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Dayton Medical Care, Inc. (Day-Med) Patient Appointment System

The document requests that the analysis team conduct a study of Dayton Medical Care's (DAY-MED) patient appointment system to evaluate its current performance and the potential impacts of a proposed improvement. Specifically, the team is asked to: 1) Examine appointment arrival and duration data to draw insights into current system performance. 2) Measure the performance of the current system using defined metrics and compare results to targets. 3) Model and evaluate the potential impacts of a proposed improvement involving buffer times, changing the late arrival grace period, and tightening appointment durations. 4) Provide any additional insights or recommendations from the analysis in a business memo report.

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Joel Christian Mascariña
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50 views4 pages

Dayton Medical Care, Inc. (Day-Med) Patient Appointment System

The document requests that the analysis team conduct a study of Dayton Medical Care's (DAY-MED) patient appointment system to evaluate its current performance and the potential impacts of a proposed improvement. Specifically, the team is asked to: 1) Examine appointment arrival and duration data to draw insights into current system performance. 2) Measure the performance of the current system using defined metrics and compare results to targets. 3) Model and evaluate the potential impacts of a proposed improvement involving buffer times, changing the late arrival grace period, and tightening appointment durations. 4) Provide any additional insights or recommendations from the analysis in a business memo report.

Uploaded by

Joel Christian Mascariña
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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MBA 791 PROJECT ONE—DAY-MED MBA@Dayton.

docx

DAYTON MEDICAL CARE, INC. [DAY-MED]


“Affordable high quality healthcare for the Dayton community”

Patient Appointment System


ANALYSIS AUTHORIZATION 20XX-12

Introduction. Dayton Medical Care, Inc. (DAY-MED) is a major health organization in the
Dayton Ohio MSA providing a wide range of health care services. We contract with employers for group
medical insurance and we support most health care services at several clinics throughout the area. Thus
we simultaneously function as an insurer and a health care provider.
As you know, your small group was established several years ago to support the management
team of DAY-MED. The group has been used for numerous special projects and ad-hoc problem solving
and data gathering efforts. It is an honor for young, ‘up and coming’ professionals to be assigned to this
group; the experience gives them broad exposure to DAY-MED management issues. DAY-MED
executives sometimes refer to you as their issue analysis team. However, the official name of your
organization is the AIG Team (your motto is Analysis leads to Insights leads to Good decisions).

This Initiative. As one element in a broad initiative to become more efficient and improve
service to customers, we at DAY-MED want to examine our most widely used appointment scheduling
system. Although the system has been used for some number of years, DAY-MED has become aware that
this important system should be studied. Our Director of Operations (the undersigned) has received a
number of comments and complaints from patients, doctors, and administrative staff. It is requested that
your AIG team conduct an analysis of this appointment system.

Current Appointment Scheduling System. This particular appointment system is designed to


serve many of our offices or clinics based upon similar appointment durations, similar variations in actual
visit durations, and similar general assumptions about patients arriving for appointments. There are
approximately 25 doctors that now use this appointment system. The system (for any one doctor) has
these characteristics:
(1) During the total appointment period on any given day, there are 16 appointments each
scheduled for 15 or 20 minutes in length (includes all doctor pre- and post-appointment
tasks). The sequence of the schedule is eight 15 minute appointments followed by eight 20
minute appointments. Thus the total planned appointment period spans four hours and 40
minutes. Typically, an appointment period begins at 7:30 AM and ends after the 16 th
appointment (scheduled to end at 12:10 PM).
(2) We place a reminder phone call to each patient 1-2 days prior to their appointment.
(3) We see patients only in the order scheduled, i.e., if any come very early, they do not get seen
earlier than any other patient scheduled before them.
(4) We allow a 15 minute “grace” period. If a patient arrives more than 15 minutes late, then this
patient must reschedule for another day.
(5) Although the first appointment never begins before 7:30 AM, for all other appointments we
begin as soon as both the doctor and patient are available.
(6) Doctors schedule their other duties after 12:10 PM (the scheduled end of last appointment).
Other activities include surgery or other operations, rounds with hospital patients, business
meetings, lunch, and yes, occasionally golf. Thus, delays in completing the appointment
period on time can have undesirable consequences for doctors and staff as well as for
patients.

Appointment System Data: For this study, a large data gathering exercise was undertaken and the results
are available in an Excel file. We believe that these data are representative of patient behavior and doctor

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MBA 791 PROJECT ONE—DAY-MED [email protected]

performance in our current appointment system. Note that in this data gathering, we only observed one
patient arrival slightly later than 15 minutes after the appointment scheduled start. Thus, for your
analysis, we are willing to assume zero percent later than 15 minutes.

