Goodman School of Business, Brock University, 500 Glenridge Ave, St Catharines, ON, L2S 3A1, Canada.
Goodman School of Business, Brock University 500 Glenridge Ave, St Catharines, ON, L2S 3A1, Canada.
Health Care Manag Sci. 2019 Jun;22(2):229-244. doi: 10.1007/s10729-018-9434-x. Epub 2018 Feb 5.
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.
医疗服务提供者可以通过增加成本较低的现有资源来满足需求，同时保持患者护理的质量。增加中级服务提供者（MLSP），如医师助理或执业护士，可以为增加医生的能力提供可行的替代方案。这项研究考虑了在何种情况下，将 MLSP 添加到单医生门诊办公室成为诊所的最佳策略，并确定应如何调整广泛研究的单阶段环境中的调度政策，以适应多阶段环境。与一个由医生完成所有服务的单阶段系统相比，我们表明，添加 MLSP 可以减少患者的等待时间、患者流程时间和医生与患者的服务时间。这反过来又可以使诊所能够看到更多的患者，或为医生腾出时间用于其他任务。使用仿真优化方法为多阶段门诊服务系统制定预约调度规则。绩效指标侧重于服务的每个阶段之前和期间的患者体验和诊所运营。
