Wcushs Is Moving to a Research Proposal

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The main capacity issue is with respect to overcapacity on the appointment side. For appointments, capacity between the two classes of clinicians is 17,888 versus demand of 6306. Among walk-ins, 45% are returning to see a specific clinician. Thus, 3784 visitors classed as walk-ins could be dealt with as appointments instead. Carwin's plan does not address this.

If those 3784 were not asked to come back as walk-ins but rather to come back as appointments, the total demand for walk-ins would be 5675 and appointments would be 10,090. There would now be capacity for both walk-ins and appointments to meet demand.

This is without even addressing the issue of scheduling. Carwin's plan is deficient in that it does not address the issue of scheduling. At present, Tuesday is grossly under capacity. There is capacity for only 48 patient visits on Tuesday, compared with demand of 84. There are also capacity shortages on Monday, Wednesday, and Thursday. On Friday, however, capacity is 84 compared with demand of 64. This capacity includes both MD and NP, which means that Carwin's plan will still leave a capacity shortfall on four out of five days.

The success measures are laid out by Carwin are perfectly reasonable. They are geared to the most pressing challenges at WCUSHS. They address average wait times, the number of users who must return, and the length of time for a return. Whether Carwin's proposed solution will result in meeting these goals is debatable.

Recommendations propose a different set of recommendations. The first is that patients who prefer to return to see a specific clinician be given appointments, rather than treated as walk-ins. This will reconcile the relative demand for walk-ins and appointments with demand. If a patient wishes to see a specific provider, there is no reason for them wait in the walk-in queue when capacity exists in the appointment system. For the most part, this recommendation will also meet the objective of reducing the amount of time a patient must wait to see their chosen clinician. An exception is with respect to some of the part-timers, who can go a couple of days without serving appointments.

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Thus, I also recommend creating loose teams. These would be structured along the same lines as Carwin's teams, but would be less formal. In other words, teams would still consist of specific NPs and MDs, but patients would not necessarily be assigned to a team. If a patient wanted a specific clinician and that clinician, that clinician was not going to have appointment times for the coming few days, and the triage nurse did not feel that the patient needed to see a clinician right away, the patient would be given an option. They could wait a few days for their specific clinician, or they could see somebody else from that team. This puts the onus on the patient to make this decision. What that will do is make it difficult for the patient to complain about any delays in receiving an appointment because they had the option to receive an earlier appointment from somebody on the same team as their clinician.

The final recommendation I would make it to adjust the schedule to match capacity at the walk-in clinic with demand. Right now, walk-in demand is being met by overcapacity on Fridays and overcapacity in appointments.

If 45% of patients are removed from the pool of walk-in customers, this will alleviate much of the day-to-day shortfalls. For example, Tuesday would now have a demand of 46 patients compared to capacity of 48. Because of the potential for variance in demand, this can still result in excessive wait times. Thus, capacity should be shifted from Friday to the other days of the week, such that each day has a scheduled overcapacity matching the average. The total overcapacity for the week will be 55%. Thus, Tuesday, with a walk-in demand of 46, should have a capacity of 71. This will avoid bottlenecks during all but the most unprecedented of rushes.

Overall, Carwin's plan is based on sound objectives, but does not work directly to alleviate the problems. The solution will result in decreased service and customer satisfaction, but will still leave the walk-in clinic.....

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