Brotman B A, Bumgarner M, Prime P
Kennesaw State University, GA, USA.
J Health Care Finance. 1998 Fall;25(1):72-7.
The Women, Infants, and Children (WIC) Program, managed by the county boards of health, provides nutrition, limited physical examinations, and food vouchers for pregnant women and for children with nutritional deficiencies. Because federal guidelines for the WIC program leave little maneuvering room to improve the delivery of services, we analyzed the client flow through a WIC clinic in the Atlanta metropolitan area to determine how that flow could be managed more efficiently. The challenge facing the WIC clinic was to increase the efficiency of their operation in an environment characterized by resource constraints, rigid regulations, and dysfunctional client behavior. In a limited physical space, the WIC clinic was expected to provide a number of sequential services to a client population that failed to arrive or arrived late 40 percent-50 percent of the time. The provision of services was further complicated by walk-ins, which were not only common but, according to federal guidelines, also must be accommodated. To analyze the clinic's problem, we used the General Purpose Simulation System for personal computer (GPSS/PC) to simulate client flow through the clinic. Estimates of the average amount of time a client spent in the clinic as well as average waiting times at each station and clerk and nurse utilization rates were generated assuming a variety of staffing levels. For comparison purposes, each version of the model was run with a 20-minute time lag before a late appointment was filled, and then a one-minute lag. The data used for the simulation were collected by clinic personnel during February 1994. It included the number of clerks and nurses available; the waiting time to see clerks and nurses for walk-ins and appointments; the waiting time to get WIC vouchers; the number of appointments met; the number of appointments missed; and the total time in the clinic for walk-ins and appointments. In all three versions of the model that were estimated, the results of the simulations revealed that reducing the time before a late appointment was filled significantly decreased the time spent in the clinic, on average, for all clients. Furthermore, the time spent waiting for both clerks and nurses decreased, the utilization of the clerks decreased, and the utilization of the nurses increased in two of the three estimations.
妇女、婴儿与儿童（WIC）项目由各县卫生局管理，为孕妇和有营养缺陷的儿童提供营养服务、有限的身体检查及食品券。由于WIC项目的联邦指导方针几乎没有改善服务提供方式的回旋余地，我们分析了亚特兰大大都会区一家WIC诊所的客户流程，以确定如何能更高效地管理该流程。WIC诊所面临的挑战是，在资源有限、规定严格且客户行为失调的环境中提高运营效率。在有限的物理空间内，WIC诊所预计要为大量客户提供一系列连贯服务，而这些客户有40%-50%的时间未能按时到达或迟到。即便是未预约而来的客户也很常见，这使得服务提供情况更加复杂，而且根据联邦指导方针，还必须接待这类客户。为分析诊所的问题，我们使用个人计算机通用模拟系统（GPSS/PC）来模拟客户在诊所内的流动情况。假设不同的人员配置水平，得出了客户在诊所平均花费的时间、在每个服务台的平均等待时间、办事员和护士的利用率等估算值。为便于比较，每个模型版本在填补迟到预约前设置了20分钟的时间间隔后运行，然后设置了1分钟的时间间隔。模拟所用数据由诊所工作人员在1994年2月收集。数据包括可用办事员和护士的数量；未预约客户和预约客户见到办事员和护士的等待时间；获取WIC食品券的等待时间；预约成功的数量；错过的预约数量；以及未预约客户和预约客户在诊所的总时间。在所有三个估算的模型版本中，模拟结果显示，缩短填补迟到预约前的时间能显著减少所有客户在诊所平均花费的时间。此外，在三个估算中有两个显示，等待办事员和护士的时间减少了，办事员的利用率降低了，护士的利用率提高了。
