Stochastic Appointment Scheduling in a Team Primary Care Practice with Two Flexible Nurses and Two Dedicated Providers

Waiting is common in appointment-based outpatient care: patients experience delays before seeing a nurse and then in the examination room before seeing the doctor. Given that service times are uncertain, the challenge for outpatient practices is to control the spacing between successive appointments to minimize waiting time while ensuring the doctor is not idle for too long. Whereas scheduling in single-doctor practices is well studied, team practice, in which one of two nurses can flexibly see the patient before the patient consults with one of two assigned doctors, is not. Optimal scheduling in a team practice is far more challenging from a computational viewpoint because the order in which patient appointments are scheduled need not be the order in which they see their doctors (i.e., patients may be allowed to crossover). In this article the authors propose a model that can solve realistic instances of this problem optimally. On the basis of analyses, the results show that (1) empty slots (which function as slack to alleviate waiting) alternate in the two doctors’ schedules and do not occur simultaneously, and (2) allowing nurse flexibility and patient crossovers produces greater benefits when service time variation is high.