Analysis, design and implementation of models for housestaff scheduling at outpatient clinics and improving patient flow at a family health clinic

Clinical experiences during the three years of residencies occur in inpatient and outpatient settings on generalist and specialist clinical services. Housestaff rotate through different clinical experiences monthly, with their primary care clinic time overlaid longitudinally on these other clinical services. The primary goals of this research are to construct housestaff schedules and improve efficiencies for residency programs. In the first phase of the research, we developed two models for constructing monthly clinic schedules for housestaff training in Internal Medicine. In our first model, the objective is to both maximize clinic utilization and minimize the number of violations of a prioritized set of goals while ensuring that certain clinic-level and individual constraints are satisfied. The corresponding problem is formulated as an integer goal program in which several of the hard constraints are temporarily allowed to be violated to avoid infeasibility. A three-phase methodology is then proposed to find solutions. The second model solves a similar problem with the objective of maximizing the number of interns and residents that are assigned clinic duty each month during their training in Internal Medicine. A complexity analysis is provided that demonstrates that the basic problem can be modeled as a pure network and the full problem can be modeled as a network with gains. In the second phase of the research, the goal was to redesign the monthly templates that comprise the annual block rotations to obtain better housestaff schedules. To implement this model, we investigate two different programs: Family Medicine and Internal Medicine. The problems were formulated as mixed-integer programs but proved too difficult to solve exactly. As an alternative, several heuristics were developed that yielded good feasible solutions. For the last part of the research, we focused on improving patient flow at a family health clinic. The objective was to obtain a better understanding of patient flow through the clinic and to investigate changes to current scheduling rules and operating procedures. Discrete event simulation was used to establish a baseline and to evaluate a variety of scenarios associated with appointment scheduling and managing early and late arrivals.