A Possible Improvement. DAY-MED’s Operations Manager, in conjunction with staff and


representatives of the doctors we support, have agreed upon the following as a potential improvement to
the appointment system -- if it can be shown to have significant performance enhancement. This one
improvement has three parts:
(1) Insert Buffer Times. Some of the loudest complaints about the current system come from doctors and
staff indicating they are “not able to predict the completion time of the appointment period.” As one
person said, “There is too much variability in end time! I can’t plan anything after work because
sometimes we’re as much as 45 minutes or more after the scheduled end time.” One concept to
reduce variability is buffers. We believe that it would be possible to add one or more buffers or
“catch-up” periods to the appointment schedule. Although this would mean extending the schedule
somewhat past the current 12:10 PM scheduled end time, we believe that our doctors and staff would
agree to it if this change results in a more consistent actual ending time (we’ve asked a number of
them). Adding up to 15 minutes to the schedule might be considered (in “chunks” no smaller than 5
min). We’re uncertain exactly where in the total appointment period the buffers would work best –
but we suggest as a first try to put the three 5-minute buffers before the 11 th, 13th and 15th
appointments. Note that the new scheduled completion time will be 15 minutes past 12:10 PM or
12:25 PM.
(2) Change the “grace” period. Since we now have patients arriving as much as 15 minutes past the
scheduled appointment start time, we believe we could change this to a 10 minute “grace” period. If
this change is made, we think that all patients will become more sensitive to their arrival times. We
believe that the change to arrival times (from that shown in the data) would stabilize to the following:
the approximate 25% now arriving after 10 minutes late will become distributed evenly to the 25
previous arrival minutes (i.e., add 1% to each).
(3) Tighten up the appointment durations. In discussing appointment length with a number of doctors,
most believe that (if given signals to help keep them on time) they could insure that most all
appointment durations are not more than 3 minutes over the scheduled length. Thus, we could
implement a system of signals such that the appointment durations would change to the following.
For 15 minute appointments, the percentages now over 18 minutes would be equally divided over the
12 to 18 minute durations. For 20 minute appointments, the percentages now over 23 minutes would
be equally divided over the 17 to 23 minute durations.

Charge to the Analysis Team.


In summary, make sure your study answers these business questions:
(1) Do the new arrival and appointment duration data give insights about causes of poor
appointment system performance?
a. Are there any conclusions about system performance to be drawn from a careful
examination of the newly-acquired arrival and appointment duration data? Use tables
and/or graphs.
b. Are there any other insights you would offer?
(2) What is the performance of the current appointment system?
a. Use the measures identified and defined in the attached table (1) COMPLETE, (2) WAIT,
(3) IDLE, and (4) OFFICE. If you propose any other performance measures, consult
with your point of contact. This is the most important need from your study -- for you to
help us develop a good understanding of the overall characteristics of the current system.
b. Note that we want to understand our system performance “on average” but also how
these key properties vary, e.g., how often the appointment system has a “very low WAIT,
very low COMPLETE or very high values of these four measures” We also want to know

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MBA 791 PROJECT ONE—DAY-MED [email protected]

how often the appointments end “on time.” Could include ‘pictures’ of the possible
values of the performance measures.
c. Produce a table of results that describes the current system versus the target values we set
(see attached table) and perhaps figures.
(3) Can the possible improvement to the system identified earlier provide significant
enhancement to performance?
a. Examine the possible improvement to this system identified earlier. Evaluate it (with the
model you develop to answer (2) above) using the same four performance measures.
b. Also, help identify any other non-quantifiable pros and cons of the existing system versus
this improvement to the system.
c. Provide one or more comparison tables.
Based on your analysis, DAY-MED may be willing to examine in detail (perhaps with pilot
projects) this possible improvement if your work indicates it may have significant payoff.
(4) Are there any additional insights or recommendations from your analysis?

Develop a business memo of your study to present to the director of operations (signature below) and to
the liaison with all the DAY-MED doctors (your point of contact). Use the requested format for business
memos since this is the format the DAY-MED uses for analysis projects. Deliver your memo with
analysis backup not later than … (date and time of the Module 5 class meeting.)
Point of Contact. James Dunne, the liaison with our doctors and the special advisor to DAY-MED’s
operations manager, has been involved with this appointment system issue and can answer any questions
you may have about our current scheduling system, about additional data you may need, and about our
desires for an improved system. He can give you the perspective of the company and the perspective of
the DAY-MED doctors. Please consult with him to make sure you understand our current system and our
needs. Please include him as an addressee on your memo.
Bottom Line: DAY-MED is depending upon you to help us to first understand (second perhaps
improve) this important customer support system.

JOAN SMITH, R.N., MBA


DIRECTOR OF OPERATIONS, DAY-MED, INC

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MBA 791 PROJECT ONE—DAY-MED [email protected]

TABLE OF DAY-MED APPOINTMENT SYSTEM PERFORMANCE MEASURES


(Use these measures in your study.)

NAME* DEFINITION TARGET VALUES


Time of completion of a total 16
appointment period measured in
Average <= 8 min
COMPLETE minutes either before (-) or after (+)
90%tile <= 15 min
the scheduled end time of the
appointment period.
Good:
Average waiting time** (minutes) for Average <= 8 min
the 16 patients of a full appointment 90%tile <= 12 min
WAIT
period. Excellent:
Average <= 5 min
90%tile <= 8 min
Total idle time (minutes) of a doctor
for the full 16-appointment period Average <= 10 min
IDLE
(note that this measure is not an 90%tile <= 16 min
average per patient).
Average time spent in the office
(minutes) for the 16 patients –
Average <= 30 min
OFFICE measured from arrival (or
90%tile <= 40 min
appointment schedule start) to
appointment end.

*Listed in Priority Order

** If a patient arrives early and the appointment begins at or before the scheduled start time,
the value of waiting time is zero. If a patient arrives after the scheduled start time but must wait,
the value of waiting time is (actual start time – actual arrival time). Thus, we don’t consider as
‘wait’ any time before the scheduled start time. Such time is due to patients arriving early for
their appointment.

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