Reducing the waitlist of referred patients in a medical specialist outpatient clinic: an observational study

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Annie K. Lewis ◽  
Nicholas F. Taylor ◽  
Patrick W. Carney ◽  
Katherine E. Harding
Keyword(s):  
Observational Study ◽  
Waiting Times ◽  
Outpatient Clinics ◽  
Content Type ◽  
Reduction Strategy ◽  
Methodical Approach ◽  
Administration Error ◽  
Local Impact ◽  
Intervention Description ◽  
The Impact

PurposeLong waitlists in outpatient clinics are a widely recognised problem. The purpose of this paper is to describe and report the impact of a waitlist reduction strategy for an epilepsy clinic.Design/methodology/approachThis observational study described the local impact of a methodical approach to tackling a long waiting list, using targeted strategies supported by a modest additional budget. The interventions were described using the template for intervention description and replication (TIDieR).FindingsOver an eight-month period, the waitlist for the epilepsy clinic was reduced from 599 to 24 patients without increasing the number of days until the next available appointment. Most referrals were removed from the waitlist without an appointment. Auditing revealed a high proportion of patients no longer required the service or referrals remained on the waitlist due to administration error. A short-term increase in clinic capacity of 51 extra appointments met the needs of the remaining waiting patients. The additional project funding invested in this process was AUD $10,500 and a time-limited amount of extra work was absorbed by using existing clinic resources.Practical implicationsThis waitlist reduction strategy resulted in a very small waitlist for the epilepsy clinic, which is now well placed to trial further interventions with the aim of sustaining the service with minimal waiting times. Not every referral on the waitlist, particularly the very long waiters, required an appointment. Other outpatient clinics may be able to apply this process to reduce their waitlists using a modest budget.Originality/valueAlthough there are reports of successful waitlist reduction, few report the intervention in detail. Use of the TIDieR in reporting enables the intervention to be appraised or adapted to other settings where long waitlists are problematic. Considerations related to implementation of policy are discussed and in this case, a locally led and executed change management strategy was a key to achieving the result.

Validating the primary provider theory in emergency medicine

2008 ◽  
Vol 21 (2) ◽  
pp. 120-130 ◽  
Author(s):  
Joseph S. Guarisco ◽  
Stefoni A. Bavin
Keyword(s):  
Emergency Department ◽  
Patient Satisfaction ◽  
Pay For Performance ◽  
Medical Center ◽  
Waiting Times ◽  
Emergency Department Visits ◽  
Business Success ◽  
Content Type ◽  
The Impact

PurposeThe purpose of this paper is to provide a case study testing the Primary Provider Theory proposed by Aragon that states that: disproportionate to any other variables, patient satisfaction is distinctly and primarily linked to physician behaviors and secondarily to waiting times.Design/methodology/approachThe case study began by creating incentives motivating physicians to reflect and improve behaviors (patient interactions) and practice patterns (workflow efficiency). The Press Ganey Emergency Department Survey was then utilized to track the impact of the incentive programs and to ascertain any relationship between patient satisfaction with the provider and global patient satisfaction with emergency department visits by measuring patient satisfaction over an eight quarter period.FindingsThe findings were two‐fold: firstly, the concept of “pay for performance” as a tool for physician motivation was valid; and secondly, the impact on global patient satisfaction by increases in patient satisfaction with the primary provider was significant and highly correlated, as proposed by Aragon.Practical implicationsThese findings can encourage hospitals and physician groups to place a high value on the performance of primary providers of patient care, provide incentives for appropriate provider behaviors through “pay for performance” programs and promote physician understanding of the links between global patient satisfaction with physician behaviors and business growth, malpractice reduction, and other key measures of business success.Originality/valueThere are no other case studies prior to this project validating the Primary Provider Theory in an urban medical center; this project adds to the validity and credibility of the theory in this setting.

Assessment and improvement of competitiveness of industrial complex

2020 ◽  
Vol 30 (5) ◽  
pp. 611-633
Author(s):  
Vadim Krivorotov ◽  
Alexey Kalina ◽  
Vasiliy Tretyakov ◽  
Sergey Yerypalov ◽  
Anna Oykher
Keyword(s):  
Resource Constraints ◽  
Electrical Equipment ◽  
Optimal Portfolio ◽  
Development Projects ◽  
Industrial Complex ◽  
Project Portfolio ◽  
Content Type ◽  
Methodical Approach ◽  
The Impact ◽  
Selection Of

