In recent years, demand for ambulatory care services in the United States has steadily increased, particularly in comparison to demand for hospital inpatient services. In order to respond to the growth in demand for ambulatory care service, there is a need for providing effective care while improving the efficiencies of health care operations. Efforts to increase efficiency in ambulatory care can include changes to day-to-day operations of an outpatient clinic such as exam room allocation policies, or one-time large scale changes such as outpatient clinic layout design. Additionally, efficiencies can be achieved by adjusting practices and decision making in multiple clinics at the same time, particularly accounting for the interdependencies that exist among multiple outpatient clinics within a health center. In this dissertation, we show that how increasing flexibility or resource sharing, and managing the clinic interdependencies can increase the efficiency of the clinics and correspondingly provide better timeliness of care. Particularly, in the first chapter, flexibility in exam room allocation policies in outpatient clinics are analyzed using a discrete-event simulation model. Rather than dedicating exam rooms to physicians, or pooling all rooms among all providers, we characterize the impact of alternate policies that partially share exam rooms among providers. Our findings show that it is not
necessary to fully share rooms among providers in order to reduce patient LOS and physician idle time. Instead, most of the benefit of pooling can be achieved by implementation of a compromise room allocation approach, limiting the need for significant organizational changes within the clinic.
In the second chapter, efficiency of patient care that is impacted by physical layout decisions is examined. Particularly, relationships between physical layout designs, flexible patient flows, and operational policies are analyzed through development of a simulation optimization framework. For this purpose, the outpatient clinic layout problem is modelled as a Mixed Integer Linear Programming (MILP) and solved with a meta-heuristic algorithm accounting for the size of the problem. Then a discrete-event simulation is used to evaluate the candidate layouts accounting for stochastic patient flows. Our findings show the importance of physical design on workflow for providers and flow of patients in the design of new ambulatory care clinics.
In the third chapter, the impact of managing existing interdependencies among different health centers are characterized. Operation of the radiology department can potentially impact several other outpatient clinics such as rheumatology, orthopedics, primary care, and surgery. In order to manage such interdependencies, a simulation optimization framework is proposed.