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2015 TOCICO International Conference

Transforming Businesses Track

Silverio de Souza
JAMES F. COX III
Professor emeritus
Terry College of Business
University of Georgia

An Examination of Different Perspectives to the Same Problem: The Academic, Practitioner, and TOC Perspectives of Appointment Scheduling in a Family Practice Medical Facility
September 8, 2015

A clash of two worlds exists: academia versus practitioners.

Academics are primarily measured and rewarded by their research contributions to their fields as recognized by publishing in the top tier academic journals (In management, the Academy of Management Journal and Review, Management Science, Operations Research, etc.). High powered statistical analyses and mathematical programming techniques are the recommended research methodologies to be published in these journals; the rigor of the research is what is of utmost importance.

On the other hand, practitioners are interested in how to solve their specific problem; the relevance of the research. Practitioners are uninterested in how you derive the solution, only whether it will help them in the day-to-day firefighting.

Goldratt (TOC Journal) offered a different perspective to research (science) as developing in stages: classification, correlation and cause and effect. In 2012, Cox and Robinson presented a case study that solved many of the appointment scheduling problems of a large family practice clinic. Since that presentation, a literature search of the appointment scheduling area revealed the above divide.

The appointment scheduling literature dates back to the 1950’s with many articles in press in 2015. In this span of over sixty years of research, no effective solution has been identified. Hundreds of articles have been published concerning how to "optimize” appointment scheduling in the academic literature. Few have been implemented in reality. The reason given is that: We are unique.

On the other hand, the practitioner literature is equally unimpressive. It is divided into three general groups: solutions addressing only one problem area; general guidelines (for lean and six sigma, for example) for problem solving in any practice; and others provide a totally different scheduling approach. These solutions offer some relief to the problems.

A review of the combined literature reveals at least 14 major problems (UDEs in TOC terminology; the asterisk indicates the UDE was also present in the family practice):

UDE 1 The no-show rate is high.

UDE 2 Many patients are given appointments later than they need/desire.

UDE 3 The no-appointment-scheduled (NAS) slots are high; greater than 20% particularly in the summer months.

UDE 4 Providers set rules for who they want to see, when, and for how long.

UDE 5 Pt wait times at practice are long.

UDE 6 Waiting-room congestion is high.

UDE 7 A number of unpunctual patients exist: some come early and some come late.

UDE 8 Walk-ins are common.

UDE 9 Occasionally a provider has an emergency pt.

UDE 10 Sometimes a provider starts a session late.

UDE 11 Sometimes a provider is interrupted during a consult service time or session; (interactions with support staff, phone calls, writing up notes, comfort breaks, etc.).

UDE 12 Provider consult time is highly variable.

UDE 13 Sometimes pts are called in order of arrival (FCFS) or need instead of by the appointment schedule.

UDE 14 Some patients require a second consult (after tests, x-rays, etc.).

These UDEs are analyzed using TOC to support the following learning objectives:

1. An understanding of the problem with academic/practitioner research from a TOC perspective. The role of uncertainty/chaos/Murphy.

2. The journey of discovery in analyzing this appointment scheduling problem will be presented (the search for inherent simplicity). The role of classification.

3. The Inherent Simplicity of the appointment scheduling problem.

4. A problem precisely identified is half solved.



JAMES F. COX III. Ph. D., TOCICO certified, CFPIM, CIRM, JONAH’s JONAH, Professor Emeritus, was the Robert O. Arnold Professor of Business at the University of Georgia. Prior to an academic career of over 30 years, he held positions in industry and the military. He taught Jonah workshops and numerous TOC workshops and programs.

Dr. Cox’s research has centered on TOC for over twenty-five years. He recently co-edited (with John Schleier) the TOC Handbook. He has written three books on TOC and has authored/coauthored over 90 articles in top academic and practitioner journals including Decision Sciences, the Academy of Management Review and Journal, Production/Operations Management Journal, MIS Quarterly, International Journal of Product Research, Production and Inventory Management Journal, and Industrial Engineering. He was the coeditor of the APICS Dictionary (five editions with John Blackstone) and more recently co-editor of the TOCICO Dictionary, 2nd edition.

Dr. Cox, an APICS member for over 35 years, held numerous chapter, regional, and national offices (BODs for 4 years, VP-Research for 2 years, Foundation BODs 9 years including 4 as president). He also served on the founding TOCICO Board of Directors and as its first director of certification. He has spoken at over 50 APICS and other professional organization chapter meetings, several regional seminars and several international conferences on TOC. He has received the APICS Voluntary Service Award and the TOCICO Lifetime Achievement Award for his contributions to the field. He is currently serving on the TOCICO Board of Directors.

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