishing a
doctor-patient relationship that promotes communication and understanding of thoughts and
preferences to improve patient satisfaction and clinical outcomes (Choi, Hwang, & Kim, 2015).
Patient satisfaction regarding appointments is often measured by patient preferences and waiting
time (Ahmadi-Javid, Jalali, & Klassen, 2017). According to Wong, Nohr, Kuziemsky, Leung,
and Chen (2017), a solution to attaining patient-centered competences in the healthcare setting is
by making decisions that are efficient and intellectual using data information gain through
technology.
Providing patient-centered care allows clinicians to deliver care that involves engaging
the patient in developing a healthcare plan that is tailored to the individual. From a biblical
worldview, patient-centered care removes any selfish ambitions of the clinicians and drives the
focus to the interest of the patient. The Bible states in Philippians 2:3-4 “Do nothing out of
selfish ambition or vain conceit. Rather, in humility value others above yourselves, not looking
to your own interests but each of you to the interests of others” (New International Version).
Improved Efficiency in Healthcare

Efficiency in healthcare systems has become increasingly important over the past few
decades as a primary result of rising healthcare expenditures coupled with increased demand for

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healthcare services and patient expectations in quality of service (Ahmadi-Javid, Jalali, &
Klassen, 2017). Efficiency refers to “performing tasks with minimal waste and resources
consumption” and is measured by utilizing tools that analyze operational metrics of inputs and
outputs (Langabeer II & Helton, 2016, p. 137, 177). The use of operational metrics aids in
improving efficiency in the healthcare organization (Langabeer II & Helton, 2016, p. 177). The
most common issues across the nation that present in terms of efficiency in patient scheduling
are no-shows and cancellations (Srinivas & Ravindran, 2018; Adams, et al., 2017). According to
Srinivas and Ravindran (2018), “the average no-show rates for primary care clinics vary between
14% and 50%” (p. 245). A common practice to address no-shows is overbooking which may
lead to increased patient wait times, decreased patient satisfaction, physician overtime, and
ultimately increased costs (Zhang & Kulkarni, 2017).
Factors affecting patient scheduling

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 practice 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 patients per year” accounting for three to fourteen percent of

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total annual revenue deficiency (Kheirkhah, Feng, Travis, Tavakoli-Tabasi, & Sharafkhaneh,
2016).
A 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 canceling 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 schedul...

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