Identifying problems in the appointment scheduling system of a major Portuguese public hospital - Is there room for improvement?

Abstract

Many authors refer to the current healthcare situation as a global crisis. Costs of care are rising worldwide, but most countries are still unable to provide efficient and timely medical care to all patients. This situation brings dissatisfaction to both patients and providers, and its consequences are felt throughout the entire care chain. In Portugal, the ever-aging population needs costly and specialized health care that is not always readily accessible. As such, in this project, we seek to identify difficulties are encountered in scheduling and executing consultations in the context of Portuguese secondary health care. Authors Cox & Boyd (2018) reviewed academic literature in the context of appointment scheduling and execution. They identified fourteen frequently occurring problems in this context. Based on these problems and using the Theory of Constraints, they developed a universal methodology for designing effective appointment scheduling systems. In this context, the appointment scheduling system is defined as the model for scheduling and executing medical appointments, and includes metrics related to their number, type, and duration. Based on the work carried out by Cox & Boyd, the present study answers the question: what are the problems resulting from the current appointment scheduling system of a large Portuguese public hospital? We surveyed doctors, nurses and administrative staff from the Outpatient Center of Hospital de São João (those who primarily intervene in the scheduling and execution of medical appointments) using a questionnaire about difficulties experienced in their daily practice, based on the problems identified in Cox & Boyd's work. A request for participation was sent to the 39 medical departments in the Outpatient Center. Eleven departments effectively took part in this study, represented by 53 doctors. Furthermore, 13 nurses and six administrative workers also took part. Our results show that professionals regard some problems as both impactful and frequent. Specifically, more than 70% of doctors believe this is the case for problems "Patient wait times in the hospital are long", "Sometimes providers are interrupted during a consultation" and "It is necessary to perform overbooking in order to see acute patients". Additionally, all surveyed nurses agree that "Patient wait times in the hospital" and "Waiting-room congestion" are two serious and frequent issues. Lastly, all administrative staff believes this to be the case for "The no-show rate is high", "Many patients are given appointments later than they need/desire" and "Doctors have to cancel appointments (i.e., due to congresses or vacation)". Our research identified a number of specific areas of concern; We hope these findings can contribute to describing the existing problems in outpatient appointment scheduling in large Portuguese public hospitals. Besides, we believe this investigation can be an important foundation for the improvement of the scheduling system both in Hospital de São João and in other hospitals.