The Impact of Two Scheduling Windows on Outpatient Management for a Clinic Charging Optional Appointment Fees With Patient No-Shows

The efficiency of outpatient care deeply affects patient services in all downstream departments within a hospital. West China Hospital (WCH) is the largest public hospital in Southwest China. Nevertheless, WCH still experienced relatively high patient no-shows. WCH offered patients the option to prepay appointment fees to motivate them to keep scheduled appointments. This study aims to investigate the impacts of optional application fees on the scheduling system and, specifically, to gain insights into the scheduling policy: Should WCH use different scheduling windows (SWs) for patients depending on whether they prepay or do not pay the appointment fee? We developed an $M/M /1/N$ queueing model to determine the optimal SWs for two patient types - prepaid or unpaid. Our study shows that WCH should use two different SWs when adopting optional appointment fees. Furthermore, we derived theoretical findings and validated them using actual WCH data. Empirical results show that there could be an average of 20% cost savings if two optimal SWs are used for scheduling. Note to Practitioners—This paper was motivated by the problem of no-shows in the outpatient department at West China Hospital (WCH). The two most common approaches to mitigating patient no-shows are overbooking and scheduling window (SW). However, excessive overbooking may lead to physician overtime and long patient wait time. This paper examined if different SWs should be used to reduce patient no-shows. Due to the high patient demand, WCH provided multiple appointment channels, using one common SW, for outpatient scheduling. WCH yet still experienced relatively high patient no-shows. For the curiosity of outpatient management, WCH considered if an option for patients to prepay appointment fees could motivate them to attend appointments. This paper aims to answer WCH’s questions by examining the overall cost differences between a system with the prepaid option and a system without it. We developed an $M/M /1/N$ queueing model to determine the optimal SWs for two patient types - prepaid or unpaid. Our study shows that WCH should consider using two different SWs when charging optional appointment fees. We derived theoretical findings and validated them using actual data from WCH. Moreover, the empirical analysis shows that the system could achieve an average of 20% cost savings if two optimal SWs are used for outpatient scheduling.