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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.

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 develop evident-based predictive no-show models considering patients’ each past appointment status, a time-dependent component, as an independent predictor to improve predictability.

A ten-year retrospective data set was extracted from a pediatric clinic. It consisted of 7,291 distinct patients who had at least two visits along with their appointment characteristics, patient demographics, and insurance information. Logistic regression was adopted to develop no-show models using two-thirds of the data for training and the remaining data for validation. The no-show threshold was then determined based on minimizing the misclassification of show/no-show assignments. There were a total of 26 predictive model developed based on the number of available past appointments. Simulation was employed to test the effective of each model on costs of patient wait time, physician idle time, and overtime.

The results demonstrated the misclassification rate and the area under the curve of the receiver operating characteristic gradually improved as more appointment history was included until around the 20th predictive model. The overbooking method with no-show predictive models suggested incorporating up to the 16th model and outperformed other overbooking methods by as much as 9.4 per cent in the cost per patient while allowing two additional patients in a clinic day.

The challenge now is to actually implement the no-show predictive model systematically to further demonstrate its robustness and simplicity in various scheduling systems.

This paper provides examples of how to build the no-show predictive models with time-dependent components to improve the overbooking policy. Accurately identifying scheduled patients’ show/no-show status allows clinics to proactively schedule patients to reduce the negative impact of patient no-shows.

The purpose of this paper is to develop a simulation-based value function (VF) that combines multiple key performance indicators (KPIs) into a unified Sigma rating (SR) for system-level performance assessment and improvement.

Simulation is used as a platform for assessing the multiple KPIs at the system level. A simple additive VF is formed to combine the KPIs into a unified SR using the analytical hierarchy process and the entropy method. Value mapping is utilized to resolve the conflict among KPIs and generate a unified value. These methods are integrated into the standard Six Sigma define-measure-analyze-improve-control (DMAIC) process.

Simulation results provided the Six Sigma DMAIC process with system-level performance measurement and analysis based on multiple KPIs. The developed VF successfully generated unified SRs that were used to assess various performance improvement plans.

The accuracy and credibility of the results obtained from using the proposed VF are highly dependent on the availability of pertinent data and the accuracy of the developed simulation model.

The proposed approach provides Six Sigma practitioners and performance mangers with a mechanism to assess and improve the performance of production and service system based on multiple KPIs when conducting Six Sigma studies.

This paper contributes to the previous research by handling multiple KPIs in Six Sigma studies conducted at the system level using simulation and VF. The research also provides guidelines for using the different methods of weights assessment to form the VF within the DMAIC process.

Theory of Constraints (TOC), though a well-established process improvement methodology in manufacturing, is still a novel philosophy for healthcare and an exhaustive review of literature is needed to summarize the key findings of various researchers. Such a review can provide a direction to the researchers and academicians interested in exploring the application of TOC in the healthcare sector. This paper aims to review the existing literature of TOC tools and techniques applied to the healthcare environment, and to investigate motivating factors, benefits and key gaps for identifying directions for future research in the domain of healthcare.

In this paper, different electronic repositories were searched using multiple keywords. The current study identified 36 articles published between January 1999 to mid-2021 to conceptualize and summarize the research questions used in the study. Descriptive analysis along with pictorial representations have been used for better visualization of work.

This paper presents a thorough literature review of TOC in healthcare and identifies the evolution, current trends, tools used, nature of services chosen for application and research gaps and recommends future direction for research. A variety of motivating factors and benefits of TOC in healthcare are identified. Another key finding of this study is that almost all implementations listed in literature reported positive outcomes and substantial improvements in the performance of the healthcare unit chosen for study.

This paper provides valuable insight to researchers, practitioners and policymakers on the potential of TOC to improve quality of services, flow of patients, revenues, process efficiency and cost reduction in different health care settings. A number of findings and suggestions compiled in the paper from literature study can be used for diagnosing, learning and making substantial changes in healthcare. The methodologies used by different researchers were analysed and combined to propose a generic step by step procedure to apply TOC. This methodology will guide the practising managers about the appropriate tools of TOC for their specific need.

Good health is always the first desire of all men and women around the globe. The global aim of healthcare is to quickly cure more patients and ensure healthier population both today and in future. This article will work as a foundation for future applications of TOC in healthcare and guide upcoming applications in the booming healthcare sector. The paper will help the healthcare managers in serving a greater number of patients with limited available resources.

