Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency's ambulatory care unit through simulation

Health Care Manag Sci (2009) 12:392407 DOI 10.1007/s10729-009-9103-1

Reducing patient wait times and improving resource utilization at British Columbia Cancer Agencys ambulatory care unit through simulation

Pablo Santibez & Vincent S. Chow & John French &

Martin L. Puterman & Scott Tyldesley

Received: 3 October 2008 /Accepted: 12 February 2009 /Published online: 13 March 2009 # Springer Science + Business Media, LLC 2009

Abstract We consider an ambulatory care unit (ACU) in a large cancer centre, where operational and resource utilization challenges led to overcrowding, excessive delays, and concerns regarding safety of critical patient care duties. We use simulation to analyze the simultaneous impact of operations, scheduling, and resource allocation on patient wait time, clinic overtime, and resource utilization. The impact of these factors has been studied before, but usually in isolation. Further, our model considers multiple clinics operating concurrently, and includes the extra burden of training residents and medical students during patient consults. Through scenario analyses we found that the best outcomes were obtained when not one but multiple changes were implemented simultaneously. We developed configurations that achieve a reduction of up to 70% in patient wait times and 25% in physical space requirements, with the same appointment volume. The key findings of the study are the importance of on time clinic start, the need for improved patient scheduling; and the potential improvements from allocating examination rooms flexibly and dynamically among individual clinics within each of the oncology programs. These findings are currently being evaluated for implementation by senior management.

Keywords Simulation . Health care . Ambulatory clinic .

Outpatient . Process improvement

1 Introduction

This study was undertaken to address significant and increasing challenges regarding the use of space and resources in the Ambulatory Care Unit (ACU) in the Vancouver Centre (VC) of the British Columbia Cancer Agency (BCCA). Physicians office space, clerical support and examination rooms were often in short supply at times of peak volume leading to overcrowding, delays, and concerns regarding patient safety. Further, patient volumes are anticipated to increase in the future as the population ages.

The BCCA provides a province-wide, population-based cancer control program for the residents of British Columbia and the Yukon, Canada. The Vancouver Centre (VC) is the largest of the five BCCA regional cancer...