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Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency’s ambulatory care unit through simulation

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Abstract

We consider an ambulatory care unit (ACU) in a large cancer centre, where operational and resource utilization challenges led to overcrowding, excessive delays, and concerns regarding safety of critical patient care duties. We use simulation to analyze the simultaneous impact of operations, scheduling, and resource allocation on patient wait time, clinic overtime, and resource utilization. The impact of these factors has been studied before, but usually in isolation. Further, our model considers multiple clinics operating concurrently, and includes the extra burden of training residents and medical students during patient consults. Through scenario analyses we found that the best outcomes were obtained when not one but multiple changes were implemented simultaneously. We developed configurations that achieve a reduction of up to 70% in patient wait times and 25% in physical space requirements, with the same appointment volume. The key findings of the study are the importance of on time clinic start, the need for improved patient scheduling; and the potential improvements from allocating examination rooms flexibly and dynamically among individual clinics within each of the oncology programs. These findings are currently being evaluated for implementation by senior management.

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Acknowledgements

This work was funded in part by a research grant from the Canadian Institutes of Health Research (CIHR) in support of The CIHR Team in Operations Research for Improved Cancer Care (www.ORinCancerCare.org/cihrteam). We thank all the administrators, physicians, nurses and clerks at BCCA’s Vancouver Centre for their contribution in this project. In particular, we are grateful of the valuable insight and direction provided by Dr. Kim Chi, Lorna Roe, Frankie Goodwin, Michelle Dumas, Pam Stewart, Lindy McKinnon, Pam Taheem, Krystyna Olkiewicz and Suzanne Ratchford.

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Authors and Affiliations

  1. British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, BC, Canada, V5Z 4E6

    Pablo Santibáñez, Vincent S. Chow, John French & Scott Tyldesley

  2. Sauder School of Business, University of British Columbia, 2053 Main Mall, Vancouver, BC, Canada, V6T 1Z2

    Martin L. Puterman

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  1. Pablo Santibáñez
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  2. Vincent S. Chow
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  3. John French
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  4. Martin L. Puterman
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  5. Scott Tyldesley
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Correspondence to Pablo Santibáñez.

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Santibáñez, P., Chow, V.S., French, J. et al. Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency’s ambulatory care unit through simulation. Health Care Manag Sci 12, 392–407 (2009). https://doi.org/10.1007/s10729-009-9103-1

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  • DOI: https://doi.org/10.1007/s10729-009-9103-1

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