This paper provides original collaborative work compiled by the authors. Since no comprehensive systematic review of TOC in healthcare has been reported earlier, this study would be a valuable asset for researchers in this field. A model has been presented that links various benefits with one another and clarifies the need to focus on process improvement which naturally results in these benefits. Similarly, a model has been presented to guide the users in implementation of TOC in healthcare.

This study aims to describe the experiences and barriers to care for women with autistic spectrum condition (ASC) under the care of the Brighton and Hove Specialist Perinatal Mental Health Service (BHSPMHS) and provide recommendations to improve the service.

Patients with an ASC diagnosis or suspected diagnosis and awaiting assessment under the care of BHSPMHS were offered to take part in the study. Five patients were interviewed to explore their experiences.

Participants had a mix of positive and negative experiences of services. Positives included the continuous support and allowing flexibility around appointments. Dialectical behavioural therapy groups running online instead of in-person was highlighted as a universal negative as well as delays in diagnosing ASC.

Those likely to meet the criteria for ASC but are awaiting formal diagnosis should be treated with appropriate adjustments to service provision as those who have received a diagnosis. Recommendations for service improvements include the provision of smaller, in-person therapy groups. Adjustments to treatments may include flexibility around appointment times and location.

There is little research into the experiences of people with ASC under the care of perinatal mental health teams. As specialist perinatal services expand, it is important to understand the experiences of women with ASC being cared for by these services, to ensure they are accessible and inclusive. The results of this study will be used to guide service development and act as a model for other services, with the intention of improving care for this patient group.

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 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.

Increased demand and the pressure to reduce health-care costs have led to longer waiting time for patients to make appointments and during the day of hospital visits. The purpose of this study is to identify opportunities to reduce waiting time using lean techniques and discrete-event simulation (DES).

A five-step procedure is proposed to facilitate the effective utilization of lean and DES to improve the performance of the Otolaryngology Head and Neck Surgery Outpatient Clinic at Cleveland Clinic Abu Dhabi. While lean techniques were applied to reduce the potential sources of waste by aligning processes, a DES model was developed to validate the proposed solutions and plan patient arrivals under dynamic conditions and different scenarios.

Aligning processes resulted in an efficient patient flow reducing both waiting times. DES played a complementary role in verifying lean solutions under dynamic conditions, helping to plan the patient arrivals and striking a balance between the waiting times. The proposed solutions offered flexibility to improve the clinic capacity from the current 176 patients up to 479 (without violating the 30 min waiting time policy) or to reduce the patient waiting time during the visit from the current 33 min to 4.5 min (without violating the capacity goal of 333 patients).

Proposing and validating lean solutions require reliable data to be collected from the clinic and such a process could be laborious as data collection require patient and resource tracing without interfering with the regular functions of the clinic.

The work enables health-care managers to conveniently conduct a trade-off analysis and choose a suitable inter-arrival time – for every physician – that would satisfy their objectives between resource utilization (clinic capacity) and average patient waiting time.

Successful implementation of lean requires a supportive and cooperative culture from all stakeholders involved.

This study presents an original and detailed application of lean techniques with DES to reduce patient waiting times. The adopted approach in this study could be generalized to other health-care settings with similar objectives.

The purpose of this paper is to explore and critically review the existing literature on applications of Lean Methodology (LM) and Discrete-Event Simulation (DES) to improve resource utilization and patient experience in outpatient clinics. In doing, it is aimed to identify how to implement LM in outpatient clinics and discuss the advantages of integrating both lean and simulation tools towards achieving the desired outpatient clinics outcomes.

A theoretical background of LM and DES to define a proper implementation approach is developed. The search strategy of available literature on LM and DES used to improve outpatient clinic operations is discussed. Bibliometric analysis to identify patterns in the literature including trends, associated frameworks, DES software used, and objective and solutions implemented are presented. Next, an analysis of the identified work offering critical insights to improve the implementation of LM and DES in outpatient clinics is presented.

Critical analysis of the literature on LM and DES reveals three main obstacles hindering the successful implementation of LM and DES. To address the obstacles, a framework that integrates DES with LM has been recommended and proposed. The paper provides an example of such a framework and identifies the role of LM and DES towards improving the performance of their implementation in outpatient clinics.

This study provides a critical review and analysis of the existing implementation of LM and DES. The current roadblocks hindering LM and DES from achieving their expected potential has been identified. In addition, this study demonstrates how LM with DES combined to achieve the desired outpatient clinic objectives.