This paper presents a case study on the use of mathematical-computer models in developing operating policies for a university-health-service outpatient clinic. Based on results predicted by the models, actual policy changes were made in the system; the paper compares the subsequent real-world results with those predicted by the models. The comparison demonstrated the validity of the models, and significant improvements were realized in the changed system. An analysis of daily arrival patterns was used to schedule more appointment patients during periods of low walk-in demand in order to smooth the overall daily arrivals. A Monte Carlo simulation model showed the effects of alternative decision rules for scheduling appointment periods during the day to increase patient throughput and physician utilization.

By using empirical studies of nursing organizations and theoretical models, improve. menta in the utilization of nursing teams have been achieved. These improvements nrc evidenced by increased time spent, with the patient rather than on other duties.A problem, so far unresolved, arises with the need to change the allocation of nurses to patients at certain times. \Vhilst this did not hinder t.he operation of the scheme when it was tested, nurses expressed some reservations on this point, and further research is clearly required. ObjectiveOne objective of an extensive research project was to develop a quantitative technique to schedule a ' small team' of nursing personnel to an appropriate number of patients based on the changing needs for care of the patients over time. The flexibility of this method is obtained by varying the number of patients that the team (of fixed size) is responsible for, rather than varying the size of the staff on a nursing unit that has a fixed num bel' of beds. If successful, it would appear that this method would secure the financial advantages of flexible nurse scheduling, the social advantages of improved patient care, and the increased nurse satisfaction imputed to ' small team' nursing. In addition, there would appear to be an advantage to the elimination of a level of nursing hierarchy (head nurse).

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This paper focuses on the development of a simulation model of a University Health Service Outpatient Clinic the implementation of which has resulted in significant improvements to system performance. The details of these improvements are published elsewhere; they amouted to savlhgs in excess of fifty thousand dollars the first year the model was used, improved physician morale, and acceptance on the part of the Health Service staff of the simulation model as a tool for decislon-making. The Health Service provides complete outpatient medical care and limited inpatient care for about 19,000 people. The resulting outpatient load of over 400 persons a day requires the services of 12 full-time physicians. The simulation model for which appointment and walk-in patients are generated separately, was developed over a two-year period and takes the general form of a multlple stage, parallel queueing system with a variable number of servers. Validation problems are discussed, and data is presented.