title: Operations research methods improve chemotherapy patient appointment scheduling.
abstract: BACKGROUND
  Clinical complexity, scheduling restrictions, and outdated manual booking processes resulted in frequent clerical rework, long waitlists for treatment, and late appointment notification for patients at a chemotherapy clinic in a large cancer center in British Columbia, Canada. A 17-month study was conducted to address booking, scheduling and workload issues and to develop, implement, and evaluate solutions.
  
  
  METHODS
  A review of scheduling practices included process observation and mapping, analysis of historical appointment data, creation of a new performance metric (final appointment notification lead time), and a baseline patient satisfaction survey. Process improvement involved discrete event simulation to evaluate alternative booking practice scenarios, development of an optimization-based scheduling tool to improve scheduling efficiency, and change management for implementation of process changes. Results were evaluated through analysis of appointment data, a follow-up patient survey, and staff surveys.
  
  
  RESULTS
  Process review revealed a two-stage scheduling process. Long waitlists and late notification resulted from an inflexible first-stage process. The second-stage process was time consuming and tedious. After a revised, more flexible first-stage process and an automated second-stage process were implemented, the median percentage of appointments exceeding the final appointment notification lead time target of one week was reduced by 57% and median waitlist size decreased by 83%. Patient surveys confirmed increased satisfaction while staff feedback reported reduced stress levels.
  
  
  CONCLUSIONS
  Significant operational improvements can be achieved through process redesign combined with operations research methods.
authors.affiliation: British Columbia Cancer Agency, Vancouver, Canada. psantibanez@bccancer.bc.ca
authors.forename: Pablo
authors.initials: P
authors.lastname: Santibáñez
authors.forename: Ruben
authors.initials: R
authors.lastname: Aristizabal
authors.forename: Martin L
authors.initials: ML
authors.lastname: Puterman
authors.forename: Vincent S
authors.initials: VS
authors.lastname: Chow
authors.forename: Wenhai
authors.initials: W
authors.lastname: Huang
authors.forename: Christian
authors.initials: C
authors.lastname: Kollmannsberger
authors.forename: Travis
authors.initials: T
authors.lastname: Nordin
authors.forename: Nancy
authors.initials: N
authors.lastname: Runzer
authors.forename: Scott
authors.initials: S
authors.lastname: Tyldesley
mesh_terms: D001071:Appointments and Schedules; D001955:British Columbia; D004334:Drug Administration Schedule; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D009874:Operations Research; D058996:Quality Improvement; D016526:Workload