Clinic overbooking to improve patient access and increase provider productivity

The problem of patient no-shows (patients who do not arrive for scheduled appointments) is significant in many health care settings, where no-show rates can vary widely. No-shows reduce provider productivity and clinic efficiency, increase health care costs, and limit the ability of a clinic to serve its client population by reducing its effective capacity. In this article, we examine the problem of no-shows and propose appointment overbooking as one means of reducing the negative impact of no-shows. We find that patient access and provider productivity are significantly improved with overbooking, but that overbooking causes increases in both patient wait times and provider overtime. We develop a new clinic utility function to capture the trade-offs between these benefits and costs, and we show that the relative values that a clinic assigns to serving additional patients, minimizing patient waiting times, and minimizing clinic overtime will determine whether overbooking is warranted. From the results of a series of simulation experiments, we determine that overbooking provides greater utility when clinics serve larger numbers of patients, no-show rates are higher, and service variability is lower. Even with highly variable service times, many clinics will achieve positive net results with overbooking. Our analysis provides valuable guidance to clinic administrators about the use of appointment overbooking to improve patient access, provider productivity, and overall clinic performance.