1.25.2008

Overbooking: The Wrong Solution for Medical Clinics

A couple of academics are suggesting that overbooking patients at medical clinics can be a good idea.

Say what?

The two academics (in the Leeds School of Business at the University of Colorado at Boulder)
say overbooking can increase patient access and improve clinic productivity, resulting in reduced costs and greater patient satisfaction.

According to the study, overbooking would address patient no shows and enable clinics to see more patients.


Instructor Linda LaGanga became interested in the issue after noticing the large number of no shows at the public health care clinic where she works. “Many clinics overbook, but they don’t do it well,” she said. “Anecdotally, they will admit they do it, but it’s not done systematically. It’s done in the sense of ‘squeezing in’ another patient.”

For their study, LaGanga and researcher Stephen Lawrence developed a computer simulation tool that enables health care administrators to weigh benefits such as seeing more patients and making health care workers’ time more efficient against potential costs such as increased patient waiting and staff overtime…

The study examined a wide range of clinic sizes and no show rates, which can be as low as 3 percent and as high as 80 percent. Typically, overbooking was most beneficial to clinics that serve a large number of patients, had higher no show rates and had appointments that did not vary greatly in length. However, the study found that many clinics achieve positive results with overbooking even if appointments varied greatly in length.

However, the study does recognize a possible downside.

Clinic administrators must be willing to endure increased patient waiting and increased clinic overtime…

“If you had a clinic in Hollywood and had only movie stars as patients, you might not want to ever make them wait longer,” Lawrence said. “So the administrator would assign a much higher relative value for increased patient waiting time.” In contrast, LaGanga’s clinic places a high value on its ability to serve more people. “We want to stop turning people away because of lack of capacity. Seeing one more person in the morning and afternoon could make a great difference,” she said.

First of all, if overbooking results in increased waiting time, I don’t know how the study can claim it will lead to increased patient satisfaction. (I guess the answer is because more patients will be able to get in, but I’m skeptical.) Also, it seems to me that ALL people deserve respect for their time, not just movie stars.

I’m willing to bet that these two academics have never heard of lean principles and don’t understand there are other ways to increase capacity. A focus on patient flow, some value stream mapping, some kaizen events, and most clinics could probably increase their capacity significantly.

I concede that no-shows can be a significant problem. But I suspect no one has ever done a good job of determining WHY that occurs. Could it possibly be that some people cancel because they decide putting up with a long wait just isn’t worth it? Or that some make appointments on several dates, or at several locations, then only stay where it looks like the wait won’t be too bad?

If a clinic applied lean thinking to increase capacity and reduce waiting time, they would get a lot of good word-of-mouth publicity about how quickly they see patients. The result might be fewer no-shows.

Encouraging overbooking simply reinforces the use of bad processes.

5 comments:

Michael said...

My local clinic opens at 9am. Unfortunately the doctor does not arrive until "around 10.30".
The receptionist fails to mention this until you have been waiting for 30 min with not sign of movement.

Ian Furst said...

Dear Ralph,
The computer model must be flawed. Every real world lean principal states that lower variation and lower over-production results in greater effiency. I've done a lot of real world work on this subject in our clinics and I can tell you that overbooking does lower satisfaction and increases cancellation rates (it also adds an abandon rate to deal with). Further, if you have a second appointment we've found that causing wait greater than 40-50min (from appt start time to check out) lowers follow through. If you're seeing consultations then surgeries it means you'll have to see twice as many consults for each surgery - not good for you or you're patients. I blog on this is at www.waittimes.blogspot.com -- if you'd consider adding it to you're links I'd be greatful. Ian.

Anonymous said...

The office I work for constantly overbooks. If the Doctors wife is not satisfied with the number of patients seen, we all know we will be working a lot of OT.

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I can see this working for a 5-10 screen app but not working at all for a 50-500 screen app. Does everyone agree with me?
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