Many researchers have explored the outpatient clinic environment. However, few have integrated demand management, resource policies, and process design. Through a series of three related research efforts, this dissertation investigates the operational influence of demand and capacity management while considering patient flow. The first research effort develops an integrated view of demand and capacity management decisions as variations in patient flow are modeled. The study examines the interactions between patient appointment policies and capacity allocation policies (i.e., the number of available exam rooms). The second effort evaluates the clinic response to queue disciplines (FCFS, SPT, and appointment time) and appointment scheduling policies as patient arrival times deviate from the schedule and patients fail to arrive for their appointment (no-shows). By evaluating various levels of arrival variability and no-shows, the robustness of policy decisions in the outpatient environment is assessed. The third study examines the appropriate deployment of labor resources that are able to substitute for the physician in an outpatient clinic. Two deployment methods are evaluated using measures of operations performance, patient waiting, and clinic profits.
The results of this research accentuate the value of integrated analysis of demand and capacity management decisions with a focus on patient flow. The development of appointment scheduling policies should consider variability of the physician service times and the patient flow through the system as both elements influence policy selection. When considering the effect of operations management decisions on both clinic and patient performance measures, this research demonstrates that the results of managerial decisions can and often do move in different directions. Some decisions require a trade-off between operations and the patient, while others benefit (or harm) both. This research demonstrates that excluding patient flow analysis from research efforts reduces the scope of activities that can be analyzed and creates opportunities for erroneous decisions.