Skip to main content
Log in

The impact of provider flexibility and capacity allocation on the performance of primary care practices

  • Published:
Flexible Services and Manufacturing Journal Aims and scope Submit manuscript

Abstract

The two important but often conflicting metrics for any primary care practice are: (1) Timely Access and (2) Patient-physician Continuity. Timely access focuses on the ability of a patient to get access to a physician (or provider, in general) as soon as possible. Patient–physician continuity refers to building a strong or permanent relationship between a patient and a specific physician by maximizing patient visits to that physician. In the past decade, a new paradigm called advanced access or open access has been adopted by practices nationwide to encourage physicians to “do today’s work today.” However, most clinics still reserve pre-scheduled slots for long lead-time appointments due to patient preference and clinical necessities. Therefore, an important problem for clinics is how to optimally manage and allocate limited physician capacities as much as possible to meet the two types of demand—pre-scheduled (non-urgent) and open access (urgent, as perceived by the patient)—while simultaneously maximizing timely access and patient–physician continuity. In this study we adapt ideas of manufacturing process flexibility to capacity management in a primary care practice. Flexibility refers to the ability of a primary care physician to see patients of other physicians. We develop generalizable analytical algorithms for capacity allocation for an individual physician and a two physician practice. For multi-physician practices, we use a two-stage stochastic integer programming approach to investigate the value of flexibility. We find that flexibility has the greatest benefit when system workload is balanced, when the physicians have unequal workloads, and when the number of physicians in the practice increases. We also find that partial flexibility, which restricts the number of physicians a patient sees and thereby promotes continuity, simultaneously succeeds in providing high levels of timely access.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

Similar content being viewed by others

References

  • Atlas S, Grant R, Ferris T, Chang Y, Barry M (2009) Patient–Physician connectedness and quality of primary care. Ann Intern Med 150(5):325–326

    Google Scholar 

  • Bennett K, Baxley E (2009) The effect of a carve out advanced access scheduling system on no show rates. Fam Med 41(1):51–56

    Google Scholar 

  • Birge J, Loveaux F (1997) Introduction to stochastic programming. Springer, New York, NY

  • Chua GBA, Chou MC, Teo C-P (2008) On range and response: dimensions of process flexibility. Working paper, NSU

  • Edington M (eds) (2001) Crossing the quality chasm: a new health system for the 21st century. The Institute of Medicine Report. Technical report, National Academy Press, Washington DC

  • Gill JM, Mainous A (1999) The role of provider continuity in preventing hospitalizations. Arch Fam Med 7:352–357

    Article  Google Scholar 

  • Gill JM, Mainous A, Nsereko M (2000) The effect of continuity of care on emergency department use. Arch Fam Med 9:333–338

    Article  Google Scholar 

  • Graves SC, Tomlin BT (2003) Process flexibility in supply chains. Manage Sci 49(7):907–919

    Article  MATH  Google Scholar 

  • Green LV, Savin S (2008) Reducing delays for medical appointments: a queueing approach. Oper Res 56(6):1526–1538

    Article  MathSciNet  MATH  Google Scholar 

  • Green LV, Savin S, Murray M (2007) Providing timely access to care: what is the right patient panel size? Jt Comm J Qual Patient Saf 33:211–218

    Google Scholar 

  • Gupta D, Wang L (2008) Revenue management for a primary-care clinic in the presence of patient choice. Oper Res 56(3):576–592

    Article  MathSciNet  MATH  Google Scholar 

  • Gupta D, Potthoff S, Blowers D, Corlett J (2006) Performance metrics for advanced access. J Healthc Manag 51(4):246–259

    Google Scholar 

  • Hippchen J (2009) Flexbility in primary care, Masters Thesis (Advisors: Hari Balasubramanian and Ana Muriel). Accessible at: http://people.umass.edu/hbalasub/FlexibilityThesis.pdf

  • Hopp W, Tekin E, Van Oyen MP (2004) Benefits of skill chaining in serial production lines with cross-trained workers. Manage Sci 50(1):83–98

    Article  Google Scholar 

  • Jordan WC, Graves SC (1995) Principles and benefits of manufacturing process flexibility. Manage Sci 41(4):577–594

    Article  MATH  Google Scholar 

  • Kopach R, DeLaurentis P, Lawley M, Muthuraman K, Ozsen L, Rardin R, Wan H, Intrevado P, Qu X, Willis D (2007) Effects of clinical characteristics on successful open access scheduling. Health Care Manage Sci 10:111–124

    Article  Google Scholar 

  • Liu N, Ziya S, Kulkarni V (2010) Dynamic scheduling of outpatient appointments under patient no-shows and cancellations. Manuf Serv Oper Manage 12.2:347–365

    Google Scholar 

  • Muriel A, Somasundaram A, Zhang Y (2006a) Impact of partial manufacturing flexibility on production variability. Manuf Serv Oper Manage 8(2):192–205

    Article  Google Scholar 

  • Muriel A, Zhang Y, Biller S (2006b) Impact of price postponement on capacity and flexibility investment decisions. Prod Oper Manage 15(2):198–214

    Google Scholar 

  • Murray M, Berwick DM (2003) Advanced access: reducing waiting and delays in primary care. J Am Med Assoc 289(8):1035–1040

    Article  Google Scholar 

  • Murray M, Bodenheimer T, Rittenhouse D, Grumbach K (2003) Improving timely access to primary care: case studies of the advanced access model. J Am Med Assoc 289(3):1042–1046

    Article  Google Scholar 

  • O’Malley A, Cunningham P (2009) Patient experiences with coordination of care: the benefit of continuity and primary care physician as referral source. J Gen Intern Med 24(2):170–177.

    Article  Google Scholar 

  • Qu X, Rardin R, Williams JAS, Willis D (2007) Matching daily healthcare provider capacity to demand in advanced access scheduling systems. Eur J Oper Res 183(2):812–826

    Article  MATH  Google Scholar 

  • Robinson L, Chen R (2010) A comparison of traditional and open access policies for appointment scheduling. Manuf Serv Oper Manage 122:330–347

    Google Scholar 

  • Rust G, Ye J, Baltrus P, Daniels E, Adesunloye B, Fryer GE (2008) Practical barriers to timely primary care access. Arch Intern Med 268(15):1705–1710

    Article  Google Scholar 

  • Solak S, Clarke J-P, Johnson E, Barnes E (2010) Optimization of R&D portfolios under endogenous uncertainty. Eur J Oper Res 207(1):420–433

    Article  MathSciNet  MATH  Google Scholar 

Download references

Acknowledgments

This work was funded in part by the grant CMMI 1031550 from the National Science Foundation. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation. We would also like to acknowledge two anonymous referees whose valuable comments helped improve the paper. Finally, our sincere thanks to Xiaoling Gao, doctoral student at the University of Massachusetts, who helped with editing of the results.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hari Balasubramanian.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Balasubramanian, H., Muriel, A. & Wang, L. The impact of provider flexibility and capacity allocation on the performance of primary care practices. Flex Serv Manuf J 24, 422–447 (2012). https://doi.org/10.1007/s10696-011-9112-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10696-011-9112-5

Keywords

Navigation