Purpose The purpose of this study is to develop a model for the selection of optimal development projects for an industrial complex (IC), aimed at improving its competitiveness. Design/methodology/approach Selection of optimal projects for IC development is carried out within the framework of a methodical approach to assessing and forecasting the competitiveness of IC based on the phased implementation of the following steps: assessment of the current level of competitiveness of an IC; optimization of the project portfolio aimed at improving the IC competitiveness; forecasting the IC competitiveness. The methodology for assessing the IC competitiveness is based on a comparative analysis of its activities against those of its leading competitors and evaluates two integral characteristics, namely, the level of current competitiveness and the indicator of the competitive potential. The methodical approach to the selection of the optimal portfolio of projects for the development of competitiveness is based on a step-by-step optimization of the portfolio using a dynamic programming procedure, which takes into account the implementation conditions of the projects, resource constraints and the prioritization of these projects. The targeted benchmark for the optimization is an integral indicator of IC competitiveness, comprising various aspects of its activities. Findings Method for multi-factor evaluation of IC competitiveness and the impact of a set of factors driving competitive advantage; set of benchmarks of IC competitiveness; the model for the selection and step-by-step optimization of the portfolio of IC development projects, aimed at increasing competitiveness in the context of resource constraints. Practical implications Methodology described in this paper was used to assess the competitiveness and optimize the project portfolio of Uralelektrotyazhmash Group of Enterprises (UETM), one of the largest power engineering complexes in Russia. The assessment was carried out in comparison with the leading domestic and global manufacturers of electrical equipment, which form UETM’s primary competition in the marketplace. Originality/value The study establishes a method for the comprehensive assessment of IC competitiveness based on the comparison of IC activity indicators with those of leading competitors. The proposed method defines an integral competitiveness index to allow for the quantitative assessment of IC competitiveness, development of measures to improve IC competitiveness and producing a methodology to forecast the impact of such measures; the study proposes a methodical approach to selecting the optimal portfolio of projects for the development of IC based on the stepwise optimization of such a portfolio while taking into account the conditions of their implementation, resource constraints and the impact on the indicator of competitiveness. This approach allows the IC to prioritize the implementation of the development projects and maximize its competitiveness in the context of available resources.

scholarly journals The impact of Covid-19 on access to psychological services

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Jack Purrington ◽  
Nigel Beail
Keyword(s):  
Psychological Distress ◽  
Intellectual Disabilities ◽  
Effect Size ◽  
Waiting Times ◽  
Psychological Services ◽  
Service Users ◽  
Content Type ◽  
Referral Rates ◽  
Adults With Intellectual Disabilities ◽  
The Impact

Purpose The novel coronavirus and associated mitigation efforts have produced barriers to accessing services for adults with intellectual disabilities. This paper aims to evaluate the impact of Covid-19 on access to psychological services. The paper evaluates monthly referral rates and psychological distress scores for service users awaiting therapy. Design/methodology/approach A quantitative service evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. A single case experimental design was used to examine the impact of events in March 2020 on referral rates. Descriptive statistics and effect size calculations were used to examine the impact of prolonged waiting times on psychological distress scores. Findings Referral rates were examined comparing a 5-year rolling average monthly referral rate for the 12 months prior to March 2020 with the 12 months following. Findings demonstrate that events starting in March 2020 have had a considerable impact on referral rates and rates have not recovered. Eight service users were contacted to determine the impact of prolonged waiting times with results demonstrating increases in psychological distress of large effect size. Originality/value This is the only paper the authors are aware of examining the impact of the coronavirus on access to services and psychological distress for adults with intellectual disabilities. It is hoped that these findings will be able to inform both policy and practice as services continue to navigate the pandemic.

Appointment system design with interruptions and physician lateness

2013 ◽  
Vol 33 (4) ◽  
pp. 394-414 ◽  
Author(s):  
Kenneth J. Klassen ◽  
Reena Yoogalingam
Keyword(s):  
Design Methodology ◽  
Simulation Optimization ◽  
Waiting Times ◽  
Outpatient Clinics ◽  
Content Type ◽  
Time Variance ◽  
Physician Time ◽  
Appointment System ◽  
High Level ◽  
Practical Implications

PurposePhysician 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.Design/methodology/approachEmpirical 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.FindingsAs 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.Practical implicationsThis 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.Originality/valueThis 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.

