The problem of appointment scheduling in outpatient clinics: A multiple case study of clinical practice

Abstract

Operations research and management science have produced many algorithms or rules for appointment scheduling, approaching that task as a mathematical optimization problem. It is, however, not sufficiently clear to what extent such problem definitions capture the objectives and limitations of appointment scheduling in real healthcare applications. This paper aims to reconstruct the structure of the problem faced by outpatient clinics by applying a multiple-case-study approach, based on a research model developed from operations-management theory, followed up by workshops. This study therefore breaks new ground by linking the problem of appointment scheduling as rendered by the operations-research literature to theory in operations management and practice in the field.The study shows that the context of appointment scheduling has changed substantially compared to the setting that the operations-research literature has largely assumed. Economic assumptions appear unwarranted in practice, and where the literature describes the service process as repetitive with only limited variety and customization, practice turns out to be excessively complex.Especially in situations of high complexity and uncertainty, approaches based on process flexibility and variability reduction appear more promising than mathematical optimization. Reducing the number of service varieties and operating at a ‘lower’ level of utilization, i.e., looser schedules, are promising practical suggestions for improving the performance of outpatient clinics.