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Physician lateness and service interruptions are a significant problem in many health care environments but have received little attention in the literature. The purpose of this paper is to design appointment systems that reduce waiting times of the patient while maintaining utilization of the physician at a high level.

Empirical data from time studies and surveys of medical professionals from multiple outpatient clinics are used to motivate the study. Simulation optimization is used to simultaneously account for uncertainty and to determine (near) optimal scheduling solutions.

As lateness increases, it is shown that, in general, appointment slots should be shorter and pushed later in the session. Conversely, as interruptions rise, appointments in the middle of the session should be longer. These findings are fairly consistent over a variety of environmental conditions, including clinic sizes, service time variance, and costs of physician time compared to patients' time.

This paper demonstrates that the dome/plateau‐dome scheduling patterns that have been found in prior studies work well under many of the new factors modeled here. This is encouraging because it suggests that a generalizable pattern is emerging in the literature for the range of environments studied in these papers and this research provides guidance as to how to adjust the pattern to account for the factors studied here. In addition, it is shown that some environments will perform better with a different pattern, which the authors denote a “descending step” pattern.

This paper differs from most prior studies in that the complexity of environmental variables and stochastic elements of the model are simultaneously accounted for by the simulation optimization algorithm. The (very few) prior papers that have used simulation optimization have not addressed the factors studied here.

This study aims to help businesses cope with consumers' no-show behaviour from a multistage perspective. It specifically identifies no-show reasons at each stage of appointment services and proposes the corresponding coping strategies.

By focusing on an outpatient appointment service, we interviewed 921 no-show patients to extract no-show reasons, invited 18 hospital managers to propose coping strategies for these reasons using a Delphi method and evaluated the proposed strategies based on EDAS (Evaluation based on Distance from Average Solution).

The results reveal ten reasons for no-show behaviour (i.e. system service quality, overuse, did not know the appointment, self-judgment, forget, waiting time, lateness, uncontrollable problems, time conflict and service coordination), which have nine coping strategy themes (i.e. prepayment, system intelligence, target, subjective norm, system integration, ease of navigation, reminder, confirmation and cancellation). We classify the ten reasons and nine themes into scheduling, waiting and execution stages of an appointment service.

This study provides a package of coping strategies for no-show behaviour to deal with no-show reasons at each appointment service stage. It also extends the research in pre-service management through appointment services.

The purpose of this paper is to maximize the expected revenue of the outpatient department considering patient preferences and choices.

Patient preference refers to the preferred physician and time slot that patients hold before asking for appointments. Patient choice is the appointment decision the patient made after receiving a set of options from the scheduler. The relationship between patient choices and preferences is explored. A dynamic programming (DP) model is formulated to optimize appointment scheduling with patient preferences and choices. The DP model is transformed to an equivalent linear programming (LP) model. A decomposition method is proposed to eliminate the number of variables. A column generation algorithm is used to resolve computation problem of the resulting LP model.

Numerical studies show the benefit of multiple options provided, and that the proposed algorithm is efficient and accurate. The effects of the booking horizon and arrival rates are studies. A policy about how to make use of the information of patient preferences is compared to other naive polices. Experiments show that more revenue can be expected if patient preferences and choices are considered.

This paper proposes a framework for appointment scheduling problem in outpatient departments. It is concluded that more revenue can be achieved if more choices are provided for patients to choose from and patient preferences are considered. Additionally, an appointment decision can be made timely after receiving patient preference information. Therefore, the proposed model and policies are convenient tools applicable to an outpatient department.

The paper aims to provide a simulation optimization solution to improve patient scheduling that accounts for varying ancillary service time such as x-ray to minimize patient wait time.

The two-step approach is to: identify patients' needs for ancillary services while scheduling appointments; and propose an algorithm to determine ancillary service time via simulation optimization. The main aim is to provide sufficient time between arrival at the clinic and the actual examination time for a patient to complete pre-visit activities without contributing significantly to patient wait time. Two case studies are included to demonstrate the approach.

Triaging at the appointment-scheduling time saves an average 17 minutes for physician's first consultation in a clinic day, and a 7 percent reduction on current average patient wait time for case 1. Case 2 results in a 9 percent reduction on average patient wait time. The scheduled ancillary service time depends on the frequency and the ancillary service time, and appointment slot design.

One limitation is the impact of modeling error on the account of ancillary service times and the modeling assumptions.

The proposed approach provides a studying method for clinic staff to account for ancillary services prior to physicians' visits for a better patient care. Two case studies demonstrated the practicability and promising results on reducing patient waiting.

This article presents a unique approach to considering the required ancillary services in outpatient scheduling system that minimizes patient wait times. The approach will strengthen the existing scheduling methods to allow the time for ancillary services.

High lateness and no-show percentages pose great challenges on the patient scheduling process. Usually this is addressed by optimizing the time between patients in the scheduling process and the percent of extra patients scheduled to account for absent patients. However, since the patient no-show and lateness is highly stochastic we might end up with many patients showing up on time which leads to crowded clinics and high waiting times. The clinic might end up as well with low utilization of the doctor time. The purpose of this paper is to study the effect of scheduled overload percentages and the patient interval on the waiting time, overtime, and the utilization.

Actual data collection and statistical modeling are used to model the distribution for common dentist procedures. Simulation and validation are used to model the treatment process. Then algorithm development is used to model and generate the patient arrival process. The simulation is run for various values of basic interval scheduled time between arrivals for the patients. Further, 3D graphical illustration for the objectives is prepared for the analysis.

This work initially reports on the statistical distribution for the common procedures in dentist clinics. This can be used for developing a scheduling system and for validating the scheduling algorithms developed. This work also suggest a model for generating patient arrivals in simulation. It was found that the overtime increases excessively when coupling both high basic interval and high overloading percentage. It was also found that: to obtain low overtime we must reduce the basic interval. Waiting time increases when reducing the basic scheduled appointment interval and increase the scheduled overload percentage. Also doctors’ utilization is increased when the basic interval is reduced.

