SEMINELLI, MICHAEL DAVID. Implementing Discrete Event Simulation to Improve Optometry Clinic Operations. (Under the direction of Dr. Thom Hodgson). As the tempo of military operations slows and Soldiers experience more time at their home installations between overseas deployments, service agencies effectively have a larger population to support. Army Medical Facilities are faced with a need to improve the efficiency and throughput of their clinics to provide timely service to this growing population all while maintaining or reducing the size of their staff. Optometry clinics provide both routine and acute care to Soldiers ensuring medical readiness and also treat Soldiers' family members and retirees from the surrounding community. A discrete event simulation was used to examine six scheduling and staffing policies for the Womack Army Medical Center's Optometry Clinic with a goal of increasing the daily throughput of the clinic with consideration to patient waiting times. The Womack Optometry Clinic serves six different patient types ranging from eye wellness exams to vision screening evaluations. All patients experience up to three basic processes in the clinic: an evaluation by an Optometry Technician, examination by an Optometrist, and if required an eye dilation exam. A discrete event simulation was constructed to model optometry clinic processes using probability distributions, derived from observed and historical data, which represent the variation in service and arrival times at each of the clinic stations. The output metrics from the baseline simulation were validated against the actual clinic performance and served as a benchmark for testing the six scheduling policies. The discrete event simulation determined the best policy increased clinic throughput by eight patients a day, generating an additional $314,000 annually, while only increasing patient wait times by 26%. As a minimum, increasing the walk-in provider's scheduled patient load from seven to nine enables the provider to optimally treat both scheduled and walk-in patients, with a $94,000 annual revenue increase. This research also identified an optimal optometrist-to-technician ratio of 2:1 was found to increase the staff utilization while having no impact on clinic performance measures. Implementation of these results will improve clinic performance, revenue, and increase Soldier's access to care.
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