BOOKS OF RtfiDIfGS - PAHO/WHO

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system, there is nr'. :vstematic procedure for cancelling the original
appointment and often the result is a no-show. This situation
can also be avoided in the recommended system by making it
part of the updating procedure to check for these duplicate appointments.
Another feature of the recommended system is that data collection
for studies such as the ones described in this paper would be
much more easily collected since all patient flow related data
could be collected at one location, i.e., the information data bank.
Thus, such an appointment system would have most of the
advantages of both centralization and decentralization. Further,
it can be easily implemented since no major changes in clinic
operations are necessary.
Strategy of going towPtr: ',¡e ultinate system
There are two ways in which improvements in systems and
procedures c,: be implemented. One is to schedule a complete
changeover on a certain day. The other is to do it gradually,
step-by-step.
The first method would be too risky and too disruptive to the
clinic operations and not readily accepted by the clinic personnel.
On the other hand, gradual improvement will not be so disruptive
and will be more easily implemented. In this implemnentation
scheme, as tangible improvements are realized,
credibility and increased confidence and patience with the system
will result. Consequently, further changes will be more
readily accepted. Figure VIII shows the dynamics of this implementation
process.
As an initial step in the implementation process, a manual
system could be devised to handle appointment-related information.
As soon as an appointment is made, information regarding
appointment availability will be immediately updated at the department
(on the appointment sheet). At the same time, some
mechanism for transferring this information to the appointment
processing area would be initiated. In this manual system, the
means of transferring this information would be by telephone,
lift or runners. Such a manual system would not be disruptive to
present clinic operations.