Abstract
We present a new scheduling approach to improve access to care at an inner-city community health centre in Vancouver, Canada, serving marginalised clients with complex biopsychosocial needs. In order to meet the specific care needs of clients, the centre provides a range of services on a booked and walk-in basis, and it is important that clients are seen in a timely manner. To align schedules with client demand, we developed a schedule optimisation model that maximises time nurses spend with clients. This new objective function allows for a simple mixed integer linear programming structure that directly incorporates carryover demand. Client-centred key performance indicators were evaluated using a discrete event simulation model. Optimisation aligns schedules to demand, leading to fewer clients who leave without being seen due to an extended wait. This increases the number of clients receiving care by up to 9 per week, without compromising wait times. Furthermore, our approach addresses service delivery concerns, including baseline nurse coverage for triage and weekly variability in total nurse hours. Strategically aligning nurse shifts to demand is an effective approach to better meet client needs without increasing total nurse staffing levels in a community health centre context.
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