A simulation study on the impact of physician starting time in a physical examination service

The objective of our project was to improve the efficiency of a screening physical examination service of a large hospital system. We began with a detailed simulation model to explore the relationships between four performance measures and three decision factors. These included various dispatching rules, physician starting inquiry time, and scheduled patient arrival time. We then attempted to identify the optimal physician starting inquiry time. Our simulations show that (1) the three patient dispatching rules have negligible influence on any of the four outcome measures; (2) two types of patient arrival policies did not affect any of the four measures; (3) the proposed optimal physician starting inquiry time decreased patient wait time by 50% without increasing overall physician utilization. Based on these finding, we propose two improved policies. Policy 1 proposes changing the physician inquiry starting time from 10:30 am to 9:00 am. Policy 1 decreases patient wait time by 50% without increasing overall physician utilization and total physician shift time. Policy 2 suggests the postponement or removal of the physician inquiry stage but patients with abnormal results will be scheduled for further inspection.