E-commerce mercantilism-practices and causes

2020 ◽  
Vol 19 (1) ◽  
pp. 51-66
Author(s):  
C.Y. Cyrus Chu ◽  
Po-Ching Lee
Keyword(s):  
Waiting Times ◽  
Internet Access ◽  
Content Type ◽  
Hard Evidence ◽  
Internet Retail ◽  
Internet Censorship ◽  
The Impact ◽  
Potential Customers ◽  
Rule Making ◽  
Practical Implications

Purpose This paper aims to highlight in particular one commercially influential but subtle constituent of China’s mercantilist stratagem – asymmetrical internet access. The wider aim of the paper is to provide a solid basis of real-world facts and knowledge to the e-commerce discussions at the World Trade Organization and the ongoing plurilateral e-commerce negotiations. Design/methodology/approach This paper uses an empirical approach to reflect the general experiences of consumers connecting from China to e-commerce platform websites in other countries and vice versa consumers connecting from other countries to China’s e-commerce platform. Findings The empirical data show that Chinese potential customers trying to connect to the websites of foreign internet retailers in 17 other sample countries are faced with prohibitively long waiting times. In contrast, the average waiting time that it takes for customers in those other 17 countries to link up to China’s major internet retail platforms is much shorter. Practical implications The hard evidence presented here serves to strengthen the arguments that such internet censorship is used by China to establish unfair e-commerce advantage. This paper further argues that the General Agreement on Trade in Services is restrained from providing systemic solutions to the digital mercantilism problem. It is essential, therefore, that the ongoing plurilateral e-commerce negotiations address this issue. Originality/value This paper is the first to publish detailed results of a systematic survey designed to analyze the impact of asymmetrical internet access in China. It is also the first to examine the extent and effect of differing internet connection speeds in the context of international trade. The outcome of the survey provides a factual base for future rule-making at the multilateral level.

The impact of non-urgent patients in emergency departments' operations

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Higor Leite
Keyword(s):  
Emergency Departments ◽  
Waiting Times ◽  
Healthcare Access ◽  
Descriptive Analysis ◽  
Lean Six Sigma ◽  
Future Research ◽  
Content Type ◽  
And Performance ◽  
The Impact ◽  
Practical Implications

PurposeGlobally, the presence of non-urgent patients in emergency departments (EDs) is considered one of the main reasons for creating excessive waiting times and overcrowding in units. This paper aims to understand the impact of non-urgent patients in EDs' operations.Design/methodology/approachThis study is based on qualitative case studies conducted within two Brazilian EDs, and uses interviews and observations to access the data.FindingsFrom a thematic analysis, three key themes emerged: characteristics of non-urgent demands in EDs, negative aspects of non-urgent patients in EDs, and the impact of the healthcare system model on EDs. These themes bring to light the impact that non-urgent patients have in EDs' operations, and provide theoretical and practical implications.Research limitations/implicationsThe limitation of this work is bound by the understanding of the non-urgent demands in EDs. Therefore, a benchmarking approach (investigating state-of-the-art practices to avoid such impact) was not applied but was suggested for future research instead.Practical implicationsThe research provides significant contributions to practitioners and policymakers, aiding future discussions to improve healthcare coverage and performance.Social implicationsThe research provides significant contributions for managers and policymakers, aiding future discussions to improve healthcare. For instance, the use of well-known techniques (e.g. lean, six sigma) are discussed and suggested to enhance healthcare capacity and performance. Furthermore, the policymakers are called upon to evaluate the healthcare access and provide regulations that involve innovative approaches to widen healthcare access.Originality/valueBased upon empirical data, this research extends the discussions related to non-urgent patient in EDs and is not limited merely to descriptive analysis, but by providing practical propositions and discussions related to the impact of these patients' presence in EDs' operations. Finally, the research provides a range of suggestions for future research related to the EDs' operational performance.

Outpatient clinic waiting time, provider communication styles and satisfaction with healthcare in India

2016 ◽  
Vol 29 (7) ◽  
pp. 759-777 ◽  
Author(s):  
Payal Mehra
Keyword(s):  
Patient Satisfaction ◽  
Waiting Time ◽  
Outpatient Clinic ◽  
Care Quality ◽  
Assessment Model ◽  
Outpatient Clinics ◽  
Communication Styles ◽  
Provider Communication ◽  
Content Type ◽  
The Impact

Purpose – The purpose of this paper is to evaluate the impact of extended waiting time on patients’ perceptions of provider communication skills and in-clinic satisfaction, in three major cities in India. Design/methodology/approach – In total, 625 patients were interviewed. The multivariate general linear model was used to determine the causality and relationship between the independent and the dependent variable. A moderation analysis was also conducted to assess waiting time role as a potential moderator in doctor-patient communication. Findings – Results show that patients with higher waiting time were less satisfied with health care quality. Male patients and patients of male providers were more affected by extended waiting time than female patients and patients of female providers. The advanced regression analysis, however, suggests weak support for waiting time and its effect on overall satisfaction with clinic quality. Waiting time did not moderate the relationship between satisfaction with dominant communication style, and overall satisfaction at the outpatient clinic. Research limitations/implications – A cross-sectional study does not easily lend itself to explaining causality with certainty. Thus, sophisticated techniques, such as structural equation modelling may also be utilized to assess the influence of extended waiting time on satisfaction with healthcare at outpatient clinics. Practical implications – Findings are relevant for providers as the onus is on them to ensure patient satisfaction. They should initiate a workable waiting time assessment model at the operational level. Originality/value – There has been a relatively lesser focus on patient waiting time in patient-provider satisfaction studies. In India, this aspect is still vastly unexplored especially in the context of outpatient clinics. Gender wise pattern of patient satisfaction and waiting time is also missing in most studies.

