Optimal Sequencing of Unpunctual Patients in High-Service-Level Clinics

Even though patients often arrive early and out of turn for scheduled appointments in outpatient clinics, no research has been undertaken to establish whether an available provider should see an early patient right away (preempt) or wait for the patient scheduled next. This problem, which we call the “Wait-Preempt Dilemma,” is particularly relevant for “high-service-level” clinics (such as psychotherapy, chiropractic, acupuncture), where preempting may cause the missing patient to wait for an excessively long time, should she show up soon. Typically, the dilemma is resolved by preemption, where the provider starts serving the patient who has already arrived to avoid staying idle. By contrast, we analytically determine the time intervals where it is optimal to preempt and those where it is optimal to wait, and find that in some cases the provider should in fact stay idle, even in the presence of waiting patients. Our results suggest that the proposed analytical method outperforms the always-preempt policy in clinics that do not overbook and have service times longer than 30 minutes. In these cases, the analytical method dramatically reduces patient waiting times at the cost of a modest increase in overtime. By contrast, in clinics that overbook or have short service times, the two policies perform similarly, and hence the always-preempt policy is preferable due to its simplicity. A software application is provided that clinics can readily use to solve the wait-preempt dilemma. Full paper available at https://doi.org/10.1111/poms.12426