A York University professor, along with colleagues at the Rotman School of Management at the University of Toronto and Toronto Western Hospital (TWH), part of the University Health Network, has examined the scheduling practices in multi-assessment, outpatient health programs. He found that many practices are plagued with patients who fail to show up for their scheduled appointment and do not alert clinic staff as to their intentions (no-shows). This results in treatment delays and the underuse of scarce resources.
From there, the team led by Professor Adam Diamant of the Schulich School of Business determined a way to schedule these appointments that both rewards dedicated patients and increases the utilization of the health practitioners – a win-win for patients and the health-care system. This research will be of interest to practitioners, policy-makers and hospital administrators.
“In these types of clinics, patients attend one assessment per appointment over the course of many months or even years. Further, the no-show rate per visit can be surprisingly high. Our proposed scheduling slashes this time by over 50 per cent and reduces the influence that no-shows have on the clinic’s operational performance,” Diamant explained.
The results of this study, funded by the Natural Sciences and Engineering Research Council of Canada (NSERC), were published in Production and Operation Management (2018).
Research focuses on bariatric surgery programs
In this study, which looked at the scheduling practices of multi-assessment, outpatient health-care programs, the researchers focused on bariatric surgery programs, like the one at TWH.
Bariatric surgery is a life-altering operation that facilitates weight loss by removing a portion of the stomach and rerouting the intestines. Those eligible for the surgery, which is funded and marked as a priority by the Ministry of Health and Long-Term Care, must be classified as morbidly obese with a body mass index of more than 40. It is notable that bariatric surgery has risen by 300 per cent (2006-07 to 2013-14) according to the Canadian Institute for Health Information (CIHI).
In these programs, patients meet with different health practitioners, at several outpatient appointments, who assess and counsel them on some aspect of their treatment. It also ensures that patients are mentally and physically ready for the pre- and post-surgical challenges of bariatric surgery. In most programs, patients typically complete one assessment per visit.
Research uncovers the cause of poor performance metrics
The researchers examined and tracked the path of patients through the system, which included:
- the regular and overtime capacity of the clinic on each day and its operating costs;
- the number of referrals and patients who failed to attend their scheduled appointment; and
- the time from referral to surgery for each successful patient and the clinic’s revenue.
From there, the researchers identified two key weaknesses with the one-assessment-per-visit policy that the clinic employed:
- a high rate of no-shows (roughly 15 per cent per visit); and
- an average time between referral and surgery that far exceeded government-mandated targets.
Finding a better way for patients and the system
The researchers then proposed a new scheduling model, which they tested using data from TWH.
Diamant explained the proposed system: “Basically, patients are asked to arrive at the start of a session. Because they arrive together, the clinic observes who is present and who is a no-show. Each patient is then assigned to complete the assessment they were scheduled for and, depending on the number of no-shows, may attend additional assessments during the session. With this practice, we observe which patients fail to show up. Depending on the number of no-shows, patients may attend extra assessments during their visit, in addition to the one for which they were originally scheduled.”
Benefits to patients:
Although patients may spend a few extra hours in the clinic per visit, the practice reduces the overall time between referral and surgery by several months. “Patients who are committed to their treatment are rewarded. They are scheduled to the assessments of patients who did not show up and thus become eligible for bariatric surgery faster,” Diamant said.
Benefits to health-care facility/system:
Using this approach, the health-care facility gained ﬂexibility to improve operational performance. In particular, the new scheduling policy ensures that the clinic’s regular capacity is fully utilized without many assessments being performed using overtime capacity.
By way of summary, Diamant said: “We showed signiﬁcant improvements in patient throughput, clinic proﬁt, practitioner utilization and wait times for surgery.” This research could prove to be highly applicable in different health-care settings.
By Megan Mueller, manager, research communications, Office of the Vice-President Research and Innovation, York University, email@example.com