2008 Headlines
Same Day Scheduling: Just What the Doctor Ordered
Professor Larry Robinson finds old system of scheduling appointments far in advance wastes time and money
July 23, 2008 | Ithaca, NY | Allowing patients to make appointments in the morning to see a physician later that day is the right prescription for efficiency, according to a new study by researchers at Cornell University's Johnson School.
The study, "The Effects of Patients No-Shows on Appointment Scheduling Policies," proves that same-day scheduling—also known as the "open access" policy—is more efficient, in terms of less waiting time for patients and better utilization of the doctors' time. The study was conducted by Lawrence W. Robinson, associate professor of operations management, and his former Ph.D. student Rachel R. Chen, an assistant professor at U. C. Davis.
"Under traditional scheduling, a set number of patients per day are booked well in advance, but may not show up for their appointment," said Robinson. "Under open-access scheduling, patients call in the morning to make an appointment for that same day. We find that in the majority of cases—except when patient waiting time is held in little regard, and the probability of no-shows is quite small—the open-access schedule will significantly outperform the traditional schedule in terms of a weighted average of patients' waiting time, the doctor's idle time, and the doctor's overtime."
A study in the 1990s by Kaiser Permanente in Northern California showed that traditional scheduling policies resulted in waiting times of up to 55 days. A separate study in 2001 concluded missed appointments at a family clinic caused losses of up to 14% in yearly revenues.
This is the first study of its kind to rigorously compare the open-access scheduling policy to the "traditional" practice of setting appointments months in advance. The researchers proved their findings utilizing a complex mathematical model that tested thousands of combinations before calculating the optimal schedule for patients for any particular combination of parameters.
It has long been standard practice for patients to make routine appointments weeks or months ahead of time. While this policy allows the doctor's workday to be fully booked, there is a downside: a significant probability that a patient will not actually show up for his or her appointment. In order to avoid the ensuing idle time, the doctor may resort to double-booking appointment time slots, which in turn will increase patient waiting. The study proves the "open access" policy performs better for patients and doctors.
In the paper the researchers compared the performance of these two appointment policies, which can be divided into two components. The first is the time that the patients spend waiting for the doctor, while the second is the length of the doctor's day, including an overtime surcharge (e.g., 50%) whenever it exceeds the standard length. They considered a single-provider service system under which patients arrive (or not) for previously scheduled appointments.
Both the traditional and the open-access scheduling policies encounter substantial variability in the number of patients seen per day: traditional, because of the no-shows within the fixed number of appointments for the day, and open-access, because of the varying number of patients who call in to be seen each day. The study finds that the variability due to patient no-shows was consistently more costly than the variability in the number of patients who call in each day.
"Because we don't model emergency patient arrivals, our results might be more applicable to specialists such as dermatologists than to general practitioners," Robinson said. "Also, the savings from moving to open-access are primarily due to reduction in the 'soft' costs of doctor's idle time and patients' waiting times, which affect productivity and patient satisfaction, instead of the 'hard' cost of overtime. If doctors are focusing only on overtime, they'll undervalue open-access systems."
