Many outpatient clinics are experimenting with open access scheduling. Under open access, patients see their physicians within a day or two of making their appointment request, and long-term patient booking is very limited. The hope is that these short appointment lead times will improve patient access and reduce uncertainty in clinic operations by reducing patient no-shows. Practice shows that successful implementation can be strongly influenced by clinic characteristics, indicating that open access policies must be designed to account for local clinical conditions. The effects of four variables on clinic performance are examined: (1) the fraction of patients being served on open access, (2) the scheduling horizon for patients on longer-term appointment scheduling, (3) provider care groups, and (4) overbooking. Discrete event simulation, designed experimentation, and data drawn from an intercity clinic in central Indiana are used to study the effects of these variables on clinic throughput and patient continuity of care. Results show that, if correctly configured, open access can lead to significant improvements in clinic throughput with little sacrifice in continuity of care.

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A fundamental difficulty in developing effective production planning models has been accurately reflecting the nonlinear dependency between workload and lead times. We develop a mathematical programming model for production planning in multiproduct, single stage systems that captures the nonlinear dependency between workload and lead times. We then use outer linearization of this nonlinear model to obtain a linear programming formulation and extend it to multistage systems. Extensive computational experiments validate the approach and compare its results to conventional models that assume workload-independent planning lead times.

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