Physician behavior directly impacts clinic's efficiency, study finds

Physicians may often change their behavior if the clinic is running late. This behavior change may impact the amount of time providers spend with patients as well as the clinic's efficiency, according to News-Medical.

In the study, researchers looked at patient and physician behavior at three Boston-based Johns Hopkins Medicine outpatient clinics. Researchers looked at data on patient appointment time, patient arrival time, patient interactions and compared it to data on physician-patient interaction from a low-volume pain management clinic, a medium-volume academic pain management clinic and a high-volume radiation oncology service. Investigators analyzed all 23,635 provider-patient interactions.

Researchers then divided the interactions into three groups.
●    Group A — Patients who arrived at the clinic and entered their exam room prior to their appointment
●    Group B — Patients who arrived at their clinic but entered the exam room after their allotted appointment time
●    Group C — Patients who arrived at the clinic after their appointment time.

The researchers found:
●    The average processing time from group A was 38.31 minutes for the low-volume clinic. The time for groups B and C were 23.23 and 29.5 minutes, respectively.
●    For the medium volume clinic, the average processing time totaled 65.59 minutes for group A; 53.53 minutes for group B; and 50.91 minutes for group C.
●    For groups A, B and C at the high-volume clinic, the average processing time was 47.51 minutes, 17.59 minutes and 47.90 minutes, respectively.

Based on these findings, researchers determined physicians' efforts to catch up with the clinic's schedule impeded the clinic's efficiency as it added unpredictable time variability to the system.

Researcher went a step further and put the data into a discrete event simulation, which artificially broadened the sample size to thousands more theoretical patients. After plugging in the data, investigators found even if a patient is not tardy, a physician's behavior could cause the clinic to run behind schedule.

Then, researchers used the computer software to virtually create a clinic in which providers treated all patients as group B participants. In the model where each patient had the average amount of face-to-face interaction with physicians, researchers noted they could lower the average amount of time it took to get patients from check-in to checkout and the variability in those times among patients if physicians' behavior was the same for all patients.

"The take-home message is that one way to ease the trade-off between wait time and face time is to reduce uncertainty in the overall system," said Chester Chambers, PhD, assistant professor of operations management at Johns Hopkins University Carey Business School and an associate faculty member at the Johns Hopkins Armstrong Institute for Patient Safety and Quality. "If a doctor is more consistent in the amount of time spent with each patient, wait times tend to go down, and it puts less pressure on the doctor to make up the time by rushing."

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