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Figure I. Total Patiet Visits 125 12n 115 l1n 1 5 10 ln5 1in - 138 - 1968 1969 1970 1971 1972 1973 THE PATIENT VISITS IN 1968 ARE USEO AS THE BASE FIGURE ('100)
- 139 - 2. ldentify problemn areas in a -, and all patient flow related operations; 3. Collect and analyze meaningful hard data to test various hypotheses regarding the status of the patient flow systems and procedures and the reasons for the evolution of these systems to their current state; 4. Delineate the most meaningful and reasonable goals and objectives for the patient flow system; 5. Recommend both long-range and short-range improvements to the patient flow related operations. Historical background The "old appointment system" was romprised of a central appointment desk (CAD) and several parrially decentralized nonuniform procedures. Within the Medical Division, the CAD scheduled physical examinations only. All types of appointments of the surgical division as well as "forme'r" appointments for all departments were made either by the desk receptionists or by the medical secretaries. Routing Section personnel were responsible for consults, X-rays, laboratory tests, special exams, and reports. Each doctor kept an appointment sheet specifying the time of day during which different types of patients should be scheduled. Because of the rapid growth of the outpatient clinic and a lack of adequate support, the CAD became less effective in performing its job. As matters worsened, complaints abcut patient flow were expressed by physicians throughout the clinic. The major criticisms were incompetence in the scheduling function and favoritism (more patients were directed to certain physicians or departments than to others.) Consequently, some departments transferred control of their appointments (except reports and consults which were kept by the Routing Section) to appointment secretaries stationed on the department floors. Further movement toward decentralization followed. As each department devised its own rules for scheduling patients, a gradual degeneration of the clinic's overall systems and procedures for making appointments resulted. This degeneration was further aggravated by the rapid turnover of clerical personnel which was HOSPITAL & iHEALTH SERVICES ArtMINISTRA1ION 1 WINTER 1978
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L 00111111 MASTER COPY - NO TOCAR B
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- ii - liancock, W., D. Magerlein y
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FOREWORD These last years, PAHO wit
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Workshop .- Education in Operationa
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-3. The format of the workshop was
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-5- 2. Programs for bringing togeth
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II. R.commendations -7- A series of
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-9- there are technically trained i
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-11- and selected individuals who h
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-13- 6. In order to improve the qua
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-15- cnve!opment will typically be
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-17- 16. All participants sbould pr
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A. Short Courses -19- Short courses
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-21- 4. Presentation of a case to b
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Topic Introduction to Systems Analy
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-25- 12. Elementary Statistics ior
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-27- 8. Applications of data proces
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-29- problems. The graduate should
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-31- Lblo-w. Also given is that typ
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- 33 -' -Case Mix Definition by Dia
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- 35 - Acknowledgment The authors w
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ML ICAL CAE1 Februurl 1980, Vol. XV
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X;' VIII, No. 2. Suippllce,t - 39 -
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- 41 - dMLDICAL C.ARE '.Fcbrtanj 19
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\'nKV 111,I No. 2, IIIJ·,ri - 43 -
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Vol. XVIII, No. 2, Supplenent - 45
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?Vol. XVIII. No. 2. Sttilluleareilt
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.'yo. XVIII. No. 2, Supplentcsit Si
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.V'oL XVIII. No. 2. Stpphlidary dia
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Vol..'XVlII, No. 2, Supplement - 55
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- 57 - MEDICAL CARE Febiuary 1980,
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- 59 - .SlDiCL ( :AL.. FcbnartlrJ p
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Vol. XVIII, No. 2, Suppletiment - 6
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- 65 - £.¡EDCAL CARE ebrNuarV 1;9
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Vol. XVIII, No. 2, Sn",,phl- steal
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VoL XVIII. No. 2, Supplemnlent - 69
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'XVII. No. 2. Supplement - 71 - P)i
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;.'. 'Vol. XVIII. No. 2. Siupplemen
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,VoL XVIII, No. 2, Supplement Major
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.. Vol. XVIII, No. 2. Supl|lemcent
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i,..X VIII. No. 2. Supplemeiint - 8
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T XVIII. No. 2. S.pphlts"t .i¿jor
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·. ¥XVIII. No. 2 Supplement )i, "
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Page 95 and 96: Vl. \'ll. No. 2. Sntiít'ult.uit M.
