Wednesday, February 20, 2008

Block Booking vs Priority Booking

What is block booking and priority booking and what are their advantages? I was recently approached by a colleague when I was talking about the advantages of block booking. He said that he wasn’t using block booking and no intention of using it.

In block booking, certain slots during the day are reserved for certain types of patients/clients. For instance, a family doctor might reserve 3 x 15min slots for asthma patients, 2 x 30min slots for new patients, etc…. The slots are held until the latest possible moment then filled with more urgent patients (more on the timing of this later). The alternative is a first-come-first-serve model (whoever calls in gets the next available appointment).

My colleague said that he saw no advantage to it. His waiting list was longer than two months to see him, in his mind no amount of juggling the schedule would change that waiting time for the patients. If the mean wait would continue to be 60 days, why play with the schedule. Rather than arguing about lean theory, six sigma and the benefits of a pull system (which are the theoretical basis for block booking) I told him about Disney World. At Disney I could take my family and get a fast-pass for each ride. I could get only one pass at a time, which let me to the front of the line at the time specified. While waiting I could get on other rides that were less popular. If I timed things well, I would spend much of the day using the fast-pass. If everyone at Disney was doing the same thing all of us would have the same effect. Although the mean wait for rides didn’t change our satisfaction was greatly improved.

Block booking works in a similar way. A patient with an acute asthma exacerbation needs an appointment sooner than someone with a sore joint from arthritis than someone with chronic migraines. If the clinic knows how many patients arrive with a certain type of ailment per month they can reserve the time based on the desired level of service. Let’s say 60 patients arrive each month with arthritis pain for evaluation. If the desired wait time is 15 working days then 4 slots per day need to be reserved. Priority booking is the same beast by another name. In priority booking, certain patient types are brought to the front of the line at the expense of others. In block booking, the natural variation in patient arrivals will result in a longer wait. In priority booking, one group of patients wait time is kept static and the others are allowed to vary. Priority booking is necessary for patient types that cannot wait more than a certain amount (e.g. chest pain, cancer, etc…) although it is used for priority programs as well by some institutions.

Block booking and priority booking add benefit to the system in 2 ways. First, they improve client satisfaction. Second, they decrease the amount of variation in the system which improves overall efficiency.

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