This work was done at a local clinic and this might limit the value of the modeled procedure times.

This work presents a statistical model for the various procedures and a detailed technique to model the operations of the clinics and the patient arrival time which might assist researches and developers in developing their own model. This work presents a procedure for troubleshooting scheduling problems in outpatient clinics. For example, a clinic suffering from high patient waiting time is directly instructed to slightly increase their basic scheduled interval between patients or slightly reduce the overloading percentage.

This work is targeting an extremely important constituent of the health-care system which is the outpatient clinics. It is also targeting multiple objectives namely waiting times, utilization overtime, which in turn is related to the economics and doctor utilization.

This work presents a detailed modeling procedure for the outpatient clinics under high lateness and no-show and addresses the modeling procedure for the patient arrivals. This 3D graphical charting for the objectives includes a study of the multiple objectives that are of high concern to outpatient clinic scheduling interested parties in one paper.

This study is carried out in one public and one private health-care centers based on different probabilities of patient’s no-show rate. The present study aims to determine the optimal queuing system capacity so that the expected total cost is minimized.

In this study an M/M/1/K queuing model is used for analytical properties of optimal queuing system capacity and appointment window so that total costs of these cases could be minimized. MATLAB software version R2014a is used to code the model.

In this paper, the optimal queuing system capacity is determined based on the changes in effective parameters, followed by a sensitivity analysis. Total cost in public center includes the costs of patient waiting time and rejection. However, the total cost in private center includes costs of physician idle time plus costs of public center. At the end, the results for public and private centers are compared to reach a final assessment.

Today, determining the optimal queuing system capacity is one of the most central concerns of outpatient clinics. The large capacity of the queuing system leads to an increase in the patient’s waiting-time cost, and on the other hand, a small queuing system will increase the cost of patient’s rejection. The approach suggested in this paper attempts to deal with this mentioned concern.

The purpose of this paper is to identify how need for service, enabling factors and pre-disposing characteristics influences access to service. In addition, the authors seek to examine the moderating influence of pre-disposing variables on the relationship between insurance and health services utilization.

The authors utilize data from a major metropolitan hospital in the USA to test and extend the behavioral model of health care.

Results indicate that insurance and pre-disposing variables have a direct impact on type of health service utilization. However, the insurance effect is found to vary by demographic factors.

This paper is limited to secondary data. Future work can incorporate both attitudinal and behavioral measures to obtain a more comprehensive evaluation of services access.

The research offers a tactical framework for management to segment consumer markets more effectively.

Through the framework, management will have the requisite knowledge to target segmented populations based on need, insurance, and pre-disposing variables which will help improve access to services and clinical outcome.

The findings of this paper will serve as a basis for future research exploring the influence of insurance on access to services.

This study aims to explore the prevalence and librarian perceptions of no-show research appointments in academic libraries. These findings are examined in light of the literature within academic libraries and other industries (health, hospitality) with appointment models.

This paper uses an exploratory survey of reference librarians across a stratified sample of academic libraries in the USA. The findings are considered through the lens of critical theory in academic libraries.

Academic libraries lack consistent understanding and language used to describe appointment-based reference models. Librarians do not gather much reliable data on the percentage of no-show appointments and further research is needed on this topic.

Study results are limited to academic librarians in the sample who responded to the survey and indicated the availability of research appointments at their institution. The implications of this paper suggest ideas for gathering appointment statistics and evaluating the rhetoric used to advertise appointments to college students.

This research is unique in that it is the first exploratory study on the prevalence and perception of missed appointments in academic library reference models.

The purpose of this paper is to evaluate the economic benefits of managing an outpatient appointments system with technological innovations.

This study uses a quantitative methodological procedures aiming to evaluate the cost-benefit relation and also the payback of the management and operation of an outpatient appointments system with technological innovations.

This study found a great benefit-cost relation of 30.6 showing the great economic value and social impact of managing an outpatient appointments regulation system with technological innovations.

This study presents contribution to the literature discussion about the economic evaluation of the benefits of managing and operating more effective outpatient appointments systems because of important technological innovations.

This paper presents and discusses the most important and commonly used strategies and technological innovations to deal with and to manage an outpatient appointment regulation system aiming to reduce the patient no-show rates.

The findings of this study show a great benefit-cost relation of about 30.6 which is being reverted to the society.

There not exist many similar studies in the pertinent literature, mostly with the Brazilian contexts.

Outpatient care delivery is one of the key revenue sources of a hospital which plays a salient role in timely care delivery. The key purpose of the study is to propose a multi-objective simulation-based decision support model that considers the cost of care delivery and patient dissatisfaction as its two key conflicting objectives. Patient dissatisfaction considers service fairness. Patient idiosyncrasies such as no-show, unpunctuality and balking have been considered in the model involving multiple classes of patients.

A model has been designed using data collected from field investigations. In the first stage, queuing theory based discrete event simulation model has been developed. Genetic algorithm has been used to solve the scalarized problem and obtain actionable insights. In the second stage, non-dominated sorting genetic algorithm II (NSGA-II) has been involved to achieve the Pareto optimal fronts considering equal priority of the two objectives.

The computational results considering various parameter settings can help in efficient resource planning while ensuring better care delivery. The model proposed in the study provides structural insights on the business strategy of healthcare service providers on optimizing the dual goals of care delivery cost and service fairness.

The study is one of the early works that helps to improve the care delivery process by taking into consideration the environmental factors as well as service fairness. The study demonstrates the usage of simulation-based multi-objective optimization to provide a more sustainable patient centric care delivery.