Appointment scheduling in multi-stage outpatient clinics.

Healthcare providers can benefit from adding less costly capacity to their existing resources in order to satisfy demand while maintaining the quality of patient care. The addition of mid-level service providers (MLSPs) such as physician assistants or nurse practitioners that carry out portions of patient care provides a viable alternative for adding physician capacity. This research considers the circumstances under which adding an MLSP to a single-physician outpatient office becomes the best strategy for the clinic, and determines how scheduling policies from the widely-researched single-stage environment should be adjusted for a multi-stage environment. Compared to a single-stage system where a physician completes all portions of the service, we show that adding an MLSP can reduce patient waiting time, patient flow time, and physician service time with patients. This, in turn, can enable the clinic to see more patients and/or free up physician time for other tasks. Appointment scheduling rules are developed for a multi-stage outpatient service system using a simulation optimization approach. Performance measures focus on the patient experience and clinic operation before and during each stage of service.