Managing Service Capacity in an Ambulatory Care Clinic

1
Managing Service Capacity in an Ambulatory Care
Clinic

• Authors David Antle and Richard A. Reid
• Presented by
• Walter Contreras

2
OBJECTIVE

• Capacity Management seeks to improve
  organizational effectiveness by increasing
  operational efficiency and reducing patient
  congestion.
• To include demand-smoothing and supply-matching
  strategies that will provide structure for a
  managers approach to effective ambulatory care.
• To decrease the clinical resource base by
  proposing low cost strategies

3
What is Capacity Management?

• is the process of planning, sizing, and
  controlling service solution capacity to satisfy
  user demand at a reasonable cost.
• or an essential element of efficient ambulatory
  care delivery.

4
Introduction

• Managing the capacity of an outpatient clinic
  requires a balanced consideration of both the
  demand for and supply of patient services.
• Actions that affect Service Capacity
• Long waiting time
• Bottleneck Activities

5
Service Capacity Management Strategies

• Two Perspectives
• Smoothing Patient Demand- permits greater use of
  a relatively fixed or constant service capacity.
• Managerial Control- matches the supply of
  services to existing patterns of demand.

6
Comprehensive Strategies for Capacity Management
7
Demand Smoothing Strategies

• Smoothing the demand for services involves
• - Requirements for both scheduled and
  nonscheduled appointments
• Regulating arrival of known patients through an
  appointment system/ making it more uniform.
• Forecasting unscheduled Demands
• Adjusting appt by time of day and day of the
  week.
• Differential pricing- pricing incentives that
  reduce charges for services rendered.
• Promoting complimentary services-
• (ex) health education, disease screening, or
  wellness promotions

8
Supply Matching Strategies

• Effective Staff Scheduling
• Cross-training clinical staff
• Adjustable capacity and Sharing capacity
• Increased participation on the healthcare
  consumers part.
• These strategies will increase the productive
  use of clinical capacity.

9
Methodology

• The University of New Mexico Cancer Center
  recently undertook a study of its medical
  oncology clinic. Staff concerns about congestion
  in the patient care delivery process prompted
  that more clinical examination rooms were needed.
• Two objectives
• Determining the characteristics of patient flow,
  including the ID of the major factors responsible
  for clinic congestion
• Determining the present use of the examination
  rooms.

10
Results
11
Results cont.

• Total of 108 Patients was included in the sample
• Daily clinic visit rates ranged from 17 to 25
  patients
• Only 12 of the sample patients were making their
  initial visit while 88 were receiving follow up
  care.
• Anything under 50 on the Mean Service
  Efficiency Percentage was given initial
  attention.
• The average patient visited the clinic for a
  total of 96.3 minutes. Direct contact with doctor
  lasted (44.5) min. The remaining time was waiting
  time.
• The nursing and medical services were designated
  as bottleneck activities since 70 of all
  patients required both services.

12
Results cont.

• Over all use of examination rooms averaged only
  31. This was found by dividing the total
  occupied time by total time available during the
  clinics hours of operation.

13
Conclusion

• Analysis of Demand Factors
• un-cancelled appointments affects congestion
• (Solution) encourage on time arrivals
• facilities, equipment, and support personnel are
  periodically nonproductive when physicians are
  unavailable throughout the week.
• (Solution) Activities on those days like cancer
  screening and education activities that will
  expand nursing activities.
• congestion affects service quality.
• (Solution) assign those with non important
  visits like drawing blood to come in on Fridays
  to relieve congestion during the week for those
  with more serious problems.

14
Conclusion

• Analysis of Supply Factors
• available patient service resources do not appear
  to impede performance.
• (Solution) Consider use of examination room
  space for additional revenue.
• Timely supply is critical
• (Solution) Increase patient participation in
  the service delivery process. Ex- filling out
  forms at home.

15
Managerial Implications

• Effective capacity management can yield
  improvements in service levels from both patient
  and clinic perspectives.
• Managers should perform Patient-flow data
  collection activities whenever capacity
  inefficiencies are not readily identifiable.
• Using simple observation and data collection can
  provide useful information for capacity
  management.
• The strategies mentioned in this article will
  help the clinic stop spending on additional
  resources by being efficient with demand and
  supply.

16

• tHe EnD