Imagine going to the doctor’s office, seeing the doctor right away, and avoiding lengthy amounts of idle time in the waiting room.
Yu-Li Huang, assistant professor of industrial engineering, and six NMSU students are researching how to redesign the outpatient scheduling system in clinics to be more efficient and reduce patient waiting.
Huang and his students are working on the project for Presbyterian Health System in Los Lunas, New Mexico. The team’s goal is to make the outpatient scheduling system more efficient, improve patient access and reduce patient waiting time. So far, the team has done the analysis, collected the results and finished the preliminary findings for the project.
Huang said two problems they found were appointment scheduling and the amount of time doctors spend on charting at the clinic. He found that in an eight-hour day a doctor spends more than two hours charting. He said that if the charting time is reduced, physicians will be able to see more patients and patient access will be improved.
“What we have found right now is the physicians in this clinic, they tend to spend about 20 percent of their time doing charting,” Huang said. “I think two hours of charting time can be reduced by providing a better computer interface.”
Huang said they are not far enough along in the project to give their recommendation to the physicians for their appointment scheduling. He believes the physicians should spend most of their time with patients and the charting should be part of the patient visit rather than leaving their schedule open to catch up on all of their charting. He also said reducing charting time is a must before he can provide a recommendation to the physicians on how to more efficiently schedule appointments. The expected outcomes will not only improve patient waiting and access to care, but also reduce the physician’s stress in a clinic day.
“One of the key elements for the type of scheduling I do is to improve the patient’s quality of service and patient access to care,” Huang said.
He said there are solutions to these healthcare issues, but there is a gap between the “theoretical base” and the “practical sense” since the solutions haven’t actually been adopted by many clinics.
“I have the theoretical base and I want to use this clinic as a pilot to see if the theoretical base can actually be implemented,” Huang said.
In October 2013, Huang hosted a workshop at Presbyterian where the chief operating officer and managers listened to his proposal and decided they wanted to move forward with the project. Huang said if they are successful in this study then Presbyterian will work with them to implement the solutions into other clinics in the Presbyterian Healthcare Services system.
Huang has also worked on similar projects, one in the radiology department at Mimbres Memorial Hospital in Deming and another at the Women’s Health Center in Las Cruces.
Huang said the Women’s Health Center had an issue with their scheduling and sought his help for a better scheduling system to reduce stress on their midwives, improve access to care and reduce the patient waiting time. Huang said their reduction in patient waiting time was significant. It started at an average of about 40 to 45 minutes, and currently the patient waits 10 to 15 minutes on average.
To come up with a successful solution, Huang looks at the data, considers the amount of time the physician spends with the patient and the variation of the treatment time. Although his projects at Presbyterian and the Women’s Health Clinic are similar, they are not identical.
Huang said for the Women’s Health Clinic he used the theory of constraints, a method that uses many different constraints to come up with an “optimal solution.” For the Presbyterian project, he is using a grid scheduling system, which is based on minimizing the costs. In the grid scheduling system he discovers the average amount of time a physician spends with a patient, then schedules appointments based on that amount of time with consideration of variation.
For example, if the grid system determines that the minimum appointment length should be 15 minutes, then returning patients will be scheduled with 15-minute appointments. Other appointments, such as new patient appointments, that might take longer, would be scheduled in 15-minute increments. That means a new patient would get a 30-minute appointment and if a patient had a need for a long appointment it might be 45 minutes long. “The process of this grid system is interchangeability,” Huang said.
“For the non-grid appointment system, where a return visit could be scheduled at 15 minutes and a new patient could be scheduled at 20 minutes, if I put the new patient into a 15-minute slot, the physician is going to be delayed and the delay is going to compound all the way to the end of the day. On the other hand, if I put the return visit patient into a new patient slot, the physician may be idle, so there’s underutilized medical resources, ” Huang said.
Huang started researching outpatient scheduling when he was a doctoral student at the University of Michigan. He studied three clinics in Michigan and after he redesigned their schedule, the reduction in patient waiting was as much as 56 percent. The clinics not only had a reduction of patient waiting, but Huang said the environment was also less stressful.
“In a couple clinics it was addressed that they used to have a very huge headache by the end of the day, but after implementing my solution the headache is gone,” he said.
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