Page 97 and 98: - 91 - R. FRIRICHIS AND J. PRAWDA W
Page 99 and 100: - 93 - 414 R. FRRKICkIS AND J. PRAW
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Page 105 and 106: - 99 - 420 R. MFRIlC}IS AND J. PRAW
Page 107 and 108: V - 101 - McUCi. (:Au AWuu IMI. VoL
Page 109 and 110: GREENLAND ET AL - 103 - the case (p
Page 111 and 112: CREENLAND iT AL - 105 - TABLE 2. Fi
Page 113 and 114: GREENLAND ET AL. 3. Cornfleld J, Ha
Page 115 and 116: 160 I indicates the flow of patient
Page 117 and 118: 162 CONGESTION POINTS ANU CONTROL.A
Page 119 and 120: 164 c 8o Table 4. The cffect of cha
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Page 123 and 124: MEREDITH - 117 - ciety. However. ch
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Page 127 and 128: MEDICAL CARE ,arch 1981, Vol. XIX,
Page 129 and 130: %,I. XIX, No. 3 iclnts. It should d
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Page 137 and 138: - 131 - A \ ,,1. XIX, No. 3 PEHFOHR
Page 139 and 140: V Xl. IX, No. 3 - 133 - PERFORMANCE
Page 141 and 142: - 135 - The fourth requirement is l
Page 143: - 137 - Systems and Procedures of P
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Page 149 and 150: u. o a.- 1 W. LZi - 143 - c c S C.
Page 151 and 152: - 145 - Thc cu rrent appointmren t-
Page 153 and 154: - 147 - A pure block appointment sy
Page 155 and 156: - 149 - ihe future. It was discover
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Page 159 and 160: - 153 - Figui.'¢ VII. Patient Arri
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Page 163 and 164: - 157 - 17. Keep the time span of t
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Page 167 and 168: .Recomme;tded systenz - 161 - .;any
Page 169 and 170: - 163 - system, there is nr'. :vste
Page 171 and 172: - 165 - - A major problem with such
Page 173 and 174: - 167 - T1c Iteole of Olieraionls R
Page 175 and 176: - 169 - Larry J. Shumc- Harvey Wolf
Page 177 and 178: - 171 - '- ionoal Heolth Ploanning
Page 179 and 180: - 173 - Regional Health Planning ar
Page 181 and 182: - 175 - Regio.,oi Health Planning w
Page 183 and 184: - 177 - Regionao rfeclth Planning l
Page 185 and 186: A^CJonoal neonah ronning 21. 1'. F.
Page 187 and 188: - .,1 - Programming, Budgeting, and
Page 189 and 190: - 183 - the health care industí ,
Page 191 and 192: - 185 - was apparently no scarcity.
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plex stochastic distribution of arr
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- 191 cumulated according to any or
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- 193 - Step 2 represents the heart
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ÍA en .aa
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- 197 - analysis, forecasting, and
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Budgeting Attitudes - 199 - The pla
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- 201 Health Services Research most
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a. - 203 - Health Services Research
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- 205 - DESIGN OF ALTERNATIVE PROVI
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- 207 - 1. A change in the immigrat
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- 209 - accessibility of health car
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- 211 - dimensional graph to illust
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- 213 - Primary Care Health Service
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- 215 - different health and educat
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- 217 - The tasks that were rated "
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IC1 o -a - i - w im W..i C -J M. -
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0 z 0 u _ I- 0 Ut. I,, uj CD Q U- ,
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TABLE 3 TASK ANALYSIS OF MALNUTRITI
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11 - 225 - TASK ANALYSIS OF MALNUTR
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- 227 - 12. Reisman, A., F.Staub, B
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- 229 - METHODS Parameters Affectin
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- 231 - ~HNCOCK Fig. 1. Daily censu
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- 233 - HANCOCK Table 1. Parameters
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- 235 - Fig. 3. Maximum average occ
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- 237 - HANCOCK ET AL Fig. 4. Maxim
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- 239 - AECOCL. Table 2. Eflect of
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- 241 - HANCOCK Discussion ET AL Th
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#12 Estinating the Need for Additio
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Pri c= arvicc a ia Indina. - 245 -
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. 1' - - IIINDLE Algorithmn for Det
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- 249 - HINDLE that all tlie primar
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- 251 - HINDLE 6. Computc Mhe Avail
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- 253 - HINDLA Tablek Meamm of Zfic
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HINDLE Tr AL HIALTH falvCU - 255 -
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- 257 - HIiDLZ 26. Ado, An . ad L.
