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首页> 外文期刊>Production and operations management >Ice-Breaker vs. Standalone: Comparing Alternative Workflow Modes of Mid-level Care Providers
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Ice-Breaker vs. Standalone: Comparing Alternative Workflow Modes of Mid-level Care Providers

机译：破冰者与独立者：比较中级护理提供者的替代工作流程模式

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摘要

Capitalizing on the operational concept of division-of-labor, clinics often reduce physician service time by off-loading some of his/her clinical activities to lower-cost personnel. These personnel, such as nurse practitioners and physician assistants, are often collectively referred to as "mid-level providers" (MLPs) and can perform many patient-consultation tasks. The common rationale is that using an MLP allows the physician to serve more patients, increase patients' access to care, and, due to MLPs' lower salaries, improve the clinic's financial performance. An MLP is typically integrated into the outpatient clinic process in one of two modes: as an "ice-breaker," seeing each patient before the physician, or as a "standalone" provider, a substitute for the physician for the entirety of some patients' visits. Despite both of these modes being widely used in practice, we find no research that identifies the circumstances under which either one is preferable. This study examines these two modes' effects on operational performance, such as patient flow and throughput, as well as on financial measures. Using queueing and bottleneck analysis, discrete-event simulation, and profit modeling, we compare these two deployment modes and identify the optimal policies for deploying MLPs as either ice-breakers or as standalone providers. Interestingly, we also find there exists a range of scenarios where not hiring an MLP at all (i.e., the physician works alone) is likely to be most profitable for the clinic. Implications for practice are discussed.
机译：利用分工的操作概念，诊所通常通过将其某些临床活动转移给成本较低的人员来减少医生的服务时间。这些人员（例如护士从业人员和医师助理）通常统称为“中级提供者”（MLP），并且可以执行许多患者咨询任务。普遍的理由是，使用MLP可使医生为更多的患者提供服务，增加患者获得护理的机会，并且由于MLP的薪水较低，因此可以改善诊所的财务状况。 MLP通常以以下两种方式之一集成到门诊诊所流程中：作为“破冰者”，在医师面前看望每个患者，或者作为“独立”提供者，代替某些患者的整体医师的访问。尽管这两种模式都在实践中得到了广泛使用，但我们没有找到能够确定哪种情况更可取的研究。这项研究考察了这两种模式对运营绩效的影响，例如患者流量和吞吐量以及财务指标。通过使用排队和瓶颈分析，离散事件模拟和利润建模，我们比较了这两种部署模式，并确定了将MLP部署为破冰者或独立提供者的最佳策略。有趣的是，我们还发现存在多种情况，可能根本不雇用MLP（即仅由医生工作）对于诊所来说可能是最有利可图的。讨论了对实践的影响。

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  • 来源
    《Production and operations management》 |2017年第11期|2089-2106|共18页
  • 作者

    White Denise L.; Torabi Elham; Froehle Craig M.;

  • 作者单位

    Univ Cincinnati, Lindner Coll Business, Dept Operat Business Analyt & Informat Syst, Cincinnati, OH 45221 USA|Cincinnati Childrens Hosp Med Ctr, James M Anderson Ctr Hlth Syst Excellence, Cincinnati, OH 45221 USA;

    James Madison Univ, Coll Business, Dept Comp Informat Syst & Business Analyt, Harrisonburg, VA 22801 USA;

    Univ Cincinnati, Lindner Coll Business, Dept Operat Business Analyt & Informat Syst, Cincinnati, OH 45221 USA|Univ Cincinnati, Coll Med, Dept Emergency Med, Cincinnati, OH 45221 USA;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

    healthcare; flow; mid-level provider; simulation; queueing;

    机译：医疗保健;流程;中级提供者;模拟;排队;

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