Essays on operational efficiency in service operations: Applications in health care
Abstract
Essay one. Examines factors associated with patients who miss scheduled physician appointments at outpatient clinics, focusing on scheduling effects and individual patient behavior. These clinics consist of many patients who carry private insurance and have choice in where to seek treatment; clinics suffer high rates of no shows when there is a delay in being able to see the doctor. Lead time, or call appointment interval, indicates a mismatch in supply and demand and contributes to cancelled or missed appointments. Secondary factors for missed appointments include prior patient history of cancelling or not showing, patient age and financial source; typically insurance provider. Essay two. Analyzes arrivals of patients at an outpatient clinic of the Indiana University Medical Group in efforts to improve patient flow and understand how variability in the arrivals and registration of patients affects waiting times. Queuing concepts were used to uncover sources of variability and to generate ideas for improvement in scheduling of patients and clinic resources that would mitigate the undesirable effect of variability. Proposed improvements steps include the reduction in inter-arrival variability, utilizing pooled queues, implementing one piece flow to prevent batching and the reduction of interruptions, particularly from overflow phone calls. A simulation model corresponding to the value stream map was developed. An implication of our study is that a systematic application of Queuing and Six Sigma concepts combined with simulation modeling can be effective in identifying opportunities for improving patient flow in challenging health care delivery environments. Essay three. Explores the call in process to outpatient clinics. An organization with 4 clinics and an overflow facility is analyzed with simulation models and historic phone logs to assess performance levels at the facilities. Clinics may have the capacity to handle the calls, but variation in phone system performance is largely a result of responsiveness and availability of staff members to answer the phones. The most successful facility provides detailed performance benchmarks and coaches employees to improve. Medical facilities that rely on workers to multitask need to have assessment tools similar to larger call centers.
Degree
Ph.D.
Advisors
Chand, Purdue University.
Subject Area
Management|Health care management
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