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- 259 - REISMIAN, DEAN, ESOOBUE, AG
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- 261 - REISMAN, DEAN, ESOGBUE, AGG
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- 263 - 1350 REISMiAN, DEAN, ESOOBU
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- 265 - REISMAN, DEAN, ESOOBUE, AGO
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- 267 - 1354 REISMAN, IEAN, ESOGCUE
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- 269 - William J. Abernothy and Jo
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- 271 - William J. Abernathy and Jo
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- 273 - William 1. Abernothy ond Jo
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- 275 - William J. Abrnarthy and Jo
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- 277 - William J. Abernathy and Jo
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- 279 - William J. Aberncthy and Jo
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- 281 - 642 William J. Abernathy an
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Decmand in Mintu és/Day Numnlber o
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Disposal System 326 IIstlic I,',i,
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i Trays 334 Colorful pattenis anid
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tiie, gency L:ghting 347 ,i',., .:.
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- 296 - REVEI.LE we believe to be t
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- 293 R£VELLE is apparent in light
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- 295 - REVEt.EI. ET AL. poSJcd pro
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- 297 - RM.VELLE EL AL. of faciliti
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REVELLE ET AL. HALTOI SERVICUS RESE
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REVELLE ET Al.. - 301 - Fig. 4. Ano
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- 303 - REVet. ¡T AL Act of 1973.
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- 305 - REVELLE possible within ilh
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- 307 - RLVELI.E 29- Khumawala. a.
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- 309 - assuring thal the maxinmum
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-311 - the implemented strategy he
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- 313 - analytical approximalions w
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- 315 - rcquired Ior shipping and o
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- 317 - Controlling ¡he system The
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- 319 - The light pen techniques ar
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- 321 - shipnients have to be on ro
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- 323 THE CREATER NEIW' YORK BLOOD
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_,~ .- - 3. 2- - TABLE 1. PATIENT C
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TABLE 3. MEDICAL INTENSIVE CARE UNI
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Nursing Stalf Level (i of nurss/day
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Table 1. Factors ¡i denad for medi
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e forecast. This section descijbcs
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ei, paid to these standards in cond
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O Emphasis u.on the explicit enumer
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*1 1 21 1 «i 1 1 1 1 - 331, -- For
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Therc are ihreec basic prcessecs fi
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- 343 - Forecasting Hcalth Care Ser
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#20 Jaime 1B. Henrs Rtxlnc. I.. Ro:
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- 347 - I v,'N ti.K 1tHm.pi.l !, t1
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Ra.fo.renem.. aid %.hs '. - 31!9 -
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; / larman u empirical research has
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I Klarman - >3 - benefits that for
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I Klaman Ctitena for Inchmion - 355
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IClarman - 37 - The prevailing tend
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1 Klarman Intargibl Benefits - .5 -
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Kllarman - 361 - thi prospects of r
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- 363 - Thua, it did not consider w
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I Klannan - 365 - again if the new
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Klarman - 367 - At the other pole,
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- 369 - seem worth exploring. Howev
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iKlarman - 371 - in the use of serv
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Kmnnan - 373 - REFERENCES 1. Havema
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- 375 - 59. Valr y, W. S. One eonoi
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- 377 - i aSll a _ . b, CuaMu L. L,
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WAHRNER ANI) I|UTTr)N The puroses I
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WARNER AND HUTfON - 381 - observers
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.AHNF:R AND IIl'TIoN - 383 - rare I
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WARNER AND HUTTrU., TABLE 1. Trenda
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W'AHNER AND IHUTTON - 387 - treatme
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AAHNER AND HU'TON - 389 - Several d
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WARNER AND HUTTON pal orientations
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w'ARNER AND UL'TTOit'u ' . N Engl I
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I,,qr *ir 'ilu.,i XV. Seplteri¡br
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In.lumin- i',)i.eIu XV. Seph.irhb'r
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In#unrvlVolutn XV. September 1978 h
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Problemas identificados - 401 - Dur
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Programas educativos 3 - 403 - 1. S
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- 405 - maestrfa, donde se supone q
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- 407 - presentación formal de inf
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- 409 - * Curso para ingenieros ind
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- 411 - ¢ 16. Hancock, W., D. Mage
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- 413 - 2. Barrenechea, J. J. La se
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- 415 - Curwso (8 a 16 horas) para
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- 417 - 4. Necesidades de los admin
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MOISES ARTEAGA DR. DAVID GOMEZ COVA
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