HOW TO MANAGE PATIENTS WHO NEVER SHOW UP

Author:

Vaibhav Singh

Executive Summary

Appointments in the Out-patient department is the first port of call for every person requiring healthcare services. Surprisingly enough, instances of patients not showing up for pre-scheduled
appointments are high and this imposes a huge cost on the system by leading to redundancy, lengthening of queues and low satisfaction scores for patients who were deprived of the service
when they needed it. Worst still, it makes the job of the doctor and administrator difficult as it compounds the problems associated with high variability if demand.

CoL has created a dynamic demand scheduler that uses proprietary algorithms that have been created using one of the largest databases in India. This demand scheduler helps hospitals and administrators to manage OPD appointments in such a manner that potential no-shows are estimated day-wise at the level of the disease so that appropriate number of overbookings can be done to ensure optimization of patient wait times and over-burden on doctors. The scheduler effectively replaces the manual effort and estimation which is presently expended at hospitals in
scheduling appointments and managing doctor calendars and patient flows.

Analysis

Health care providers (HCPs) deliver services through the Out-patient Department (OPD) and the Inpatient Department (IPD). OPD involves consultation provided to patients by the doctors without getting admitted in the hospital. Each doctor allocates certain hours of the day to attend to outpatient cases. The hours are sub-divided into slots called appointment slots equaling the expected length of the consultation. 

The process followed is that patients block appointment slots with doctors in advance to ensure that they are seen and also to ensure that wait times are reasonable. Compare this to the typical post
office where people walk-in randomly and are queued into a first come first serve line. The appointments so mentioned are done either telephonically or online using either the native online
appointment portal of the HCP or via third party appointment portals.

Since reneging on appointments have little cost, it has been observed that quite often out-patients do not turn up for the appointment and neither do they inform the HCP about the change in their plans. This is termed as ‘no show’. Since these slots are perishable they go waste or in other words, the doctor is unproductive for the length of the slot, which is a major loss to the healthcare economy.

As one can imagine, the HCPs do not have a mechanism to predict the ‘no-show’ and therefore are unable to optimize the doctor’s time. However, what some HCPs do is to overbook i.e setting up
appointments in excess of the capacity as using some back of the envelope calculation. This procedure of overbooking is unscientific and very often forces the doctor to attend to more patient than planned, thus leading to either reduction in the per-patient time spent (affecting quality) or forcing to doctor to commit more time than planned on OPD. Such inefficiency imposes at least 2 additional costs on the HCP, namely, Patient wait time and doctor over time.

CoL has created an analytics product that uses proprietary algorithms to extract information from the existing HCP data to compute accurately the optimal number of patients that should be booked in advance to ensure that

  1. Doctor overtime/overbooking is minimized. Doctors, therefore, can better manage and plan patient care in both IPD and OPD.
  2. Patient wait time is minimized. Therefore providing an enhanced patient experience.
  3. OPD profitability is maximized while maintaining the quality of service.
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