Enhancing outpatient appointment scheduling system performance when patient no-show percent and lateness rates are high

2018 ◽  
Vol 31 (4) ◽  
pp. 309-326 ◽  
Author(s):  
Mahmoud Barghash ◽  
Hanan Saleet
Keyword(s):  
Waiting Time ◽  
Waiting Times ◽  
Multiple Objectives ◽  
Outpatient Clinics ◽  
Arrival Process ◽  
Content Type ◽  
Scheduling System ◽  
Modeling Procedure ◽  
Basic Interval ◽  
Patient Arrival

Purpose 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. Design/methodology/approach 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. Findings 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. Research limitations/implications This work was done at a local clinic and this might limit the value of the modeled procedure times. Practical implications 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. Social implications 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. Originality/value 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.

Signpost appointments in an adult psychological therapies team

2018 ◽  
Vol 23 (1) ◽  
pp. 1-11
Author(s):  
Katie Phillips ◽  
Lucy N. Macintyre ◽  
Alison McMullan
Keyword(s):  
Treatment Planning ◽  
User Satisfaction ◽  
Service User ◽  
Waiting Times ◽  
Individual Therapy ◽  
Assessment Process ◽  
Content Type ◽  
Psychological Therapies ◽  
The Uk ◽  
The Impact

Purpose In Scotland, individuals referred for NHS psychological therapies are expected to commence “treatment” within 18 weeks of receipt of referral. With high demand, high non-attendance rates and limited capacity, this can be a challenging goal. The service discussed here was keen to develop a way of seeing individuals referred sooner and improving the efficiency of the assessment process. The purpose of this paper is to look at the impact of introducing assessment (“Signpost”) appointments on waiting times, attendance, and treatment planning. Design/methodology/approach Signpost appointments were offered to all existing, and any new referrals, to an adult psychological therapies team (PTT) in NHS Lanarkshire. Clinicians kept a record of the outcomes of these appointments over a six month period. Waiting times and attendance figures were compared before and after the introduction of the Signpost system. Findings Following the introduction of Signpost appointments, individuals were seen sooner for both assessment and therapy. Attendance at first appointments improved and Signpost appointments helped inform treatment planning. Although alternatives were discussed, the majority of clients were still offered individual therapy. Service user and staff satisfaction was high. Practical implications The results from this study led to assessment (“Signpost”) appointments being rolled out across other adult PTTs in NHS Lanarkshire. Originality/value There is little research looking at the impact of assessment/signpost appointments on adult mental health services in the UK. In the current climate of public service cuts, this study provides an innovative way of reducing waiting times and maintaining service user satisfaction, without requiring more resources.

scholarly journals Enterprise systems: the upgrade process model

2016 ◽  
Vol 29 (6) ◽  
pp. 822-840 ◽  
Author(s):  
Gerald Feldman ◽  
Hanifa Shah ◽  
Craig Chapman ◽  
Ardavan Amini
Keyword(s):  
Process Model ◽  
Enterprise Systems ◽  
Structured Interviews ◽  
Web Based ◽  
Content Type ◽  
Qualitative Survey ◽  
Methodical Approach ◽  
Proposed Model ◽  
The Impact ◽  
Survey Approach

Purpose Enterprise systems (ES) upgrade is a complex undertaking that recurs throughout the systems’ life span, therefore, organisations need to adopt strategies and methodologies that can minimise disruptions and risks associated with upgrades. The purpose of this paper is to explore the processes undertaken during upgrading ES, to identify the upgrade project stages. Design/methodology/approach This research is grounded in a qualitative survey approach, and utilises a web-based survey questionnaire and semi-structured interviews as methods for data collection. The data were gathered from 41 respondents’ and analysed using qualitatively inductive content analysis principles to derive meaning and to identify the trends about upgrade processes. Findings The study findings stress the importance of adopting a methodical approach to ES upgrades. Also, it suggests that due consideration should be given to the impact of new version features and functionality, the risks and the effort required for supporting upgrade projects. Research limitations/implications The five-stage upgrade process model can be utilised as a strategy to minimise complexity and risks associated with upgrade projects. However, this study only proposes logical generalisations; therefore, future studies could explore these stages in-depth to offer generalisable arguments applicable to ES upgrade phenomenon. Originality/value The study proposes a five-stage upgrade process model that offers a systematic approach to support upgrade projects. The proposed model extends previous models by proposing alternative strategies to support ES upgrade projects.

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